Pumping Irony

In her mid-20s, she is attractive, active and intelligent. She only wanted to lose a few pounds, maybe as many as 20. So she did what any novice would do – she joined a health club and put her goals in the hands of a trainer. Not all trainers are created equal.

Her body told her to back off the unaccustomed strenuous exercise on the second consecutive day. Her trainer told her not to listen to her body. Listen to him. You’ve got to push. Feel the burn. No pain no gain. She felt the burn. She felt the pain. After the workout, the trainer turned her out into the 115-degree heat of a Memphis summer afternoon.

She lost the 20 pounds – and more – after spending 14 days in the ICU suffering from exercise induced acute renal failure.

Among the most insidious of unintended consequences, Rhabdomyolysis is the rapid breakdown of skeletal muscle due to injury to muscle tissue. Damage to the skeletal muscles (arm and leg muscles qualify here) causes them to break down and release a cocktail of chemicals into the blood, among them myoglobin (the pigment which carries oxygen in the muscles), creatinin kinase, electrolytes and enzymes. Your hard-working kidneys are downstream from this flood of debris and the renal tubules can become clogged with this flotsam. As suggested by New Zealand researcher C.J. Milne, “the kidney may respond by ceasing its excretory and metabolic functions.”

Boy, Howdy.

Massive rhabdomyolysis, according to Douglas M. Peterson, MD, “may arise with marked physical exertion, particularly when the following risk factors are present:

• The individual is physically untrained (or novice)
• Exertion occurs in extremely hot, humid conditions (been to Memphis in the summer?)
• Hypokalemia (abnormally low potassium content of the blood) from sweating”

Sound familiar? It certainly does to the young Memphis woman and her family.

Rhabdomyolysis comes in three flavors:

1) traumatic or muscle compression: We can thank Hitler’s Luftwaffe for the first modern description of rhabdomyolysis. The relentless Nazi bombings during the remarkable Battle of Britain left many Londoners trapped in the debris of bombed houses and factories, and the “crush victims” often developed renal failure and died within a week. While not clear at the time, the relationship between muscle injury and renal failure began its nascent journey there.

2) non-traumatic exertional: As described in the young woman’s trial above, this consists of “muscle membrane injury as a predictable consequence of extreme exertion, compounded if an untrained individual performs eccentric exercise in a hot environment.” [C.J. Milne]

3) non-traumatic non-exertional; the remaining few whose problems arise from medical, rather than environmental, conditions.

A fast trip to the Emergency Room and a thorough understanding of the hospital environment by her parents were key in saving the young Memphis woman’s life. Treatment, following her admission to the ICU, included aggressive fluid replacement to flush the myoglobin and other harmful substances from her body. But if the kidneys are not functioning, how are the waste materials flushed from the body?

Dialysis. From a couple of catheters placed near her collarbone, the patient’s blood passes through an artificial kidney and releases its waste materials into a dialysate solution which is flowing in the opposite direction.

Imagine two parades travelling down the same street, one marching north and the other marching south. The parade marching south is composed of Wall Street bankers with money bulging from their pockets. The parade marching north is populated with pickpockets and grifters. As the two parades meet and pass each other, the pickpockets deftly remove excess funds from the wallets, pockets and purses of the bankers. In this case, the Wall Street bankers are your blood, and the pickpockets are the dialysate. The bankers notice only that they march with a lighter, more lively step after having been relieved of the weight of the excess funds, while the grifters have no trouble in disposing of the largesse.

We have been trained to put our trust in others rather than in our instincts and the messages that our bodies send us – and more often than not with sound results.

When the auto mechanic tells us that our belts and hoses have 60,000 miles of wear and need replacing, do we argue and insist that we can probably get another 20,000 out of them?

Or when the cardiologist reports that your artery is 70% blocked, do you argue against the placement of a stent in favor of meditation and acupuncture?

We pay trained professionals to render a service based on their training and experience. When the professional says, “Don’t listen to your body, listen to me,” we listen to the trainer.

But the body sends reliable messages from genetic training that spans lifetimes.

Remember your first cigarette? Coughed up your toenails, didn’t you? Did you listen?

How about your first experience with alcohol? Mine involved cherry vodka poured into a bottle of Sprite. Not enough alcohol for a buzz, but enough to send me sprinting from my sleeping bag to the latrine with some astounding diarrhea and no steps to spare. I should have listened.

Had I been the young Memphis woman, I would have followed the same course as she. I would have expected that the trainer knew what he was about, and I would have pushed past the limits my body was telling me should not be transgressed. And I would have ended up in the ICU suffering from exercise induced acute renal failure.

But no more. I learn from her difficult lesson, and I give more credence to my instincts and to a body which has continued to serve me despite myself.

And what of the trainer and those like him, who say “Push yourself,” and “Pump harder”?

To them I say, “Go Pump Yourself,” and I drink a cold lemonade on a cool veranda.

Thanks to Dr. Stein in Nashville and Dr. Moskimus in Memphis for their guidance and assistance in researching this post.

The Thing About Thyroids

It looks like a mutant moth which is trying to mate with your windpipe. Or a fleshy bowtie which is too small for your shirt collar and has slid halfway up to your chin.

It is the thyroid gland and I had half of mine removed on Monday.

The thyroid produces a hormone which regulates the body’s metabolism – not too fast, not too slow, but juuust right. The metabolism affects the health of all that is you: brain, heart, muscles, bones and digestive tract; skin, hair and nails.

It’s a lot of responsibility for such a small citizen, so it partners with the pituitary gland to maintain proper balances. The pituitary is located in the brain and looks as much like testicles as anything outside of the scrotum. Must be one reason why men think about sex so often (don’t act so shocked).

Here’s how they work: The pituitary gland monitors the amount of thyroid hormone in the blood. Depending on the level, the pituitary sends TSH (thyroid stimulating hormone) through the bloodstream to the thyroid. This lets the thyroid know it is time to cook up another pot of hormone and dish it out to your other organs.

There are several reasons why the thyroid can misfire. Hypothyroidism (produces too little hormone); Hyperthyroidism (too much hormone); Graves disease; nodules; goiter and - sometimes - it doesn’t malfunction at all, it just sends out teasing little whispers that lead the doctors and patient on a merry chase.

My thyroid was one of the mischievous little teases. It led me on a convoluted journey which began with my primary care physician, led to the endocrinologist, on to ultrasound monitoring and then into surgery. It all started with a low sodium count and ended with a lobectomy, a two-and-half year dance across meadow and stream.

Nodules, which were the mitigating factors in my procedure, do not have the decency to grow on the outside of the thyroid. They are resident within the thyroid and monitored by ultrasound imaging. As such, when they need to be removed, they cannot be stripped away like a wart. The thyroid itself must be removed in part or in whole, depending on the nature of the nodule – benign or malignant.

So how do we determine the benign or malignant intent of the nodule? Fine Needle Aspiration (FNA) provides us with the answers. The physician, guided by ultrasound imaging, penetrates the nodule with the needles and removes cells for a biopsy. And the needles, while small enough to do the job efficiently, are not so small that your family member seated across the room cannot see them administered and hide behind a newspaper.

The results of the biopsy on my nodules revealed cell structures which eventually become cancer in 15% to 20% of the cases, especially in men. The surgeon, who performed the biopsy, consulted with the primary care physician and the endocrinologist and all agreed that removing part or all of the thyroid was the best option. Why, they counseled, take a chance on developing cancer, when the solution was a simple and routine surgical procedure? The only tradeoff is a lifetime of popping tiny purple pills, which have turned out to be surprisingly inexpensive (the patent expired). My wife and I agreed with their recommendation and surgery was scheduled – outpatient.

Two things of note concerning the surgery: 1) the wait is much longer for the family than the patient; 2) the anesthesia used for the surgery does not leave the same goofy euphoria as the drugs used in a colonoscopy.

The patient interacts with many staff members throughout the visit, beginning with paperwork and ending with the wheelchair ride to the front door. My hands-on caregivers were: Dr. Friedman, anesthesiologist; Cathy-with-a-C the surgery nurse; Kathy-with-a-K the nurse anesthetist; Dr. Williams, the surgeon; and Mark, Pippa and Jenny in recovery. There were others, but anesthesia has robbed me of their names. All were excellent and most appreciated.

But my most important care partner was my wife – from the first meeting with the surgeon to driving me home following the procedure, she was a trooper.

There is much more to know, such as the parathyroids and their effect on blood calcium, the importance of taking thyroid medicine, natural vs. synthetic thyroid medicine, etc. You may do self-study if you wish (I recommend The Thyroid Book from KRAMES Patient Education). But the important thing to know is that there are many of us ‘Thyrandroids’ out here. We all do fine with our little purple pills, and you may one day walk as one of our own – MWAA-HA-HA-HAA!

(Illustrations ©2008 TheStayWell Company)

Cattle Call Update

On Saturday morning, July 10, 2010, the orchestrators of the second Cattle Call I attended were soundly spanked by The Tennessean newspaper. Front page. Above the fold.

This particularly egregious Post Secondary Education Career Institute, unnamed in the earlier post, is High Tech Institute, a subsidiary of the Anthem Education group.

According to The Tennessean:

Nicholas Cutcher came home from the war, eager to train for his peacetime career.


What he got, after nine months of study and $15,000 worth of tuition, was a degree from High-Tech Institute of Nashville that he says was worse than useless. Months after he earned his degree as a limited-scope X-ray technician, he still hasn't found work...

…"Why did I pay $15,000 a year for a job that's going to pay me $12 an hour?" said Cutcher, who served as a medic in Iraq and returned home with a Purple Heart. The federal G.I. Bill, and by extension American taxpayers, picked up the tab for his education.

Seems like the industry requires an Associates Degree, rather than a certificate, to even think of employing an allied healthcare worker. Crutcher says his qualifications were laughable when he worked at unpaid intern positions following his graduation. He had not been instructed in many of the fundamentals, such as properly positioning a patient preparatory to taking an X-ray.

And, The Tennessean reports, there is more:

But Stratton Douthat, who spent four months last year working as an admissions recruiter for High-Tech Institute in Nashville, said his experience at the school was more like working for a high-pressure used-car dealership than an educational institution. Recruiters operated under strict quotas, made hundreds of calls a day to try to drum up new students and would go down to the unemployment office to try to entice the newly unemployed to enroll at the school, he said. "They're supposed to be changing lives," Douthat said. "They were after those student loans and Pell grants."

The Directors of Admission for Nashville and Atlanta must have hurried out the building before the hiring interviews concluded in order to cash the government checks. Priorities.

Eat or Be Eaten

“I don’t eat anything that had a face,” the young woman explained in describing her vegetarian diet. My ill-advised follow-up question, “What about potatoes? They have eyes.” ended the dialogue as she moved off to a less cretinous conversationalist.

How many of us, I have often wondered, would continue to eat the meat of face-bearing animals if it required killing the animal, field dressing it and processing the meat?

Using nature as our guide – and the human race is as much a part of nature as the tse tse fly and the sparrow – all is fair in the name of survival. The mantra is Eat or Be Eaten.

Nature has a way of illustrating the point to us, often with a ferocity that galls the tender of heart. My home is in the dead center of suburbia. We embrace nature on our acre of wildlife sanctuary, playing host to several clutches of bluebirds throughout the summer. One of our favorite times is when the fledgling bluebirds leave the bird house on their maiden flights. Tentative and clumsy, the fledglings are encouraged to leave the nest by their parents from nearby trees.

Having witnessed two of the young blues awkwardly leave the nest, we hit a dry spell where the remaining fledglings were resisting all encouragement to take flight. We took flight on an errand of our own and returned shortly. I spotted what I thought was a water stain running from the hole in the bird house to the hydrangeas underneath. Closer inspection revealed not a stain, but the ass end of a snake.

I pulled the snake out of the hole and flung it over the fence. The snake did not seem to have ingested anything, yet when I opened the bird house, I found two dead fledglings, eyes closed and no respiration. I removed the bodies to a shaded area up the hill, hoping that they were only suffering from a fear-induced shock. Snakes really piss me off.

Pondering on the event later, I had to admit that the snake was just doing what snakes do. It was not emotionally constrained by the fact that birds have faces. It was acting under a more rigid imperative - survival. Nature had equipped the snake to climb bushes, slither through holes and ingest face-bearing, feathered fowl. And come to think of it, nature had equipped the bluebirds with wings to evade snakes and pursue face-bearing insects (not all faces are attractive).

This has been a banner summer for finding mammal remains and entrails in our yard. The bird bath seems to be a popular place for feathered predators to leave the odd chipmunk leg or unidentifiable cartilage. A gathering of flies clued me to what – judging by the fur – was a puddle of rabbit entrails in the wooded area behind our house. I guessed that the remaining sweetmeats would be gone the next day, and indeed they were. Only a small tuft of fur remained to remind the world of the rabbit’s existence.

And that is not necessarily a bad thing. The rabbits have spent the past winter and spring procreating like – well, rabbits. They have proved to be a scourge to my wife’s garden, eating tender shoots and buds a’borning. They have no fear of humans. Only the well-aimed rock has moved them from their feasting, and then only by a few feet. This is the first year that I have cheered the coyote sightings, forgiving their transgressions against small pets. ‘Go get ‘em, boys!’ I cry and point to the closest warren.

And the deer. As bucolic a sentimentality as they portray when seen at dusk, grazing with their fawns in the neighbor’s yard, they have been worse than the rabbits at decimating the garden. While lilies may not have faces, they DO have throats, and the deer snapped off more than 100 helpless buds before they had the chance to bloom – taken before the flower of their youth. Had we a hunting rifle, my wife would have culled the herd, despite city ordinances against such activity in the ‘burbs.

Among the backyard atrocities we have witnessed we can include: a blue jay carrying off a cardinal chick from its nest; a hawk nailing a starling on the ground and spreading its wings over the victim as it delivered the coup de grace; a larger hawk snatching a squirrel from its repast and disappearing over the rooftops; a crow fending off attack as it attempted to abduct a mockingbird chick; and a neighborhood cat carrying a baby rabbit off to show to its homeowners (cats have no owners, only homes). All the victims had faces. So did the victors.

I also have no doubt that, were I to have an ‘episode’ in the back yard and lie dead or helpless, other face-bearing creatures would have no problem in feeding on me. The crows would come first, to feast on the sweet moistness of my eyes and any other fleshy portions readily accessible. The coyotes or neighborhood dogs would follow to rend flesh and open the body cavities to the gut and prized heart. Insects would follow quickly to feast and lay eggs, and the vultures – God’s recylcing experts – would remove remaining soft tissues and stink.

Back, then, to the earlier question. How many of us would continue to eat the meat of face-bearing animals if it required killing the animal, field dressing it and processing the meat? Probably more than we suspect, since that would indicate we were thrown back to a more agrarian way of life, where survival depended on taking advantage of every food source available throughout the seasons.

Plus, nature has equipped us with the tools to eat whatever we need – eyes to see, ears to hear, brains to track prey and fingers to pull triggers. We have incisors to cut through lettuce and cabbage; canines to rip flesh; and molars to crush nuts and grains. Eat or be eaten. I am nobody’s smorgasbord.

Cattle Call

Having participated in group hiring interviews, I can only imagine that they must be similar to group sex. While the anonymity of being part of a like-minded group is appealing, you still worry over performance issues. The like-minded goal in the group hiring interview is to get a job rather than get laid, and in either group, only the top performers will move to the next level.

Or perhaps it may be compared to reading for a part in a theater production. The pressure of reading for a role is much less than the group hiring interview. As we say in the theatre, ‘There are no small parts, just small actors.’ But in the group hiring interview, there are absolutely no small parts, only the lead – a one-man or one-woman show.

Group hiring interview, group sex or theatre tryout, they all share an apt moniker – Cattle Call.

In my search for the elusive paycheck, I have been invited to three Cattle Calls. The potential employers have all had one thing in common – searching the world for students to train and tuition dollars to drain. We once called them Vocational Schools or State Technical Institutes. Government grants and increased competition have driven these schools to a new euphemism: Post Secondary Career Education Institutions. They will train you in photography, culinary arts and graphic design, or prepare you for a career as a medical assistant, instrument processing tech, paralegal, dental assistant or rent-a-cop.

My admiration goes to the institutions that make no bones about open competition. They carry a more sophisticated and organized approach to the Cattle Call. Through the many on-line elimination rounds (think Spelling Bee for the job seekers) the canny institutions let you know if you have or have not made the next round. The final e-mail from the most sophisticated of the three informed me that I was one of 37 semi-finalists to make the group interview, and I could choose one of two sessions in hopes of making it to the final three. All I needed to bring was my resume, a positive attitude and a presentation of no longer than three minutes to address to my competition. One of 37 semifinalists is a more impressive statistic when you understand that these were culled from more than 300 applicants.

The second institution to invite my participation was much less sophisticated and, frankly, surprisingly inept. The word ‘transparency’ was apparently not in the lexicon of any of their curricula. I was invited in for a 6:00 p.m. interview with Ms. Cox, Admissions Director. I arrived early and asked for Ms. Cox at the front desk. I was handed a clipboard (I have come to loathe them) and told to fill out the application. It came as a shock when two more people followed me in close order, asking for Ms. Cox, stating their 6:00 appointment times, and seating themselves with clipboard and pen.

The waiting room or outer lobby is wonderful in its tension at the Cattle Call, as each applicant tries to look solemn and competent in his or her own space, while longing to size up the competition. As the unchallenged geezer of the group, I make no hesitation in striking up playful banter with my solemn counterparts – a gift from my mother. When asked in a physician’s waiting room ‘What time is it over there?’ my mother lightheartedly and with great bonhommie replied ‘Same time it is over there.’

An attractive young woman in a well-fitting seersucker suit (as my father would have said, she had a ‘cute figure’) stepped into the lobby and asked us if we were there to meet with Ms. Cox. We admitted we were, and she gave us a million dollar smile and said Ms. Cox would be ready for us shortly. Another young woman, also sartorially complementing a cute figure, escorted us back to a classroom a few minutes later. The woman in seersucker was indeed Ms. Cox. Maybe she had been sizing us up. There were about 12 of us in this Cattle Call.

Her attractive young associate, Ms. Cox informs us, is the Admissions Director from the Atlanta campus. The group interview is apparently an exercise requiring more than one hand. Ms. Cox has us introduce ourselves, including a brief work bio. I win the Longevity Award in the group, having been employed longer than the average age of each of my competitors. Ms. Cox explains that we will discuss the position for a few minutes, take the Wonderlic test and then each be interviewed individually following the testing.

We go through some embarrassingly infantile ‘If you were a tree, what kind of a tree would you be’ questions. We are then asked to spend no more than two minutes to tell the class why we are the best candidate for the job. When the needle spins to a young man whose background includes backup vocals and sound work for a heavy metal band, he asks if there is a restroom he can use. The Atlanta associate directs him to the closest facility. He never returns.

Two late arrivals have been seated just prior to our ‘Why I Am Best’ exercise. One of the Tardy Two is shocked to learn that the job is considered a sales position. I wonder how closely she had read the ad, since its title proclaimed ‘Admissions Recruiter/Sales Representative.’

With still no mention of salary, commission or other compensation, Ms. Cox and Ms. Atlanta proceed to pass the test to each of us. ‘The Wonderlic Personnel Test is a twelve-minute, fifty-question test used to assess the aptitude of prospective employees for learning and problem-solving in a range of occupations. The test was developed by industrial psychologist Eldon F. Wonderlic. The score is calculated as the number of correct answers given in the allotted time. A score of 20 is intended to indicate average intelligence [courtesy of Wikipedia].’

The Wonderlic is routinely given to prospective NFL players at the annual combines, in part to see how quickly they can adapt to learning new offensive and defensive schemes. Offensive tackles average the highest scores at 26, followed by guards at 25 and quarterbacks at 24. Halfbacks trail the field at an average of 16. Two talented quarterbacks are notable exceptions, former Miami Dolphin Dan Marino and the Tennessee Titans’ Vince Young each scored 16 on the Wonderlic.

The questions are easy at the beginning and increase in difficulty as you progress. Almost no one answers all 50 in the 12 minutes, and fewer still get them all right. The 12 minutes fly past, and we are all startled when Ms. Cox and Ms. Atlanta call time and take up the tests. Ms. Atlanta calls four of the early arrivals to individual interviews, and advises the rest of us to return to the lobby and continue filling out our applications.

As we reach the lobby, the majority of the applicants do not stop there but simply exit the building. The Tardy Two are leading the way at great speed. Only two young women and I are left in the lobby. As we are about to complete our applications, we see Ms. Atlanta come into the lobby and exit the building. A long day, we discover, having driven up from Atlanta, and she has been excused for the rest of the evening.

A blur of blue seersucker flashes past us, and we see Ms. Cox exit the building moments after Ms. Atlanta. We have all three completed our applications and, handing them to the receptionist, ask when Ms. Cox will be returning for our individual interviews. She does not know, so we find someone who does. Ms. Cox has left for the evening, we are told, but leave our applications and she will call us. I step into the parking lot just as Ms. Cox, still resplendent in seersucker, powers out of the parking lot in a sports car which I could not have afforded in my best commission years. She pays little heed to the students milling about the parking lot between classes.

Four weeks later, the same ad for the same position at this Post Secondary Career Education Institution ran on the internet job boards.

I was invited to my third Cattle Call yesterday. Again at a Post Secondary Career Education Institute. Be still my heart.

Name That Blog

   The past eight months have been nothing less than a blunt object applied repeatedly and skillfully to my psyche. I lost my job in October (just shy of 13 years with the company), the Internal Revenue Service suggests that they require more money from me (an unfortunate misunderstanding), my wife routinely beats me at Scrabble (who knew that ‘xu’ is a Vietnamese coin?), and – most disheartening of all – I am not so clever as I had imagined.

I have not entered the blogosphere lightly, weighing narcissism against self-expression. Narcissism has won. If self-expression was my goal, then I would write these words, stash them in a file on drive c:/, and never see them again.

Narcissism views self-expression in its reflection from a still pond, and believes that the rest of the world can only benefit from viewing the same image.
Horse puckey.

   Still, narcissism pushes me onward.

   A demanding mistress - or gigolo in the interest of equanimity – narcissism demands a price for its companionship. ‘Name the Blog’ is the first bauble extracted as fee for service. It is in this, the very first phase of courtship, that I learn that I am not so clever as I thought. Or at least no more clever than those who have blogged before.

With whimsy as my guide and the ‘bon mot’ as my destination, I choose the phrase to become the banner of my blog and the url address to attract thousands of clicks per post. I chuckle as the first phrase leaves my fingertips and enters the blogosphere: ‘Passing Gas.’ The chuckle is short lived. Some blogging wag has secured the phrase.

It is the work of a moment to find a suitable synonym, which evokes both frivolity and an underlying seriousness. I choose ‘Breaking Wind,’ release it to the blogosphere and in less than the work of a moment it is thrown back in my face. Too clever too late.

My brain churns as I attempt to stay loyal to the theme, and I recall a fellow counselor from scout camp. A notorious moaner and sleep-talker, he returned to camp one summer with a couple of years of college under his belt. His nickname, handsomely sewn on the back of his fraternity jersey, identified him as ‘Crack.’ Why, we asked, ‘Crack?’ They called him ‘Crack,’ he said, because he was always cracking wind. Aha!

Rather than ‘Cracking Wind,’ I decide to sidestep the obvious and name the blog ‘Cracking Wise,’ which carries only a hint of gastric discharge and suggests a bit more gravitas in a blog worth reading. Again, I am late to the party. My title was roundly dismissed. Hmmmmm.

Nothing more concisely describes the last eight months than the words ‘Roundly Dismissed,’ which is the fate I hope for this blog. And nothing would be please me more than to have you read these posts, enjoy them or not, then roundly dismiss them from your minds.

Return if you will, for narcissism has been window shopping, and has informed me that the next trinket required to assure its consort is something called ‘Followers.’