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Mark Schweickart

Dave's post about The Kingston Trio's revival of the banjo reminded me of one of my songs that I don't think I have foisted upon you guys yet. It doesn't actually use a banjo, but it is from the Bluegrass option that Apple used to include as samples one could incorporate into a song, and in this case uses a fiddle, mandolin, bass, harmonica, and drums. Basically, I just used these pre-recorded tracks to go with the lyrics I wrote for a song in a screenplay I had been working on. Maxx, the main female character, and her boyfriend Jerry are performing this in a small bar venue. In the script, she had been raised by a Bible-thumping, river-baptizing, hypocritical father, which inspired her to write this song years later.

Since this is just me making a demo song, you will only hear me singing both Maxx and Jerry's parts. Sorry about that.

James Hamilton, M. D.

Statins, Part II

I'll make this the final part, at least for now, and keep it short.

There are a few points and the final chapter regarding statin drugs has probably not been written.

Statins really revolutionized the treatment of hypercholesterolemia and, subsequentially, the outcome of atherosclerotic diseases. In "the old days" when I entered the medical field we were limited in our knowledge and ability to lower cholesterol levels. Niacin and fibrates (Atromid-S) were not all that effective. Statins were, and still are, very effective in decreasing LDL (bad cholesterol) levels.

Of course, diet, exercise and lifestyle modifications are always considered first line therapy for treatment and prevention of cholesterol related issues. But, let's be real folks, at our age are we actually going to change that much how we live?

There are a lot of statins now on the market. The relative effectiveness of these depends not only on dosage but the kind of statin. Some are "stronger" than others. 

One can also divide statins into another category that being solubility. Lipophilic statins are soluble in fat and hydrophilic ones in water. Simvastatin, atorvastatin, cerivastatin, fluvastatin, pitavastatin and lovastatin are primarily fat soluble whereas pravastatin and rosuvastatin are mostly hydrophilic.

It would seem to me that tissues that absorb various statins (based on solubility) might be targets for any side effects that could occur - that is, IF they occur. The brain is fatty, the liver is more "watery". So, if a patient would get an adverse reaction to a certain statin, switching to a different statin may be indicated. A tissue that we do know can be affected, occassionally seriously, is muscle tissue. Although that is fairly rare it is more likely that that affect is caused by the patient being on other drugs that, when combined with certain statins, can cause severe muscle damage. 

Medical studies are not infrequently found to contradict each other. That is possibly due to the fact that the human body has a lot of "pathways" that can be affected in different ways. Preventing atherosclerosis in arteries (including carotid arteries) is good for the brain and probably outweighs many direct toxic effects that could damage it. Certainly strokes damage brain cells. Also preventing heart attacks is beneficial to the brain.

As one can see there are no easy answers, but I, personally, am a fan of statin therapy in the right clinical setting.

There are newer and stronger drugs on the market now for hypercholesterolemia, most of which are directed at younger patients who have hereditary forms of the disease. PKSC inhibitors are injectable monoclonal antibodies (very expensive) that are available and dempedoic acid is also occasionally used along with the more standard (statin) medicines.

Again, your individual doctors should know your cases the best and which medicines at which doses would be most appropriate for you.

To your health,

Jim

Mark Schweickart

Thanks Jim for sharing your knowledge on this. I initially resisted taking a statin for cholesterol control, but finally did come around on this. Given what you are saying here, I am reassured about that decision. Thanks again. 

Michael McLeod

Jim: So appreciate your acumen.

If only because it gave me a chance to use the word "acumen" in a sentence.

Also, next time I'm out with my beloved I'm working "hypercholesterolemia" into the conversation just to see how impressed she'll be.

But my appreciation is serious.

Meantime:

I just think everybody should look at this.

https://www.youtube.com/watch?v=eqhgzRhYtM0

James Hamilton, M. D.

Mark and Mike,

Glad you appreciated my comments.

And, Mike, as for the medical jargon, we probably overuse the prefix "hyper-" at times. My favorite is "hyperemesis" which means too much vomiting. That leads one to believe that there should be a term such as "hypoemesis" meaning too little vomiting 🤔. I've never had a patient with that as their chief complaint!

(I say that in jest but not to belittle the serious condition of hyperemesis gravidarum which can occur in some pregnant females.)

Jim

David Mitchell

From Rachmaninoff's Piano Concerto #2 

R.I.P.  Erik Carmen    (loved this song)

Joseph D. McCarthy

Time for a commercial.

If Money can't buy happiness.

   Explain MOTORCYCLES and BEER.

Michael McLeod

Jim: As a devoted wordsmith I think I will try to come up with a word that means "Just enough vomiting." You know, a word that convey a sense of "ah, that hit the SPOT!"

James Hamilton, M. D.

Mike,

Medically speaking, that word would be "euemesis". ​​​​​​

Jim

Michael McLeod

Rats. You just punctured my balloon. I was gonna spend all afternoon on this project. Then came my nemesis: "euemesis." ("Emetic" would be, I guess, a related word with the same Latin root.)  

FYI I had actually begun tinkering.  An early possibility was "puke perfect." I was also toying with "hurl-y burl-y"  to describe the opposite, meaning a particularly bad experience. But I was going for a single syllable. A companion to "barf."  Nothing so far. It's possible that I have better things to do.

David Fredericks

Michael....I think the single syllable companion word you're looking for is "yak".

Michael McLeod

Oh lordy dave. Have not heard that word for years - it doesn't often come up in polite company, as my momma might have said -- and you are absolutely right.  ("come up" is now reminding me of "upchuck." Isn't language fascinating? Ok boys and girls can someone use it in a sentence???

John Jackson

Not to change the subject from these delightful topics, but we’re just a few short days from the holiest day of the year and this year it’s on Sunday so it’s even holier!  To get you in the mood here’s Back Home in Derry, a song by Irish legend Christie Moore.  Lots of Irish songs have emigration as the theme but this is a song about forced emigration - Australia started as a British penal colony and many/most of its original “settlers” were Irish “transported” there for various offenses.  The song is also interesting because its melody (except for the chorus) is the melody of Gordon Lightfoot’s “Wreck of the Edmund Fitzgerald” (lots of these old Irish melodies keep getting recycled).

Slightly related - one of my favorite (and quite cheap – under $10 in NJ) wines is an Australian wine called 19 Crimes and it refers to the nineteen crimes that could get you exiled for life to Australia.  I swear I’m not getting paid for this plug but here’s a link to the 19 Crimes site that shows the list:

https://19crimes.com/pages/the-19-crimes      

Joseph Gentilini

Thanks for sharing the song and the history lesson, John J.  The song was beautiful and yet errie.  joe

Michael McLeod

Yes: Thanks for the lift, John -- and there's a lift of another sort afoot to celebrate . Godspeed, spacex! With all the debates and disunity and general grimy grumpiness I haven't felt like cheering on like this for quite a while. 

James Hamilton, M. D.

To All Who Like Winter

The last two days have brought a LOT of snow to Colorado Springs. It is well known that March is usually our snowiest month but this topped anything which we have seen since moving here 48 years ago. I shoveled the deck of about 9" of snow yesterday afternoon but more snow fell last night. So far we have had about 2 feet total and it is not quite done yet. 

Our driveway is somewhere in this shot. Note the newspaper in the lower middle of the picture. Our delivery person seldom misses a day!

But the yearlings appreciated the broken branches of a Ponderosa pine which supplied a nice salad of pine needles (YUM!!):

Have a great weekend!

Jim

Michael McLeod

Salt is the crack of junk food. I got lightly salted cape cod kettle cooked chips and they don't even come close to getting  me off. It's a junk food bummer.

David Mitchell

ERIN GO SOUTH !

Many of you "Yankees" may not know this, but nearby Savannah has the third largest St. Patrick's day celebration in the US after New York City and Chicago. Georgia was a British penal colony for many years and Savannah has one of the largest Irish Catholic populations in the mostly "un-Catholic" South. 

There is even a popular, (but politically incorrect) local joke that the Jews own Savannah*  The Irish Catholics run Savannah, and the Blacks (slaves) do all the work. And to this day, that is not far from the truth. 

(* most of the early landowners were wealthy British Jews attracted by Oglethorpe).

People come from all over the world to be here for Savannah's parade and festivities - I mean hundreds of thousands.

Now, don't get me wrong. I absolutly love downtown Savannah.  But take my advice - don't ever come here for St. Patricks Day!

The city is a mob scene of crowds numbering in the hundreds of thousands of just my closest drunken friends!

Traffic in the city is at a complete standstill - no cops keeping the traffic moving at all - so every downtown intersection is gridlock. Everyone is drunk. And most of them seem to be standing in the crosswalks - with their drinks in hand. A few years ago I had to pick up a family at about 11;00 pm, that I had brought in and dropped about 10:00am that morning. Long story short - it took me hours to get to them and when I did, the husband was so drunk he cursed me abusively all the way home. He ranted on so awfully, even his drunken wife finally told him to shut up!

Looking across the Savannah River at downtown Savannah from the South Carolina side    

Michael McLeod

That's a pretty greenish skyline tho, dave.

Funny how some things start looking better the further away you get.

John Maxwell

Joseph D. McCarthy

As long as we are on words:  The following was provided by a neighbor.

HASH, x.  There is no definition for this word - nobody knows what a hash is.

HEATHEN, n.  A benighted creature who has the folly to worship something that he can see and feel.

HOSPITALITY, n..  The virtue which induces us to feed and lodge certain persons who are not in need of food and lodging.

I think I may remove this neighbor from my email accpunt.

Michael McLeod

seriously: everyone needs to look at this.  All the way to the end. Then  you;re  going  to want  to share it.

https://www.youtube.com/watch?v=HluNprK-0pg

Michael McLeod

Ok I just called up a weird memory and this is the  only audience that can fully relate to it.

I teach a writing class at a private college and I had a bad class the other day, felt awkward in my presentation, and that put me in mind of a terrible thing that happened to a teacher, a nun whose name escapes me, when I was in grade school at  Immaculate Conception.

I cannot remember her name. Not sure of the grade where this happened either. But this was a nun who could not control a class. And we, as a class, could sense that, and at time we  got  utterly loud and crazy, and there was this one time when we frustrated her so much that she left the classroom and slammed the  door  -- and large panel of thick, rippled glass in the middle of that door shattered with a noise  that could clearly be heard, I am sure, up and down the hall.

And the principal  turned up,  and talked softly to sister mary margaret. I believe that was her name.

Over the years since then I call up that memory and feel so bad for her.

I'm sure I was one of the  bad kid ringleaders. 

I am so going to be cast  into the depths of hell.  And sister mary margaret  - who no doubt mentioned that possibility to me long ago - will be upstairs, where  she belongs.

John Maxwell

Mark Schweickart

Speaking of Maxwell memories of times gone by, I am happy to say Jack popped into Los Angeles the other day (to visit his three adult sons who now live here), and he and I were able to get together for two afternoons of strolling the highways and byways of yester-year. It was sort of like that old Richard Pryor routine where Pryor would say, "First he'd tell a lie, then I'd tell a lie." And for us, on and on we went. Of course we weren't actually lying, it's just that as fuzzy as my memeory is these days, I can't help but wonder how accurate our anectdotes were. Of course it's much easier to remember the 50's, 60's, and 70's than it is last week, so chances are we got most of the stories straight.

That Jack, he sure has some tales to tell. Quite the raconteur.

A great visit.