Sunday, October 31, 2010

Botswana! Better than the Commercial!

Sable antelope

     There is a current commercial in which many species of African animals are seen frolicing in the African river, living in complete harmony. The lion drinks next to the zebra. The meerkats ride on the back of a crocodile down the peaceful river. It is an idealic scene and it makes the object of the ad memorable. But for me it always reminds me of our views of wildlife in Chobe National Park where indeed it is almost as harmonious. I decided to tell you a little about Botswana and include some photos here. We haven't viewed any of our trip photos in this blog for a while. In this post, you will see some of the animals. Birdwatchers look for my next post in which there will be photos of many of the beautiful birds to be seen in Botswana.

Wednesday, October 27, 2010

Cataract Surgery

A Fragment of Vision!

     I have spent  a few days twice during the last month taking care of my 93 year old mother after she had cataract surgery. She is basicly blind from so called "wet" macular degeneration. But she had enough peripheral vision to get around in her own home to live independently. In fact, she still bakes cookies and makes macaroni salad and potato salad ( her own recipe with both mayonaise and Henri's Tastee Dressing) to take to church pot luck events and fundraisers. However, lately her vision shut down in both eyes due to a rapid progression of her cataracts. Now in today's world of discussion about money spent on seniors and particularly during the last months or year of life, one might say: "Why would you do cataract surgery on a lady who is already blind from macular degneration?" It is a reasonable question. But this 93 year old woman still lives independently by herself, still contributes to the community, and is still sharp as a tack with her mind. How do you deny such a surgery to her, even if it only provides a miniscule improvement in her vision? Well, fortunately her retinal specilist agreed and found a doctor to do the bilateral cataract operations as soon as was possible. Well, this 93 year old breezed through the surgery. Oh, she was a little nervous about the first surgery; her systolic blood pressure reached 180 probably due to this anxiety. Indeed, she had only had surgery of any kind once before in her life -- the removal of a diseased gallbladder more than 30 years ago. And this was an operation on the eye for which she would be awake. But a little short acting IV sedative (Fenenyl) and she breezed right through the surgery. She said it went so fast she thought they were just preparing her eye for the surgery and she was told that it was over. (Well, this adept eye surgeon averages 7 minutes per patient of actually removing the cataract. The patients are moved through at about the rate of 30 minutes per patient in the OR.)  Of course, it might have also helped that I was with her, a retired physician, and even more so that her second daughter works as a teaching RN in the operating room of that hospital and could keep us all posted on exactly what was going to take place when. Mom was discharged from the recovery room about 2 hours after the surgery ended.  I stayed with her for 2 nights after each surgery. I could tell an improvement after the first one. Before the surgery she had begun to feel around just to get past the table in her kitchen, or to get through doorways. She had become uncertain and indeed a little unstable on her feet. The family feared a fall would put her out of commission for good. But immediately as we arrived home after the first surgery I noted that she was moving around with more confidence. She knew where that table was and where the edge of the door frame was. And as the swelling cleared, she could begin to use her machine which magnifies print such that she can read a few words again. These are little things but in her case every fragment of remaining vision is important.
     She is looking at a long and lonely winter. She used to be one of 4 widows, all over 80 in my small home town of Pecatonica, IL. But now my aunt has entered a nursing home near her daughter in central Illinois. My 94 year old cousin has had to stop driving and has been in and out of the hospital and is currently in a nursing home recovering from one of those hospital stays. The 4th widow also has macular degeneration and is also suffering from dementia. My mother's local support system is being decimated by age and debility. We three daughters will have to attend to her more frequently this winter and we are thinking of employing a companion to come in a couple of days a week to just be there for Mom. She was getting sick of the Talking Books that were coming in the mail, so I updated her subscription there and am getting her some Talking magazines and some newer and different books topics. She "watches" some television and enjoys the History Channel. We are keeping that going. Phone calls from family members help and her fellow church members are wonderful about taking her to church events and to her doctors' appointments.
     All of this prompts me at 67 to consider what my husband and I might need in our old age. One never knows how the cards dealt to us are going to play. We can plan for some expectations such as having long term care insurance in place, but we can't forsee everything. I just hope I have a family and a support group like my mother's and the strong will and determination that she has at this advanced winter of her life.

Friday, October 22, 2010

A Dowdy Stamp Club? Not!

     Since I have retired I have been participating in a couple stamp clubs locally -- the Milwaukee Philatelic Society and the American Topical Association Chapter 5. Many of the same people are involved in these two clubs and in many of the other local clubs that are part of the Wisconsin Federation of Stamp Clubs. Generally the members of these clubs are past 65 like myself because no doubt such people have more time to work on their stamp collections. Both clubs work on attracting youth into the hobby because if we don't we will be the last of this hobby. One of our members has worked very hard at attracting youth, and has won an Award from the National organization due to her hard work. I have been helping her out at a monthly youth stamp meeting and occasionally at other functions where youth are encouraged. Generally the members are kind, gentle and friendly people. Many are educated but not all have college degrees. Recently through my youth worker friend, I have learned of a member who does not fit this mold.

Sunday, October 17, 2010

Retirement: It's great!

     Today I attended my medical clinic retirement luncheon. About 20 of us retired docs from our clinic get together for lunch once a month. We pick a different restaurant each time and move them around town; sometimes we try new restaurants. Our discussions range from travel reports about trips taken, our families and their happies and their sads, and also, of course, our run-ins with medical care from the other side of the check in desk. At least, we can share the latter, because it is bound to happen. Almost everyone of us present has had something to be treated or has a family member going through medical stuff right now.

     I love retirement! People ask me if I ever miss my patients or my medical practice. On rare occasion, I do miss having that doctor identity, but it really does not occupy a large part of my thoughts. I tell people, "Yah, the other day I thought about that for about 30 seconds." That does seem to be the way of it. I was ready to retire when I did it. I have a lot of interests and wanted to spend more time on those interests. That's where the name of this blog came from. A doctor friend that I used to share an office with often called me the Renaissance Woman because I had so many interests and had read and done so much with those interests. She felt she could ask me about almost anything and I could give her an answer or I could describe a personal experience that answered her question. So she called me Renaissance Woman. The term was usually Renaissance Man. The definition of this term started because during the Renaissance there was much less knowledge about fields of study so one person could be knowledgeable in multiple fields in the arts and sciences such as Leonardo Da Vinci, as an example. A modern definition for the use of that term applied it to a scholar who was in a position to acquire more than superficial knowledge about many different interests. The term was first recorded in written English in the early twentieth century when it was used to describe a person who is well educated, or who excels, in a wide variety of subjects or fields. Usually it meant that the man was accomplished in areas of both the arts and the sciences. Since I had been called a Renaissance Woman due to my many interests, I decided to call myself that in my blog. As my profile says, I am interested in gardening, writing, water color painting and drawing, learning piano, geneology, reading, keeping fish, travel, interior decor, stamp collecting, toy collecting, exercise, tennis, medicine, birdwatching. As you can see I don't have enough time to tend to all my interests, but I try.

     I was going through some stacks of papers and I found this list of quotes on retirement that were in the Editor's Note of Physician's Money Digest, June 30, 2003. This was a throw away newspaper that was sent to all doctors free, paid for by the advertising within. I should explain what "throw-aways" are. Doctors pay for subscriptions to receive medical journals and some newsletters or newspapers that have scientific articles in them. These subscription journals are peer-reviewed. That means that the scientific articles are judged by a panel of experts and/or an editor before the article is accepted to be printed in the journal. But there are many medical journals or magazines that are not peer reviewed. Doctors or other experts are asked to write articles for them, and the article are accepted without peer review. The advertising fees pay for the publishing of the journal. There are no subscription fees. Now there is often good articles and good information in these "throw-aways." But they are usually not kept, or bound. They are read and thrown away.

     Following are the quotes from that Editor's Note:

     The things that should accompany old age; fairly good health to the end, an unceasing interest in life, and the affectionate esteem of a largre circle of friends.  William Osler, MD

    A doctor is happiest twice in life -- the day they hang up a diploma and the day they take it down. Howard J. Bennett, MD

     Our lives bregin to end the day we become silent about the things that matter.  Dr. Martin Luther King, Jr

     How far you go in life depends on your being tender with the young, compassionate with the aged, sympathetic with the striving, and tolerant of the weak and strong. Because someday in your life you will have been all of these.  George Washington Carver

     Be happy while you're living, for you're a long time dead.  Scottish Proverb

    Love prefers twilight to daylight.  Oliver Wendell Holmes, MD

    There is an enormous number of managers who have retired on the job.  Peter Drucker

     A person can stand almost anything except for a succession of ordinary days.  Johann Wolfgang von Goethe

     Don't think of retiring from the world until the world will be sorry that you retired.  Samuel Johnson

     Sooner or later i'm going to die, but I'm not going to retire.  Margaret Mead

    The harder you work, the harder it is to surrender.  Coach Vince Lombardi

     I have never liked working. To me a job is an invasion of privacy.  Danny McGoorty, Irish pool player

     The trouble with the rat race is that even if you win, you're still a rat.  Lilly Tomlin

    I retired because of illness and fatigue. The fans were sick and tired of me.  Coach John Ralston

     My doctor work interfers with my life.  RenRae

Note: The Wordle image that I opened this post with contains the words that were used most often in all of these above quotes with their size relating to their frequency of use. There is a wonderful site online that creates these wordles. You can paste in text, or link to a URL or other site and then tell the application to create a Wordle with these words. You can choose the shape, the directions of the words, the colors and the font. Very artistic, isn't it? This is especially useful if you are creating a genealogical image because the surnames and the places of birth will stand out with the most common ones being larger. Try it at this site:


Tuesday, October 12, 2010

Like a Bird by Asaf Solomon

Bird's Eye View

"Asaf Solomon, a dedicated Galilean, nature lover, and farmer, photographs the land of Israel while flying over it in a powered paraglider, a picturesque craft that gives the passenger a sense of freedom and tranquility, as well as the opportunity to take photographs from an unorthodox angle."
The above introduction is from the Magazine Eretz. We have his book "Like a Bird" showing his magnificent photographs of the land of Israel from the sky. Patterns, birds, nature and archeological landmarks vy with each other to produce a view of Israel that I have never seen. I have been there 7 or 8 times and of course my husband lived there until he was 33 years old. But every time we go to that little country we find something new to see. There is a new national park, or some new event to see. This little country unbelievably has 60 some national parks. They do a wonderful job of preserving their important holy legacy -- holy in three religions. But this book shows still a new view. I recommend you get this book if you can find it. It is in Hebrew, but that doesn't matter; you will just miss out on the short titles of each photo. But the photographer Asaf Solomon has a website and you can see a few of his views there. This book is a wonderful coffee table book of a smaller nature and will certainly arouse interest and conversation in your home.
"Like a Bird" by Asaf Solomon. 2009 Kinnaret, Zmora-Bitan, Dvir -- Publishing House Ltd. St. Or Yehuda 60212, Israel  ISBN 978-965-517-351-2

     The above photo is taken from the jacket cover of the book. It is copyrighted and printed here with permission of publisher and author. It is my favorite. It shows the Star of David plowed up in a field, in the Hula Valley in the north of Israel. We have been there in the fall of the year when 10s of thousands of cranes are stopping there on their yearly migration from Europe to winter in Africa. In this photo, the tractor is scattering seed just on the Star of David outline. The cranes are therefore landing and feeding on the Star. For a lover of Israel and a birdwatcher like me, this is a wonderful photo.

Sunday, October 10, 2010

The Spy Network!

Russian Spies in the Family! (Names changed to protect our relatives and friends)
    We recently had more overnight Israeli house guests. This time it was a first cousin, once removed to my husband, Amos, on his father's side of the family. Emma, the cousin, and her husband Dimitri grew up in Communist Bessarabia, which is now the independent country of Moldova. They lived in the capitol city, Kishinev, and immigrated to Israel in the 1980s. Dimitri was more or less a favorite "nephew" of my father-in-law Moshe. Moshe helped Dimitri and Emma get settled in Israel and helped Dimitri get a good managing job with the electric company in Israel. Emma is a pediatrician who practices in Israel. They now have two grown sons and grandchildren. We had become friendly with Dmitri and Emma and had hosted them before in our home in Milwaukee. They seemed a very nice couple and we thoroughly enjoyed their company. We had even traveled with them from Virginia where we were all at a family bat mitzvah to our home in Milwaukee, through Gettysburg and Niagara Falls and other stops along the way. On that trip we stopped in downtown Chicago on the way home, and we took them up on the Sears Tower to see the view. Then Emma asked us if we could leave them in downtown Chicago and they would catch a bus up to Milwaukee at the end of the day. They wanted to do some shopping, she said. We offered to wait for them and go entertain ourselves for a while and pick them up at a set time. "No," she said that wouldn't do. They insisted on staying by themselves in the big city ostensibly "to shop."

Wednesday, October 6, 2010


                                          Entrance to Tel Megiddo National Park

                                           Model of historic Megiddo, Museum at the Park
    In this post, I raise the topic of Israel and that little country's many, many biblical and archeological sites. Many of the approximately 70 national parks are related to the poignant history of this little piece of our planet. My sabra husband and I had visited Israel many times, usually staying in Natanya, a Mediterranean city about halfway between Tel Aviv and Haifa. In our treks around the little country we would always take Route 66 inland to access Nazareth, the Galilee, Tiberias, and the Hula Valley and Golan Heights even further north. In all those trips we drove past a site that I had never noticed or realized what it was -- Tel Megiddo. It sits right along this major highway which runs along the eastern side of the low hills that blend into the Carmel mountains along the Mediterranean sea. That route at that particular site apparently coincides with Via Maris, the ancient Roman road that led from Egypt to Damascus and Mesopotamia. The importance of that road, and the strategic importance of a fortified city at this southeastern point overlooking the large Jezreel Valley in Northern Israel made this site a fortified city 5000 years ago. It was conquered twice by Egypt in the 15th century BCE and again in 605 BC. These two battles and sieges were recorded in Eygyptian hieroglyphics and the second one in the Old Testament of the Bible. King David was there and King Solomon refortified it after one of its destructions.  But it was destroyed many more times because archeological digs at Tel Megiddo show at least 26 layers of destruction and rebuilding. During all these rebuildings the same area was always used as a sacred area, probably transitioning from a circular altar where there were animal sacrifices and perhaps early on even human sacrifices, to more familiar sites of worship that would have served King Ahab and King Josiah of the Caananite kingdoms from the Bible. Its site includes huge stables built to house chariot horses for King Ahab, and a very complex waterworks, with cisterns, and a 70 meter underground tunnel hone into the rock to reach a spring that was outside the city walls.  Ahab turned Megiddo into “Ir Rekhev” and built the impressive water works. Israelite Megiddo fell to the Assyrians in 732 BCE and was finally demolished by the Egyptians in 609 BCE. An Ivory Palace was discovered there with the largest hoard of Canaanite objets d'art and jewelry made of ivory every discovered in any Caananite site. When we stopped to visit this site and walked among the ruins, I felt something similar to what I had felt when gazing at the Old City of Jerusalem. I was overcome by a sense of awe at the tenacity and strength of human culture that would keep reconstructing this city time after time, when destruction should have ended its existence. It is a testament to humanity even if one ignores the religious importance of these sites.

                                           Jezreel Valley through the Gate of the City
                                           The Sacred area of the ruins, Jezreel Valley in background

                                          A public grain silo from King Jeroboam, (8th century BCE)

                                          The Southern Stables, built in King Ahab's time for chariot horses.

                                           The Jezreel Valley from Sacred Site, Tel Megiddo

                                           Jezreel Valley agriculture, Nazareth in distance

                                           Sacred area from above, with circular altr to right.

                                          Shaft entrance to tunnel to spring, Tel Meggido
                                          Exit to spring, Tel Megiddo

     Then I began to research this site. Har means a small hill or small mountain and the name of this city was always Meggido which some have said means Assembly. So this name of the place in Hebrew and Arabic is Har Meggido. The name for this place in Greek, is Armeggedan. Recognize the name. Yes this is the site that the prophesized final battle between good and evil at the End of Times will take place. It makes sense that a city of such importance in BCE history would be the place where the final battle would be predicted to take place. Multiple times my husband and I drove past this site without knowing its importance. Enjoy the photos of this site that I have posted here.

     One of the most important archeological sites in Israel from the time of the bible, Tel Megiddo is a beautiful and impressive national park near the town of Afula. Megiddo was important in antiquity: it is mentioned in Egyptian writings and is forecast to be the site of Armageddon in the Christian Book of Revelations. Recognized as a UNESCO World Heritage Site in 2005, the impressive remains of several civilizations draw many visitors and pilgrims.

Monday, October 4, 2010

Physical Therapy

     As my readers can see, I have not posted a new article for over a month. Yet I am looking over the new flags that made hits on my website and also where some of these viewers came from. I feel I owe you a posting, so I decided to write a little about why I have been delinquent.

     I have been accessing the medical profession again from the consumer side of the desk. My elbow has been continuing to have daily pain from my melanoma surgery. I have had various types of strange pains starting about 2 weeks after the surgery. At first it was, I think, a nerve pain with hyperesthesias (extreme sensitivity to normal touch) over the area, and allodynia, which is accentuated pain from stimuli over the area. I saw a physical therapist at the Hand Clinic at the Medical College of Wisconsin. But she really didn't have much to suggest and showed me a couple exercises to try to stretch the nerves, and slapped some corticosteroids cream on the site and gave me an ultrasound treatment. But she said she was not allowed to get the ultrasound head very close to the relatively new incision so she couldn't really get to the area that was bothering. Even so I found the vibration of the ultrasound to be very annoying, accentuating the pain.

     This was very similar to therapy years ago for my knee and mostly what was done was modalities ie ultrasound, and electrical stimulation. That time zapping my quadriceps muscles with electrical stimulus while I was voluntarily contracting them was I thought extreme torture. And I did not complete that session. My knee slowly got better on its own.

     Since my pain is persisting and some of that hyperesthesia is better, but now I am having deep pain with motion and with hanging my arm down, I have decided to try therapy again. It is after all three months since my surgery. A friend from my Spirit Mind Body group gave me a name of a therapist at the Sports Therapy clinic near my home. After the first visit with him, I was very optimistic. I now think there are therapists and then there are therapists. He was great, treating my whole body, found some things that I didn't know could cause me trouble. Very thorough. and astute at picking up on what I told him about the nature of my pain. He found a lot of tightness in my neck and shoulder, and at the acromioclavicular joint in the shoulder. He also said I was lacking about 40% motion when turning my head toward the surgical arm. He said one of my vertebrae was turned on the other because of that muscle tension. so he took it upon himself to strengthen this out and release those tight muscles. Just with the first two sessions I was felling somewhat better in the arm.

     But then he started working on my surgical site and that elbow. He was probably too vigorous that first time. Within a day or two I began to recognize the pain; it was no longer strange or a stranger to me. I now had lateral epicondylitis, or tennis elbow. Somehow all that manipulation of the elbow had centered the pain and inflammation right on that lateral epicondyle. I had experienced tennis elbow before from playing tennis, but this one was created with the help of a surgeon and a physical therapist and it was a wing-dinger. But at least I knew what to do for this. I purchased a fresh new tennis elbow band and wearing it brought some relief. I have been wearing it much of the time since. My physical therapist was bummed out that he had caused a lateral epicondylitis, and stayed away from the elbow until about my 7th or 8th session. He continued to work on my neck and shoulder girdle. He is good, he identifies the muscles and performs maneuvers and asks me to move certain ways against resistance while he is isolating those muscles. My grip strength is lagging and seems to have plateaued at about 30% down from normal. We are able to record increases in neck range of motion, and arm range of motion after these sessions.  But then the next session, I have lost all that range of motion and everything is all tightened up again.  I have learned that therapy is an example of the cliche: Two steps forward, one step backwards. In fact it may sometimes be one step forward, two steps backward. Once I seemed to get a flare up of the arm pain after attending an Imax movie -- looking up. Once when I seemed to have moved backwards, the therapist took a history of my activities and we decided it might be me working a lot on my laptop, writing blogs and, -- I admit it, playing solitaire, or mahjong on line. So I have limited my computer time or else tried to steal the desktop machine which is more ergonomic from my husband, which is not always easy. So, indeed, you have not seen any blogs for a whole month.

     I am still occasionally taking steps backwards. I went to water aerobics on Saturday and had a different and very young teacher. Of course, the moves were different because of the different teacher and she did a lot of arm work with buoys in the water. I stopped using my bad arm about 2/3 of the way through when I saw this, and I iced it after, but still I was pretty sore the next day. My therapist says I must stay positive, so I will try. Thank goodness for tennis elbow bands! And I will get better; I know it. It is just a slow process.

     In the middle of this whole therapy thing, I did go back to see the plastic surgeon who operated on my arm. First let me go against rules and generalize that I think many surgeons (my son excepted) do not deal well with postoperative pain, particularly the pain that is different or more than expected.  He was not very interested in the neuropathic pain I was reporting to him when I returned to get the sutures out. This 3 month follow up was just as disappointing. He really didn't address the location, nature or degree of my pain. He put his finger on a spot on my forearm which was slightly tender, and brought up a diagnosis that I had never even heard of, called a radial tunnel syndrome, and he suggested I was creating it by wearing my tennis elbow band too tightly. He also criticized my therapist implying he was treating me appropriately.  He was otherwise showing off for the medical student that was with him. He also was critical of the report that my oncologist had sent him because she had decided that the total depth of my melanoma was only 0.48 mm which is very superficial. This depth would probably not justify as wide an excision as I had and would not justify a sentinel node biopsy. So he told me that we still do not know the depth. He still said we can't be sure and add up the depths, which of course would be 0.48 mm and 0 since nothing was found in the wide excision specimen. Just to make sure his student knew the degree of surgery was justified, he told me that we still had to be paranoid about this melanoma, that it could come back. Then he said,"Now, if you ask me do I think it has spread, I would say 'No.' but I do think we will never know the depth of this lesion, so I would class it as more advanced class of tumor than your oncologist did." OK, that's going to make me feel good and confident. Needless to say, I found this appointment very disappointing.

     In an unrelated experience, I wanted to write another tale of a medical interaction. Amazingly, my husband had a nevus removed from the bottom of his foot about a week after I had my melanoma surgery. A dermatologist in my clinic had been watching this lesion on the bottom of hubby's foot for about 6 months and just could not live with it there anymore. He was going to do a very shallow biopsy of it, but knowing how my depth was disturbed by the shave biopsy, my husband insisted that at least 1 mm of tissue be removed in the biopsy. The dermatologist said he was uncomfortable about doing this and so wanted to send my husband to a surgeon. He called me into the exam room to explain this to both my husband and me at the same time. But then he began speaking to me about my amelanotic melanoma. He related that he made the same "mistake" that my dermatologist made and shave biopsied an amelanotic melanoma on a young woman. He felt bad about this, but then he said: "But it really didn't matter, because her melanoma had already metastasized and she died of a brain met." Yes, he said that to me and I was still wearing the big bandage on my arm from having my melanoma removed. This was an example of the doctor talking with the doctor and his being unable to view me as a patient. He was in truth not very sensitive to the situation. I told this story to my water aerobic lady buddies, and they thought it was terrible. They wanted to know his name, but I refused to give it to them, because this dermatologitst was a good doctor. He was just having trouble telling between the patient and the doctor.