Ounces of Caution, Pounds of Cure

When my car needs repairs for problems I can't identify, the strategy of starting off with the cheapest interventions makes sense. Why spend the money on the most costly intervention and risk unnecessary expenditures?

This approach to solving problems makes good sense, until you start talking about the car being your own body. Case in point, if you have a problem with your brain or heart whose origin you can't identify, do you want the doctor to throw the take-2-aspirins-and-call-me-in-the-morning strategy at the problem or the ER-stat-to-make-sure-it's-not-a-stroke-or-heart-attack strategy?

With the car problem, the main consideration reduces to the issue of cost-benefit. If the cheapest solution works, great, you haven't emptied your bank account to tackle it and the benefit is that your car continues to function. If your car is the most precious possession you own you may not choose to take the chance that the simple and cheap solution could end up doing long-term damage because it didn't address the underlying issues.

That's the kind of consideration that comes into play when your car is actually you and the problem is an unusual headache or atypical chest pain. No one wants to take the chance that the simple solution could overlook a serious problem. At least that's how modern health care thinks about it. Or so it seems.

Last Wednesday, I was in the instructional technology lab talking to the padawans when I became conscious of a dull pressure on the left side of my breast bone a couple ribs down, right over my heart. "Hm. A pain in my chest. That's strange."

Mentally I compared it to pain I developed 20 years ago when I was a graduate student in medical art. At that time—for the period of several months—whenever I sat slouched and then straightened up, my chest would feel tight in that same place. (Ignore the issue of slouching. I still do it.) If I arched my back, I could get the nitrogen that accumulated to release with a knuckle-cracking pop. But this felt different. I left a voicemail message for my wife and mentioned it to a colleague and the boss in case it should change too rapidly for me to mention later.

Sitting at the reference desk for an hour the discomfort seemed to disappear, but when I started walking around it seemed to return. After another 2 hours I decided to call my wife again and have someone drive me to the hospital. My wife works in benefits administration and urged me to call our primary care provider whom she was certain would have a walk-in EKG machine. As luck would have it, that afternoon was when the office, a teaching clinic, was off for rounds. The answering service operator insisted I go to the hospital. Off I went with my colleague driving.

The emergency room admitted me as soon as I walked in at 3:21 p.m. and hooked me up for an EKG. That and a blood test for enzymes that get released when the heart tissue dies that causes the pain of a heart attack both came back negative. Still, as a precaution, the attending physician admitted me for observation.

The question is if a car is running well and has always been well maintained, is comprehensive service justified? If I am a healthy male with low cholesterol and no history of heart trouble, was this course necessary? When your heart is potentially at risk, no one would recommend taking a chance; so in I went. My wife arrived to settle me into my room and said goodnight so she could get the kids home from our friend's house.

On hindsight, here is the kicker. The attending physician stopped in before the end of the evening. Chest pain that originates from the heart does not change with movement. Mine did. Likewise it cannot be replicated by manual pressure. Mine could. She speculated that my pain was musculoskeletal in origin. I must have strained my chest muscles or breastbone; although I could identify no specific, originating event. She said a stress test the next morning would likely confirm her hunch.

The stress test comprises an MRI scan with thallium dye in your coronary arteries—the arteries surrounding and feeding the heart. It’s done in 2 stages, the first after getting your heart rate elevated using a treadmill, then the second 2 hours later after resting. I did great. No evidence of narrowing of arteries that could have caused chest pain. I even impressed the cardiologist who observed that my heart rate at the same point on the treadmill as other patients was lower than average. That sounds pretty fit for someone who doesn’t do much exercising. Of course, you have to put that into perspective: I’m more fit than the average person being tested in the emergency room. Go ahead, laugh.

When all was said and done and my wife had picked me up to drive me home, I had a prescription for extra-strength Motrin to ease the ache and a full coronary workup at emergency room prices.

My question again: Was all that entirely necessary? With a few minutes of pre-screening by phone, a physician could easily have gauged my symptoms for the likelihood of a heart attack. I had no sweating connected with the pain. There was some dizziness, but not concurrent with the pain (plus this had already been happening for 2 weeks and seemed likely to be latent vertigo from a cruise I’d just returned from). The pain changed based on activity. I could recreate it by pressing on the spot where the pain originated. All of this was determinable through dialogue. In fact, apart from the EKG, the enzymes tests, and the stress test, the attending physician and cardiologist both determined this by talking to me, as obviated by their combined skepticism that my pain was heart-related, and 2 nurses, 1 physician assistant (educated at Arcadia University!), and 2 resident physicians surely also determined this though none of them actually articulated so.

To the comment that EVERYONE offered—it’s better to be safe than sorry—I must reply: That’s what medicine is about—risk assessment. I am low risk for heart attack and the verbalization of my symptoms plainly suggested I was not having one. Considering my risk, I could have gone into the doctor’s office to get a walk-in EKG. Yes, I have a family history of heart trouble (my dad had quadruple bypass surgery—at 81 years-of-age, non-emergency—and both parents have high blood pressure), but that’s information that’s already in my medical history. It would have been a fraction of the emergency room cost to have a preventive stress test done as part of routine screening.

Wiser medical, insurance, economic, political professionals will comment about my observations from a more informed perspective, but this event gave me a noteworthy personal connection to the health care debate.

Get Back--Thoughts from Horseback Riding

As of this writing, I'm on vacation with my wife's family in Canaan Valley Resort and Conference Center, Canaan Valley, WV. I'm blessed to have 2 fantastic families: mine and my wife's. I expect and receive good things when I'm with Barbara's family. Expect some good reflections. Here are some i-ruminations that come from a horseback outing with Mountain Trail Rides.

I went horseback riding for the first time in 20 years. I'm sure I enjoyed the experience 20 years ago, but I treasured this experience. I was the sole adult at family reunion who was interested in accompanying the five nieces. We were one group among 15 people going on a ride in the Appalachian mountains of West Virginia. All fine, really. Despite the sound of it, the company was quite nice. What made it a real pleasure, though, was the thinking.

The trail guides first mounted the children. Then they began mounting each of the adults. And slowly I started becoming self-conscious. There I stood in front of all the adults as each of them got her/his own horse. Wife Barbara watched while taking pictures and commented about my conspicuous lack of a beast. I nervously laughed and insisted with melodramatic petulance: I always get picked last! I edged even further forward to no avail. I got my horse dead last despite now being virtually in the center of the yard. I cried for all the times my awkward little boy self got picked last for kickball, basketball, and dodge ball. Not. Even as it has a way of recalling youth, adulthood also has a way of forgetting it. Good thing, too, I say.

If being high off the ground as you are on the back of a horse is the first thing that comes to mind, feeling your foundation jitter about must be the second. It's not like being in an earthquake, but it is oddly disconcerting. For a few moments. It is after all a creature that you are sitting astride, not a vehicle that you have to shift into gear to mobilize. Chamois, a buff-colored mare, is not docile. She shifts her weight and shuffles about the yard as she gets used to feeling me. Niece Tabitha watches me pat Chamois' neck and advises me not to pat her there. She takes horseback-riding lessons bi-weekly near her house in southern Maryland. She tells me that her instructor calls a spot closer to the horse's shoulder the friend spot. I lean over and pat the massive, muscular sturdiness of my mount feeling an odd combination of machine and living thing. I sense the humidity of her body through her coat. I pat her several times throughout the 65 minute ride and feel a variety of moisture levels from this base level to something approximating that of a mild workout as she walks, occasionally trots, and once canters (according to another sage young rider who sports her own helmet and riding pants).

Let me offer some comparisons between mountain biking and horseback riding. Biking in a single file requires concentration. Riding permits you to enjoy the pastoral mountain scenery with just a rein held loosely in one hand. Biking leaves you anxious over your 2 wheels sliding into the muddy furrows of the trail. Riding gives the assurance of four-hoof drive. A bike requires effectively no maintenance on the rider's part. A horse snatches at birch leaves and thistles. A bike takes gullies in the trail with equanimity. A horse swallows them up with relish. A bike exerts itself modestly. A horse sweats. A bike is inanimate. A horse is Alive.

A Good Read—And Ingredients for i-Rumination to Boot

Yes, I know, the common myth about librarians is that all they do all day is read books. In fact, there's very little I've read for pure pleasure in many years. And not even much for professional reasons. Much of substance in that world is in the form of articles and book chapters. I will exclude from my list all the children's and juvenile audience books I've read to or in parallel with my kids. Sure, some have been diverting, well-written, and thought-provoking, but they are in a different class. What I have read for an adult audience are by authors I can name on one hand—four fingers on one hand, no less. Accept this posting as a brief reader's advisory before I get to my main point. If you know me, it's what I do; fly off on tangents a bit before returning to the flight plan.

The first author is Jan Karon. I picked up a book a friend was reading more than a decade ago and started leafing through it on a whim. The narrative about a small-town, Episcopal rector in New England instantly caught my attention and the friend graciously let me borrow it. At Home in Mitford showed what a effective author could do with the idea of life and faith. A more recent volume from Karon, Light from Heaven which is based on the same characters, came across my desk within the few years which I absorbed with as much relish as for the first book.

The second author is Stephen Lawhead. Though one national bookstore classifies his book as young adult literature, Lawhead's Dragon King Trilogy was enticing enough for me to purchase the entire collection in one—the first fiction book I bought in decades. Passed on from a church friend as good reading about faith and chivalry from his younger days, I bought it to read to my kids and ended up finishing it myself staying up nights like I did in years long passed.

The next author, Alexander McCall Smith, came as a recommendation from Landman Library's circulation librarian when she heard me comment about enjoying Light from Heaven. She rightly believed I would enjoy the details of life in another place—in this case, Scotland. In my middle age, I guess my tastes have turned more toward traditional values, though, so I didn't enjoy Friends, Lovers, Chocolate as much as I might have without Isabel Dalhousie's ostensible preoccupation with non-marital amour.

I've just finished reading a second book from fourth author, Jason Fforde. The first of his books, The Fourth Bear, I read on a trip to China last year. It turns out that book was the second in the series. As I write in the middle of a camping vacation, I've just closed The Big Over Easy, the first book in the series. Okay, his characters are not without their own share of vices, but the creativity of his Nursery Crimes Division series more than compensated.

What I enjoyed about this series is Fforde's take on a fictitious Reading, England, world where nursery rhyme characters co-exist with a very modern and human world. Fforde does a delightful job of assimilating Mother Goose's characters with other mythical creatures—how about Prometheus—in two mystery books featuring Detective Inspector Jack Spratt and Detective Sergeant Mary Mary. In The Big Over Easy, the reader learns that Jack is also (without his awareness, even) he of giant-killer fame. In actuality, three of the four were just unusually tall. He eats de-fatted bacon sandwiches and doesn't disclose to his second, human wife (his first died from eating no lean) that he himself is a nursery character until the second book, fearing her rejection of him. Fforde manages to recall the tauntings DS Mary received as a child for being contrary and successfully kills off Humpty Dumpty and Wee Willie Winkie naming adult OCD pig thief Tom Thomm and retired masher Giorgio Porgia among the suspects.

Riding on the bus, The Big Over Easy was the stimulus for a conversation about changing cultural interests. Seatmate Margaret was on her way to visit her son's family when she took interest in my reading. What she couldn't help observing is how unlikely it seemed that children of her grandchild's age would even knew anything about the nursery rhymes of old. I myself realized that I had little reason to refer to Little Jack Horner or the Four and Twenty Blackbirds in conversations with my 10-year-old daughter and 8-year-old son. I and my wife are more likely to refer to the king and knights of the Dragon King series and anyone from the Star Wars universe than Mother Goose's alternate reality. The books we read to my kids were more contemporary classics by Stan and Jan Berenstain, Cynthia Rylant, and Donald Crews.

Perhaps to the credit of my wife and me, we try to elaborate with my kids about anything that comes up in the news or in conversations or in information we want to share from our reading. So we talked about franchising when Rita's Water Ice got bought out and about nuclear non-proliferation when we drove by a display rocket. What I mean to say is that we talk about everything including Mother Goose if it's relevant.

I observed to Margaret that college students that I've spoken to have a way of knowing about a lot that predates them, such as rock and movies of the 70s and 80s. Those bits of entertainment form the backdrop of their lives in part because of what their parents knew and because of what they can still readily hear and see themselves. In the days before parents could put their kids in front of Saturday morning cartoons or DVDs collections, they would be reading children's classics of their day such as Hans Christian Anderson or the Brothers Grimm.

This made me think about my job as an academic librarian. In Arcadia's Education Department students can take courses in children's literature that could very well detail works in earlier collections by earlier authors. Though the Sciences Librarian, I can easily be taking library research questions that look at Mother Goose and the place of nursery rhymes and fairy tales. The job of a librarian is to help bridge the gap between users' experiences and what they need to know. Will all young students learn about those characters and themes? No, but those that choose to learn, I'll be around to help.

A Man of Ideas

I'm generally a sociable guy. But not always. Like many sociable people, I need my own quiet time even in public. Recently, though, I've begun to realize that the problem might not be so much my need for quiet that keeps me from conversing.

I've realized vaguely for several years and more consciously for many months that the most tedious meetings for me are news only meetings. This is true both in the university and in my church where I serve on the lay leadership. I'm most stimulated and engaged by meetings in which ideas start bouncing around.

A number of months ago, I was at a church gathering in which members from different social strata were supping together. The edict came down from the organizers for everyone to sit at a table where they didn't know at least 2 people. Obediently, I did so. I struck up a thoughtful conversation with 2 college students, one of whom I knew only a little from a membership class I taught. I started getting a bit creative about the idea of volunteer service and ended up enjoying myself immensely. Not that I wouldn't have been conversational anyway in such a setting, but what made this particularly enjoyable was that ideas were starting to bounce around. By my own definition, I was engaging in i-rumination, and I was loving it.

I've been to social gatherings in which I've met new people and talked superficially. In those circumstances, I've enjoyed myself nominally. I've been to other gatherings in which I've connected well with people and gotten into some rousingly thoughtful and enjoyable conversation.

The difference is the exchange of ideas.

I've started to realize just how important to me the ability is to i-ruminate, ruminate intellectually. I've been aware of the importance in meetings. I've been aware of the importance in social gatherings. Now I think I discovered the importance to me therapeutically.

I was supervising a padawan in the library's Faculty-Staff Technology Resource Lab today. While editing a video project procedure with her, I caught myself getting compulsive about the details. The question was how much information to include. More now was time-consuming, but less now could mean more work or confusion for someone else later. I settled for more information now, but the need to resolve the issue of when to invest more time or not bothered me.

With a bit less work pressure during the summer than normal, I headed into the staff area vaguely desirous of a conversation with one of the other librarians. The boss JB was in a meeting with the collection development manager. The circulation manager was in late to cover evening hours. The serials librarian was away from his desk. Ambling into the break room, I found him starting a pot of coffee. He acknowledged he had some time and I sat down. I started tossing out the newest details of the video project (of which he already knew something being a media person in a former professional life himself).

He let me lay out the issues about this fairly trivial issue and let me connect it to the bigger issue of task management. With this project I was thinking to redesign some larger aspects of this annually recurring effort. Last year we were too hampered by the impending deadline to dare even tweak the procedure. This year we had started early enough to have the whole summer to breeze through. If we invested some time now, we could make life easier for someone else later and even have a better product. It didn't take long to recognize that the time we had available made it possible to do some experimentation with the procedure and still get the work done under the old procedure if a new one failed.

Good enough for me. I'd had the chance to process the issues by talking them out and reached a productive conclusion. And my mood had lifted considerably.

So, I've come to a greater understanding of how important it is for me to be able to talk ideas. It satisfies me professionally, socially, and now, at least I can speculate, emotionally.

If we ever meet, feel free to share with me something you've been thinking about lately. Share with me your own piece of intellectual candy. I'm sure to conclude the conversation happier and more thoughtful. And hopefully, I'll offer you a piece of i-candy in return.

Clogged Drain II

Here's where I can extol the benefits of both Twitter and blogging. I may not be writing a lot of blog posts at the moment, but I'm still tweeting regularly. On the other hand, it's possible to string together 3 tweets into one long thought, but blogging works so much better for that.

Last Sunday night, I put my idea to the test about unclogging my master bathroom sink drain. The first thing I did was remove the pop-up drain plug. It's pretty simple to do because the nut holding the pop-up lever in place is nylon. I can undo it with finger pressure. Pull the lever out, remove the pop-up drain plug, then re-secure the lever (otherwise water would leak out from the open nut!). Removing the plug allows the plunger to move unimpeded. (I can't claim credit for knowing this. I read it when I was googling the topic of clogged drains before my last effort.)

With the drain out, I applied myself to plunging. Hold one hand over the overflow hole (don't want the valuable pressure to come out there) and shoofa, shoofa, shoofa. I tried a good 5 or 6 times with slight improvements in flow, but not enough.

When the drain is completely open, you should be able to open both faucet valves full blast and have all the water drain out without accumulation. In this case, the water kept filling the sink after each plunging effort.

The theory I had was that enough pressure moving back and forth across the septic accretion would eventually work it loose. The concern I had was that the clog was too far away from the drain opening for the pressure from a simple plunger to work it free. I already knew the clog was nowhere in the drain from the plug back into the wall where the drain flow dropped. This meant it had to been in the wall, a good 2 feet away from the drain opening where I was plunging.

It can't be a good practice, I know, equating septic accretions in drains to food particles in teeth, but I'm not Miss Manners. When you have a piece of food stuck in your teeth with nary a toothpick in sight, you can use your fingernail, but sometimes that doesn't work. So you can suck air through your teeth to try freeing up the renegade ort. This can go on for a while, but eventually you usually sense the particle freeing up. Keep sucking enough and that bit of roast beef will eventually succumb. Burp.

It's the movement of the particle back and forth that allows it slowly to work free from the dental crevasse detaining it. My logic was that enough plunging would accomplish the same thing with my clog.

After a couple more tries with the plunger, the drain abruptly cleared. My mental efforts were vindicated. My clog problem was over. And I never paid a plumber.

I concluded last blog asserting that a success could mean I have a piece of i-candy to share with you. I've changed my mind and decided that the term "i-candy" only works well when the product is intellectual in nature--an illustration or a concept. So, no i-candy for you in this effort. Similarly the mental effort I might apply when the outcome is not physical ought not be termed "i-rumination." So I'm working on the idea of applying the term "mental mechanics" to the thinking effort. I don't have a term for the product yet. I'll let you know when I conceive one.

Next post: A return to i-candy. I think.

Clogged Drain

A number of months ago, I turned my mind to a developing problem: A slow drain. Not just any slow drain, an incorrigibly slow drain.

The obvious solution was the usual. I released the pop-up drain plug and cleared out all the accumulated hair.

That worked a little, but it was still not the drain of old. I've gotten a lot more tolerant of problems as I've gotten older, so the next effort didn't come for another couple (or more) weeks.

The next solution was to drop the drain trap and give that a go. I cleared out a good bit of accretion, but found to my surprise that the drain was still slow.

As far as I'm concerned, the thoughts I'd devoted to this problem don't constitute i-candy. Half-baked ideas and theories are what I call i-ruminations. (Our instructional technologist called them once ruinations. There may be some truth to that.) These efforts only become i-candy when they've reached the level of revelation.

The question was where did the clog reside? It wasn't in the stopper or the trap. In fact, I removed the drain pipe to the wall and cleared that outflow pipe right to the down pipe. So that meant the blockage had to be in the wall. The next step would have to be a professional plumber with a snake. But I'm as cheap as the next homeowner and didn't want to go that route until I'd exhausted the next easiest options. Short of borrowing a snake from some as-yet-unknown friend, I didn't immediately know what that option was.

In this case, I let the problem persist for a few more weeks as I continued to ruminate. Every time I used the sink, though, I'd devote more mental capital to the problem.

Actually, I did have an idea of the next easiest solution, but had already implemented it without any success. I'd taken a plunger to the drain at least twice, each time with no significant improvement in drainage.

But why hadn't it worked? If the developing blockage was in the wall, perhaps it was farther down the drain. If it was far enough down, the plunger could have failed simply because any change in pressure from the plunging action would have been inadequate so far away from the source. After all, air is a highly compressible substance; gases are like that.

If you blow through a short length of tube, the air coming out the end is pretty close to the pressure of that coming out of your mouth. As the tube increases in length, the pressure drops simply because of the compressive nature of gases. You have to blow much harder for the output pressure to be equal to the output for a shorter tube. The pressure change from a plunger is going to be pretty constant, so the farther away from the plunger the constriction happened to be, the less impact there would be from the plunging.

When the drainage matches the flow from a faucet trickle, desperation sets in. Oddly, the solution still didn't come in the form of a call to the plumber. My willingness to spend money had not increased an iota. So out came the plunger again. I didn't give up so easily this time. I shoofa-shoofaed a score of repetitions.

To my surprise the drainage improved. The flow now matched the flow from a modest faucet stream. It was time to ruminate.

If the septic accretion was further into the wall, why had any more plunging made a difference? (My willingness to try again was a bit less baffling. The cost of plunging is infinitesimal. The cost of a plumber? Shudder.) Repetition can be remarkably effective. The voice of a child asking for a cookie once is irritating. The sound of a child asking for the 100th time is erosive. (We do all know what happens if you give a mouse a cookie don't we?) I think what happened with my drain was that repetition did what just a few plunges failed to do; it gave an opportunity for some of the accretion to become loosened and freed.

I have a theory that plunging the drain for a longer time could make the real difference. I'll probably have to wait for the constriction to increase in order to maximize the pressure and its effectiveness, but if I'm right, I should have a freer drain, my hard-earned cash still in my pocket, and a happier wife.

I'll let you know. There may be some i-candy in it for you.