Archive for Ease and Disease

What reason do you need to be sure?

The FBI’s definition of a “mass murder” specifies a minimum of four deaths, not including the murderer himself, in a short period of time. A lot of these get into the news, particularly if (1) firearms are involved and (2) the killer belongs to a group disfavored by politicians and news media. Blaming the weapons is fatuous — when I was in the Army, we had literally hundreds of guns on hand, and not one of them ever broke loose — which means there might be something else involved:

SSRIs have a risk of increasing violence in patients, even in patients who have no previous history of violence or aggression before taking the medication.

This risk of violent behavior, both to the individual taking the medication and those around them, is so significant, it has led to the FDA mandating a black box warning on all SSRI medications. These black box warnings are designed to provide information and draw attention to the fact that the medication has serious and life-threatening risks.

As of 2004, all antidepressants in the U.S. are labeled:

“Anxiety, agitation, panic attacks, insomnia, irritability, hostility, aggressiveness, impulsivity, akathisia, hypomania, and mania have been reported in adult and pediatric patients being treated with antidepressants for major depressive disorder as well as for indications, both psychiatric and nonpsychiatric.”

This of course does not mean that every mass shooter was driven to it by Prozac — Elavil, which I take, is older than God and has no black-box warnings at all — but given the American tendency to treat antisocial activity first with drugs, this is an area that probably needs more attention before the next person tries to shoot the whole day down.

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Ask your doctor if it’s right for you

Pretty much all the prescription-drug commercials on TV follow this same uninteresting pattern:

Sufferers of Sweaty Elbow Syndrome can relax. Clinical trials have shown that Placebon causes up to a 7.5% drop in elbow sweat production in almost half of users. If you or someone you love are living with SES, ask your health care provider about Placebon.

In rare cases, patients reported depression and suicidal thoughts. Stop taking Placebon and see your health care provider if these occur. Side effects are rare, and include herniated discs, coronary artery blockages, and sudden incontinence. Patients who use alcohol or have visited regions with ebola outbreaks should not take Placebon. Do not take Placebon if you are allergic to Placebon.

Emphasis in the original. One question, of course, remains unanswered:

How in the Ninety-Nine Names of Spongebob am I supposed to know if I’m allergic to a drug I’ve never taken?

This is so they can say “We warned you” when the stuff makes you deathly ill. CYA all the way.

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Fair to meddling

Used to be, you had to have had six hours of chemistry to be able to comprehend the term “opioid.” Now it’s on page A-2 of the paper almost every damn day:

The news media makes a lot of noise about addiction, but I wonder how much of a problem it really is. If you look at the estimates of how much heroin and cocaine are being imported, it looks like either everyone is getting stoned every day —or— some people are using a heck of a lot, like a gram a day. I don’t think everyone is getting stoned, so there must be large population of heavy drug users.

As for busts (arrests), I wouldn’t be surprised if it was just the newcomers who are getting busted. The old established outfits don’t want any competition, so they are happy to tip off the cops whenever they get wind of an upstart trying to horn in on their racket.

Ultimately, of course, the government becomes the dealer of choice:

So the best people were quite determined not to see Linda. And Linda, for her part, had no desire to see them. The return to civilization was for her the return to soma, was the possibility of lying in bed and taking holiday after holiday, without ever having to come back to a headache or a fit of vomiting, without ever being made to feel as you always felt after peyotl, as though you’d done something so shamefully anti-social that you could never hold up your head again. Soma played none of these unpleasant tricks. The holiday it gave was perfect and, if the morning after was disagreeable, it was so, not intrinsically, but only by comparison with the joys of the holiday. The remedy was to make the holiday continuous. Greedily she clamoured for ever larger, ever more frequent doses. Dr. Shaw at first demurred; then let her have what she wanted. She took as much as twenty grammes a day.

“Which will finish her off in a month or two,” the doctor confided to Bernard. “One day the respiratory centre will be paralyzed. No more breathing. Finished. And a good thing too. If we could rejuvenate, of course it would be different. But we can’t.”

“You are a true believer, blessings of the State, blessings of the masses. Work hard, increase production, prevent accidents and be happy.’

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Aw, go fund yourself

If you’re asking “How do we get to single-payer health coverage?” here’s part of the answer:

After rejecting a 60-year-old woman’s request for a heart transplant for lack of “a more secure financial plan,” Grand Rapids, Mich.-based Spectrum Health recommended that she start a $10,000 fundraiser to come up with the money, according to a Detroit Free Press report.

The recommendation came via a Nov. 20 letter from a nurse with Spectrum Health’s Heart & Lung Specialized Care Clinics. In the letter, the nurse told Hedda Martin of Grand Rapids that the multidisciplinary heart transplant committee determined she is “not a candidate at this time for a heart transplant due to needing more secure financial plan for immunosuppresive medication coverage.”

Immunosuppresive drugs help prevent a person’s body from rejecting a new heart or other transplanted organ. The nurse also told Ms. Martin the transplant committee “is recommending a fundraising effort of $10,000.”

The letter was reportedly posted on social media by the patient, sparking backlash from some commentators over the committee’s decision. According to the report, some commentators on Twitter compared the committee to a “death panel.”

Warning: Malwarebytes barked at that link, citing the presence of dubious code.

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Don’t take any crap

Instead, give it:

According to the Centers for Disease Control and Prevention, about one in every 59 children in the U.S. is diagnosed with autism, up from one in every 150 in 2000. They report that “about half a million people on the autism spectrum will become adults over the next decade, a swelling tide for which the country is unprepared.”

The apparent rise in autism spectrum disorder (ASD) and its stubborn resistance to treatment has spurred a legion of researchers to enter the field and explore the disability in innovative ways.

Currently, effective treatments for ASD include behavioral therapy, speech and social therapy, psychiatric medications, and dietary and nutritional approaches. However, no medical treatments have been approved to treat core symptoms of ASD such as social communication difficulties and repetitive behaviors.

One promising avenue of autism research involves the gut microbiome, which is the collection of microbes that lives in our intestines and helps us in many ways including digestion of our food, training our immune system and preventing overgrowth of harmful bacteria. Recent research suggests our gut microbiomes also affect brain communication and neurological health. Worldwide, interest is growing in the idea that changes in normal gut microbiota may be responsible for triggering a vast range of diseases.

In a new study, “Long-term benefit of Microbiota Transfer Therapy in Autism Symptoms and Gut Microbiota,” published in Scientific Reports, Arizona State University researchers Rosa Krajmalnik-Brown, Ph.D., James Adams, Ph.D, and lead author Dae-Wook Kang, Ph.D, demonstrate long-term beneficial effects for children diagnosed with ASD through a revolutionary technique known as Microbiota Transfer Therapy (MTT), a special type of fecal transplant originally pioneered by Dr. Thomas Borody, an Australian gastroenterologist. Remarkably, improvements in gut health and autism symptoms appear to persist long after treatment.

The researchers speak:

Cite: Dae-Wook Kang et al, Long-term benefit of Microbiota Transfer Therapy on autism symptoms and gut microbiota, Scientific Reports (2019). DOI: 10.1038/s41598-019-42183-0

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Hungry hungry HIPAA

No medical procedure is complete without paperwork:

Went to the lab this morning to get my blood drawn. The lab is part of the medical industrial complex, so you have to pay a visit to the registration desk first. “Papers, please” or the equivalent, but not too many questions, no filling out of forms, and only two signatures required. Don’t understand why they need my wife’s birth date, nor why they need a signature acknowledging their privacy policy. I mean, it’s their policy, not mine. They need proof that they have shown it to me? This is double no-good no-think. Whatever.

I think they’re required to shove that form under your nose at least once a year, or the sacred stores of Lortab will be placed off limits.

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Next: Tommy John surgery

Sometimes events overtake us even in the world of fiction:

“Lou Gehrig,” a comedian once joked, “actually died of Lou Gehrig’s disease. Now what are the chances of that?”

I suppose you had to be there. But it occurred to me the next morning, while I was thinking up excuses not to get out of bed, that some fairly unlikely things had been happening to me of late, things I wouldn’t have dared to predict a couple of months ago. That space/time discontinuity, or whatever it was, could have opened up a path to just about any place in the universe. Or it may have been there all along, waiting for someone — make that somepony — to pass through. I’d never have known. It never would have occurred to me that the fabled land of Equestria was something more than just a clever idea by some talented people, a premise on which stories could be based, a pretext to sell toys to youngsters — and, yes, I admit it, occasionally to me. And the idea that Twilight Sparkle, of all ponies, should find that portal, step through it, and find me at the other end? What are the chances of that? With apologies to the late Mr. Gehrig, I consider myself the second-luckiest man on the face of the earth.

The Sparkle Chronicles (2012), chapter three

I definitely didn’t see this coming:

There’s an interesting article at Skeptical Inquirer by Harriet Hall suggesting that Lou Gehrig was misdiagnosed. He didn’t have amyotrophic lateral sclerosis but chronic traumatic encephalopathy (repeated head trauma):

“In 2010, McKee et al. published a study suggesting that repetitive head trauma in collision sports might be associated with the development of a motor neuron disease. It was based on autopsy findings of abnormal proteins in the brains of three athletes. McKee herself stressed that the findings were preliminary, but the study prompted many to question whether Lou Gehrig was correctly diagnosed with ALS or actually had CTE as a result of his many concussions.”

An acquaintance of mine died from ALS a few months back. Given the sort of fellow he was, I’m sure he would have found this at least slightly amusing.

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Gouge potatoes

What we’re looking at here:

Insulin aspart was approved for medical use in the United States in 2000. In the United Kingdom it costs the NHS about £ 1.89 per 100 units as of 2019. In the United States the wholesale cost of this amount is about 30 USD. In 2016 it was the 87th most prescribed medication in the United States with more than 8 million prescriptions. Manufacturing involves yeast, which have had the gene for insulin aspart put into their genome. These yeast than make the insulin, which is harvested from the bioreactor.

The most recent NADAC says $35 or so, if they can get it for you wholesale. Which, of course, they can’t:

Senate Bill 1019 would permit a pharmacist to dispense this stuff without a prescription in case of emergency; I’m not quite sure how this is going to affect routine refills, but the bill has arrived at the House after passing the Senate 46-0.

(With thanks to Dan Lovejoy.)

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Gratuitous gratuity

More than just a mere tip:

The family got together for lunch on Saturday at The Imperial restaurant in downtown Portland. With a name like that, and the fact that they take reservations, I was a afraid it might be expensive, but it wasn’t too awful. $150 for six, with coffee, no alcohol. Because there were six of us, the bill included the tip. It also contained a 3% wellness charge. I have no idea where that came from.

I was curious enough to try to track that down, and:

From the DOC restaurant menu: A 3% health and wellness charge will be added to each check to provide health insurance and living wages for all our staff. Thank you!

Which, I suppose, might be preferable to just jacking up the price and not explaining why. Judging by the comments on that second link, though, a lot of people would prefer the jackage.

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This spud’s for you

I hadn’t heard this before:

Truth be told, I’m not entirely sure I’m hearing it now.

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Tons of money, stat

So why is it that we spend more on health care than pretty much everyone else on the planet? One theory:

Perhaps because we think we like to think we are sick and we like spending money on doctors and lab work and drugs. Perhaps because we are willing to spend the money and the medical establishment is willing to take it. In any case, I suspect it’s just our mindset: charge on until we are stopped, and then bust down the barricade and charge on some more… Crazy people run up bigger medical bills, and we Americans might be the craziest of all.

I dunno, but I suspect most of our health care dollars are spent on old people, and a lot of that is spent on people who are not even mentally with us anymore. It is easy to foist unnecessary treatments on people who are barely aware of what’s going on. But hey, Medicare will pay for it, so it gets done.

Certainly the medical establishment doesn’t go out of its way to keep from taking our money.

And then I look at the doctor’s office, which includes three actual medical personnel and four people who push paper, and I am no longer surprised.

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What is Stage Four?

“The thing to note about Stage Four,” said Christopher Hitchens, “is that there is no Stage Five.”

Alex Trebek, host of Jeopardy! v2.0 since its debut in 1984 (Art Fleming did the 1.0 version through the 1960s and 1970s), isn’t going to let Stage Four get him down:

“Now, just like 50,000 other people in the United States each year, this week I was diagnosed with Stage 4 pancreatic cancer,” he said. “Now normally, the prognosis for this is not very encouraging, but I’m going to fight this, and I’m going to keep working.

“And with the love and support of my family and friends and with the help of your prayers, also, I plan to beat the low survival rate statistics for this disease,” he said.

He then joked that he has to keep working due to contractual obligations.

“Truth told, I have to! Because under the terms of my contract, I have to host Jeopardy! for three more years! So help me. Keep the faith and we’ll win. We’ll get it done.”

It’s hard to imagine Trebek not working. For that matter, it’s hard for Trebek to imagine Trebek not working:

In 2018, while being interviewed by Harvey Levin on Fox News, Trebek floated the idea of retirement, saying the odds of him leaving Jeopardy! in 2020 were 50/50 “and a little less”. He added that he might continue if he is “not making too many mistakes” but would make an “intelligent decision” as to when he should give up the emcee role. However, in October that year, he signed a new contract to continue as host through 2022.

He’d had a few health issues before, but heck, the man is 78 years old. In the meantime, I’m guessing he’ll take Thoughts and Prayers for $1000.

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Harshing your melanoma

A drug that seems to work against skin cancer? As Glenn Reynolds would say, “Faster, please”:

For people with the deadly skin cancer melanoma, one dose of the drug Keytruda before surgery might stop the cancer in its tracks, according to a groundbreaking new study.

Keytruda (pembrolizumab) is a PD-1 inhibitor, an immunotherapy drug that triggers the body’s immune response to attack cancer cells. According to results of this study, the drug’s effects peak as early as seven days after treatment — much earlier than previously seen in other studies.

It even works on politicians:

Keytruda is the drug responsible for the remission of former President Jimmy Carter’s cancer in 2015. Carter, then 90, had melanoma that spread to his brain and liver. Treatment with Keytruda appears to have cured him.

And don’t ask the price:

The drug isn’t cheap, costing about $150,000 a year. Keytruda is covered by most insurance, including Medicare, but copays can be high, according to the Kaiser Family Foundation.

The surgical option, though, isn’t likely to be any less expensive.


You got a lot of nerves

To me, the amazing thing about hand transplants is not that they work fairly well, but that they work at all: all those nerves have to be positioned just so. Anyone whose nerves have gone to hell will recognize this pattern:

When I read about these things, it takes me back to the decade in which I had nerve injuries in both my arms and suffered constant and often substantial neuropathic pain (I’ve described it here and elsewhere). I’m not comparing myself to these patients (thank goodness). Nevertheless, I have had a fairly lengthy experience of nerve injury, and then a lengthy convalescence (a couple of years, actually) and rehab from nerve surgery, and am well aware of the dangers and difficulties inherent in rehabbing any nerve problem. Hand transplants involve a great deal more, of course. But they also involve the reconnection and growth of many nerves, and that takes a long long time.

In particular, the article recalled a dream I had a night or two after surgery on my right arm. I dreamed that my arm had been amputated and I’d been given another arm that was attached at the shoulder with clumsy, Frankensteinish stitches. At the time, my right arm was essentially unusable, and in tremendous pain. The rehab ended up being fraught with problems — I changed physical therapists about four times before I found one who knew how to help me — and my recovery took two to three years. It’s been about twenty years and I’m now about 85% to 90% better than I was before the surgery, which is practically miraculous and for which I’m very grateful. But a person doesn’t forget an experience like that.

Two and a half years following all that spinal stuff, I have to wonder if “recovery” means anything in my case. Pain has been mostly quieted, and I am grateful for that, but I still can’t walk more than a couple of steps. Since I tend to be a bit wobbly when standing still, I’m thinking that somewhere along the way I misplaced my equilibrium. At least I don’t dream about it.


Adjusted for inflation?

Bernie is Not Pleased:

U.S. Senator Bernie Sanders sent a letter to Catalyst Pharmaceuticals on Monday asking it to justify its decision to charge $375,000 annually for a medication that for years has been available to patients for free.

The drug, Firdapse, is used to treat Lambert-Eaton Myasthenic Syndrome (LEMS), a rare neuromuscular disorder, according to the letter, made available to Reuters by the senator’s office. The disorder affects about one in 100,000 people in the United States.

The government is intensifying its scrutiny of the pharmaceutical industry and rising prescription drug prices, a top voter concern and a priority of President Donald Trump’s administration.

That word “free” actually means something in this case:

In the 1990s, doctors in the US, on behalf of Muscular Dystrophy Association, approached a small family-owned manufacturer of active pharmaceutical ingredients in New Jersey, Jacobus Pharmaceuticals, about manufacturing amifampridine [the generic name] so they could test it in clinical trials. Jacobus did so, and when the treatment turned out to be effective, Jacobus and the doctors were faced with a choice — invest in clinical trials to get FDA approval or give the drug away for free under a compassionate use program. Jacobus elected to give the drug away, and did so for about twenty years.

But that compassion stuff buys no yachts:

Catalyst anticipated that it could earn $300 to $900 million per year in sales for treatment of people with LEMS and other indications, and analysts anticipated the drug would be priced at around $100,000 in the US.

Fooled you, analysts.

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Fark blurb of the week

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Also, the clappers were clean

This I hadn’t heard of, but it seems to make sense:

Something Sentara Hospital has done is switch over as much as possible to copper-infused materials. Copper is naturally anti-bacterial, so this is just another weapon in the fight against in-house infections. There are fliers and signs and notices everywhere about it, explaining why the linens, towels and rags are all the color of chocolate milk. Even the tabletop of my bedside table was copper infused.

I noticed though (and it took me until the second night there to nail it down) that when I was laying in bed with my CPAP machine on, that there was a very faint odor. I finally realized that because of the copper, I constantly smelled just a whiff of blood. After three days I hadn’t gotten used to it.

A TV news report from that area:

Results published within The Journal of Hospital Infection shows results that Cupron infused copper in patient gowns, pillowcases, fitted and flat sheets, washcloths, bath towels, bath blankets and thermal blankets has helped drop infection rates at six Sentara hospitals in the Hampton Roads and North Carolina area.

The study published in November 2018 says that using the products by Cupron — a copper-based antimicrobial technology company — has significantly reduced occurrences of Clostridium difficile (C. diff) infections and infections caused by multi-drug resistant organisms (MDROs), including MRSA and VRE.

Impressive. And in the long run, I’d guess, possibly less expensive than the usual topical treatments.

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Don’t ever get sick

To misappropriate a line from J. B. S. Haldane, it’s not only more expensive than we imagine, it’s more expensive than we can imagine.

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A late arrival, one might say

A few days back, I wasted some time and space on the delusion held by some men to the effect that they think their junk is about to disappear. But weirder things than this actually happen:

Some children with a rare genetic condition appear female at birth but later develop a penis and testes around the time puberty begins. But what causes this to happen?

An article in BBC Magazine tells the story of some children in the Dominican Republic with this condition, who are known in the country as Guevedoces, which roughly translates to “penis at 12.” One child named Johnny was raised as a girl, but when he matured and neared puberty, he grew a penis and his testicles descended, according to the BBC.

Felicita apparently looked like any other girl until puberty kicked in. Enter Johnny.

Are these, then, trans men? After all, they were identified as female at birth. And I wonder if any of them decided, even after Mr. Johnson arrived, to continue to live as the girls they thought they were.

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This is not for you

There are wrong prescriptions, and there are really wrong prescriptions:

I’ve been prescribed a medication that isn’t covered (at all) by my medical insurance. Since it costs close to $1,500 per month at normal retail prices, there’s no way I can afford it; so the doctor who prescribed it signed me up with a specialty pharmacy, to see whether I qualified for a reduced price.

A few minutes ago I received a phone call from the pharmacy to confirm the information the doctor’s office had provided to them. All went well until, at the end of the call, the nice lady on the other end of the phone said, “You’ll be receiving your first prescription of (Drug X) next week.”

I hesitated, then said, “What medication was that, please?”

“(Drug X).”

“Er … I don’t recognize that name. Don’t you mean (Drug Y)?”

A brief pause, some background noises, and:

“You’re quite right; it should be (Drug Y). I’m afraid I mixed up your file with someone else’s. I’m sorry. I’ll correct it.”

I said, “Thank you – but what was the drug you were going to send me?”

With a quiver in her voice, she said, “It was hormone replacement therapy, to treat the menopause.”


And now I feel sorry for those who actually need this drug and get to peel off eighteen grand a year for it.

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Excessive whiteness

It’s a tough life for an albino in Africa:

Albinism is a rare, hereditary condition that leads to a lack of pigmentation in the hair, skin and eyes. Without melanin in their skin, those with albinism are more vulnerable to the damaging effects of the sun.

In Africa, albinism is associated with many negative misconceptions and superstitions. As a result, many albinos suffer stigma, alienation and even physical abuse.

There’s no known cure, but at least the misconceptions and superstitions are being addressed:

The Albinism Society of Kenya have held a Mr and Miss Albinism beauty pageant in Nairobi to support those with the hereditary condition.

The pageant, called “Accept me, include me, I can,” included participants from Kenya, Tanzania and Uganda, and aimed to boost the confidence of young people with albinism.

And the winners are:

Emmanuel Silas Shedrack, 20, from Tanzania and Maryanne Muigai, 19, from Kenya were crowned the winners.

There were thirty contestants in all.

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This seems stressful

Rather a lot of us suffer from high blood pressure, and stories like this don’t make us feel any better:

For the third time in recent weeks, a blood pressure medication has been recalled because it may have been contaminated with an agent linked to cancer.

Sandoz, a generic pharmaceutical company that’s a division of the Novartis Group, said it’s voluntarily recalled losartan potassium hydrochlorothiazide tablets because the pills could contain the impurity N-nitrosodiethylamine (NDEA).

Sandoz said the tablets are manufactured by Lek Pharmaceuticals in Slovenia and the impurity found is a probable carcinogen. However, it said, no issues have been reported concerning the affected tablets.

How times have changed. If you’re around my age, you may remember Sandoz as the developer of LSD, which was first marketed as a treatment for various mental ailments in 1947 under the name “Delysid.” Timothy Leary, at Harvard in the 1960s, began promoting the stuff for, um, nonprescription use. (Eric Burdon’s New Animals dropped a tune called “A Girl Named Sandoz” on the B-side of “When I Was Young”; it fooled no one.)

As it happens, this is the antihypertensive I take, though the stock I have on the shelf did not originate with Sandoz or its suppliers.

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Steps must be taken

The electorate wants things that look like solutions, even when they aren’t:

You might laugh but I remember the 1982 Tylenol thing and that is now why we’re all condemned, when we need a painkiller or OTC antihistamine out of a new box, to have to:

1. Pry the heavily-glued-shut box open

2. Remove the silly plastic “sleeve” that has been heat-shrunk onto the cap and neck of the bottle, and fewer of them have convenient tear-strips than they should. (“A pair of scissors, my kingdom for a pair of scissors” she cries, while searching the house mid-headache)

3. Punch through a “sealed for your protection” (the fig-leaf they put on foods is “sealed for freshness”) foil or foam capper

4. Dig out the cotton that’s stuffed in there, I presume to either keep the pills from breaking or to serve as a bit of a desiccant

All of this because an employee in the company poisoned some capsules … in which case all those things would not have prevented it.

Add several more steps if your remedy of choice has even the slightest resemblance to methamphetamine.

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What could be crueler?

Selma Blair, picture of youth. I first saw her as Cecile in Cruel Intentions, circa 1999; I realize that this was 19 years ago, and she was already 27 then, but the numbers inside my head don’t add up.

Selma Blair, sitting in the back seat

Selma Blair, taking a swim

Selma Blair, modeling something or other

But then there’s this:

The BBC reminds us:

There is no cure for MS, but treatment can help manage symptoms. This may include painkillers or drugs to reduce nerve inflammation, physical therapy to ease muscle stiffness, or medication to slow the condition’s progression.

Then again, life itself might well be an incurable disease of sorts.

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Hey, hey, we’re the munchies

There is, of course, a solution:

In case of emergency

The North Texas Poison Center is at 800-222-1222. As the sign says, The Pizza Guy is at 972-733-1222. Try not to mix them up.

(From reddit via Miss Cellania.)

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Paws to consider

Seeing yourself deteriorating — and retaining your sense of humor about it — to me seems only slightly short of miraculous:

The Internet is chock-full of cat videos. Among them there is one that gave us a chuckle a few years ago: a sullen cat pushing various objects off a table. And then came a day few weeks ago when I reached for a remote control sitting on the table right next to me. Rather than grabbing it, I pushed it off the table. It was impossible for me to pick it up with my right hand, which is now in a more-or-less permanently clenched fist.

Dee’s observation: You have now officially become a kitty.

We won’t ask him for a video. But:

Alas, she is right. But at least I don’t have to lick myself all over.

And he doesn’t quite sound sullen. (Yet.)

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The lowest form of cuisine

Circle K might not be your first choice for dinner:

No, not even QuikTrip.

Still, the person who’s never had so much as a 7-Elevem Slim Jim has had no opportunity to build up the kind of immunity our well-traveled road warriors count on.

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Miseries past

“Well, it sounds like you’ve been unhappy for a long time.”

“Honey, you have no idea.”

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Everything from here down

“Tell me where it hurts,” says the doctor.

“I think I just did.”

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This shouldn’t be about me

Arlo Guthrie:

“During these hard days and hard weeks, everybody always has it bad once in a while. You know, you have a bad time of it, and you always have a friend who says “Hey man, you ain’t got it that bad. Look at that guy.” And you at that guy, and he’s got it worse than you. And it makes you feel better that there’s somebody that’s got it worse than you.

“But think of the last guy. For one minute, think of the last guy. Nobody’s got it worse than that guy. Nobody in the whole world. That guy… he’s so alone in the world that he doesn’t even have a street to lay in for a truck to run him over. He’s out there with nothin’. Nothin’s happenin’ for that cat.”

There are times when I have to remind myself that I’m not the last guy.

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