Winter workshop

On March 3rd, 1865, Congress passed and President Lincoln signed into law, a bill calling for "In God We Trust" to be inscribed on U.S. coins. Upon reading this piece by John Murray in the Wall Street Journal this morning, I immediately recalled a brief historical vignette, my Grandpa, my mom's dad, told to me.

Back in the really old days, when cities like Cleveland Ohio were platted; ie, surveyed and laid out into city blocks with long extending roads leading from Public Square, East, West and South, public transportation took the form of "Street Cars". This light rail system moved on parallel tracks in the center of the street. Initially these streetcars were pulled by horses and after the turn of the 20th century, by electic motors, obtaining electric power from overhead wires. These streetcars ran from center city to rural communities. (There was a light rail system with regular service from Public Square to the community Chagrin Falls 20 miles out of town). Automobiles were rare, especially in the defined ethnic clusterings, like the Czech ghetto, and almost everyone used these streetcars to get to and from work, clothing and grocery stores, and services like doctors and dentists, insurance agents, etc. Work and life services were organized along these public transportation corridors. As a fluid immigrant community, the Czech ghetto, as was the Hungarian community on the North of it, and Romanian to the South, had immigrants who came almost on a daily basis from impoverished countries ("Give us your tired and poor, its huddled masses yearing to be free") whose people, many of whom were refugees from subsitance farms, were unfamiliar with living in cities, let alone in a "modern" city with streetcars. Therefore, when there was a need to get from one's particular ghetto, one had to ride the streetcar. One of the problems the immigrants encounted with the streetcar system, was paying for the ride with the correct coinage.  Some people did not know what the fare was, ie did not read or speak English. They would put multiple coins in their hands and have the streetcar conductor pick out the right fare from the outstretched hand. Or, not having any coins at all, offer some personnel object as price for the ride. As opposed to kicking them off the streetcar, the conductor would solicit someone else who got on at the same stop, to speak to the person who didn't have the correct fare, in their native language, about how the system worked. 

Grandpa related one incident where a lady ahead of him was bewildered by the streetcar system, seeing others ahead of herself offer coins for the fare, she having none, and, with some reluctance, took off her rosery and offered it as fare. The conductor, refused the rosery, speaking through a nearby interpreter, that the fare needed to be in money and not her religious object. The lady did not have the correct fare, but rode to her destination anyway. The next day, Grandpa got on the same streetcar with the same conductor and saw a hand printed sign in English and Czech: "In God we Trust, all others pay CASH." 

WINTER'S APPROACH

I am looking out the Westward viewing window of the Sun Room. Large snow flakes are coming straight down from a gray sky. The snow fall began late this morning and has been steady ever since. From green grass to snow covering lawns, tree branches and the Lake. The snow has been so heavy, it is lying on top of the water similar to snow lying on the ground. There have been some ducks that have been swimming in the water, snow accumulating on their chests as the plow paths in the snow, much like children making paths in the snow on the ground. The ducks, seem to have tired of their efforts and have subsequently paddled to shore. The evergreen trees to the side of the Sun Room, have bows bending downward from the weight of the heavy snow. A red squirell is making tracks across the snow in the yard in front of me. The roofs across the way have an even coat of white. The pine trees harbor red cardinal song birds as well as smaller blue and gray colored ones as well.

I am snug and warm, what with the floor heating. Three shallow holiday candles burn in ceramic leaf shaped holders. The smell of turkey soup comes from the kitchen.

We are entering our winter time; not quite the Winter Solstice yet, but visibly winter has arrived. Quietly.

Thanksgiving

There were times when we spent Thanksgiving at the Cottage. I would leave OSU and Columbus Ohio, hitch-hike my way to Cleveland Wednesday early afternoon. Grandma Honicky would finish her school day about 3 PM, we would pack the car and drive to a rest stop (Lackawanna) just before Buffalo New York. The problem with the drive at that time, Interstate 90 was not completed. One had to drive through various towns along the way, which had struggled with their State Legislature to block the building of the Interstate as the City officials correctly surmised that the downtown businesses would collapse without the traffic. So we would first drive Route 20 out of Cleveland, then pick up parts of completed Interstate 90 outside of Geneva Ohio, then have to drive Route 5 through Ashtabula Ohio and Erie PA. Just East of Erie's City limits was a deep ravine, made by a river with water flowing North off the Appalachian mountains. This particular Wednesday evening it had been snowing, a truck had jack-knifed its trailer across the road about 1/3 rd of the way down the hill. Only one car at a time could run the opposite shoulder around the trailer's rear brakebar, that steel piece you see hanging down from the rear of the trailer. As the tractor was down in a steep ditch, the attached tailer was canted down at the tractor, but its rear end rose high in the air. The brakebar hung high in the air and any mistake and getting too close, that steel piece would rip open the roof of the car like a can opener. Since the road was slippery already from snow, one had to have enough speed to get momentum to get up the ravine on the other side. With heart in my mouth and pulse racing, I sped down the hill, two wheels in the gravel shoulder and two wheels on the pavement and I passed the menacing wreck reached bottom of the ravine, and sped up on top of the ridge. Mom and I drove silently to the rest stop. We were going to meet the Tyler's, have dinner, exchange passengers and form a two car carivan through Buffalo, cross the Peace Bridge and head along the shores of Lake Ontario via the Queen Elizabeth Way. Near Burlington Ontario, we left the QEW for Route 6 heading North. Between Burlington and Guelph was a town called Puslinch, a solitary gas station, and just beyond the gas station was a narrow bridge, just barely wide enough for two cars. Bill Tyler, Rae, Ralphie and I in the Tyler's Oldsmobile stationwagon had a very scary encounter when a car coming in the opposite direction was crossing the bridge at the same time as we were beginning to cross. The oncoming car's tires hit slush on the road. The spray covered the whole car like a wave in the surf. We came out the other end, the windshield wipers were not able to clear the windows for 3 or 4 seconds, an eternity. After Guelph came Arthur, Mt. Forest, and others. We re-arranged the crew in Owen Sound, downtown Owen Sound since there was no drive around as there is today. Continuing on Route 6, up a steep hill made by the Niagra Escarpment, we took the Shallow Lake cutoff towards Wiarton. The Wiarton Highway Garage you will note is located on top of the hill above Wiarton. Salt trucks strategically are placed to plow and salt the road on the way down since no truck could climb that hill when it was icey. Up the hill we went towards the Mile Inn. At that time there was a sharp high banked left turn. Route 6 heads West for two miles and then there was a high-banked curve to the right. The road became gravel from there on to Tobermory. Just past Wiarton, the Lake effect of snow is apparent and there was lots of snow. Route 6 had been recently plowed and there were 3 foot ridges on either side of the road made of snow. As we passed the Howdenvale Road, we came over the ridge and down into the flat portion of the Peninsula, just before Pike Bay Road. In the middle of the road a rabbit sat staring at us as we came bearing down. We slowed and the rabbit started to run in front of us, weaving from one side to the other. We stopped. the Rabbit stopped. We started again and the rabbit started again. Each time the rabbit ran in front of us. After several stop and goes,I slowly increased my speed waiting for a time when the rabbit weaved clear to the right side of the road. By now the rabbit was a blur as I accelerated past it. We all had an emotional outburst of laughter. As we got to Little Pike Bay Road, it had stopped snowing and the wind had blown the snow off the gravel roads, leaving exposed little rocks. It was 1 AM, the sky was crystal clear, the stars were brilliant. We drove Tyler's Turnpike with white powder snow billowing from either side of the car since in the bush, the wind had not blown the road clear. Before there was a Tori, there was a gate we unlocked (same key now as then) and turned right, headlights catching the snow clouds from our tires. First came the boat house, then the cottage, all shuttered. The porch in its early years was a screened in porch. Bitter cold, frozen breath, flashlight in hand, I stepped from Black Beauty and walked in 6 inch deep snow to steps leading to the porch. I unlocked the padlocked porch door, walked in and unlocked the cottage. "Hello house" I called, walked to the bedroom and turned on the electricity. The smell from the cedar branches we had left on the beds to keep the moths away, permenated the cottage. I gather up the paper and branches and put them into the fireplace and opened the damper. But, before I could start the fire, I had to climb onto the roof, and remove a stone cap covering the fireplace flue. The cap was to keep critters from making a winter's home in the chimney. That done, mom was already moving the groceries into the cottage, I climbed down and proceded to first light the paper in the fireplace, establishing updraft, added the now tinder dry cedar bows, and soon there was a roar and flames shooting up the chimey. I added the dry split birch logs left for just such a purpose. The stone of the fireplace was cold, the fire was hot. I went outside to bring in more stuff, there were sparks shooting out of the chimney, a reminder of the fire hazard of fireplaces. I made a mental note to buy a fireplace metal screen cover such as we have on there now. From our purchases at the Duty Free Store before crossing the Peace Bridge in Buffalo NY, we dipped into out stash of booze, mom had a shot of Canadian Club whiskey, and I had an ice cold beer. We said our "good night's" and we promptly got under the covers and fell fast asleep. The next morning we headed over to the Tyler's, to help with the Thanksgiving meal; Bill was cooking the Turkey.

Detroit, Washington DC and the 2nd Amendment

Detroit was recently awarded the "Most Dangerous City" Award by Congressional Quarterly from data obtained through FBI records. Last year and the year before, the award went to St. Louis MO. This year St Louis dropped to 2nd. Recently, in Detroit, 4 people were shot and killed in a "known drug house", 2 of whom were small children. Also in Detroit, an owner of one gas station was shot to death by the owner of an across the street gas station over a $0.03 per gallon price decrease.

The US Supreme Court has agreed to hear arguements in the case of a Washington DC ordinance banning hand guns. The issue of course is the legislative attempt to deal with violence by banning hand guns in the City, and the specific rights guarenteed by the Constitution.

A little context is needed I believe, to understand those 27 words in the Constitution. Our Founding Fathers feared a standing army which could be used to control the populace. They were well versed in Classical literature and the power of a small group of well armed and trained soldiers, like Spartans. Their solution to threats by other countries, would to raise a citizen militia, farmers, merchants, artisans and such, who would have their own weapons. Not everybody would be in the militia, only, landed men and their male children; hence, the provision of hanging 13 year olds for treason. It was envisioned that someone who was landless who would fight in a militia would be paid in land the Government controled; hence, they would become land holders. Things certainly didn't go as our Founding Father's envisioned, did they. We have two standing armies (Army and Marines), an Air Force and Navy. What keeps our military from taking over the country has been the indoctrination at the Service Academies of the officers, that military takeover of the government is just not the way to do things.

Fast forward to the mid-twentieth Century and the emergence of the "Saturday night Special" in the urban slaughter scene; a snub nosed 38 calibre handgun that would fit into a pant's pocket or a women's purse. Prohibitions on its manufacture, licensing, distribution, sale, carrying were codified into laws, without, I might say, without a Supreme Court hearing. In its place, has come a cornicopia of handgun weapons, most of which are semi automatic, have 9+ round magazines, and are carried by many people who are specifically prohibited from carrying any weapons, namely criminals, crazy or otherwise. The currrently popular "Glock" carried by police forces throughout the country is manufactured in Switzerland a nation with the highest per person gun ownership.

What has been the track record of handgun bans? Well, the hand gun ban in Washington DC has been in place for 31 years. Last year there were 137 gun related homicides. Has this number of gun related homicides substantively changed from before the hand gun ban? No. Are comparisons of before and after handgun bans were instituted valid? No. So much has changed regarding our nation's cities, the disappearance of ethnic districts (formally called ghettos) which had been the predominant social organization has morphed into a massive flight of people, money, and social controls, with, in many instances, people of color filling in the void. Drugs, violence, joblessness, ignorance have become the new urban reality.

From my perspective, address the issues of violence, poor health, joblessness, ignorance by spending the limited resources of cities on increasing an educated police presence on the street (more boots on the ground), getting the best people into leadership position in the city's bueacracy (changing hiring and firing policies and proceedures), shun gimics and politically correct solutions, build the infrastructure for job development (ie, shed work rule restrictions, put the grant monies already going into cities in the hands of accountable bueacrats, etc), provide basic health care including have a health education nurse go into every home to assess the vaccination status, nutritional status, mental health status and basic health information awareness of each person in the household; an educational system that rates its teachers by personal inclass assessments, performance ratings, expects continuous teacher learning and its validation; assesses the children in an ongoing basis; enact a two way communication system with parents that weekly informs them how their child is or is not progressing. Provide a set of expectations that the school has for the parent's involvement in their child's learning.

Hand guns perse do not appear to be the problem, they are a symbole of a society believing that violence is an acceptable solution to the discontent one feels. Unfortunately, violence seems to be hooked to "justice", respect, entitlement. Disconnecting justice and respect and entitlement from violence requires a willing media for this educational campaign.

Have I said enough for now?

Silver Bells in the City

Kathy is decked out in her white quilted parka. Around her neck is a neckles of flashing minature christmas tree lights. I am in my dark green MSU sweatshirt with an overlaying red vest. Festively attired, we head to Clara's for dinner prior to the Silver Bells in the City Electric Light Parade in downtown Lansing. Clara's roof lines are strung with white lights. There is a warm glow inside the old Lansing Train Station.

After dinner, Kathy and I walk to the corner of Washington Street and Michigan Avenue, joining the 30 people deep thong lining Washington Street. First come the Lansing Police Department Motorcycle mounted police, sirens bleeping, and red and blue lights flashing. The first float for this years electic lights parade, aply enough is the International Brotherhood of Electirical Workers local 665 wearing outer teeshirts claiming "We Build Lansing". Their float is covered with lights, and animals and people, and... Next comes the Eastern High School Marching Bank drum beat, whistle, raising of instruments into a round of Frosty the Snowman, followed by more electric light bedecked floats: the Humane Society, Salvation Army, Potter Park Zoo, People's Church, Lion's International Air Force fighting the War on Blindness: Diabetes, Glaucoma. The United State Army has a light covered HumVee with a sign: "Peace on Earth". The United States Marine League Capital Detachment, a lighted "deuce and a quarter" truck with a sign " If you can read this, thank a teacher." The MSU Rodeo Club galloped down the roadway followed by Sparty in the MSU Recycle truck's forward bin "Keep MSU Green". The final float was from Peacock's U Cut It Tree Farm, a train engine, covered train cars with people waving from the windows, a flat car with Santa in Red Suit and white beard, and a caboose with Miss Lansing and Miss Michigan spotlighted and waving. There were 60 floats in all; a dozen marching bands; 100,000 people lining Washington Street, and Capital Avenue.

The temperature was 37 degrees F; the sky overcast. As the last float came by, the crowd moved from Washington Street, West towards the Capitol Building, Capital Avenue, and the Douglas Fir tree, brought down from the Upper Peninsula, near Gladwin MI. When we got to Capital Avenue, we caught the tail end of the parade: The Holt High School Marching Band, Peacock's Train and the follow up Motorcycle Mounted Police. A few speaches from visiting dignataries, the lighting of the Christmas Tree on the lawn of the State Capitol followed by a burst of fireworks highlighting the State Capitol building.

Lansing, platted in 1847 and in April of that year, designated by the State legislature as the Capital of Michigan. 160 years later, Lansing hosting "Silver Bells in the City."

Greening of the World

I am sitting in the sun room with my Canadian purchased red vest on reading about global warming. According to some intergovenmental agency "experts" in the UK and USA, measurements of surface temperature around the world have gone from a period of stability, ie, not changed since 1998, to global surface temperature decreasing recently. The earth's Southern Hemisphere has been cooling for the past 8 years with snow fall in Buenos Aires for the first time since 1918. Australia has suffered its coolist June ever. Sorry Leah. Yes, the atmospheric level of carbon dioxide has risen, the surface temperature just has not followed. Now there's a howdoyoudo. My local newspaper tells me that I should expect a colder than normal winter this year. Gas supplies for my furnace are still plentiful, I have my new vest, and several more, I regularly wear my Christmas present slipper stockings (thanks Bec), I have set the thermostat to 68 degrees, and bundled up a bit more.

If this global warming story turns out to be a hoax, I am going to be really pissed. It would mean that I have misallocated my stock portfolio, and will be a pauper at a time when energy prices go through the statosphere. Imagine Kathy and I sitting with a blanket around our shoulders, typing on our computers with half-finger gloves on, like Bob Cratchet, trying to coaks a few more BTUs out of the stand alone electric heater at our feet. Will Ebeneezer Coal Company Scrooge have night time visitors? provide us retirees with electic rate relief? the golden turkey of the 21st century. It is just interesting what actual measurements can do to highfalutin talk.

Inconvienent Trueths

Last week, October 31st 2007, an article circulated in the lay press about over-weight and obesity and the risk of various cancers. Most of the cancers were in organs believed to be influenced by hormones: breast, pancrease, endometrial, prostate, color-rectal, ovary, gallbadder. Further evidence of hormonal influence was the observation of a protective effect that obesity has on premenapausal women from cancer and the deletarious cancer effects of obesity has on post-menapausal women. Speculation is that estrogens play a role in modulating these cancers. Interesting is the observation that premenapausal women have a lower risk of heart disease and stroke, only to catch up to men's rate of heart disease and stoke 15 years after onset of menapause, irregardless of weight, "normal weight" or obese.

I wondered about the weight issue on heart disease and cancer since I myself have been mindful and repeatedly reminded of my own weight issue.

Over the last several years we have heard much about an obesity epidemic in the USA population, which is spreading to the rest of the world, with the pronouncement by various authorities that this global epidemic is likely secondary to the world populaton assuming our Western diet: high calories and high fat: red meat is bad. The solution: fish, whole grains, fruits, nuts, a prudent Mederteranian diet is good or so the experts/media/politicians would have us believe.

Now the Inconvienent Trueths:

1) Since 1992, for all causes of death (heart, stroke, cancer) have been going down (this is the main reason why our longevity has been going up), as our weight has been going up. Body Mass Index (wt in Kg/M2) is broken into categories: <18 is malnourished, 18 to 25 is ideal body weight, 25 to 30 is over weight, 30 to 35 is class I obesity, 35 to 40 is class II obesity and >40 is class III obesity. The known health effects of weight, whether heart disease, stroke, cancer, are in a "U"shaped distribution; that is, the "excess deaths" occur at both ends of the spectrum. Those with BMI<18.5 and those with BMI >40 account for almost 90 % of the excess deaths. Those with BMI <18.5 compose 6.3% of the population and represent 1/3 of all the excess deaths. Those with BMI in the overweight category (25 to 30), live longer than those in the ideal weight category (BMI 18.5 to 25). Those in the Obesity I category, BMI 30-35 live as long as those in the ideal BMI. One speculation for this "paradoxical" situation has been that as the incidence of cigarette smoking has declined, there has been a decrease in tobacco related deaths, and a weight gain in those previously in the ideal weight category who are now in the overweight category.

2) The diet and heart disease connection was articulated from the observation that Japanese men who immigrated to Hawaii developed heart disease while the incidence of heart disease was low in Japan. The authors speculated that moving to Hawaii meant assuming a Western diet; hence, onset of heart disease. Inconvienent truth; the Japanese who came to Hawaii continued eating the very same diet they had eaten in Japan (not terribly suprising considering our own ancestry, the Czech's continued eating what was familiar to them when they came over at the turn of the previous century to Cleveland Ohio). If all 22 nationalities with data at that time on heart disease in their native lands and immigration to Hawaii had been used in the data set, there was no statistical difference in incidence of heart disease amongst immigrants to Hawaii. There is likely another explaination, but the data has not been analysed for another explaination.

3) In an article by Flegal et al, Journal of the American Medical Association February 8th, 2005, volume 293 pages 1861 to 1866, in the opening sentence for the results of the Women's Health Initiative, involving >50,000 women, "Despite the findings that a low fat diet did not reduce the risk of breast cancer, heart disease, stroke, colon cancer..." Meaning, the intervention of low fat diet over the 6+ years of the study did not change any of the outcome parameters. Yet, the recommendations were to implement a low fat diet!

4) A summary article of the epidemiological evidence linking weight, heart disease, stroke, cancer is: Compos et al, International Journal of Epidemiology 2006, volume 35 page 55. The authors speculate upon why the data that has been known for more than 35 years, including data through 2006, which refutes a link between weight, cancer and heart disease has been ignored. These authors invoke: "moral panic". Moral panic and it assumption by general society at a particular time, is described as "the fabrication of risks during times of rapid society change."

Does any of this sound familiar? Blame Saddam Hussain with WMD. Blame an Obesity Epidemic. Blame Western Culture and diet. Blame Global Warming. Blame mercury in the form of Thermistol in vaccines for the autism in herown child was the most recent Hollywood science starlet on the Oprah Winfred and Larry King shows promoting her book: Inconvienent Trueth: Her child was conceived two years after Thermistol was removed from all childhood vaccinations. What happens during a moral panic, along comes a demagogue: " I have a solution... it'll be painful... you will have to give up some of your rights... but, just do as I say and...."

In my opinion, and what is likely, and from my predictive insight into the future you will see, is that the "clear and present danger" which is blatantly evident to all right now, will fade from view as the light of science is cast upon it. You say there is a lot of science out there linking one thing to another? The problem I see is selective use of science information.To come to the present conclusion; ie, for the majority of us, that there is a health risk with incremental increases in weight, one has to ignore: Inconvienent Trueths. A theory which encompasses all the trueths, eludes us at this time.

Spartan football

Aside from the fact that we lost to Michigan, it was a great night for football. It is late in the regualar football season, yet global warming has had its positive effect in East Lansing. Starting time, 3:30 PM, temperature at kickoff was 55 degrees; Wind from NorthWest at 14 MPH, and a cloudless sky. A beautiful day for football.

After the Star Spangle Banner U o M looked like a juggernut and was up 14 to 3 by half time. After 3 michigan 3 and outs, MSU was ahead 17 to 14. The stunning play by Jevon Ringer starting at the MSU 18; a sweep to the left, immediately diagnosed by Michigan, 4 maze and blue about to tackle him for a loss; he reverses field, the MSU quarterback throws a knock down block on a defensive lineman, and Ringer cuts across field and down the sideline pushed out of bounds on the 5 yard line. End of the 3rd quarter, change in field direction, MSU lines up in a power I formation (3 running backs behind one another and the quarterback under center, the quarterback fakes to one, the another running back and lobs a touchdown strike to the tight end who has flared out to the right and into the endzone.

The eventual score however was 24 MSU and 28 UoM. MSU could not stop the air attack and lost with 2 minutes to play; ending a 4th and 18 with an incompleted pass.

So it was. The night was cool but the wind had died. The only difficulty was the score at the end of the game.

Another day at the office

Today was my second subspecialty clinic at CareFree, a clinic for indigent patients and families; all comers accepted irregardless of ability to pay. It is not quite clear yet, whether contributions to CareFree constitute donations to a charitable organization; not all the paperwork has been filed I believe. Much of the professional staff however, is voluntary. Therefore, there is a certain degree of disorganization inherent in such a system, who is coming, who is going, who is on first.

As an illustration of the above, my first pediatric patient two weeks ago was a 57 year old women seeking Social Security Disability coverage for a cornicopia of complaints. As coincidence would have it, she had my MOTHER as a teacher. "Oh Dr. Honicky, I once had a teacher by that name." "Where were you living at the time?" "Cleveland, Ohio." "What part of Cleveland?" "The East side." "Where abouts on the East side?" "Moreland Hills." She taught me and my twin sister, I think in the 8th grade." Wholely moley, she was right on: 8th grade History at Orange Middle School. This women's life had been a bumpy one, homeless, vagabond, abused, and now living in the Lansing area near her daughters on food stamps and welfare. The CareFree clinic wanted me to evaluate her for asthma as she had difficulty breathing several weeks before when she was lying down reading to her grand children, and, oh by the way, she now is morbidly obese. I evaluated her and sent her a copy of my dictation outlining my diagnosis, acid reflux, coming up the esophogus, spilling into the airway and causing laryngeal spasm; hence, abrupt onset of difficulty in breathing. She appeared at the clinic today and told me that I was the only doctor to have sent her a clinic dictation for which she was grateful, only, she wanted to correct a few errors: she has 3 daughters and not 2.

Today's new patient was a 12 year old who must have followed Leah as she drove back from Columbus Ohio last week; entwined as he was in Child Protective Custody. In the room was the child, his mother, and a social worker. My first step was to interview the child about his asthma, what did asthma mean to him, how does it feel, what makes it better, worse, when was the last time he felt bad, queried whether he took his medicines, whether he could feel his asthma getting worse, etc,etc,etc. As we talked together, his mother kept interjecting, trying to answer for him, but he persisted; he listen, read my handouts, asked questions, made eye-to-eye contact, came up with unique answers to questions that I posed. I asked him what made his asthma the very worst: cigarette smoke; do you smoke cigarettes? No? does anybody in your family smoke cigarettes? His mother immediately interjects that she only smokes outside and a pack of cigarettes (20) lasts 3 weeks. The look on the child's face of incredulity was a picture to behold. He learned from me that Jerome Bettis, who played running back for the Pittsburg Steelers has asthma. I showed the child a picture of untreated asthma and a healthy lung. I asked the child what did Jerome Bettis's lungs look like, the child pointed to the asthmatic lungs. I told him that Jerome Bettis could not run as he did unless his lungs looked normal. I asked the child, what made the difference between his own lungs and those of the football player. "He took his asthma medicines". That's right. During the interview, during the review of systems I asked about injuries and he showed me his finger. "I got 5 stitches in it." "How did you get injured?" "I got cut by a broken beer bottle that I was shooting at. Where is the gun now? I asked. "My step father bought it for me, but he keeps it." His mother adds that he was staying at a cousin's house, the cousin is now in jail for molesting children. Mom continues, he tells me that he wasn't molested, but you can ask him again as you examine him when we leave the room as he is shy and doesn't like me to see him without his shirt on.

There are two more patients for next week's clinic. I will begin at 9 AM and work to my usual 1 PM.