Doctor Eclectic

Doctor Eclectic
Doctor Eclectic

Wednesday, October 23, 2013


I was infected with my first and I believe only, STD in my late twenties.  The carrier was my wife of long standing who is still with me and we both have long ago put that condition away in some dim recess of memory.  After all, it is exceedingly common, quite non-debilitating, and treatable.  In fact its name doesn’t suggest any type of social outcast: Herpes Labials, Herpes Simplex, or more commonly termed recurrent cold sores.

The problem with it is that recurrent part.  Once infected the virus hides, most likely in a nerve trunk, and surfaces as a lesion on the lips or vicinity thereof, triggered by a plethora of conditions, including: sunlight, stress, generalized weakened resistance, and sometimes just dumb bad luck, perhaps the day before a photo shoot or an important job interview.

Why this comes to mind at this time in my life is that number two son, recently definitely middle-aged as he is in mid-forties, just had a serious recurrence and, on the recommendation of one of his fellow teachers, asked me to write a prescription for Zovirax.

I was familiar with the product from Dental Meetings over the last several years, and had brought home a few samples, all of which seemed to be in a forgotten place when I had the need to use them.  So I wrote the prescription, and it seems to have been the promised miracle drug, clearing up the lesion from the “aura” stage without recurrence some two months later.

Where was that product fifty years ago?

The first treatment I remember came not from my dental education or even post-graduate education.  It was anecdotal and, as I remember it, called for placement of a red dye on the affected area and exposure to ultra violet light (pretty easy to find in Haight-Ashbury times).  Since the dye and the light are both carcinogenic I feel fortunate not to have traded an innocuous malady for a fatal one.

The next treatment, also anecdotal is one I still use: daily doses of Bioflavonoids, which must have some effect since I can count on the fingers of one hand any episodes over the last multi-years since I began the regime.  I decided to see if the science supports the results.  What I found is that there are more disclaimers for the generic acyclovir’s effectiveness than are seen on afternoon advertisements for medication during afternoon reruns of Bones or Soaps.  The tablets, which are priced in the mid-teen range as to cost almost list themselves as placeboes.  Antivirals affect viruses but don't cure their effects. The ointment, which is what I wrote the prescription for promises little better, and has a price tag approaching $200, a figure short of the $747 that was on Tim’s EOB.  His copayment was $30.

I found a natural product (maybe my Bioflavonoids) competitively priced with the tablets as a five-day regime.

I thought I would see what the ADA had to say about advances in viral control: almost nothing since 2005, where they were still advising there is no cure for cold sores, and questionable improvement by treatment over letting nature take its course.

Being in the midst of recuperation from a total hip replacement I was impressed that the ADA supports the American Heart Association and the American Orthopedic Associations recommendation to make prophylactic antibiotic treatment for joint replacements elective.  Since I recently had to have my Hygienist confirm that fact before she would clean my teeth, I was pleased to see the ADA on top of that issue.

Later today I will be attending a Webinar on the Dental Quality Alliance Committee and metrics to follow to determine Best Practices for desired Outcomes.  It would seem to me that viruses should be high on the list of what we track, particularly as to how we treat their effects.  I recently wrote about the HPV and how directly it has been connected to Oral Cancer.  Michael Douglas has very recently put himself in the spotlight as being infected by the HPV during oral sex, and we have a vaccine for that virus!

Although my infection was much less specific, I believe there are things to learn from this prevalent condition.

I am intrigued by recent applications of a governmental right called “imminent domain”.  In my next post I’ll tell you why.  Please stop on by.

Tuesday, October 15, 2013

The Fifth Estate

There is a trailer showing now for a soon-to-open film titled The Fifth Estate.  I knew the term but for the life of me couldn’t remember why, or what significance it might have for today’s culture.  I told Mary that I thought the Fourth Estate was the press, but couldn’t remember what the first Three were.  We set off on our respective quests: me, to Google and Wikipedia (to which I contribute by the way), and she to the dictionary in our family room, a wedding present of 53 years, which is used almost every day.

She came up with a definition of the Fourth estate as being scientists.  I came up with the Fourth being indeed the press, but the first Three?

A complete surprise!

Turns out the term was coined by Thomas Carlyle who paraphrased Edmond Burke commenting on a change in Parliament procedure that would allow the public to know what was going on in their government by letting the press attend sessions.  The press was termed the Fourth Estate; the first three being respectively, the Clergy, the House of Lords, and the House of Commons.  Prior to 1787, although the public had a say as to who represented them, they had no knowledge as to how well they did so.

William Randolph Hearst
Almost immediately the more liberal United States embraced the concept.  The press was tremendously influential in our politics, as evidenced in the Jingoism and Isolationist fervor surrounding the Spanish-American War.  Influence continued, as did the awareness of the value of the press in garnering public support for Executive agenda.  The press began to flex its political muscle with the rise of William Randolph Hearst, who moved into the large American cities and started what was called “yellow journalism”.  His power began to be used by political machines such as Tammany Hall to unify support from mostly new immigrants.

By the time I became interested in journalism, the press’s political influence was being edged aside by that of science, since the Cold War and the fear of The Bomb were making the populace concerned with the race between the U.S. and the Soviet Union for science mastery: hence Mary’s definition as to what constituted the Fourth Estate.
Julian Assange

Whoever chose the title for the film that explores the rather convoluted and interesting life of Julian Assange made an apt change.  The creator of WikiLeaks has certainly brought the influence of the press into perspective by morphing into what Social Media brings to the table.  Of all the changes we see in the print media: movement toward online reading, streaming, podcasts, news on demand, Yelp-like critical comment, and content condensation, none would seem to have gained more power faster than sharing information in a real-time manner.

Whether in the populist “spring” movements, Facebook and Twitter political influence, the whys and wherefores of drone attacks, or negotiating through the media, as we watch argument about debt ceilings and the ACA, there is no doubt that social media such as WikiLeaks have a profound effect on the political scene, not the least being how money is raised.
Benedict Cumberbatch

As one who has no dog in the fight, I am content to watch from the sidelines and marvel at the pace of change around me.  I am anxious to see what Benedict Cumberbatch does with the role.  I have been very pleased with what he did to reinvent Sherlock Holmes.

My next post is going to touch on a subject without being salacious: a STD.  Curious?  Come visit.

Thursday, October 10, 2013

Hip, Hip, Hooray!

similar to my right hip
Two weeks ago Wednesday I entered Saddleback Memorial Hospital at 1:00 PM for 3:00 PM surgery to replace my right hip.  Am I glad I had it done?  A definite yes!  Was it the “Sunday in the Park with George” experience, friends had suggested?  Not so much… It has, however given me some perspective on the procedure, elective surgery in general, and how the ACA may dramatically change our healthcare delivery system, some elements for the better.

I was definitely lacking in coping well with the three major adaptations involved in the procedure: loss of driving privilege and consequent dependency; change in sleep patterns, and change in routine.  My personal view is that the medical staff could have better prepared me for these before the procedures, which might have made for less stressful scheduling and smoother conditioning for my, euphemistically termed “Coach”.

Cobalt, Ceramic and Titanium
My recovery was complicated by a “bout with gout” that gave me serious pain in my right ankle, both knees, and my right big toe.  I have medication that is quite effective for my out and when I started taking that I rapidly got back to comfort in doing my exercises.  My goal for today is to use my walker, not for support as I walk, but for security, as I gain strength and balance to eventually move to a cane, and soon after, to normal, if cautious walking.

The first I learned about sleeping was at a class orientation where half of us were scheduled for hips and half for knees.  We hip people were shown tools to assist in dressing, eating and reaching, and our “wedge”;  a three-foot long by one-foot wide Styrofoam piece with Velcro straps that would be our new bed companion, for about four weeks.  Our old bed companion would soon find better accommodations, since sleeping exclusively on my back brings out the snoring in me.  The second night was the worst since Mary, now on the fourth level couldn't hear my cries for assistance.  She solved the problem the next night by adding a night light to help me orient myself, and by retrieving the Bosn’s pipe I used to call our children in for supper when they were young.

Last night for all intents and purposes I slept through the night, with no need to get up.  And I have adapted well to the changes in my routine.  Much of what I do is virtual, from home, on the computer with a few exceptions.  On the day of surgery one of those exceptions came in the form of a call from my agent for a CarMax commercial in LA.  The 11:30 audition didn’t fit with the 1:00 PM procedure and my agent seemed ok with that.  The next day, however, I got a callback for a Hyatt commercial.  I let them know I could make the shoot, but not the callback and asked for a reschedule.  Didn’t happen…

That experience made me realize how much the driving thing would affect my routine.  I usually try to go to my consulting job (about 50 miles away) once a week, although there is no contract or requirement to do so.  The commercial thing is another matter and to have Mary drive me for three hours for a 5-minute audition is unfair to her.  The driving she does with me as a passenger is predicted to be a month, although I’m hopeful for acceleration.  It has been mostly for social, with a couple exceptions: my driver’s license yesterday, a haircut on Tuesday, and some shopping, masquerading as Physical Therapy.

The vagueness of predicting of how long I will be a dependent passenger is understandable since the starting point of the patient varies significantly, as does the procedure, appliance, and recuperation from doctor to doctor, but I would think that planning the timing of an elective procedure should take into account the availability of the caregiver for an anticipated length of time.

Which brings me to one of my observations: I had no idea of the number of knees replaced in a year in the U.S. (about 600,000, with an almost equal number of knees).  I had been told that the procedure is bankrupting Medicare as people live longer and have desire, and perhaps productive need to have the procedure.  Cost containment has directed post-surgical home visits and disallows one I think would be cost effective: i.e., a pre-surgical visit my a Physical Therapist to the site of recovery, where one’s routine and environment could prepare the patient for recovery.  Even if this had to be paid for by the patient, it would be money well spent.

Perhaps this could be a Silver or Gold upgrade under the ACA.

My experience prompted me to look into what exists in books to prepare.  Most are very technical and I ordered two to read on my iPad.  I might write a book if I find a good illustrator.  The working title is, “Grandpa got a new hip, and boy, are we glad!”  But that will wait as my monthly Writer’s Club meeting on Friday complicates tickets we have to see Bernadette Peters.

There is a film opening soon called, The Fifth Estate, which reminded me that the Fourth Estate was very important to me in college.  Read my next Post to see what is the Fifth Estate and why we should shake the dust off from our notions of how important are the influential processes of our government.