Essays on América
To a Surgicenter and KP:
And skillful doing:
From the first step
off the gurney,
to the very last,
I’ll remember you,
The skillful people,
whose kind attention
was gently lavished
on a troubled knee,
Who slept on attic floors
of Alta Peruvian Lodge
doing light work,
to ski free that Spring of ’53;
Was injured in a fall
leather strapped to 7 foot boards
with strips of metal
screwed to the edges;
Who since those days
went many mountain miles,
but often effused complaints,
until it could do no more.
How is it, Dr David,
that so many people become
a selfless, seamless whole
at a Surgicenter,
To give a stranger’s knee,
A second chance to ski,
lead pack llamas up trails,
bike, or walk the city,
When the mother country
burns with uncivil warfare,
enraged by opinions
not our very own?
This old knee
doesn’t give away
it’s private opinions,
except only to say:
From the first step
off the gurney,
to the last off the earth,
… Thank You.
Panamà… as we pronounce it would be Pànama… is a metaphoric inversion expressed by the different accents. I first went there as an intern in 1954-55, not yet age 22, interested- vaguely- in tropical medicine but more concretely in adventure. Among my 8 colleagues, half were preparing for missionary work, one for public health, one for psychiatry. Before 1903, Panama was an isolated part of Colombia, an oligarchy run by four or five families. It was inaccessible by land across the Darien. The current sometimes road, actually highway 5, or the Pan American Highway, is still often impassable.
A canal had long been considered to facilitate travel between the Atlantic and Pacific, which required a long sea voyage around Cape Horn or difficult overland Balboa took across the isthmus of Panama. A French venture acquired permission to build the canal under the direction of Ferdinand deLesseps ( Suez Canal, desert, flat, no locks). He wanted to cut a similar sea level swatch across Panama. 40,000 French (and French colonials) died there due to that miscalculation, graft, malaria, yellow fever, poor nutrition and dysentery; it was abandoned. But in 1903 the US felt it could big crazy things. Teddy Roosevelt tried to arrange a canal treaty with Colombia and failed. But because of the isolation of the isthmus from Colombia the locals felt like colonists, and resented their voiceless circumstances and distant and neglectful rulers, like the rebellious British Colonies in North America. They found common cause with Teddy Roosevelt who wanted a canal, and revolted, assisted by U S gunboat diplomacy.
The US Canal Zone was about 10 miles across and some 50 miles long. Panama is Water, and water is the Power that could operate the locks of a canal. A dam was required to store that water, and also control the swampland created by the ever flooding Chagas River; and thereby to control mosquito borne diseases. Incredibly the huge project was completed by 1914! The original locks still operate unaltered, today.
Overall, The US Army Corps of Engineers and Black Caribbean laborers really did the heavy lifting: John F. Wallace conceived the engineering of the canal but became a victim of the terrain, disease, and the political bureaucracy; he survived there for less than one year. John Stevens, a famous civil engineer, took seriously the yellow fever/malaria problem. The largest earthen dam ever built controlled the Chagas River, and drained the swamps; which controlled the mosquitoes, malaria and Yellow Fever, and provided the gravity flow water power to operate the canal locks. Col. George Washington Goethels was finally given unrestrained authority, and was able to complete the job over the next 7 years. William C Gorgas, a U S Army physician who understood the relation of malaria to mosquitoes, convinced the Army to drain the swamps, making it possible from a medical standpoint to build the canal. A second canal was started but abandoned because of WWII; now it has been completed, arguably by China, who also had studied the sea level alternative as across Nicaragua but abandoned it.
In 1954 the canal was still operated by the US civil Service. There was segregation of several sorts. First, upper level administrators and U S military had the option to live on base, with typical military housing and commissary privileges with access to US goods and food. Most privileged long term US citizen employees of the Canal Company lived in bungalows. Second, short term US citizen employees like MD interns, lived in curious multi family wooden apartment buildings, each apartment located upstairs from a parking area below. The apartment buildings were oriented with long sides facing the sea breezes. They were two story wooden structures with space for parking underneath, and 12 ft high ceilings. There were no internal doors; the kitchen, dining and bedroom were in one line so that that the sea breeze, could flow through open screens placed above 8 ft. Each apartment had a bathroom off center and a heat closet to keep clothing dry. Construction was so light that people learned to speak quietly, even quarrel in harsh whispers. Sexual revelry was often audible, though as invisible as the morning alarm clock, flushing of toilets. Notice the 6 ft eves, a traditional style there. In the city they offer much needed shelter for passersby on sidewalks but shoot waterfalls out onto cars in heavy rain.
When I was there in 1975 the buildings were scheduled to be torn down. But the location was ideal, and all the infrastructure already in place. They were acquired somehow and have been gentrified, rebuilt so nicely that the old structures can hardly be seen. In the photo above, some of the screened breezeways persist. The open lower floor also is still there, but made into a living area, like a covered outdoor garden or patio.
The third level of segregation was provided to ‘local raters’ whose situation devolved from the building of the canal. The US Army had recruited English speaking workers among blacks of the Caribbean. Communication was more practical in English, and the work performance was superior to indigenous workers. ( Only the Spanish had managed to induce los indios to work through a brutal choice made clear in a statue at a Mission in Baja CA: a priest holds a bible in one hand and a skull in the other. Believe or die. Work now to live, and die for the glory of God and the Catholic Queen. But the Caribbean blacks were different, perhaps in part because, though paid less than US citizens, and they had significant inducements: Local raters’ were provided decent livable wages, living quarters, medical care, and allowed to buy US imported goods at a reduced rate from a local rate commissary. In the long run, however local raters felt abandoned after September 7, 1977, when President Jimmy Carter gave the Canal to Panama; a long standing local resentment of blacks with special privilege boiled over. Soon many ex local raters had nether job, nor any apparent citizenship. Yet there was, and is, a Black American Atlantic Coast and black Carribean island archipelago; it may be largely invisible to most of us in the USA, though it consists of many black communities which are the source for much unique American and Brazilian music, art, dance, custom, and language. Therefore, the abandoned black local raters of Panama, did not live in limbo; they have adapted or relocated. It’s instructive to kindle and google the many American Black authors, and the Quaker beginnings of the emancipation movement. The very first American revolution was black: Haiti. * Like most US citizens I often focus only on the Northern Hemisphere. We tend to forget that we are all Americans: one continent, one hemisphere, with a shared history, indigenous, immigrant past, and present.
We visited Panama City in late 2016. Much has conspired to make it the commercial and banking center of South America, rivaling Miami. The canal was gradually and totally transferred to Panama control by 2000. Panama has retained the $US as their currency, which stabilized the economy; despite many problems it became a place where people with means could find refuge from chaos at home, or for various thieves to hide money, including drug money.
The former head of the militarily, Manuel Noriega, a cooperator with the CIA, became de facto dictator and drug lord .The US invasion to depose him in 1989-90 was complex, while brief was a real war that has left a shambles of Noriega’s base of operations still unpaired. And the whole episode has became the source of many true lies: afterward there was an election at the insistence of the US; but the winning candidate was assaulted and Noriega declared the election null and void. While US invasion was widely supported by the populace, it was real warfare against a well prepared military, deadly and destructive. It was hugely condemned, as customary, in Europe and the UN; The Panamanian military was dissolved. However, the emergence of Panama as a commercial and banking center, and a repository for suspect money, continued.
The second canal has been completed, financed largely by the Chinese. Transit fee $100,000,000. A Trump hotel, shaped like a huge sail, looks like a twin to one in Dubai. A metro was completed last year.
Upscale barrios and yacht harbors, continued to appear. Old is being gentrfied, the president lived there near a fast growing tourist area, and expensive restaurants flourish. As to the currently strong US dollar, Panama is something of an exception, comparable to Chile. Most other countries today are, by comparison, a bargain. But it is a good place to visit, safe for the average sane foreigner, usually cool at night, when the ocean breeze is up. In the 50’s that meant street dancing to Lucho Ascarraga’s wild electric organ: Cha Cha Chas, with typical flat foot moves, keeping the whole foot including the heel on the floor and moving The Rest… none of that heel-high stuff. That, happily, is the same today.
Ancon Hill is the highest spot overlooking the Pacific entrance of the canal, with old gun embankments at the top, set among tropical forest. Several hundred yards down hill is the site of Gorgas Hospital where I interned in 1954. My oldest daughter was born there, delivered by a descendant of one of the founding families.
My Grandparents, Leon and Anna founded the Methodist church just at the edge of the Canal Zone. It was built and supported by the North American population of the Zone who operated the canal, and large number of military people who guarded it. But when the canal was given to Panama that U S population very quickly disappeared. The old church is imposing, but obviously neglected now. There was no pastor, but we spoke with a woman in the parish and she took us inside the elegant but sad and tired building.
We visited the site of the old Gorgas hospital, of French design. It had a stolid central administration building surrounded by a series of white one story buildings in colonial French style… a series of medical units, white wooden buildings with 11 foot high ceilings where the top four feet were open screens. The units were interconnected by covered walkways among sculptured tropical gardens to allow for air circulation. How well I recall doing a femoral stick on babies or spinal taps, sweating in the humid night air. At least that is the way it all comes to my mind; it is all gone. One wing of the admin center where interns stayed and sometimes slept during 36 on and 12 off shifts looks down darkly past the surrounding neglected padlocked wire fence strangely dressed in banners left over from some event. No one was around to ask if we might go in; and yet that seemed a small loss. I didn’t much want to view the corpse from the inside.
Even most of the relics of Old Town were full of color and life, on the way to being restored. thier roof still extended out 4 feet over the sidewalks and balconies to shelter people from the rain.
And the restoration was everywhere evident as well, set among the colorful lives of a small rich country whose future seems bright.
And we pretended to be rich turistas nortamericanos:
*You may want to kindle and google the many black authors of the Americas, the John Woolworth and the Quaker beginnings of the emancipation movement, and the first American revolution, which was black: in Haiti. Like many US citizens I often focus only on the Northern Hemisphere. But we are Americans: one continent, one hemisphere, with a shared history, indigenous, immigrant past, and present.
* * There is a 645 pp third edition of a book Americas by Peter Winn. But frankly, it seems to me simply a compulsive compilation of the ‘news’ we read in the US. Whenever the author treats places and peoples I know very well, the omissions and commissions of errors really rankle me terribly. My bias is this: The record of a people and a time are found in between the lies, and lines; and in fiction, poetry; in other words in Literature. Usually what we call News or History is moribund fiction without flesh or soul.
Feb 6 – Mar 25 2015 Brazil and Chile
In the USA we are familiar with syncretism of the Northern Hemisphere, especially in what we call The West, meaning Greece, Rome, and Europe. We speak of the Melting Pot especially in that regard. Yet The Americas, meaning the continents of our hemisphere, also share the unique mestizo heritage of our indigenous and European past. Syncretism often reflects change, hopefully progress. But it can send a message; in several American countries, Mexico, for example, El Día de la Raza – or racial day- is celebrated on October 12, which is Columbus day in North America. But there it is devoted to the mestizo or mixed race. Syncretism can be seen everywhere. In the Americas, especially in North and South America there are some curious inversions, geographical, linguistic, and cultural:
In the South, Daylight savings is ‘Spring back, Fall forward’; and Winter lives in the Deep South not the Far North. Santa spends Christmas in South America though he and his reindeer sweat in Summer heat. The global map below is a way of looking at the same world from another viewpoint.
In the Americas we share some holidays that sometimes seem out of place; the indigenous altiplano peoples love dance, song, and colorful costumes and in Puno, on the shores of Lake Titicaca, Halloween is celebrated with wild abandon: jack o’lanterns, witches, trick or treats; the next day is a traditional Día De Los Muertos, or day of the dead, with feasting and ceremony held at a local cemetery, more strictly a Spanish American religious holiday.
In Cuzco Cathedral there is a beautiful painting of the Last Supper by an Inca artist – of the people who actually built the cathedral with stones originally carved by their ancestors, from structures torn down by the hands of the conquered at the command of the conquerors. The Cuzco painting features not wine, but chicha, a purple fermented corn drink. The meal is cui– roast guinea pig. There are corn based dishes the table. Judas clutches his gold in the lower right hand corner wearing the curiously browned face of Pizarro who looks directly out at the viewer, as does Christ. It is a syncretic symphony.
Where the Valley of the Inca meets Lake Titicaca, small groups of Uros live on their floating reed islands; I first was there 40 years ago, when they were isolated, impoverished, fearful, sickly and short lived. The children attend a floating totora reed island public school. They have solar electric panels, with connections to the world, and have become quite worldly, taking visitors on guided tours in 30 foot long reed boats, welcoming them onto their islands, greeting them with multilingual songs, and coaxing visitors into conversations, story telling and singing. They invite visitors into their reed homes, explain the raising of guinea pigs and birds for meat, speak about potable water and waste disposal, and recycling systems. They welcome overnight visitors. The change from 1975 is almost inconceivable, until one takes into account syncretic development.
The oldest painting in a Sao Paulo museum, was done by a French artist who had never been there; all his native subjects wear white skin and French faces, a curious syncretic error. In North America Spanish and native place names are everywhere, among those of classical Greece, Rome, and Europe. Yet while we myopically worry, pander, and focus on the forever fratricidal Mideast and Europe, we become ever more American—North and South. Ordinary Americans are by most measures relatively apolitical, hardworking, and productive. That is a priceless advantage in a chaotic world; we try to preserve American syncretism, and reject Mideast bad tempered tribal misogynist and vindictive jealous gods who urge us to destroy one another in- of course- His name.
I am writing this at the home of a rancher in the Lake District of Chile. Even in this, the 4th year of drought, his farm is green because of the unique climactic conditions where mountain and sea air clash. He has set up a small hydro-power plant purchased in– of all places–Redding, CA. His home is modern, with automated radiant heating, showers– no tubs, no bidets. It is electronically world connected, but preserves a fancy old wood-burning kitchen stove that conveys a feeling of simpler times past. Even in summer, the old stove is lighted and used for cooking; it is ecologically sound for this region, operating on modest amounts of renewable fuel. It is a perfect syncretism of North, South, old and new.
Language itself a verbal and cultural living recording of syncretism; indo-european group winds its way across the globe- from Sanskrit to English. Spanish and English in particular are melting pots of Indo-European languages, rich with related words, ideas, literature. In the Americas there is constant ebb and flow of language fostered by our proximity and shared past and present.
While everything in our Americas North, South, or Central, is not ideal, or without troubles and unsolved problems, by comparison we are far more civil than much of the world, avoiding America wars. To young Americans everywhere I suggest this: Don’t just look East or West: Look North and South. The Americas are your home, our home; savor them, save them, cherish them, share them. As the saying goes, if everywhere is your home, Where is your home. While you should not reject the East and the West but your true syncretic home and your wider American family is here, and now.
“Do all the good you can, by all the means you can, in all the ways you can, in all the places you can, at all the times you can, to all the people you can, as long as ever you can.
“The greatest Christian virtue is doing, the least is talking.
“Beware you be not swallowed up in books!
“An ounce of love is worth a pound of knowledge.
I have seldom been so rewarded for being a Methodist as on my fourth trip to Colonet, Baja California, where I was privileged to interpret for Doug McNeil and Kevin Kinsella while they worked on a Lighting For Literacy (LFL) project guiding middle school students in lighting up the lives of eight families living in Ejido Punta Colonet. In doing so they also lighted up middle school STEM projects (Science, Technology, Engineering, and Math) in the minds of students who put together the lighting systems and went to Colonet to install them.
The cats at Los Gatos Methodist Church (LGMC) and Rotary International (RI) know (LFL) well, having witnessed it’s lightening fast 60 day gestation and assisted its birth in 2012. Their very first solar lighting installation was actually in Colonet, Baja Ca. Within the next two years LFL projects reached 8- and counting- continents, and introduced STEM and LFL to 1200 and counting middle school students at that age where inner spaces and lives can be lighted up in the process of lighting up remote places. AT Colonet this April I felt enlightened as well. I would go anywhere with these dudes and these children.
Without burdening the reader more heavily with words, a browser will lead to many links, here are a few that can tell about LFL better than I.
The photographs below tell of the experience more clearly than words, and may lead the reader to consider the possibility of LFL:
First job of every morning putting together two units for two houses. I couldn’t see how it was done, but these people did.
The plastic bag holds mounting brackets and connectors. Note all the wires, and the name of the student on the lid.
The rechargeable battery goes in the box too. Simple, no? Yeah, Right!
A fence perfectly representing the environment. The stakes are dried up spikes of cactus plant shoots. They are placed on barbed wire, then tied on with rolled up salvaged black plastic bags.
Below are dried roots of the same cactus- Maguey- dug up from the sullen and reticent gravelly soil with considerable effort, to serve for cooking fires.
Dogs, dogs, dogs, everywhere. We saw no house without doggy gangs of 5 or more. They alert arrival of strangers and fend off coyotes, if they are lucky; but numbers help.
The little Pichons must take care of their own hygiene.
Alejandro cleaning the spines from Prickly Pear cactus …new growth leaves, or nopales are used for a very common vegetable dish. He gave us a one week old dried rattlesnake which he advised us to let dry more, then grind up, and use with any food…like re fried beans and ground rattlesnake. Cascabel con frijoles refritos.
I fell under the spell of this admirable woman. She was a migrant farm worker from Chiapas, not speaking any Spanish; met and married. Their 15 year old son works for a builder and did much of the block construction; 15 years is adult at times. (During WWII my dad worked at a copper mine in Chihuahua. When I was 10 he took me to El Paso and put me on a troop train with $5. I got to Northern CA with some help from the soldiers. Like children in Colonet, we were older when younger then. From this distance that doesn’t seem a bad thing.
I can’t pronounce or recall her name but will never forget her. In this photo Antonio, the pastor of the Christian church in Colonet is helping her dig a footing for a table in her wash house.
Another home when the light was turned on in this dark windowless room. It is only the equivalent of a 60 watt incandescent bulb, but What a difference! I like this photo also for the high heeled shoes over the door. There were 3 pairs but I didn’t want to be too intrusive with my photos.
Little silent things like those shoes have much to say if we listen.
Another wash-house with a dog in its shade, and a fenced garden in back overlooking open countrywide. Unseen are 10,000 ft
peaks to the East. –The Sierra de San Pedro Mártir. But here the only vegetation remaining is thorny scrub brush and
maguey cactus; nonetheless it is a beautiful green Spring after heavy Winter rains, and there are stubborn tiny flowers everywhere.
The lights installed, instructions given; the switch is turned on by one of the children; and LFL makes the final point by giving each child a set of age appropriate books; we take a last group photograph. Adios is the perfect word.
Observations about Family
I would have never gone to Colonet without following my children, Amy and John and their Los Gatos family. The April 2017 buildings would not have been successful without my son Fred, who drove 1800 miles to be here; or 3600 if he gets home; or his Colonet counterpart, Ivan. Or pastor Antonio. Or, need it even be said, the VIMers who were the glue that put it together. It strikes me that this LFL project post tells of the nature of family. Families who keep animals in, and desert varmints and coyotes out with close spaced brittle dead stalks of cactus plants, wire and plastic waste; who carve out a place in the desert to imagine a house into existence– no, a home– largely made of trash. That’s what only families can do, like those pictured above.
I acknowledge that fat, happy, flawed, or failing, all I am is family. My parents and grandparents, and my Methodists; even my intolerant or rude fellow citizens; and not least, my children who refuse to let me go through my own rosy second childhood quietly, but take me to places like Colonet, to be nourished or frightened by the life forces of VIM and LFL.; I blame you all for disturbing my golden years; but especially Amy, Fred and John; if they aren’t a blessing disguised as family, who is?
Here you are, in the photos below, my babes, late on that Sunday afternoon, after a long trip and a long drive, framing the first wall. Like, Wow! What Energy! What discipline! What Organization! What Execution! But unfortunately the very next morning I had to go pal around with Doug/ Kevin et al.
So thank you, I suppose, for disturbing my personal quiet, reflective peace!
Self Management of Early and Silent Diabetes or Pre-Diabetes
Colonet is an inland town of about 2500 in Baja California. I have gone there four times with my daughter Amy and the Los Gatos Methodist Church to build small houses. They have now built more than 40, generally during Easter vacations so school children can participate. There are two doctors offices and two pharmacies in the tiny town but it serves a wide local area; ‘universal care’ is available at a government clinic staffed – in a common South American way –by a recent medical school graduate who must pay back year for year of medical school by staffing several remote rural clinics; he is there only a few hours each week, so people line up at 4 AM for one of the few openings. Otherwise they must see a private doctor at about US$35 a visit. For those who have a job, the average daily income is about US $10 per day, but work is not available year round. The nearest hospital is 60 Km distant.
It may seem surprising, but the area is highly agriculturally productive. The largest tomato grower in the world is nearby. The Driscol strawberries we buy here are grown in the region. Why? It sits between the ocean and the Sierra de San Pedro mountain range that reaches up 10000 feet to suck in winter rain, allowing for irrigation like a tiny San Fernando Valley; water and sun and hard work make it productive. Migrant workers, often speaking no Spanish, invade for harvests. This year it rained a great deal and the area is lush with small blossoming plants and green with bushy growth.
The local Christian Church has been very helpful in building the small homes. They often help people to acquire a tiny plot of land, which is a required, as well as someone in the family with a job. The pastor’s wife has diabetes as does her mother and their four year old daughter; they assisted in preparing for a series of evening diabetes screening clinics during my week there. The disease is so common that among the first 20 people screened ( excluding the pastor’s family) 9 had diabetes or pre-diabetes. Below is the translation from Spanish of the written introduction and information that was given to people who attended the screenings. Of course, the problem is obvious: When you find a person with diabetes, under these circumstances what do you do? I believe self management is the only realistic, timely, and practical option. To make that sort of thing work, it is best for small groups of people with diabetes to work together over time to solve problems like Where to find medications and supplies most reasonably; How to measure and keep track of glucose levels; How to safely adjust medication in view of the results. The pastor has an internet connection. It is a long and twisted road, but one that otherwise most Colonet people with diabetes travel alone. What follows below is information provided at the screening clinics, addressing the screening process, the general nature of the disease, glucose self monitoring, and possibilities for self treatment. It is translated and redacted from a Spanish blog.
RAPID SCREENING FOR DIABETES AND PRE-DIABETES
Blood glucose is measured about two hours after a sugar or starch rich meal.
Diabetes Positive Screening test:
- Any blood glucose level above 200 mg/dL at any time, including the
- Challenge test: Blood glucose above 200 mg/dL 2 hours after a sweet or starchy meal
- After 10 hour fast: any blood sugar over 125 mg/dL
PreDiabetes Positive Screening test:
- after a 10 hour fast: blood sugar 100-125 mg/dL
- 2 hours after sweet or starchy meal blood sugar 140-199 mg/dL
Conversions between mmol/dL and mg/ dL here
Screening tests are highly suggestive but not diagnostic. When positive, reconfirm whenever possible, with a qualified laboratory and physician.
These screening tests are valid at all ages.
Diabetes has serious complications, all caused by elevated levels of blood Glucose (sugar). In early years the disease is silent. One feels fine while high glucose levels destroy the most delicate but critical circulation in the kidneys, retina of the eyes, feet, and elsewhere.Fortunately we live in a time when prevention of that damage can be effective, and simple. But only those who have or who discover their disease can successfully treat it; especially those with the most common kind: silent diabetes. To do that the disease must be revealed… diabetes diagnosed if present,. , and then controlled by:
- Using a personal glucose monitor to keep track of blood glucose levels
- Measuring and recording glucose levels
- Learning to manage the illness… i contend that is best done as a member of a small group who regularly share their experiences and information.
Some may wonder why it is essential or practical to self control and self manage this particular illness. Although it can best be done with the help of a physician, only the person who has this disease can do so. Physicians cannot hang around 24/7. The time a physician can actually help most is after the disease had done so much damage that a foot has to be cut off, or a kidney replaced: too late for prevention. A competent physician welcomes self management of early or silent disease. All this may seem complicated, but it becomes quite natural quickly when the diabetic can:
- measure, blood glucose, record the result, and then
- use the results to manage and control the disease
- share results and experience with others who have diabetes for: a) interpretation of results; b) finding sources for test strips, medications or professional advice;c) understand medications and ways to manage it. For example, glucose monitoring is crucial, but very expensive. However, an hour drive away is a large international chain store where costs for glucose monitoring supplies are: ( US$): Monitor $ 9.00; 100 test strips $17.88; one time cost of lancing device $5.84; 100 lancet needles, $1.84 Total $34.24 , adequate for about 6 months monitoring– $0.19/day! By comparison, costs where test strips alone are $ .50-.75 each, are many times that depending on how many strips are required.
The personal glucometer (glucose measuring device or meter) is inexpensive, accurate and lasts for years. One must learn to use it, use it regularly and record results and circumstances affecting each test. . At first it is advisable to measure glucose levels often in order to better understand the illness. Yet because test strip use can often gradually be reduced to as little as 5 or six times weekly, plus anytime a concern arises. For example, one might suspect, for whatever reason, a blood glucose is low, and eat “just in case.” That should not be done: measure, don’t guess!
The blood glucose monitoring record: ( for one month…the first of 30 spaces appear) below)
|Date mo/day||Time 24 hr||Level before meal||2 hours later||Useful details like: what was eaten, an unusual event like illness, or any other comment|
How food affects blood glucose:
Carbohydrates fats and proteins can all be converted to glucose…which is vital to the human body even if too much is harmful. Some carbohydrates convert to glucose very quickly and therefore are a problem for people with diabetes:
Fast: processed or refined bleached grains like white wheat flour, and white rice; processed fruit sugars (fructose) like corn sugar and beet or cane sugar; starchy vegetables like potatoes and some sweet fruits like peaches, apples, bananas, oranges.
Slow: beans, seeds like most nuts, peas, lentils, meat, fish, chicken, cream is less fast than milk because less lactose, milk sugar.
Take control of your diabetes when it is silent and serious irreversible complications are most easily prevented.
You are the only person who can control your disease!
Note 1) Insufficient insulin was discovered to be present in diabetes nearly 100 years ago. Insulin is made in the pancreas; in the most common sort, Type 2 diabetes, the pancreas still can make some insulin, but not enough to meet the body needs; so glucose accumulates. The disease usually gets worse with time– especially if not controlled well. In type 1 diabetes almost no insulin is produced, and that is a different but related illness.
Note 2) Fasting blood sugar— after not eating for about 10 hours– can be deceptive in Type 2 diabetes because the pancreas has been resting (usually overnight) making enough insulin to keep blood glucose levels normal or nearly so.
Note 3) Hemoglobin A1C test: Red blood cells are not alive. They were grown in the bone marrow, and when growth is complete, they are delivered to the blood where they act as tiny carriers of Oxygen. That Oxygen is delivered to the tissues, and the empty red blood cells are sent back for more. They live about 90 days and are then discarded. But when they were being formed they took in the amount of glucose that was in the blood at that time. Therefore, the average glucose level in those red blood cells is a measure of the average blood glucose during the previous 90 days. Problem: both high blood sugars and low blood sugars can be seen in early type 2 diabetes because the pancreas can over react to high blood sugars and therefore over-produce while trying to catch up at night. So an average of high and low glucose can be deceptively normal. Conclusion: a challenge test, similar to the old glucose tolerance test, is superior to looking at averages or fasting blood glucose level. This screening test is significant because it offers a fast, and economical screening that can be done by anyone with a glucose meter.
Note 4) The personal glucose meter was pioneered by Richard K Bernstein, an engineer with severe diabetes working on a glucose monitor for physician offices. His diabetes became so advanced he began to control his own blood glucose very tightly and began to improve; then he did his own study among students, which suggested a personal glucose monitor was the key to diabetes control. What happened is classic:The study results were rejected by the academic medical profession. So he went to medical school and began to practice immediately as a diabetes specialist. His book –The Diabetes Solution- is largely viewable on line
Dr. Bernstein completely recovered on a very low carbohydrate high protein diet and tight glucose control; he suggests an average blood glucose of 81 mg/dL; he is alive, and lively, over 80 years old. He participates regularly in Teleseminar Webcasts. The March 29 2017 event can be seen here.
* A Modest Proposal is a 1729 satire by Jonathon Swift: ‘For preventing the Children of Poor People From being a Burthen to Their Parents or Country, and For making them Beneficial to the Publick’. He outrageously suggests newborns be harvested for food to reduce the numbers of poor and also feed the rest. Perhaps the only bearing of Swift’s satire to this little essay is the focus on the millions of poor we seem willing to sacrifice to diabetes, even though it’s cruel, and irrational. and avoidable.
By working together outside a system that tends to sacrifice the good to the perfect, and by self managing their own disease, people can at least greatly improve their lives and well being. Yet for our world’s millions of unsuspecting pre-diabetic and diabetic people, only those who discover their disease early and begin to self control it can easily limit its ravages. I believe that worldwide– and even in the USA– there are tens of millions who could benefit from a similar process until something more academically perfect comes along.
Even privileged, idealistic and committed people can become insensitive, intolerant, and dismissive, based on disagreement about dogma, about the meaning of ideas and words. Words are, after all, only symbols; like metaphors they represent things or ideas usually unseen. When we hear or read a word, we rewrite it in our own minds. We interpret and give it our own personal twist. When one half of our nation cannot stand to hear or see the other half, because of ideas or words, it would seem wise to ask ourselves Why do Words Hurt? Why are we so willing to wound one another? Or to put another way, Why so terribly thin skinned? Who ever said ‘sticks and stones will break my bones but words will never hurt me’ was from another era; like Swift.
It seems to me more appropriate to think about deeds rather than only words. So in Colonet this year, I wore a baseball cap with a silent modest proposal written on the face to imply that :
We are in this together. In this place, this nation, this world. We should try to ‘read’, or value one another for what we DO, not what we appear to BE: Not color of skin or political affiliation; or religion; or citizenship, or age, sexuality or gender— but rather, our behavior; our acts; and judge ourselves and others as reasonably as our acts allow.
Where oh where has my little dog gone; oh where oh where can he be?
With his ears cut short and his tail cut long
Oh where oh where can he be?
Children’s song by Septimus Winner (1827 – 1902)
Where O where has P Dog* gone,
Where, O where can it be,
With no ears turned on
My doc can’t talk with me.
With eyes on a laptop screen
And hands confined to its keys,
I’m cold, untouched and unseen
paper gown’d at 70 degrees.
My provider’s gloves are thick and blue,
We avoid each other’s infections
I find that considerate, don’t you?
Providers too need protctions.
But why, why not , touch me
or ask what’s on my mind?
Hear my lungs, tap my knees
To find what is there to find?
The EMR holds my future and past;
My imaging, scripts, and labs show
All that matters, first to last
All providers need to know,
To fill the blanks on screen,
Clicking each little square
So it can be clearly seen
every code is entered there.,
And kindly saying at the door
“See you next month; we’re done;
Your scripts are filled once more
For problems please call 911!
* Archaic: Physical Diagnosis by touching, feeling, listening, and speaking.
What follows is Creative Non Fiction about a hot air sauna burn in late November, 2016
I am Pablo. I most enjoy those times when I alone am personally responsible for what I do, whether in on a mountain peak, or in an ultra-lite over the Sierras, or a Cessna flying from California to Punta Arenas, Chile. At times, of course, that sort of self indulgence, lust for adventure – arrogance perhaps- has put me precariously clinging to a cliff face, or flying alone over SW Argentina when it was prohibited by the threat of war. Similarly, I enjoy dry heat so much it recently put me alone in a sauna, on Thanksgiving day 2016, for between 20 and 40 minutes. I cooked myself like a turkey. The recipe, or receta para asarse:
Lie down in a hot air sauna at the highest, hottest level. If you are diabetic and use repository insulin, which activates more quickly in heat, drink some water often, and eat an apple or an orange every 20 minutes.
I followed the recipe, but remember nothing after lying down to begin my second 20 minute session in the sauna, until sitting in a wheelchair, confused, frightened, and hyperventilating, amid about ten strangely dressed strangers in a strange world who spoke in unintelligible tongues. I had no recollection of being found unconscious in the sauna or being extracted. I could not formulate my own thoughts, or movement or speech. I began to shiver and have coarse muscular spasms. There was no pain, but I was angry at having no control of what was happening; about missing the rest of my life; maybe that anger motivated me to mumble some jumbled thoughts that surfaced: though it took me several long minutes to get the words to form, i finally managed to say:
“Diabetes!” a voice in English said,
“Your blood sugar is 87. You are going to be fine.” Happy to hear a familiar language, I said
“Adrenalin?” The voice said
“ No. ” and after I insisted on some water with sugar. The voice said “ Your blood sugar is 87. ” I said
“Wet towels, Ice” …The voice responded
“Your temperature is normal now.”” But then my wife and daughters appeared and got the towels, and gave me sugar water with a straw. I suggested
“Ambulance.” The voice said
“ It is on the way” I still could not get up or control my movements, and felt hopeless, as if i were sliding into oblivion. But gradually I was thinking more clearly assuming I was in Sacramento. I began to fear I would live, and be terribly embarrassed when my E R colleagues saw me and learned of my my stupid sauna behavior.
I was lifted on to a wheelchair and for what seemed a very long time was pushed down a long series of poorly lighted bare cement halls and walls, set among conduits, and dark recesses. Then out into the night to be lifted onto a sheet, and then to a cot and placed into primitive station wagon ambulance. I began to recall I was in some other country, but couldn’t recall which: In the ambulance I asked about a place I had been recently:
“ Brazil?” My wife, Marili answered,
“ Panama!” It all came back to me. I had been alone in the hot air sauna of a hotel. I felt that surely I would need to be hospitalized for some time and said,
“ You go home as planned. I’ll fly back later, or come by helicopter.”
“No, we will not and you will not!”
By the time we got to the hospital, I was fully alert, coherent, and coordinated. The nurse took vitals, did an EKG, asked my name and birth date, asked the litany of questions about illness, medicines, and allergies, and drew blood with some difficulty due to collapsed veins. The Dr. repeated the same questions, checked my coordination and strength. My Family Angels were allowed to be with one at a time. Lili asked about an MRI, because it might be possible I that I had a stroke or a fall with injury because found unconscious with strange lower extremity injuries. And though the Dr. said there was no need, and I agreed, the universal rule prevailed: when a test is possible and suggested it must be done. In short order the normal labs and MRI results were back, and I was released. The Dr. explained that I had minor first degree burns. Obviously neither of us knew much about Hot Air Sauna Burns* at the time. We paid the $753 bill, of which more than $400 was for the MRI.
As I write it is six days since trying to cook myself for Thanksgiving; I am now guardedly thankful to be alive, and in relatively human condition. It was at first curious that most of my injures were below the knees; it became clear they were not abrasions, but: Bullae! Blisters. The skin is cooled by evaporation of sweat and by cooling from blood circulation; because circulation is less in the lower extremities by comparison to the rest of the body, both circulation and sweating are decreased there… more blistering or burning result. Deep partial thickness burns are very tender to touch . They can look something like the skin of a turkey leg that begins to blister as it cooks. On standing up the pressure increases immediately and for about 10 min causing pain. very pa. Yet after lying down again they become more tolerable. I lie about a lot. The deeper ones form an eschar… a leathery covering that must be scraped off to allow healing; that eschar removal process is almost beyond tolerable, but smaller wounds like mine are not worth the risk or trouble of anesthesia. When being cleaned up I despair about the purpose or significance of life. On the other hand, yesterday I was able to do a half hour of upper body workout and a half hour of elliptical trainer. I should be healed within a few weeks, though full recovery will require several months, and resolve to avoid hot air saunas from now on.
* two links on the subject:
- Virve Koljonen, MD, PhD Summary from ResearchGate \
Hot air sauna burns (HASBs) are rare but potentially fatal injuries with simultaneous rhabdomyolysis. The mechanism of HASBs involves prolonged exposure to hot air because of immobility. The burned areas are on the parts of the body that are directly exposed to hot air. This type of heat exposure results in a complex injury, in which full-thickness skin damage occurs concurrently with deeper tissue destruction. Sauna bathing is becoming more and more a popular recreational activity around the world. The objective of this review article is to familiarize burn care specialists on this unique and clinically challenging type of burn injury and to illustrate our department’s long experience in treating.