Friday, December 31, 2004

Lessons - Good and Bad - From 2004

Now that 2004 is coming to an end, let it be a time for all of us to reflect back on the year. It was a monumental year in many ways. Lessons and wisdom to be learned abound, at least for me personally, in a year truly like none I can remember. As Patrick Henry once said, "I have but one lamp by which my feet are guided, and that is the lamp of experience. I know no way of judging of the future but by the past." Let us be guided by experience, and reflect upon the experiences of 2004.

Things I learned from 2004, good and bad, in no particular order of importance:

1. Celebrities are, by and large, not taken very seriously by the majority of Americans. I learned this during the 2004 elections as I saw "celebrity" after "celebrity" cry out to minorities, America's youth, and to anyone who might listen to "Vote or Die." Screaming from, MTV, VH1, and every rooftop in Beverly Hills to vote for the Democratic candidates. While cleverly avoiding mentioning any particular candidate as prescribed by Federal Election Commission rules, they wanted Bush out and the John Kerry in. Fortunately, with all their ranting and raving they only accomplished one thing: alienating most of America who were offended by silly, superficial "celebrities" telling them what they should do and, worse, what they should think.

2. You're never lonely if you enjoy your own company.

3. The world is at the mercy of the forces of nature. From the awesome fury of the fall hurricanes in the Southeastern U.S. to the horror of the Christmas tsunami in Southeast Asia, all our technology and all the king's horses could not put the world back together again. At least not right away and not without great tragedy and loss.

4. Husbands kill their wives with frightful frequency in the U.S.

5. Islam, Christianity and Judaism have been at war for over two millennia and, by all apparent reasoning and experience, will never peacefully coexist.

6. It's never a bad idea to admit you are wrong or, better still, to admit you don't know the answer. The older I get, the more I realize what I don't know.

7. Web logs (BLOGs) are fun, cathartic, and - at times - informative and entertaining. BLOGs are the Gutenberg press for the third millennium. Everyone is an author.

8. All book publishers and most music and movie producers will produce anything they think might sell. As a corollary, people will buy almost anything. If Anna Nicole Smith and Paris Hilton can write and sell books, William Hung can sell a "music" CD and Michael Moore can produce and make money from movies, I have all the proof I need. P.T. Barnum was right: a sucker IS born every minute.

9. What we have - individually and collectively - should never be taken for granted.

10. Mel Gibson is much more than a good actor.

11. You don't need talent to be "famous" in today's American culture. See item #8.

12. Elections in our democracy have been irrevocably damaged since the 2000 vote count. Now and forever, if the vote count does not go as a candidate or a party wants, the courts will decide who wins. Corollary: There is no longer the honorability of a "graceful loser." The term "honorable loser" has, sadly, become an oxymoron like "jumbo shrimp."

13. Western civilization has passed its zenith and is on a rather slippery downward slope.

14. Despite the self-promotion talents of Brittany Spears, she is not "the American Dream;" Bill Gates is the American Dream.

15. "Political Correctness," whatever it that may be, is a plague on America. To be "PC" in everyone's eyes is to say nothing and to believe nothing. It, in my opinion, may prove our greatness failing. When will we ever learn: you can please some of the people some of the time, but you can never please all of the people all of the time? Why must we try?

I learned a great deal in 2004. Some I share here, more painful lessons I shall keep to myself. I do still believe in the values proposed by our Founding Fathers but I also cannot help but see their hold on us is loosening. I was encouraged by the voter response in 2004 and see that we, as a people, have not yet given up on America. I still have hope for our country but we should never lose sight of what we sacrificed to be who we are. (See item #9).

God Bless you all and I hope and pray that 2005 will be a happier year. I close with a quote from Charles Hamilton Aïdé:

I sit beside my lonely fire
And pray for wisdom yet:
For calmness to remember
Or courage to forget.

Thursday, December 30, 2004

Judeo-Christian Guilt versus Muslim Practicality

Nothing better contrasts the divide between Western, self-imposed guilt and the stark realities of the Muslim religion than a couple of news items over the past year. Specifically, I refer to cultural differences in the proper way to handle illegal immigrants in predominantly Judeo-Christian countries (read: America) and those predominantly Muslin (e.g. Malysia). To examine this single issue speaks volumes about the way these countries and their people deal with "outsiders."

In our first example, let us look at our own country. We are certainly a multicultural land and our country was founded on the premise that all are created equal and all, regardless of race, creed, religion, etc. are deserving of the same benefits and protections under the law. Over the last 100 years, we have established a formalized method for immigrants to come to our country and, through a process, become full citizens of America. We issue nearly 150,000 "green cards" annually for immigrants to legally live and work in the U.S. "Illegal" immigration continues at an estimated rate of 8-10,000 per day and has become a much-debated issue with rising unemployment among documented citizens and, particularly, after the 9/11 attacks.

How do we, as a culture and a people, propose to deal with the ever-rising tide of illegal immigrants? Our President has declared that "the nation has failed millions of illegal immigrants who live in fear of deportation," and in January, 2004 proposed an ambitious plan that would allow undocumented workers to legally hold jobs in the US for the first time. The program that would bestow temporary legal status for at least 6 years on 8 million undocumented immigrants, as long as they keep their jobs. But it would not automatically put them on a path to obtaining citizenship or even permanent resident status. He said recently "We must make our immigration laws more rational, and more humane. I believe we can do so without jeopardizing the livelihoods of American citizens." What Bush calls his "temporary worker" program was eagerly embraced by business groups but condemned as stingy and impractical by advocates for immigrants. Many said it has little chance of passing Congress in the form Bush described.

So, once again, we must make amends for our sins. What sin is this, you ask? The sin of being a prosperous nation with a high living standard and land of great opportunity. In my opinion, it is analogous to the bee apologizing to the bear who is raiding the hive for the bee's honey. It goes like this:

"Mr. Bear, I am so sorry to have made such wonderful, nutritious and tasty honey. Mea culpa! It was so wonderful that it has attracted you, through no fault of your own, to my hive. You have eaten the honey that I produced by the hard work and sweat of my brow but I won't sting you because it is clearly my fault. You couldn't help yourself and, besides, I can always make more. Though some of us will starve this winter from lack of honey, we shouldn't blame you. Slurp on, Mr. Bear and I will get back to work."

Perhaps, a real-life example will be better appreciated. According to Heather Mac Donald, reporting in the Dallas Morning News, "Fear of offending the race and rights lobbies has trumped national security at DHS. This spring, for example, Asa Hutchinson -- the department's undersecretary for Border and Transportation Security and now a contender for the top job -- shut down a successful border-patrol initiative to catch illegal aliens.A specially trained team had apprehended about 450 border trespassers in several Southern California cities. The Los Angeles Times, La Raza and every other advocacy group for illegal aliens protested that the arrests were racially motivated and that they were 'scaring' illegal aliens."

God Forbid, we scare the illegal aliens! This is the way the Judeo-Christian mind is supposed to work and has worked for centuries.

As contrast, let us examine the Muslim way of dealing with the same problem. Malaysia is the most populous Muslim country in the world. As background, you should know that, beginning in the 1970's, an Islamic revival called the dakwah movement has rapidly taken hold, mostly among young, educated urban Muslims. They sought to return to the fundamental beliefs of Islam, inspired by Islamic movements in other parts of the world, including the 1979 revolution that established an Islamic government in Iran. The dakwah movement contributed to a growing Islamization of Malaysian life. Malyasia is one of the most prosperous nations in Asia.

A a comparatively well-to-do country in Asia, illegal immigration from Thailand and other neighboring countries has become an increasing problem to the native Malaysians. In 2004, the Malaysian government announced an "amnesty period" during which an estimated one million illegal immigrants can return home without penalty. Loosely quoting from Amnesty International, mass deportations could start at any time. Penalties include jail, fines and caning [for the uniniatiated, "caning" is much like flogging; bamboo stalks are used instead of whips and/or chains]. Malaysian government officials acknowledge the contribution to the economy that foreign labour makes. After mass deportations in 2002 there were severe labour shortages in the construction and plantation sectors, prompting the authorities to ease the immigration process for certain industries. Malaysia has refused over the years to offer protection to refugees on its territory as it is not a party to the UN Convention on Refugees. Home Minister Azmi Khalid told Agence France-Presse recently there would be no change in plans to deploy more than half a million Malaysian members of volunteer neighborhood security groups to track down and detain the illegal migrants.

A distinct difference in philosophy, no? In the Malaysian government and, I have to assume, the Malaysian mind, if we need labor, come on in. When we no longer need laborers, we will, if you're lucky, jail or fine you. If you are not so lucky, we will summarily cane you. The cutoff seems to be around 3-4% unemployment. If unemployment in Malaysia drops below 4%, come on down! If it goes above 4%, you could get caned. In Malaysia, the bee still, apparently, resents the bear's gluttony.

Before we collectively start wringing our hands in horror over the Malaysian government's "insensitivity" to the rights of illegal immigrants, we need to cut them some slack. After all, in response to the tragedy of the December tsunami, the Malaysian goverernment, in a robust display of benevolence and empathy, announced the amnesty period for getting the hell out of Malaysia has been extended to January 31, 2004. You want to see compassion? Now, that's what I call institutional humanity and charity!

Perhaps it is time America to truly embrace some of "humaneness" of the Islamic faith. Let us learn from other faiths and governments and incorporate some of their high ideals in dealing with some of our own problems. The only problem I see, though, is where the heck are we going to get all that bamboo cane?

Wednesday, December 29, 2004

The Guilt of Disaster (or "How to Get Millions in Aid from America")

Is anyone, other than me, more than a little angered by the recent negative news about our country and its perceived lack of charity for the tsunami victims in southeast Asia? Well, I am thoroughly peeved.

I am, let me assure my gentle readers, deeply sympathetic for the victims of such a monumental disaster. This once-in-a-century (or two) catastrophe is a horror for its victims, probably as great as any in recorded history. I am saddened as I hear stories of the hundreds of thousands dead, injured, or homeless. The loss of human lives and property will be disastrous for the region.

What I have another completely different set of emotions - namely, anger, outrage, intense frustration - for is the apparent U.N. doctrine that we, as the world's most productive and "rich" country, are "stingy" and somehow responsible for the whole mess. I will go so far as to say I am thoroughly ticked off.

By now, with the liberal-leaning mass media trumpeting these criticisms of our country (as they always do), you are familiar with the story. U.N. Emergency Relief Coordinator Jan Egeland, a Norwegian, said on 12/27/2004 that "If actually the foreign assistance of many countries now is 0.1 or 0.2 percent of their gross national income, I think that is stingy really. I don't think that is very generous."

This from an overpaid [I have no idea what he is paid but, if he works for the U.N., I am sure he is paid out of proportion to what he actually accomplishes - such is the nature of that august organization] paper pusher for an organization widely known as the great "Black Hole" of charitable institutions. The more "contributions" the U.N. demands from the world's countries, the less it accomplishes and the more bloated it becomes. The more money they "guilt" from our country and others, the more corruption they ooze out and the more officials they can overpay to criticize the Western world, our cultures and, of course, our "stinginess."

[Rhetorically, I ask Mr. Egeland: Exactly how much did the U.N. (and the rest of the world) contribute to disaster relief and rebuilding in the southeastern U.S. after this fall's catastrophic, multi-billion dollar onslaught of a record number of hurricanes?]

Perhaps he would be better served to ask Koffi Annan and his son and all the other corrupt U.N. flunkies to simply write out a check from their soaring bank accounts, recently filled to capacity from skimming off the Iraqi "Oil-For-Food" Program, and take care of the whole disaster? Maybe he could get more sympathy (read: dollars) from countries actually in that regions of the world (Russia and China, perhaps?) instead of singling out countries like ours, on the other side of the globe? I don't hear of any major contributions coming from the oil (and cash) rich countries of the Middle East (save Saudi Arabia) - who share the Muslim religion with the countries most affected by the disaster - do you?

At last count here's the scorecard as of 12/29/2004:

The United States is offering a total of $35 million, followed by Japan with $30 million. Australia has now pledged $27 million, Saudi Arabia $10 million and Germany $2.7 million.

Does anyone see Russia, China, France, Italy, Greece, or - better still - the European Union! - kicking a little something into the pot? I don't. Nor do I expect to. No, all I hear are guilt mongering directed at us. But, why shouldn't Egeland cast his venom at the Great Satan of the World, i.e. America? We are the country who has the most and are most easily prone to taking guilt trips to bail out the woes of the world.

Come suckle at the great teat of the world, American, all you tired, water-logged victims of Western Imperialism. All you have to do to get in line at the spigot is to say something that will make liberal America feel guilty, and you can move to the head of the ever-lengthening line. I am sure that, if enough guilt is heaped on our ears and our eyes by the media, the American liberals will soon be marching on Washington to demand we do more to help out the world downtrodden. Tim Robbins, Susan Sarandon and Sean Penn will be on MTV and VH1 expressing their moral outrage that we didn't send the entire Army Corps of Engineer's to Sri Lanka to sift through the rubble and rebuild all the luxury hotels (undoubtedly built by Western tourists' dollars) destroyed there. Bruce Springsteen, Sting, Bono, and the Dixie Chicks will organize concerts called "Feel Guilty, America!" to raise money to boost their album sales and their bank account. Oh, I am sure, 1 or 2% of the concerts' gross profits will go to replanting the rain forests of devastated Thailand.

After all, when the story gets homogenized by the media, this great disaster will be entirely our fault anyway. Somehow, it will be linked to President Bush's failure to ratify the Kyodo Agreement on greenhouse gases. Isn't everything due to global warming? Global warming undoubtedly caused the instability in the earth's crust that resulted in the earthquake that started the whole thing. It's a domino effect! That's the ticket!

I am equally convinced that the U.N. will spend $100 million on a study (incidently, the study group will be headed by one of Annan's relatives) about how to warn sunbathers around the world that they are about to be killed by a tsunami. Given that this type of disaster occurs, what, every century or so, it will be very timely and cost-effective. No one will think to suggest that, perhaps, all the money spent studying the problem would be better spent in relief of the victims now. Nothing will be actually done but they will commission a study on the problem so, if this does happen again in the next 2 or 3 centuries, we will be better prepared. I am equally convinced that the study will conclude that, if the U.S. spy satellites had been directed on the Bay of Bengal, instead of something so mundane as looking for terrorist training camps in the Malaysian forests, America could have prevented the entire catastrophe.

Such is the world we live in. And, unfortunately, such is the collective consciousness of America poulace. All you have to do to get into America's pocketbook is to trip our hair-trigger "guilt switch" and the dollars spew forth. It's sad, really, but it will never change. Colin Powell has already apologized for us. Can a Michael Moore documentary be far behind?

Addendum #1: It has already started! See CNN news article of 12/29/2004

Addendum #2: Egeland clarifies his remarks. (snicker snicker)

Addendum #3: I wholeheartedly agree! Let the U.N. take over relief efforts!

Addendum #4: The "illustrious" N.Y. Times confirms the worst: we ARE too stingy.

Addendum #5: One New York newspaper agrees with us.

Addendum #6: The Concert and Telethons are on! We are the World, Part Deux!

Tuesday, December 28, 2004

If Your New Year's Resolution is Losing Weight, Read On!

Is This the Year You Get Healthy?

It is rapidly approaching the New Year and, given the increasing prevalence of obesity in our country and the world, I am going to take a wild guess and say the most common resolution is going to be to lose weight. Just a wild guess, but I think I will be in the ballpark of most "Top 10" lists and polls on the topic. Since I have dedicated my medical practice for the past 10+ years to guiding patients through this process, I am going to offer some advice. The advice, such as it is, comes from several sources:

Personal Experience - During my internship and residency - a stressful but very sedentary period in my life - I ballooned up to 250 pounds. Now, loosely packed on a statuesque 69" frame (I was one who explained my weight as being a victim of being "big boned" or, for the non-Southerner, "large framed"), I was big. I sported a 40" waist and wore an size 44 jacket. I shopped in the leftover tables because, at least back then, they were not a lot of men buying 40 X 29 (29" was my inseam) pants. I remember I always wore an oversized white coat because, in the deluded mindset of an obese person, I thought it would visually "slim me down." Anyway, I have lost the weight and, for the most part have kept it off. Having had a heart attack at age 34 and a quadruple coronary bypass at age 42 was more than enough encouragement. Now, I proudly have a 32" waist (which I didn't even have as a high school athlete) and no longer wear a white coat, even in my medical clinic.

Professional Experience - I have been treating overweight (I guess I should use the more politically correct "weight challenged" but being "PC" will be the topic for a future rant) patients for over 10 years now. I can pretty much spot the ones that will succeed in losing weight usually with our initial evaluation. Just talking to patients gives you an idea of their motivation. Also, you can get an idea of how badly damaged their ideas about weight loss are. Sometimes I get fooled; usually, after 6 weeks, I sadly see I was right. Losing weight is a lot like quitting smoking. When you are ready, you will do it. Before that point, no matter what you hear or are prescribed, you won't. It's like a light switch. It's either off or on. Being ready - truly ready - to lose weight is (as I throw out yet another metaphor) like being pregant. You are or you are not.

Research - I have pretty much read everything there is to read - both in the lay literature and in the medical journals - about losing weight. It all basically says the same thing and that is what I advise in my clinic and what I will advise here. Early in my medical career I was taught the doctor's mantra in the late 80's and early 90's - people are obese because they eat too much. My advice to the desperate people asking my medical advice was: "Just push yourself away from the table and you will lose weight." What I was saying was: "It's your lack of self-control that is your problem. Quit being a glutton!" I was wrong and, the more I read about obesity, the more I realize how wrong I was. Obesity is a complex problem with genetic, physiological and behavioral components. And, since it has so many components, it is is truly difficult to treat. However, it can be treated.

That said, let's get started.

1. What diet do I recommend you follow?

Here is the first of, probably, many "shocking" answers: I don't care. If you believe in and want to follow one of the low carbohydrate diets - such as the Atkins or South Beach diet - that is fine with me. I can't really get behind any diet that sells you prepacked foods (Jenny Craig, WeightWatchers, etc.) because most people are not willing to buy their groceries at those prices for the rest of their lives. My personal and professional preference is a low fat diet. I recommend a diet with no more than 30 grams of fat per day. The remainder of your diet may be split into carbohydrate and protein depending on your personal tastes. Some people enjoy meat - protein -and that is fine. Chicken or fish and baked or broiled are best but, heck, you can have beef too if it is lean and not heavily marbled with fat. If you like hamburger, buy ground sirloin or chuck rather than the 50% fat standard hamburger at the meat counter. Fried foods are to be avoided at all cost. Some people like breads, rice and cereal - carbohydrates. I do not put any restrictions on these.

My point is: any diet will work if you follow it and exercise regularly. I am more concerned with your activity level than I am with what you eat. All diets share one common thing- they are reduced in total calories. They differ only in what foods make up the calories you do eat. You can follow your personal food preferences in selecting your diet. After all, this is how you are going to eat the rest of your life. So chose an eating plan you can follow for the rest of your life for that is how long problems with controlling your weight will last.

Editorial Follows: I hate the word "diet" because it means, to most people, a temporary "fix."The thinking goes "I will follow this diet for 6 months, lose my weight and then go back to what I was eating before." Do I need to tell you what the inevitable result of this approach is? When you stop your diet, and resume your usual eating habits, you will gain back at least 125% of what you have lost. Notice, I didn't say 100% - I said 125%. Obesity if not like a cold. It cannot be treated for 6 months or until you lose your weight. If you think you are "cured" you will regain your weight. Obesity is a disease, much like diabetes or high blood pressure. It cannot be cured - only controlled. You are making changes toward a permanent lifestyle, not a temporary change in habits. In order to keep weight off, you will have to be conscious of the being prone to gain weight - just like a diabetic is conscious of their blood sugar - all your life. If you have been overweight in the past, you will always be "pre-obese." The minute you turn your back and stop doing those things that are necessary for healthy living (exercising, sensible eating, you will gain weight again.

2. What should you do for exercise?

It my strong belief, born out of many years experience and observation, that exercise is the cornerstone of any successful weight control program. Following a structured, semi-controlled eating plan - better known as a diet - will certainly help you lose weight. But the only behavioral change that can guarantee that you consistently lose weight and keep weight off is to become more active in your daily life. You simply cannot avoid it - if you want to lose weight, you must exercise. Now, as to what exercise is the "best," it is very much like which diet is "best." Here's your rule: The best exercise for losing weight is the exercise that you actually enjoy doing and have the opportunity to do on a regular basis. It's like (another metaphor) murder investigations.You look for motive, opportunity, and method.

- Your motive is to lose weight and, ultimately, to keep weight off. Simple enough.

- Opportunity is making the time to exercise. Yes, I know you are busy. We all are. Yes, I know you have a job, several small, children and and really demanding spouse. Yada, Yada, Yada! I would hope you have enough self-esteem and sense of self worth that you believe you could and should spare 3-4 hours per week to making yourself more healthy.

- Method is the tricky one. If you would love to cross-country ski for exercise and live in Alabama, that is probably unreasonable. ["Probably" because you could get some rollerblades and ski poles and "ski" all over your neighborhood] If you want to swim and live in Montana, that may be difficult as well. Seek an opportunity and method of exercise that is easy to get started doing and to keep doing. The simplest is just walking. If you can't get outside, then use an exercise video. My patients really like the "Walk Away the Weight" video series. If you have arthritis and walking aggravates your joints, you should try an exercise bicycle, CardioGlide, or rowing machine (they are all basically equal in effectiveness)

3. Why Should I exercise?

What happens when you don't exercise, and you starve (diet) for a few weeks and do manage to lose a few pounds?Here's what happens: you may lose body weight but what you have lost, research shows, is usually 50% fat and 50% muscle. If you have starved off 10 pounds, congratulations! You have just lost 5 lbs of fat and 5 lbs of muscle. Now, guess which body tissue most determines your resting metabolism and, ultimately, how likely you are to keep this weight off. If you guessed your muscle mass (or "lean body mass"), you're right! Fat tissue is metabolically inactive and burns very few calories during a normal day's activities. Muscle tissue is very metabolically active and uses calories all day, even when you are not exercising. If you lose muscle, your metabolism drops proportionately. [Parenthetically, that explains why men usually lose weight faster than women. Men, genetically and morphologically, have a higher muscle mass and, thus, a higher metabolism than a woman of equal weight.] So, what have you accomplished by starving off this 10 pounds" You have lowered your metabolism and, thus, made it even harder for you to keep the weight from coming back.

This is the much publicized "Yo-Yo Dieting" problem. Most people have done this over years and years - lost and regained, lost and regained - that, when they get in their 40's and 50's, they find it increasingly more difficult to lose weight. Why is that? Simple. It is because they have lost muscle mass every time they have lost weight through starving (diet) without exercise. Now, they have reduced their metabolism to that of an amoeba and they couldn't lose weight if they ate two crackers a day. If they would start exercising to build their muscle mass back up, they would probably be able to lose weight again. But only with improving their lean body mass which, in turn, improves their metabolism.

4. Does any type of exercise actually improve my metabolism?

I am glad you asked! While most people concentrate on aerobic exercise while losing weight, this is not really an optimal plan. Aerobic exercise got it's good reputation due to well-publicized authors like Kenneth Cooper and by the myriad celebrity videos. [Rhetorically, I ask: If you are a celebrity, you must know how to exercise properly, right? I mean who knows more about exercise than Jane Fonda, Suzanne Summers, or Carmen Electra? I can't think of anyone, can you?] I will freely admit aerobic exercise, such as walking, swimming, jogging, etc., is useful for general health and well-being. But, in order to increase your chances for long-term success, anaerobic exercise should be included in any exercise regimen. Anaerobic exercise is work that requires your muscles to work against resistance. As an example, weight lifting is anaerobic exercise. Pushups and sit-ups are anaerobic. Anaerobic exercise builds muscle mass and, thus, improves metabolism. Therefore, if you are 25 and are losing weight for the first time, you can probably stick with aerobic exercise and preserve your muscle while you lose weight. However, if you are in your 40's or 50's and have lost and regained weight more than 2 or 3 times in your life, you would probably benefit from 2-3 sessions per week of anaerobic exercise.

5. How much weight should you expect to lose?

Healthy weight loss is not 30 pounds in 30 days. Healthy weight loss occurs when the body can burn fat without sacrificing muscle. If you drastically cut calories to less than the body needs, the body will burn energy from any source it can find. Available sources are protein (i.e. muscle) and fat. In starvation mode (i.e. a diet), the body will burn fat as easily and as readily as protein. That is why exercise is so important during weight loss. If you are exercising and using your muscles, the body will concentrate on burning only fat for energy. You will preserve your muscle mass and how much muscle you have determines your metabolism. If you are exercising and cutting back on calories to a healthy level, you should reasonably expect to lose 1 -2 pounds per week. If you have 100 pounds to lose, you should plan on a year of consistent exercise and calorie reduction. In order to lose one pound per week, you only have to reduce your daily calorie intake by 500 calories per day [specifically, there are 3500 calories in a pound of fat tissue; reduce calories 500 calories per day for 7 days and, eureka!]. That will result in one pound of fat loss per week - if you are exercising. Don't be in a hurry! If you have gained weight for five years, you shouldn't expect to lose it in 2 months. As you probably already know: it's a lot easier to gain weight than it is to lose it. Be patient. Slow and steady wins the race.

6. Do diet pills work?

Equivocally, yes. Why do I equivocate? Because the current generation of medications(phentermine, phendimetrazine, diethylpropion) can be useful to give you an "energy boost"when initiating an exercise program. They also, at least for a few weeks, will help get your appetite under control. But the energy and the appetite suppression are short lived. They are useful and, I might add, safe for initiating a medically-supervised weight loss program. There is no longer any "Phen-Fen" to worry about. Phentermine and the other medications mentioned have all been available by prescription since the 1960's and have never been taken off the market.They have withstood the test of time. But they are not the key to a successful weight loss program. The keys to weight loss are, in order of importance, personal motivations, exercise and reasonable , healthy eating.

Well, there it is, folks. Your New Year's Resolution explained and all planned out for you. If weight loss is not one of your resolutions, good for you! If it is, maybe this will help you get some ideas about how to lose weight once and, more importantly, for all!

Thursday, December 23, 2004

An Open Letter to Mrs. Pat Tillman

Dear Mrs. Pat Tillman,

I am writing a long overdue letter to express my sympathies and heartfelt condolences on the death of your husband (see Time magazine). I cannot express to you how I was moved by the sacrifice made by Mr. Tillman on behalf of our country and it’s citizens.

If I could spend 5 minutes with you and if it would not be too personally painful for you, I would ask you to tell me about your husband. Very few Americans these days, including myself, have ever had the honor and privilege to meet anyone they could actually refer to as a "hero." In our modern world of artificially important and superficial accomplishments, we are relegated to thinking of much lesser men promoted as "heroes." Baseball players that pitch in the World Series with a bad ankle or actors who fall off horses and become advocates of spinal cord research are labeled in the mass media as "heroes." Apparently, some polled on the Internet are so unfamiliar with the concept of heroism that they chose to vote for a singer who, like so many people in America, rose above their poverty to win a popular talent competition on television. (BeliefNet) That is hardly heroism; that is America and what this country offers anyone. And that is what your husband fought to defend.

Your husband was so much more, Mrs. Tillman. I would want to know what he talked about with his friends or at night before he went to sleep. What books did he like to read? I would want to know what he ate for breakfast and what he prayed for at night. I would want to know if he ever told you about a dream and, if it was not to personal, what he dreamed. What was his favorite subject in school? Did he ever give a speech that I might find on the Internet? I would certainly be enriched by whatever words he delivered in that speech. What sort of things did he keep in his football locker and on his mantle?

Do these sound like silly questions? I am sure they do. But I would really treasure the information. You see, Mrs. Tillman, this is true "hero worship." Your husband was worthy of that sort of respect and, if I may dare say it in these times, awe. The questions are all designed to give me an idea of what makes a person like Pat Tillman. Men like him, so sparse in our world, are to be examined and thought of often.

Who among us would give up so much to serve his country? I am old enough to remember stories of a couple of generations back when men gave up much and volunteered to give up their comforts and, if necessary, their lives in defense of their country. I consider Ted Williams and Bob Feller heroes. They left their sport (baseball) in the prime of their careers and left their privileged lives behind to face death in World War II. But they were lucky enough to return from war alive and resumed their careers. I am truly sorry that your husband made even a greater sacrifice.

I am also sorry that, in order to find someone to even remotely compare to Mr. Tillman that I have to go so far back in our history. With all the men and women that have died for their country since World War II, we have few that had the conviction to serve and left behind so much. Lest I be misunderstood, I consider all the men and women who have served and died defending their country my heroes. They all made the ultimate sacrifice for their country. They gave up their future, their families and their lives for what they believed in, just like your husband.

But Mr. Tillman’s singular sacrifice was even more rare. He had everything we all dream of having and, yet, he left it behind for a higher service. Not service for personal gain, fame or comfort, but service for a country that allows these privileges for all who are willing to work and dream of them. His beliefs were so strong that he could not, like the vast majority of Americans, consider service to his country someone else’s duty. He sacrificed all so other’s could live their dreams. His dream, if I may presume, was a safer America. A safer country for his family, his friends, and just we ordinary citizens.

So, on behalf of myself, my family, and my country I want to thank you for what you and your husband have given to this country. It was your love and strength that allowed your husband to become the hero that he is to all of us. You and your husband are forever my heroes. May God bless you and your family and comfort you in your pain and loss. Never doubt the worthiness of the cause in which your husband gave his life. Service to country - particularly, service that results in such sacrifice - is always noble and worthy of all of our admiration.

I will never forget your husband’s life and his service to our country. I will never forget to pray for you and your family. I will think of Pat Tillman whenever someone throws around the term "hero" cheaply and quickly in some everyday event. I now have a standard for my definition of a hero. It will not be easily or quickly matched in my lifetime. Of that, I am quite confidant.

Tuesday, December 21, 2004

Movies as 2-Hour Cartoons?

Have you noticed lately that movies have become more and more like cartoons?

I watched the lamentable "Torque" on cable a few days ago and absolutely laughed at the:

A. Really terrible acting
B. Cookie-cutter storyline
C. The absolutely unbelievable and gratuitous "special effects"

Now, before you start thinking I am some old geezer praising the days of the silent movie, let me assure you I am not. I have enjoyed recent special effects-laden movies like Spiderman (1 and 2) and X-Men (1 and 2). Certainly, the Lord of the Rings trilogy will be remembered as one of the very best ever. But, I do see a trend in the total absurdity of some of the latest movies. It seems to me that special effects have become the reason for the movie - not something to enhance the movie itself.

A movie, at least in my thinking, is story telling. A movie should show us comedy to laugh at, human emotions to empathize with, a historically recreated life or event, etc. A movie should be about something. A movie should give us something to think; amovie should make us feel something. What I see in "Torque" (and the hundreds of other movies like it) is, apparently a shift in what Hollywood seems to think we want: i.e. special effects for the sake of special effects. In other words: the story be damned, let's make a cartoon. Apparently, producers now believe that if the special effects have enough of what I call the "WOW Factor," then audiences won't care if the acting and the script are meaningless.

For those who see a lot of movies, let me contrast a few. "Pitch Black," Vin Diesel's star vehicle from a few years back, was a decent movie. Certainly, it wasn't "War of the Worlds" but it had actors acting and a story that you could actually follow. There was some conflict in the characters and their interactions and some special effects that aided in telling the story. Flash forward now the sequel of Pitch Black, "The Chronicles of Riddick." Here, we have the complete reversal. A cartoon without a story. A big budget (probably close to $100 million) that allows Vin Diesel to growl and flex and kill lots of bad people. The actors, including the "star" (and, Lord Knows, I use that term very loosely here!) are secondary to the special effects department generating a disjointed smorgasbord with a high "WOW Factor" of spaceships, explosions and space scenery.

"Torque" (which is just a poorly scripted knock off of "Fast and Furious," "2 Fast, 2 Furious," "Drumline," "You've Been Served," etc. etc. ad infinitum) is even worse that "Chronicles." It is bad special effects and no story. There are countless other examples. Contrast that with the "Bourne Supremacy," another sequel. Special effects we sprinkled throughout the movie but, wonder-of-wonders, there was also a story. Dare I even say it? There were also actors and acting. The special effects were part of the story and added in the presentation of that story. They were not the soul reason for the movie to exist. The "Bourne Supremacy" was a good, if not great, movie.

"The Chronicles of Riddick," which cost more than twice as much to produce as "Bourne Supremacy," was a bad movie. "Torque" probably also cost more than "Bourne" to produce (and it certainly was not on the acting talent) and was a really, really bad movie. Other recent movies which turned out to be, for the most part, cartoons include "Catwoman," and Walt Disney Company's "Hidalgo" and "The Alamo." At least "The Day After Tommorrow" - which has as much special effects as one could cram into a movie - had something of a story (a father's redemption and importance of family) and something to think about (what global warming might or might not do). If you hear someone describe a movie with "You won't believe the special effects!" as their first sentence, then you can usually forget anything resembling a script or acting.

I watched another movie recently that was a refreshing reminder that movies that actually have actors acting and a story to be told still exist. That movie was "White Oleander" and has Michelle Pfieffer, Robin Wright and Renee Zellwegger and Allison Lohman. There were no special effects, if you exclude make up (tattoos and the like). The budget was probably almost entirely actor's salaries. And the acting was very good. The story was a meaningful one and there was a point made. It was truly a breath of fresh air in an otherwise cartoonish film industry.

Fortunately, the audiences are starting to speak out in the form of empty seats. The "blockbusters" listed above ("Catwoman," "Hidalgo," "The Alamo," "Chronicles of Riddick") all lost money. According to a recent (12/21/2004) AP article, "with nearly two weeks to go before the end of 2004, domestic box-office receipts appeared likely to top last year's total of $9.27 billion, nearing $9.4 billion, according to Exhibitor Relations, which tracks the figures." But the increase in box office receipts are attributed to a rise in ticket prices, up 3.85 percent to an average of $6.25; attendance fell by 2.25 percent this year after dropping 3.8 percent in 2003.
So, the number of "butts in the seats" are declining. Just like all entertainment industries (see baseball, football, basketball, etc.), to make up for falling attendance the Hollywood brain trust decides to increase prices. But how long can rising ticket prices support an industry that continues to produce inferior products? Can a $10.50 movie ticket justify the experience of seeing what is, essentially, a cartoon? No story, no acting, just lots of explosions, body parts and a loud soundtrack. I am not so sure it can.

Perhaps, among the teenage date crowd where a movie is primarily used to fill in an appropriately decent interval of time before the sex starts, the price will be paid and not given a second thought. But, among people who actually expect to be challenged and entertained by a movie, that seems like an awfully high price with little or no return. You can expect to put out an inferior product and sucker consumers in with fancy ads and "start power" but, eventually, you will have to deliver something of quality. And Hollywood hasn't done that with very much consistency for some years.

On second thought, maybe Hollywood should stick to cartoons with a story. "Shrek," "Finding Nemo," and "The Incredibles" didn't do too bad at all, did they? But Hollywood should always remember, they did have a story. A good story will trump exploding buildings and mahem every time.

Saturday, December 18, 2004

Blinded by the Lights

What ever happened to true fame, i.e. fame that is earned by talent or societal contribution? Are there any people today who actually have earned our remembrance 50 years from now? I personally remember John Kennedy. I remember Groucho Marx, Lenny Bruce and Frank Sinatra. I remember books with tales of George Patton, Rembrant, Michaelangelo. I still remember from my youth Ghandi, Jackie Robinson and Chuck Yaeger. I remember Clark Gable and Lawrence Olivier. I can see their faces and their images in my mind's eye. I know what they accomplished and how they truly changed society and the world I live in.

Today, who are in the minds of popular culture? The "next generation" of people to be remembered? William Hung? The new "Fab Five" (I still remember the "Fab Four") from "Queer Eye for the Straight Guy?" Jessica Simpson? Joan Rivers or her daughter? Or, God save us, Ashlee Simpson? Or, perhaps we will remember Paris Hilton for something other than her last name? Do we still remember Justin Guarino from anything other than a list of "Top 10" really bad movies? How about Kimberly Locke or The Rock? Fifty years from now, people might remember Bill Clinton but not for being a former President of the United States. Will we remember Scott Petterson when all his appeals are used up? What about Amber Frey or the "celebrity lawyer" tandem of Gloria Allred and Mark Geragos? I may be able to recall some of these names a few years from now but will my children even know what silliness got them in the news?

I wonder, sometimes, if all the stars in the heavens - metaphorically speaking - are set. And, if so, what we are left to today - the "stars" we talk about at the water coolers and watering holes - are merely bottle rockets. You remember bottle rockets, don’t you? They are the little sticks we sat in coke bottles and lit on the Fourth of July or New Year’s. They would burst out the bottle, rapidly ascending to the stars as fast as light. Only, the little rockets never made it to the stars. They burn out, disappear in the night and fall quietly and quite unceremoniously back to earth. No one ever looks for them because they are useless and their "talent" is burned out forever.

"Fame" today in our E! and TV Guide world appear to be much like the bottle rockets of our youth. Fame, in the modern sense, is a fuse lit by publicists and talking heads who generate the lift off and into the sky of our collective minds the fake star goes. They shoot towards the heavens - where the real stars live. But, soon enough, the publicists and talking heads find something or someone else to talk about. Another rocket sits in the coke bottle, just waiting for someone to light the fuse. And we, the spectators at the fame game, are quick to turn our heads to new bottle rocket as it takes off on its doomed flight into the sky. In the modern world, fame has nothing to do with talent; it has everything to do with "buzz."

By now, we should have a collective case of whiplash. Our heads are being turned faster and faster as more and more bottle rockets are fired off each day. The faster they are lit, the faster we turn our heads. Another interesting observation is that the quality of the lowly bottle rockets is, if it is even possible, declining. Today's bottle rockets don’t go as high or burn as long as they used to. They just burn really bright for a shorter and shorter time.

I wish we had room for new, permanent stars. Unfortunately, the heavens are full. Further, I submit, that as long as our eyes are fixed on the fleeting glow and the unrelenting glare of bottle rockets, we will never be able to see the real stars. In order to see the true stars, our eyes need to be accommodated to darkness. Stars are best viewed far away from the city lights and in the dark quiet of the countryside. Unfortunately, we will never have that luxury anymore. There are far two many distractions in the sky.

Wednesday, December 15, 2004

It's Official - We're Killing Ourselves (and anyone who moves here)

For years, people have been saying that they are overweight because of their genetics. "All my family are big-boned!" or "I am built just like my parents!" Well, that might be partially true; I do believe that genetics plays a role in obesity. But I also believe that environment (what we eat, what (if anything) we do for exercise, etc.) always trumps nature (genetics). Now I have proof.

In the December 15, 2004 issue of the Journal of the American Medical Association (JAMA) there is an article titled "Obesity Among US immigrant Subgroups by Duration of Residence" from Northwestern University, Chicago. The conclusions are:

"Among different immigrant groups, number of years of residence in the United States is associated with a higher BMI [a measure of obesity] beginning after 10 years. The prevalence of obesity among immigrants living in the U.S. for at least 15 years approached that of U.S.-born adults."

So, you may come here skinny, but we will fatten you up within 10 years! Now, if genetics were in control, immigrants from Africa, Asia or elsewhere should have the same incidence of obesity living in the good old U.S.A. as their non-immigrant countrymen. But, not so! Once you immigrate to the U.S. and start adopting the much-fabled U.S. lifestyle (you know, watching TV, eating fast food, stressing out, rushing to make schedules, etc.), you get fat just like the native born Americans.

It just goes to prove what I have preached to my patients for years. It is the lifestyle, silly rabbit! If we would stop eating fatty, fast foods (how's that for alliteration!) and get off our ever-expanding buttocks and exercise, we could reduce our rates of obesity. But, then, that would require some effort on our part, God Forbid! And, as I step on my soapbox again, that is not the American way! We want a pill or, if we must, surgery to overcome our laziness and poor eating habits. We don't want to actually have to do something to lose weight! That would require personal responsibility, self-control and discipline. Anything but that, Doc!

So, give us your tired, your downtrodden, your skinny people from anywhere in the world. American is the land of opportunity, dreams and obesity!

Maybe it's time we started expanding the Statue of Liberty to better reflect her age and nationality? Then as immigrants passed by Ellis Island, they could see what they are getting into!

Tuesday, December 14, 2004

A Culture of Anxiety and Fear Cannot Be Healthy

The media has been catching a lot of flack lately for a number of factual error and perceived bias. The NY Times and Washington Post are purely liberal; Fox News is strictly conservative. You've heard the shouts from both sides. I have been thinking a great deal about the way American media cover the news lately and its effect on our society. I believe, on both sides of the media circus, there is enough blame to go around. Specifically, blame for the American societies "culture of fear."

We have become a culture consumed by fear, dread, and self-loathing. And, for the most part, it is the food for thought we are fed by the media, liberal and conservative. We live our lives in fear. We fear terrorism. We fear serial homicidal maniacs. We fear gangs violence, road rage, rapists, child molesting priests, greenhouse gases and global warming. We are all inadequate and need fixing up (extreme make over, anyone?) What are we supposed to think about when that is all we have on the news? The more sensational and the more horrific the story, the more time and ink will be devoted to it. The familiar news phrase, "If it bleeds, it leads," has been supplanted with "If it smacks of impending doom, let's make lots of room!"

Exhibit A: the coverage of the Peterson trial recently. Undoubtedly, this was a heinous crime. But to devote hours of exhaustive analysis on Court TV as well as mainstream media was a prime example of what titillates our society's interest. Trust me, there would not be thousands of hours on a case of a husband killing his wife unless the media knew Americans would love watching it - and the advertising that bombards us while we do. The previously unknown Peterson is now one of the most famous faces in our country. Next up on the docket of horrific murders: Robert Blake. On deck for Murder TV: Mark Hacking.

Exhibit B: the proliferation of what I will call "Crime TV." We don't just have to wade through the horrors of real life, we also seem to enjoy a good fictional dismemberment as well. What are the ratings for "CSI" (Las Vegas, Miami, or New York flavor)? How's "Law & Order" doing after, what, 12 seasons? Not to mention, "Law & Order: SVU" which is about really, really vicious and horrific crimes. And if you are really looking for the end of life as we know it, there is "24" (with Keifer Sutherland), heading off plots to blow us all to kingdom come. Or, for those craving some really scarey drama, how about "Without a Trace" for fiction about people just disappearing off the face of the earth at the hands of some shadowy villain. And, finally, there is always "Cold Case" where we get to review a really monstrous crime that has been unsolved and is now reopened so we can review it again. And to round out our television crime festival, let's not forget "NCIS" (Naval Criminal Investigation Service") where we can see members of our armed forces commit and fall victim to crime. All, clearly are must see TV. Just so you don't think I am exaggerating, here are the Nielson Ratings for the week of November 29-December 5, 2004:

1. CSI CBS 9:00PM Thu 15.5 23.0 17,027,000
2. CSI: MIAMI CBS 10:00PM Mon 14.5 23.0 15,940,000
3. EVERYBODY LOVES RAYMOND CBS 9:00PM Mon 12.3 18.0 13,481,000
4. E.R. NBC 9:59PM Thu 12.0 20.0 13,176,000
5. SURVIVOR: VANUATU CBS 8:00PM Thu 11.7 18.0 12,788,000
6. WITHOUT A TRACE CBS 10:01PM Thu 11.7 19.0 12,874,000
7. TWO AND A HALF MEN CBS 9:31PM Mon 11.6 17.0 12,749,000
8. NFL MONDAY NIGHT FOOTBALL ABC 9:07PM Mon 11.5 18.0 12,585,000
9. ABC PREMIERE EVENT-12/5(S) ABC 8:00PM Sun 11.2 17.0 12,286,000
10. 60 MINUTES CBS 7:00PM Sun 10.8 17.0 11,792,000
11. APPRENTICE 2 NBC 9:00PM Thu 10.8 16.0 11,877,000
12. LOST ABC 8:00PM Wed 10.8 17.0 11,787,000
13. LAW AND ORDER:SVU NBC 10:00PM Tue 10.5 17.0 11,523,000
14. NCIS CBS 8:00PM Tue 10.3 16.0 11,235,000
15 LAW AND ORDER NBC 10:00PM Wed 10.2 16.0 11,142,000
16. CSI: NY CBS 10:01PM Wed 9.8 16.0 10,696,000
18. COLD CASE CBS 8:00PM Sun 9.1 13.0 9,963,000

Just in the interest of being "fair and balanced," I am pleased to report that "Rudolph, the Red-Nosed Reindeer" was the 20th rated show for the week. By my count, 8 of the top 18 shows (remember, this is for the week that is presumably a "let's get into the Christmas Spirit!" week) are crime/gore/violence related drama. And, I do not include "60 Minutes" which is hardly know for uplifting stories of better times ahead and individual acts of kindness. At a time when "real" crime is declining significantly in our nation (see Bureau of Justice Statistics) , we seem to be longing for murder, rape, and torture to make a comeback.

So, what is the problem? It's sort of a chicken versus the egg conundrum. Do networks inundate us with horror, crime and violence because that is what we WANT to watch, or do we watch horror, crime and violence because that is what TV shows us? Whatever happened to "Little House on the Prarie?" Whatever happened to shows that were uplifting to the spirit or the mind?

Here is the point, finally, of this ranting: In my opinion, the constant bombardment of our minds - voluntarily (our fault) or involuntarily (the media's fault) - has led to our society which is living in a state of constant fear and anxiety. Continuing the argument, this chronic anxiety has led to a higher incidence of anxiety-related illnesses - specifically, hypertension, heart disease and mental illness, among others - in our society than in all of the other societies of the Western world. We currently have a life expectancy of a little over 77 years; that is less than England, Sweden, Switzerland, Singapore, Norway, New Zealand, Japan, Iceland, Italy, France, Canada and others [The data comes from the U.S. Census Bureau's International Data Bank]

I use these examples because these are countries that we, as a society, are most similar to in culture and society. As a physician, I find this appalling and more than a little embarrassing. We have the best medical facilities and physicians in the world, yet we - as a society - die younger than most other similar societies.

It is my hypothesis that in a society fed a constant diet of fear and violence, we live in a constant state of anxiety; i.e. we are in perpetual "fight-or-flight" mode, physiologically. As a result, we have higher incidences of anxiety-related diseases and, not surprisingly, obesity and depression, as well. We are a society of fear, a culture of anxiety. We seem to revel in it, though it is killing us, day by day.

I, for one, refuse to participate in the vicious cycle we have directly or indirectly fallen into. I will not live in fear of impending terrorist attacks, global warming, gasoline shortages, drive-by shootings, or any other of the 21st Century specters that haunt our televisions. I choose to be happy. I am not going a Polyanna or pretend I live in Never Never Land or the Emerald City but I will not live like - or believe - I am in Somalia or Ethiopia, either. I choose to live without fear. I will work to change what I can and ignore what I can’t. And I won’t allow the media ratings to dictate what I will allow into my mind. I would rather watch a History Channel or National Geographic show than one minute of yet another murder mystery.

By the way, if the world comes to an end, send me an email.

Monday, December 13, 2004

Performance Enhancement

Just a quick note today about something that struck me as one of those " WOW! I never thought of it like that!" moments that we sometimes have. The thought was about the current steroid controversy in sports, specifically, baseball.

Now, right off the bat (pun intended), let me say that I disapprove of the use of steroids in sports. But not for what the usual pundits cry out, i.e. "they ruin the integrity of the game." What they mean to say is "we can no longer compare statistics of today's ballplayers with the Babe Ruths, Ty Cobbs, and the older generations." Well, DUH! Today's ballplayers, in almost all sports, are better than the past generations. They are bigger, stronger, faster, in better condition, and almost any other parameter you can name. Except, perhaps, their love of the game and respect for the fans. But that is a subject for another entry.

But, I wonder how the argument against "performance enhancing" drugs really holds up without the veil of "it's the principle of the thing, dammit!" Don't most of us use "performance enhancing drugs" to do our jobs better?? How many people are using Prozac (or Paxil, Zoloft, ad infinitum) so that we can wake up, get out of bed and not think about blowing our brains out in the bathroom from depression? How many of us use Paxil or Ativan to overcome our social anxiety so that we can use a keyboard in a crowded office without our sweaty palms dripping in the keyboard and shorting out the machine? How many of us are taking something for Adult Attention Deficit Disorder (AADD) so that we can concentrate and do our jobs? Are these not "performance enhancing drugs?" I wonder.

Even more of stretch but possibly relevant, how many of us take something for high blood pressure, high cholesterol, migraine headaches, low thyroid, sexual disfunction, or irritable bowel syndrome? I would venture to say that a majority of adults take SOMETHING for one or more of these conditions. Are these not performance enhancing? Do they not cut down our sick days and increase the length of years we will be able to work before we go on disability or die? Is that performance enhancing??

Now before you shout out "yeah, but steroids are illegal!" I know that. That is the same reason we cannot use cocaine in the office to improve our energy level and the same reason we cannot smoke a join (a "blunt" for new generation) to calm us down on the drive to work. I am not justifying the use of illegal drugs in the workplace or any place else.

My point is simply this: Many of us use what are, in my opinion, performance enhancing drugs every day. Legally and under (presumably) a physician's direction. But we should look at our world - and the world of sports - with a little less of a jaundice eye and accept the fact that our modern work is full of performance enhancing drugs. Athletes who used banned drugs are wrong and should be punished. But perhaps we, as "drug-modified" humans, ourselves should not get so outraged when we hear about it in other workplaces.

Let he who is without pills throw the first stone.

Thursday, December 09, 2004

Here I am, now what?

Never have had a blog before, but I do love to write so this should be fun.

Anyway, let's get the preliminaries out of the way:

I am 53 y.o. (will be 54 on Christmas Day), male and live in the Deep South. I am a physician and have been "practicing" (always thought that was an interesting way to say that - doesn't everyone want a doctor who is through practicing?) medicine for the past 25 years. I am in private solo practice (which implies that I really can be difficult to work with, I suppose) and single. Enough of that junk.

Anyway, I hope to make this a regular "Dear Diary" sort of activity. Since I am quite sure no one I actually know will ever find this online (no, I do not plan to share the web address on my business cards so I can be completely, totally honest), I hope to make it therapeutic and a bit of a catharsis as well. If anyone does actually find their way here, so much the better.

I will end this monumental, if terribly boring, first entry. Soon, I hope to explain to myself why health care in this country sucks, why guns don't kill people - people kill people, and why our country has become a society of fear mongers and pessimists.

Have a great day and Happy Holidays!