Monday, June 26, 2017

The lying liar leading us to ruin

“A lie can travel half way around the world while the truth is putting on its shoes.” — Charles Haddon Spurgeon, English Particular Baptist preacher often called the Prince of Preachers

THIS IS the country we live in now. Last week The New York Times felt compelled to make the unprecedented move of using a full page to print all of the lies SCROTUS* has told publicly since taking office. (Here's a link that will take you to the full list of lies and the entire article.)

*So called ruler of the United States

Trumps' Lies
By David Leonhardt
June 23, 2017

Many Americans have become accustomed to President Trump’s lies. But as regular as they have become, the country should not allow itself to become numb to them. So we have catalogued nearly every outright lie he has told publicly since taking the oath of office.

All the President’s Lies

President Trump’s political rise was built on a lie (about Barack Obama's birthplace). His lack of truthfulness has also become central to the Russia investigation, with James Comey, the former director of the F.B.I., testifying under oath about Trump's “lies, plain and simple.”

There is simply no precedent for an American president to spend so much time telling untruths. Every president has shaded the truth or told occasional whoppers. No other president — of either party — has behaved as Trump is behaving. He is trying to create an atmosphere in which reality is irrelevant.

We have set a conservative standard here, leaving out many dubious statements (like the claim that his travel ban is “similar” to Obama administration policy). Some people may still take issue with this standard, arguing that the president wasn't speaking literally. But we believe his long pattern of using untruths to serve his purposes, as a businessman and politician, means that his statements are not simply careless errors.

We are using the word “lie” deliberately. Not every falsehood is deliberate on Trump's part. But it would be the height of naïveté to imagine he is merely making honest mistakes. He is lying.

Trump Told Public Lies or Falsehoods Every Day for His First 40 Days

The list above uses the conservative standard of demonstrably false statements. By that standard, Trump told a public lie on at least 20 of his first 40 days as president. But based on a broader standard — one that includes his many misleading statements (like exaggerating military spending in the Middle East) — Trump achieved something remarkable: He said something untrue, in public, every day for the first 40 days of his presidency. The streak didn’t end until March 1.

Since then, he has said something untrue on at least 74 of 113 days. On days without an untrue statement, he is often absent from Twitter, vacationing at Mar-a-Lago in Florida, or busy golfing.

The end of May was another period of relative public veracity — or at least public quiet — for the president. He seems to have been otherwise occupied, dealing with internal discussions about the Russia investigation and then embarking on a trip through the Middle East and Europe.

Trump’s Public Lies Sometimes Changed With Repetition

Sometimes, Trump can’t even keep his untruths straight. After he reversed a campaign pledge and declined to label China a currency manipulator, he kept changing his description of when China had stopped the bad behavior. Initially, he said it stopped once he took office. He then changed the turning point to the election, then to since he started talking about it, and then to some uncertain point in the distant past.

The Public’s Mistrust of Trump Grows

Trump has retained the support of most of his voters as well as the Republican leadership in Congress. But he has still paid some price for his lies. Nearly 60 percent of Americans say the president is not honest, polls show, up from about 53 percent when he took office.

Friday, June 23, 2017

Fake democracy

“What difference does it make to the dead, the orphans and the homeless, whether the mad destruction is wrought under the name of totalitarianism or in the holy name of liberty or democracy?” ― Mahatma Gandhi

ACCORDING to the US Code of Laws, Title 36, U.S.C., Chapter 10 as amended by P.L. 344, 94th Congress, flying the American flag upside down in an official signal of distress. I honestly wonder whether our nation can be saved; please consider my virtual United Stated flag flown upside down.

Attached is a breathtaking opinion piece in today's New York Times.

Our Fake Democracy

By Timothy Egan 

June 23, 2017

We tell ourselves stories in order to live, as Joan Didion said. We do this as a nation, as individuals, as families — even when that construct is demonstrably false. For the United States, the biggest institutional lie of the moment is that we have a government of the people, responding to majority will.

On almost every single concern, Congress — whether it’s the misnamed People’s House, or the Senate, laughably mischaracterized as the world’s greatest deliberative body — is going against what most of the country wants. And Congress is doing this because there will be no consequences.

We have a fake democracy, growing less responsive and less representative by the day.

The biggest example of this is the monstrosity of a health care bill, which a cartel of Republicans finally allowed us to peek at on Thursday. The lobbyists have seen it; of course. But for the rest us, our first look at a radical overhaul of one-sixth of the economy, something that touches every American, comes too late to make our voices heard.

Crafted in total darkness, the bill may pass by a slim majority of people who have not read it. Inevitably, with something that deprives upward of 23 million Americans of health care, people will die because of this bill. States will be making life and death decisions as they drop the mandated benefits of Obamacare and cut vital care for the poor, the elderly, the sick and the drug-addicted through Medicaid. The sunset of Obamacare is the dawn of death panels.

It would be understandable if Republicans were doing this because it’s what most Americans want them to do. But it’s not. Only about 25 percent of Americans approved of a similar version of this bill, the one passed by the House. By a nearly 2 to 1 margin, people would prefer that the Affordable Care Act be kept in place and fixed, rather than junked for this cruel alternative.

The Senate bill is “by far, the most harmful piece of legislation I have seen in my lifetime,” said Senator Bernie Sanders. At age 75, he’s seen a lot.

Remember when Republicans used to pretend to care about crafting the people’s business in sunlight? “It’s simply wrong for legislation that will affect 100 percent of the American people to be negotiated behind closed doors.” That was Mike Pence in 2010.

Why are they doing it? Why would the people’s representatives choose to hurt their own people? The answer is further evidence of our failed democracy. About 75 million Americans depend on Medicaid. This bill will make their lives more miserable and perilous in order to give the top 2 percent of wealthiest Americans a tax cut.

And where are the 75 million now? They are nowhere. The sad fact is, the poor don’t vote. Up to 80 percent of low earners do not show up at the polls, and it’s even worse in midterm congressional elections. The Republicans can screw the poor, whose population is disproportionately large in red states, because those citizens will not fight back.

So, little surprise that Republicans are also working to make it even harder for the poor to vote. They can seek to disenfranchise one class of Americans, and get away with it from the safety of gerrymandered seats.

The symptoms of democratic collapse — from the opioid crises of people who long ago checked out of active citizenship to the stagnation of class mobility — cry for immediate action.

It takes the median worker twice as many hours a month to pay rent in a big city today than it did in the early years of the baby boomer era, as Edward Luce notes in his new book, “The Retreat of Western Liberalism.” Add towering increases in health care and college costs to that and you’ve got an unclimbable wall between low-income limbo and a chance at the middle class. The United States, once known for our American Dream, now has the lowest class mobility of any Western democracy, according to Luce.

What is Congress doing? Nothing on wages. Nothing on college tuition. And the health care bill will most surely force many people to choose between buying groceries and being able to visit a doctor.

Our fake democracy reveals itself daily. Less than a third of Americans support President Trump’s decision to withdraw from the Paris Climate Agreement. In a truly representative government, you would see the other two-thirds, the common-sense majority, howling from the halls of Congress.

Most Americans are also against building a wall along the Mexican border. They would prefer putting taxpayers’ billions into roads, bridges, schools and airports. But the wall remains a key part of President Trump’s agenda.

Trump is president, of course, despite losing the popular vote by nearly 3 million people. Almost 60 percent of the public is against him now. In a parliamentary system, he’d be thrown out in a no-confidence vote. In our system, he’s primed to change life for every citizen, against the wishes of a majority of Americans. Try calling that a democracy while keeping a straight face.

Wednesday, June 21, 2017

The benefits of extra-virgin olive oil

“Let food be thy medicine and medicine be thy food.” — Hippocrates

WE'VE ONLY cooked with olive oil at our house for years. Extra-virgin appears to have extra advantages. Below are the main points from three articles from USA TODAY to help you keep your heart and brain ticking along.

FYI: Coconut oil has more saturated fat than lard. Yikes!

Extra virgin olive oil staves off Alzheimer's, preserves memory, new study shows

By Sean Rossman

June 21, 2017

Temple University research shows extra-virgin olive oil protects against memory loss, preserves the ability to learn and reduces conditions associated with Alzheimer's disease.

Researchers at the college's Lewis Katz School of Medicine found mice with EVOO-enriched diets had better memories and learning abilities compared to the rodents who didn't eat the oil.

The real effect of EVOO appeared in the inner-workings of the mice's brains. Neuron connections in the brain were better preserved in those on an EVOO diet.

Also, olive oil reduces brain inflammation and activates the autophagy process, whereby intracellular debris and toxins are removed. Such debris and toxins are firm markers of Alzheimer's disease. A reduction in autophagy, researchers claim, is suspected to be the beginning of Alzheimer's disease.

Olive oil is the cornerstone of the Mediterranean diet, which is praised for its various health benefits. This study, which was published Wednesday in the Annals of Clinical and Translational Neurology, adds to that previous research.

"The thinking is that extra-virgin olive oil is better than fruits and vegetables alone," said senior investigator Domenico Pratico, a professor at the Lewis Klein School of Medicine. "As a monounsaturated vegetable fat, it is healthier than saturated animal fats."

Alzheimer's disease is the most common form of dementia in the United States and affects a person's thought, memory and language. The U.S. Centers for Disease Control and Prevention said the disease typically starts after age 60 with mild memory loss. There is no cure.

Alzheimer's cases are on the rise. In 2013, 5 million Americans had the disease. That number is expected to triple to 14 million by 2050.

Pratico said the "exciting" finding sets researchers up for another experiment. The next step is to introduce EVOO later in the aging process.

"Thanks to the autophagy activation, memory and synaptic integrity were preserved, and the pathological effects in animals otherwise destined to develop Alzheimer's disease were significantly reduced," Pratico said. "We want to know whether olive oil added at a later time point in the diet can stop or reverse the disease."

Coconut oil is out. These are the oils you should be using, experts say

By Ashley May

June 20, 2017 

Last week, the American Heart Association said coconut oil is unhealthy, reigniting a conversation about saturated fat and leaving some confused about what is healthy. 

When shopping for a healthy oil, 
Donald Hensrud, medical director of the Mayo Clinic Healthy Living Program, said to go for one with high levels of monounsaturated or polyunsaturated fats. Both are considered healthy fats that lower cholesterol. Also, avoid partially hydrogenated oils — that's the source of trans fat, which raises bad cholesterol.

Here are some of the healthiest oils, as recommended by doctors and researchers: 

High in monounsaturated fats: Olive oil is the shining star of healthy oils in this group. Many experts point to a study in The New England Journal of Medicine that enrolled 7,447 people ages 55 to 80-years-old and showed eating olive oil (or nuts) greatly reduced the risk of cardiovascular disease. Research also suggests olive oil could help reduce the chance of breast cancer.

The type of olive oil can matter. Extra virgin olive oil has slightly more nutrients, Hensrud said. Sediment in the bottle could actually translate to vitamin E. 

Avocado oil, which contains 71% monounsaturated fatty acids, has become a popular choice, and experts say for good reason. It has some of the same properties as olive oil, plus it has a high smoke point — meaning, it's safe to cook at high temperatures. Oils with low smoke points create toxic compounds when overheated (think: frying). Safflower and sunflower oils also contain high amounts of monounsaturated fats and have high smoke points (above 400 degrees). 

High in polyunsaturated fats: The American Heart Association's Dietary Fats and Cardiovascular Disease advisory showed corn oil, soybean oil, peanut oil and canola oil all contain high amounts of polyunsaturated fats. Canola oil and peanut oil are high in both monounsaturated and polyunsaturated fats. Canola is best for baking because it's largely tasteless and peanut oil is good for frying because of its high smoke point.

Coconut oil isn't healthy. It's never been healthy.

By Ashley May

June 16, 2017

The American Heart Association recently released a report advising against the use of coconut oil. 

The Dietary Fats and Cardiovascular Disease advisory reviewed existing data on saturated fat, showing coconut oil increased LDL ("bad") cholesterol in seven out of seven controlled trials. Researchers didn't see a difference between coconut oil and other oils high in saturated fat, like butter, beef fat and palm oil. In fact, 82% of the fat in coconut oil is saturated, according to the data — far beyond butter (63%), beef fat (50%) and pork lard (39%).

"Because coconut oil increases LDL cholesterol, a cause of CVD [cardiovascular disease], and has no known offsetting favorable effects, we advise against the use of coconut oil," the American Heart Association said in the Dietary Fats and Cardiovascular Disease advisory. 

Tuesday, June 20, 2017

The Emoluments Clause

“If what’s going on is somebody is buying something from The Trump Organization to buy favor, there’s no way you’d ever figure out who that person is or what favor they’re trying to buy.” — Jack Blum, Washington attorney specializing in offshore tax evasion and financial crime and former staff lawyer for two U.S. Senate committees

I'M DESPERATELY hoping that one of the current lawsuits suing SCROTUS* for violating the Emoluments Clause of the US Constitution succeeds. That's the provision that bars federal officials from accepting foreign payments and gifts without congressional approval. 

Below is an article from USA Today detailing some of SCROTUS' recent real estate transactions. How blatant does it have to get?! Remember, although the trust is run by his sons, HWSNBN** is the sole beneficiary of the trust and can withdraw money any time.

* So called ruler of the United States
** He who shall not be named 

Most Trump real estate now sold to secretive buyers

By Nick Penzenstadler, Steve Reilly and John Kelly 

June 13, 2017

Since President Trump won the Republican nomination, the majority of his companies’ real estate sales are to secretive shell companies that obscure the buyers’ identities, a USA TODAY investigation has found.

Over the last 12 months, about 70% of buyers of Trump properties were limited liability companies – corporate entities that allow people to purchase property without revealing all of the owners’ names. That compares with about 4% of buyers in the two years before.

USA TODAY journalists have spent six months cataloging every condo, penthouse or other property that Trump and his companies own – and tracking the buyers behind every transaction. The investigation found Trump’s companies owned more than 430 individual properties worth well over $250 million.

Since Election Day, Trump’s businesses have sold 28 of those U.S. properties for $33 million. The sales include luxury condos and penthouses in Las Vegas and New York and oceanfront lots near Los Angeles. The value of his companies' inventory of available real estate remains above a quarter-billion dollars.

Profits from sales of those properties flow through a trust run by Trump’s sons. The president is the sole beneficiary of the trust and can withdraw cash any time.

The increasing share of opaque buyers comes at a time when federal investigators, members of Congress and ethics watchdogs are asking questions about Trump's sales and customers in the U.S. and around the world. Some Congressional Democrats have been asking for more detail about buyers of Trump’s domestic real estate since USA TODAY’s initial report.

Their concern is that the secretive sales create an extraordinary and unprecedented potential for people, corporations or foreign interests to try to influence a President.  Anyone who wanted to court favor with the President could snap up multiple properties or purposefully overpay, without revealing their identity publicly.

The real estate cache, which Trump has never fully revealed and is not required by law to disclose, offers unique opportunity for anyone to steer money to a sitting President. The increase in purchasers shielded by LLCs makes it far more difficult to track who is paying the President and his companies for properties ranging in price from $220,000 to $10 million – or more.

The clear post-nomination shift since last year to more shell-company purchases is unique to sales by Trump’s companies, even in his own towers and neighborhoods. Condos owned by others in the same buildings, and sold during the same time period, were bought by LLCs in no more than 20% of the transactions. In some areas, the share was far less.

“If what’s going on is somebody is buying something from The Trump Organization to buy favor, there’s no way you’d ever figure out who that person is or what favor they’re trying to buy,” said Jack Blum, a Washington attorney specializing in offshore tax evasion and financial crime and former staff lawyer for two U.S. Senate committees.

The reason for the shift is unclear. The White House refers all questions about Trump's businesses to The Trump Organization, which would not answer questions about the sales.

Experts in real estate and corporate law say there are many reasons to create an LLC and use it to buy property. Some buyers, including celebrities, foreign political dissidents and even police officers, may use them to protect privacy. Investment groups use them to purchase properties in partnership.

The method is more common among the wealthy or famous in the buying of multimillion-dollar properties. For instance, President Obama and his wife are behind Homefront Holdings LLC, a corporation registered in Delaware which in May purchased the family’s home in the Kalorama neighborhood of Washington D.C. for $8.1 million, according to district property records.

There are more nefarious reasons to use LLCs, including to illegally hide assets, shield profits from taxation and launder drug money or funds embezzled from a foreign company or government. Even when LLCs are used legally, they can hide the identities of the buyers.

USA TODAY found no sales by Trump's companies that were obviously above the market rate, based on analysis of comparable properties in the same buildings and neighborhoods.

In Las Vegas, condos sold by Trump’s companies sold within a few dollars per square foot of other resellers’ units in the building. Prices were near flat, moving up $6 per square foot since Trump took office compared to before he announced he was running.

In New York, the tiny number of sales and uniqueness of each skews comparisons. Two were below-market sales by Trump to his son, Eric. The two since the election are at opposite ends of the spectrum. One $16 million deal was a short sale of a penthouse at Trump Park Avenue. At $3,800 per square foot, it sold in the low end of the range of a dozen comparable units in its Manhattan neighborhood. A smaller $2.5 million condo at Trump Parc East, at $3,085 per square foot, was at the high end of the range for 47 recent sales of comparable condos in the area.

The Trump Organization announced in January that a new corporate ethics officer would screen all real estate deals to prevent conflicts of interest. Neither the company, nor the ethics lawyer, would discuss on the record its screening process, specific deals or buyers' identities.

Sen. Sheldon Whitehouse, a Rhode Island Democrat on the Senate Judiciary Committee investigating the Trump campaign’s contacts with Russians during the 2016 election, raised concerns about the source of funds, considering Trump’s history with foreign investors in his development projects.

“Once you know—as we do – that corrupting influence by Russia is a matter of Russian practice through shell corporations, that puts a particular spotlight on transactions in which the President of the United States through his direct business interests is involved,” said Whitehouse, who is pushing legislation that would force more disclosure about the owners of all LLCs in real-estate transactions. “It’s easy: simply disclose who the party of interest is on the other side so we know it’s an ordinary business transaction and it’s not influence peddling.”

USA TODAY used corporate, financial and other records to track down 18 officers and other people related to 17 LLCs that bought Trump properties since last May. Six spoke to reporters; 10 did not respond to calls or other attempts to reach them. One who responded did not want to discuss his purchase and another hung up on a reporter asking questions about a recent purchase.

Tracking down the people behind 2 L Nevada LLC shows how difficult it can be to determine who is paying Trump.

The LLC paid a half-million dollars for two condos in the President’s shimmering golden tower near the Las Vegas strip in April. The only person identified for the buyer in public real estate records is the lawyer for the company.

In incorporation papers, 2 L Nevada lists one officer -- another LLC with an address at a Vancouver mail drop being used by as many as a dozen Canadian companies.

USA TODAY reporters scoured public records to identify the names of every company and person using the mail drop address in Canada, and eventually found the buyer.

Brian Lovig of Kelowna, British Columbia, the conservative blogger behind 2 L Nevada LLC, said he had nothing to hide. It's an investment, and he said his family used an LLC on the advice of their trust’s manager. He said he didn’t think any buyer could influence the President via real estate purchases.

“Buying a few units in a hotel isn’t going to make the President jump circles,” Lovig said.

In fact, Trump attorneys have argued that same point, saying profits from individual real-estate sales route through a maze of subsidiaries and eventually become mixed in a large pool of undifferentiated money in the trust. That, they say, makes a conflict from an individual sale difficult to imagine.

Another entity using LLCs to deal in luxury Trump real estate is the Black Tulip Organization, a French-owned investment firm with offices in New York and Miami. Records show Black Tulip provided the money behind the purchase of two of Trump’s Vegas condos during the election, and three more since Election Day – using five different LLCs.

Public records tie the $1.3 million worth of purchases to Benoit Pous Bertran, a French national, who said he was not trying to hide his firm’s identity with shell company names like “JOYP Holdings” and “Galiz Holdings.” Rather, Black Tulip was using the routine protections of a LLC. He said the purchases are not aimed at gaining attention or influence from Trump.

“This is one of the few buildings in Las Vegas where you can buy hotel condominium units, which is why we purchased there. I’m not too into politics and I’m not even a citizen. I’m French,” Pous Bertran said.

Black Tulip, which Pous Bertran said has invested in other Trump projects, runs a real estate investment fund it has said is bankrolled by investors around the world, including Brazil and Russia.

At Trump National Golf Course near Los Angeles, the President’s company sold a pair of oceanfront lots to LAT Homes LLC and Author Homes LLC in April. The two companies trace to one address, a house on the same street. The LLCs are incorporated in Michigan by a Bangladesh-born author and investor who owns a mansion adjacent to the lots.

Subir Chowdhury said his deal was motivated by a desire to develop the oceanfront properties, not politics.

 “My experience, not only with Mr. Trump but the Trump Organization, is stunning — literally stunning experience. Brilliant. Because of the professionalism,” he said.

Chowdhury, a management expert who has written 15 books including several bestsellers, buys high-end lots and develops luxury houses, negotiated an earlier land buy in the Rancho Palos Verdes neighborhood with Trump over Twitter back in 2013. He says he likes working with The Trump Organization.

Chowdhury’s companies paid Trump $3.8 million and $2.4 million for two lots this year. Per square foot of ground, that is about twice what others paid for lots on the same street. He said the premium reflects the lots’ much-better views of the Pacific Ocean.

Even though he tweeted a picture of Eric Trump, thanking him for visiting his family's home, weeks before the sale, Chowdhury repeatedly asked a reporter not to reveal his purchase.

“Because these are all LLC owners," he said, "and I don’t want the rest of the world (to) know, hey, I’m the owner of these properties.”

Chowdhury buys high-end lots and develops luxury houses, and he says he likes working with The Trump Organization. “My experience, not only with Mr. Trump but the Trump Organization, is stunning — literally stunning experience. Brilliant. Because of the professionalism,” he said.

Chowdhury, a management expert who has written 15 books including several bestsellers, negotiated an earlier land buy in the Rancho Palos Verdes neighborhood with Trump over Twitter back in 2013.

Chowdhury’s companies paid Trump $3.8 million and $2.4 million for two lots this year. Per square foot of ground, that is about twice what others paid for lots on the same street. He said the premium reflects the lots’ much-better views of the Pacific Ocean.

Even though he tweeted a picture of Eric Trump, thanking him for visiting his family's home, weeks before the sale, Chowdhury repeatedly asked a reporter not to reveal his purchase.

Sunday, June 18, 2017

Diagnosis: a medical mystery

"The good physician treats the disease; the great physician treats the patient who has the disease." — William Osler, Canadian physician and one of the four founding professors of Johns Hopkins Hospital

WE'RE fans of The New York Times, as you already know. Periodically (little publishing pun) the NYT Magazine that comes with the Sunday paper runs a feature called Diagnosis. Essentially each one is an account of a baffling medical case that a doctor or team of doctors was finally able to solve, although not always soon enough to save the patient. This one has a happy ending. And thank goodness for doctors who take the time to really observe and listen.

Illustration by Andreas Samuelsson

She Had Never Suffered From Anxiety. Was She Having Her First Panic Attack?

By Lisa Sanders, M.D.

June 7, 2017

She didn’t have any urgent medical problems, the woman told Dr. Lori Bigi. She was there because she had moved to Pittsburgh and needed a primary-care doctor.

Bigi, an internist at the University of Pittsburgh Medical Center, quickly eyed her new patient. She was 31 and petite, just over five feet tall and barely 100 pounds. And she looked just as she described herself, pretty healthy. Doctors often rely on patients’ sense of their well-being, especially when their assessment matches their appearance. But as Dr. Bigi was reminded that day, patients aren’t always right.

The patient did say that she had seen her old doctor for awful headaches she got occasionally. They felt like an ice pick through the top of her head, the patient explained, which, at least initially, usually came on while she was going to the bathroom. The headache didn’t last long, but it was intensely painful. Her previous doctor thought it was a type of migraine. He prescribed medication, but it didn’t help. Now her main problem was anxiety, and she saw a psychiatrist for that.

Sudden Panic

Anxiety is common enough, and because the patient was seeing a specialist, Bigi wasn’t planning to spend much time discussing it. But then the doctor saw that in addition to taking an antidepressant — a recommended treatment for anxiety — the patient was on a sedating medication called clonazepam. It wasn’t a first-line medication for anxiety, and this tiny woman was taking a huge dose of it.

The young woman explained that for most of her life, she was not a particularly anxious person. Then, two years earlier, she started experiencing episodes of total panic for seemingly no reason. At the time she chalked it up to a new job — she worked in a research lab — and the pressures associated with a project they had recently started. But the anxiety never let up.

Her first full-fledged attack had come early one fall morning. She was on the subway going to work when she suddenly had a stabbing pain in her head, similar to the headaches she experienced in the past. Then her heart began to pound as if she were running a race. She was drenched in sweat. Her stomach heaved. At her stop, she lurched out of the car and braced herself against the wall of the station. The feeling eased a bit as she took deep breaths. Within an hour she felt fine and forgot about it.

But then the following week, she was driving to the mall when her heart started to race again, and she thought she might throw up. She pulled off the road and called her husband. He had a history of anxiety and suggested it might be a panic attack. He tried to reassure her, but even as the symptoms receded, she was scared they would return. She turned the car around and drove home.

After that, she would have these attacks maybe once a week — then, over time, they became more frequent, often daily. She felt a kind of constant low-level anxiety, knowing the terror could come at any time. She avoided taking public transportation or driving. Her parents often gave her a ride to and from work. She did cognitive-behavioral therapy for nearly a year. She started exercising daily. Nothing seemed to help. Antidepressants had side effects at levels higher than a baby dose. Finally, a psychiatrist started her on the clonazepam three times a day as needed. Now she took a high dose — every eight hours — and it helped. The medication made her feel a little stupid, mentally not nearly as sharp. But it did tamp down her anxiety.


It seemed obvious to the patient that her symptoms were a response to anxiety. At least two specialists confirmed the diagnosis, and she was being treated for it. And yet to Bigi, the story seemed atypical. Most patients with anxiety had experienced it their whole lives, or at least since adolescence. And the fact that she was taking two medicines for anxiety — one at a very high dose — and still felt anxious was also strange. Bigi wondered if this might be something other than the run-of-the-mill anxiety disorder.

Two possibilities came to mind: a surplus of thyroid hormone or of adrenaline. The thyroid gland acts as a kind of carburetor in the body, adjusting the speed of the body’s metabolism. Set too high, with too much thyroid hormone, everything goes too fast. Adrenaline is produced by the adrenal gland in response to threats, creating the fight-or-flight response. Released inappropriately, it could cause a racing heart. Both were far less common than simple anxiety. But they were worth considering.

During the exam, Bigi looked for any sign of disease. The only abnormality was that the patient’s blood pressure was higher than she would have expected in a slender woman who exercised daily. Other than that, her exam was normal. The patient’s neck might have been enlarged if she had too much thyroid hormone, but it was not. If she had too much adrenaline, her blood pressure might drop drastically when she stood after lying down, a phenomenon known as orthostatic hypotension. But it didn’t.

Bigi figured it probably was anxiety, just as the woman assumed. The doctor reminded herself that an unusual presentation of a common disorder, like anxiety, was much more likely than even a classic presentation of an oddity, like excess hormones. She told the patient to continue to work with her psychiatrist to get her symptoms under control.

Before putting the case to rest, Bigi decided to order a couple of simple blood tests to double check for thyroid or adrenaline abnormalities or clues of any other disorder. Bigi wasn’t surprised when the thyroid test came back completely normal. As many as one in 200 individuals will end up with an overactive thyroid. But when the results of the adrenaline test came back, Bigi was stunned to see that the patient had 30 times the amount of adrenaline normally found in the blood. Individuals can have more adrenaline than normal in times of physical or psychological stress, but levels this high strongly suggested that the patient had an adrenaline-producing tumor known as a pheochromocytoma or pheo. She called the patient and arranged for her to follow up with an endocrinologist.

The subspecialist repeated the blood test, and when it came back just as high, the patient was sent for an M.R.I. of her abdomen and pelvis to look for a tumor. The young woman had a baseball-size mass growing out of her left adrenal gland, a one-to-two-inch pyramid-shaped gland on top of the kidney. These tumors are rare — on the order of three to eight per million. A patient with a pheochromocytoma will usually have high blood pressure, as well as episodes of headaches, sweating and a racing heart — all of which she had. Of course, these symptoms are far more common than the tumor, and most people with episodes like this do not have a pheochromocytoma. But some do.

She had surgery to remove the tumor, and over the next few months all of her symptoms melted away. She hasn’t had to take any medications at all since.

Head vs. Body

Until Bigi suggested that there might be a physiological cause for her racing heart and other strange feelings, the patient assumed that her symptoms were psychological. She had known lots of people who had anxiety and panic attacks, and what they described seemed to match what she was feeling. And her friends, even her brother and sister-in-law, physicians both, all thought it was stress or possibly bipolar disorder. Even Bigi didn’t really think the patient was going to have a physical cause for her anxiety and panic attacks. As we constantly remind ourselves and our patients, when you hear hoofbeats, the chances are good that it’s a horse. The most common diagnosis is usually the correct one. But we must also remember that sometimes the circus is in town.

Lisa Sanders, M.D. is a contributing writer for the magazine and the author of “Every Patient Tells a Story: Medical Mysteries and the Art of Diagnosis.”

Thursday, June 15, 2017

Solace through eyes and ears

“Art is the only way to run away without leaving home.” — Twyla Tharp, American dancer, choreographer and author

SINCE the election, I haven't been what you'd call, very chipper. I'm disappointed in the result, obviously, but more than that, I'm distraught that such a narcissistic, shallow, infantile, cruel, selfish, intentionally ignorant person as SCROTUS* even exists in the world!

*So-called ruler of the United States 

I mean, come on! What's happened to natural selection? This is not someone who is good for humanity or the planet. And speaking of what's good for the planet, we as a species certainly aren't. My opinion? The Earth ought to shake us off and try again.

The only thing that gives me any optimism about the human race is witnessing moments of exceptional creativity and artistry.

Have you seen the video that's been making the rounds of Mandy Harvey, who is deaf, singing on America's Got Talent? She's enough to convince me to give humanity at least a few more minutes on the Universal clock.

Paul and I are both such suckers for art and music. He's all about the ears . . . he's a musician after all. I'm designer, and so for me it's all about what goes in my eyes. Living with him has been a 25-year music lesson, and from his point of view, he's spent that same length of time learning visual discrimination. I've listened to thousands of hours of jazz, he's toured art museums with me around the country, and we're both impressed by how much the other has absorbed.

Since early May Paul has been trying to make my eyes happy by treating me to art. For my birthday he bought me a metal, welded bat I'd admired . . . the flying kind, not the kind I might be tempted to use on HWSNBN*.

*he who shall not be named 

I was curious about the creator of our new houseguest, so I called the shopkeeper to enquire. The maker is Henry Dupere — or at least he was the original designer. Henry died, but his wife continues his work. Here's a bit about him from his website:

"During his career as an aircraft welder, toolmaker and manufacturing engineer, Henry Dupere tinkered with metal sculpting in his spare time, and his efforts were often rewarded by delighted responses from his friends and co-workers. Finally after 18 years in industry, he gave in to his creative instincts and relocated his family to Arizona to pursue a career as a full time artist."

In April both my ears and Paul's were charmed when we were guests of friends Shawn and Shari Mullen at the Des Moines Vocal Arts Ensemble gala. I didn't realize that Shawn would be one of the performers until we arrived! There were individual singers, duets, small groups and large-ensemble performances, and Shawn sang and played both alone and in several of the ensembles. 

Shawn performing Copperline on April 22, 2017

The evening included a silent auction, and one of the items was a sculpture by Jason Wilson, artist and owner of Dane Fabrication. I thought highly of it and asked Paul if he'd object if I put in a bid. We watched it all evening, and we were the only offer, but at the last moment there was a frenzied round of bidding that we didn't feel we could beat. I kept Jason's card, however, and contacted him the following week to ask him if he would consider making a duplicate for the amount of our original bid. I didn't think we had a snowball's chance, but he was kind enough to say yes.

You can see from the photos that it's a sculpture of Iowa corn stalks and tassels, but what makes it even cooler is that it's made out of salvaged plow parts. There are also two receptacles incorporated, one for bird seed, the other for water, and there are places to affix actual ears of corn.

All along I thought Paul had just been indulging me, but once we were notified that the sculpture was done . . . goodness, I haven't seen him this animated about anything for a long time. As it turned out, he had loved our potential work of art from the start as much as I had, but just like when he finished his University of Iowa degree last year, he only allowed himself to get excited once it was real. He installed our new work of art this past Tuesday.    

Yesterday Paul further enabled my art addiction by purchasing a mixed media piece I've had my eye on for several months. There's an unprepossessing little emporium next door to the tailor we use, and I'd stopped in several times and admired Stephanie Dillon's compositions. Paul happened to go with me yesterday, and when I showed him her work, he too was smitten. So lucky me, I got to take the one below home. It's called Baby and the Dingo Swim with the Fishes — mixed media: acrylic, watercolor, ink, gouache and oil pastels with a section of a map affixed.

Tuesday, June 13, 2017

He was right before; he's still right

"For the sake of our country and the world, the Democratic Party, in a very fundamental way, must change direction." — Bernie Sanders, Independent senator representing Vermont and former presidential candidate

PAUL AND I were fans of Bernie Sanders well before he declared he was running for president. We supported him at our precinct caucus, where we — the Sanders faction — actually beat Hillary Clinton five to four. 

I liked him then; I like him now. Here's his op-ed from today's New York Times.

Bernie Sanders: How Democrats Can Stop Losing Elections

By Bernie Sanders
June 13, 2017

In 2016, the Democratic Party lost the presidency to possibly the least popular candidate in American history. In recent years, Democrats have also lost the Senate and House to right-wing Republicans whose extremist agenda is far removed from where most Americans are politically. Republicans now control almost two-thirds of governor’s offices and have gained about 1,000 seats in state legislatures in the past nine years. In 24 states, Democrats have almost no political influence at all.

If these results are not a clear manifestation of a failed political strategy, I don’t know what is. For the sake of our country and the world, the Democratic Party, in a very fundamental way, must change direction. It has got to open its doors wide to working people and young people. It must become less dependent on wealthy contributors, and it must make clear to the working families of this country that, in these difficult times, it is prepared to stand up and fight for their rights. Without hesitation, it must take on the powerful corporate interests that dominate the economic and political life of the country.

There are lessons to be learned from the recent campaign in Britain. The Conservatives there called the snap election with the full expectation that they would win a landslide. They didn’t. Against all predictions they lost 13 seats in Parliament while Jeremy Corbyn and the Labour Party won 32. There is never one reason elections are won or lost, but there is widespread agreement that momentum shifted to Labour after it released a very progressive manifesto that generated much enthusiasm among young people and workers. One of the most interesting aspects of the election was the soaring turnout among voters 34 or younger.

The British elections should be a lesson for the Democratic Party. We already have among the lowest voter turnout of any major country on earth. Democrats will not win if the 2018 midterm election turnout resembles the unbelievably low 36.7 percent of eligible voters who cast ballots in 2014. The Democrats must develop an agenda that speaks to the pain of tens of millions of families who are working longer hours for lower wages and to the young people who, unless we turn the economy around, will have a lower standard of living than their parents.

A vast majority of Americans understand that our current economic model is a dismal failure. Who can honestly defend the current grotesque level of inequality in which the top 1 percent owns more than the bottom 90 percent? Who thinks it’s right that, despite a significant increase in worker productivity, millions of Americans need two or three jobs to survive, while 52 percent of all new income goes to the top 1 percent? What person who claims to have a sense of morality can justify the fact that the richest people in our country have a life expectancy about 15 years longer than our poorest citizens?

While Democrats should appeal to moderate Republicans who are disgusted with the Trump presidency, too many in our party cling to an overly cautious, centrist ideology. The party’s main thrust must be to make politics relevant to those who have given up on democracy and bring millions of new voters into the political process. It must be prepared to take on the right-wing extremist ideology of the Koch brothers and the billionaire class, and fight for an economy and a government that work for all, not just the 1 percent.

Donald Trump wants to throw 23 million Americans off health insurance. Democrats must guarantee health care to all as a right, through a Medicare-for-all, single-payer program.

Mr. Trump wants to give enormous tax breaks to billionaires. Democrats must support a progressive tax system that demands that the very wealthy, Wall Street and large corporations begin paying their fair share of taxes.

Mr. Trump wants to sell our infrastructure to Wall Street and foreign countries. Democrats must fight for a trillion-dollar public investment that creates over 13 million good-paying jobs.

Mr. Trump has withdrawn the United States from the Paris Agreement on climate change. Democrats must take on the fossil fuel industry and accelerate our efforts to combat climate change by encouraging energy efficiency and the use of sustainable energy.

Mr. Trump has proposed deep cuts to higher education. Democrats must make public colleges and universities tuition free, and substantially lower student debt.

Mr. Trump has doubled-down on our failed approach to crime that has resulted in the United States’ having more people in jail than any other country. Democrats must reform a broken criminal justice system and invest in jobs and education for our young people, not more jails and incarceration.

Mr. Trump has scapegoated and threatened the 11 million undocumented people in our country. Democrats must fight for comprehensive immigration reform and a path toward citizenship.

This is a pivotal moment in American history. If the Democrats are prepared to rally grass-roots America in every state and to stand up to the greed of the billionaire class, the party will stop losing elections. And it will create the kind of country the American people want and deserve.