My efforts to quit vaping came to the do-or-die phase at a pretty bad time. Basically, right when Clancy was resigning. That was leaving me in a pretty bad place because it was high-stress and I had no coping mechanism. It wasn’t through sheer grit that I didn’t turn to vaping, but rather where I was in the Welbutrin cycle. Long story short, I could vape all I wanted, but my nicotine receptors were scrambled and it wouldn’t do any good. I still vaped, but the whole puffing-to-no-effect was causing its own anxiety. So I basically had to make the decision whether to stop taking the Welbutrin or stop vaping. I just couldn’t keep doing both.

I decided to stop vaping. The first thing I did was order a Nintendo Wii U. Back before I smoked, playing basketball outside was the way that I found my zen and organized my thoughts. Due to the peculiarities of the house, I couldn’t set up a hoop here. Nor was there space for my backup plan, a pool table. But I had been circling the Wii for a while because it has some indoor activity stuff that could serve the same purpose.

Until I started taking it again, I’d forgotten one of the primary effects of Welburtin is that it reduces the need for sleep. I need about six hours a night usually and Welbutrin makes it so that I have trouble even getting that much. It’s an effect that subsides with time, but it takes a while. In this case, it leaves me with ever-more time to be awake and not vaping. At a time when I desperately want time to pass to that I can get over the hump, there are suddenly more hours in the day.

It was, it turned out, remarkably successful. Instead of vaping, I’d play one of the games from the Sports Resort package. I ended up doing a lot of it, in fact. So much so that with each progressive day, my muscles were more and more tired. Not in a bad way, though! I could just feel it. On the fourth day, the Wii Fit package arrived. For those who don’t know, the Wii Fit is the exercise program. It’s more physically intensive than sports.

I got the fit to help distract me from the vaping. Which it did. Just not at all in the way that I had imagined.

I had been playing Wii Fit for about 90 minutes when I jerked my back something fierce. It wasn’t too bad at first, but it kept getting worse. And worse. And worse.

When your back hurts, your body generally compensates by using other muscles. Which is all very well and good… unless all of your other muscles are three days into utter exhaustion. Then your legs and arms simply don’t have the energy to compensate. It then throws more burden to the back, which then spasms. And round and round it goes.

The second day was pure agony. I cannot remember the last time I felt so much pain. Clancy could not remember ever seeing me in that much pain. I was in a place where I was slouched on the sofa and I literally could not move enough to either sit up on it or lay down on it. Clancy tried to move my legs for me and that was even worse. And with each spasm, the muscles would tighten more, which lead to more spasms and more muscle tightening in a really vicious cycle.

Among the few things that helped was showering. So once I was able to get up and move around – which did happen eventually – I went into the shower. Clancy literally had to help me get dressed afterwards.

Now, the Himmelreich-Truman household is actually a drug den. Clancy gets medications for various things and she fills them whether she has to use them or not. The same is true of me. The Welbutrin I’d been taken was prescribed in 2010. So when something like this happens, we have options. This was especially true since the medicine cabinet was thrown at her when she busted her kneecap. She asked if I wanted to take some muscle relaxers. I asked if they were addictive and she replied that they weren’t but that she never took them because they made her feel loopy and dull.

I said that I wanted all of the muscle relaxers in the universe.

I came close to actually taking the Vicodin, which is addictive. I was in that much pain. It didn’t quite reach that point. Things did gradually start getting better, slowly. It was two steps forward and one step back. I put myself and my daughter at risk trying to drive her to preschool when my back was not in good enough shape that I could sit freely in the car seat (I basically used one of my two arms to prop me up). That was a step back. But showering twice a day and taking the drugs would represent a couple steps forward.

It’s been almost a week now since that happened. The nice Wii that I bought has barely seen any use as new games that I ordered before the injury started arriving. The biggest lag has really been that I have nowhere to distribute the weight, too. My arms are better, but my legs are still really sore. My back is almost better, though the legs keep pushing weight in that direction. The biggest bullet dodged was that throughout this entire thing, I never needed to use the can for serious business. That felt like a ticking timebomb about to go off because pushing excrement through requires pushing some of the same muscles that were spasming. Somehow – probably related to the diet – I went four days or so without needing to go.

I eventually had to stop taking the Welbutrin because I wanted to keep waking hours to as much of a minimum as I could. And vaping wasn’t really on my mind. Which turned out to be a real upshot because the big thing that I was trying not to do was really kept out of a mind that was crowded with physical pain and preoccupation.It has really only started to hit me the last couple of days that I have been well enough to go back to it (but not wanting to). At this point, it’s a longer trip to go back and restart the habit than it is to plow forward.

One last side effect of all of this is that it has forced Lain into greater independence. As a matter of routine, I carry her to the car and from the car into the church for preschool. But since I couldn’t, I forced her to walk. She, in turn, has taken to asserting her independence more and more. When Clancy busted her kneecap, Lain was really quite scared of her. She’s a little bit older now, though, and seems to have adapted to my malady well. She was even fetching my cane while I was needing it.

As things presently stand, my back is in pretty good shape but my legs are as sore as they’ve been in a long time.

So, none of this has gone as I had planned, but it does seem to have gotten me over the hump. It has even helped with the diet as going to the kitchen and getting something to eat was suddenly an ordeal. My calorie intake dropped from 1800 to 1500 or so and I was in too much pain to be hungry.

There is no grand lesson here, other than that if you have an MD wife telling you to take it easy with the active video games, you should probably listen to her.

Unless you’re desperate to kick a habit.

Source

‘Charging Bull’ sculptor says ‘Fearless Girl’ distorts his art. He’s fighting back. – The Washington Post

The project is about “girl power,” she said, a message to corporate boards on Wall Street with a dearth of women members “that we are here, that we are heard, that we are permanent.”

They also drew inspiration from Di Modica’s surprise installment, albeit with a permit, and dropped her off in the middle of the night. The girl quickly became an online sensation, earning praise from Chelsea Clinton and actress Jessica Chastain and drawing its own swarm of women and girls who felt inspired.

The plaque at the feet of “Fearless Girl” reads: “Know the power of women in leadership. SHE makes a difference.”

This overt reference to State Street’s SHE Index could contribute to Di Modica insistence that “Fearless Girl” is nothing more than marketing trickery orchestrated by the firm’s New York advertising partner, McCann.

“That is not a symbol!” the 76-year-old Sicilian immigrant told the New York Post and Market Watch in March.

New York City’s relationship with its bread and butter industry is really quite fascinating. It’s analogous in some ways to mining towns’ relationship with the mining industries that often don’t treat them well.

Of course, Wall Street does actually treat New York reasonably well, all things considered. Certainly better than Anaconda ever treated Montana, or Shell treats Louisiana. And in both places, when the chips are down, they know who butters their bread.

It was a really fascinating thing after Deepwater Horizon, when folks everywhere seemed to be saying that we must halt offshore drilling. Everywhere except Louisiana, which had paid the heftiest price for the disaster. To this day they have not forgiven BP. But still, drill baby drill.

They need it. The joy of being as relatively privileged as New York City is that they don’t. They can be wealthy and sanctimoniously resentful of its source.

Facebook failed to remove sexualised images of children – BBC News

The National Society for the Prevention of Cruelty to Children (NSPCC) also voiced concern.

“Facebook’s failure to remove illegal content from its website is appalling and violates the agreements they have in place to protect children,” said a spokeswoman.

“It also raises the question of what content they consider to be inappropriate and dangerous to children.”

The BBC first asked Facebook for an interview about its moderation system in late-2015, and repeated the request following this follow-up investigation.

The social network’s director of policy Simon Milner agreed to be interviewed last week, on condition the BBC provided examples of the material that it had reported, but had not been removed by moderators.

The BBC did so, but was reported to the UK’s National Crime Agency as a consequence.

This story is almost comical.

I can't stop watching this gif. Watch everyone avoid Oklahoma for as long as possible pic.twitter.com/kbFPb9ZHe6

— Comfortably Smug (@ComfortablySmug) March 31, 2017

The inflection point occurred a couple months ago.

First, just a bit of background. My wife works at two hospitals, Stone County Hospital and Mills County Medical Center. She was hired primarily to work at Mills, but because there were three people doing a job that could (theoretically) be done by two, that meant that she had some hours to make up working at Stone. Also, when I refer to “hours” that’s not “hours worked” but rather “coverage hours” which means hours that the service is taking in patients. So if she is working 16 hours for patients that come in within a 12 hour span, she gets 12 hours. Also, she is expected to take phone consultation call on the evenings of the days that she works, so if she’s working 12 hours, she also has another 12 of phone consultation (or 14 if the shift is 10).

One of the three doctors at Mills County Medical Center resigned, which left Clancy and one colleague having to do the entire job. This is possible, but it also leaves no room for somebody getting sick or going on vacation. The problem for Clancy was that in addition to her duties at Mills, they were still giving her hours at Stone. This was in addition to the above-mentioned phone consultation and one night a week of full call (where she is expected to go in). So Clancy asked the person responsible for scheduling if she really needed to be working those hours at Stone.

In response, she got a really terse, somewhat condescending letter from a higher up outlining what he thought the hours were. She was expected to work 144 hours per four-week period (that’s 36 hours a week, the remaining four being sick/vacation/holiday), and she had 12 shifts of 8 hours at Mills and so needed to work three shifts of 12 hours at Stone to make 144. He went on to explain about how people who want their job have to work a minimum number of hours yadda yadda.

The problem was that his math was wrong. The shifts at Mills were 10 hours instead of 8 and there were 14 of them instead of 12. And on top of that, they were giving her four days at Stone rather than three. The result was 140 hours at Mills, plus another 48 at Stone, for a total of 188 hours that wasn’t including phone consultation or on-call. The latter of which being a particular sticking point because most doctors don’t have to do it because they can’t deliver babies. They did a whole thing of “Do you really want to be the kind of employee who is sitting there counting hours?” but at the end of the day her argument was pretty bulletproof.

So they stopped scheduling her at Stone. However, to “make up for it” they expanded the coverage hours at Mills from 10 to 12. That meant that she was back at 168 hours, plus phone consultation plus obstetrical call with no vacation, sick time, or holidays. Clancy agreed to it because she mostly just wanted to (a) stop working at Stone and (b) stop having 10 day work stretches.

Unfortunately, it simply proved to be too much for her. She got several consecutive weeks of above-average patient loads. On top of all that, her employer worked out something with another service that Clancy and her colleague would start taking some of their patients, too. Clancy has never been the fastest worker, and she just got overwhelmed with it. Last month we racked up $850 a month in hotel expenses because she would work until she was too tired to drive. Attempts on her part to streamline her efficiency were thwarted by the constant level of reaction that she was in. Being away from her daughter and living in hotels ate away at her, and she was still getting yelled at by her superiors for not having her paperwork done in a timely manner.

So this week, she submitted her resignation. Her contract is up for renewal in June and she will stay on until then. We’re not sure what comes after this. We probably won’t be relocating for a new job immediately. She will likely do some temp work to keep us afloat and work on trying to become more efficient at her next job, to work smarter instead of so long and so hard. And beyond that, to take the time to find the right job, instead of doing what we’ve been doing, which is kind of falling into the jobs she’s taken.

It is unlikely we will be staying in the area for more than a year or two. I’m going to miss some of the conveniences of living so close to the city, and I’m really going to miss this house. But fortunately we won’t have to uproot in the immediate future.

One of my New Years resolutions was tending to my health. Most particularly the vaping, the weight, and soft drink consumption. These are all interrelated. The vaping is not a health problem in itself (I believe), but it coincides with my soft drink consumption because I do them both together, and with weight insofar as vaping provides relief to overeating. This post is about the weight thing.

I had tried to vaguely “eat less” and eat more of the high-fiber cereal in the morning, but it really wasn’t working. What I decided instead was simply to start counting calories and see where I stood. I never got an accurate measure, however, due to the Hawthorn Effect. Once I knew it was being counted, I modified my behavior almost immediately. According to the calculator I basically need to stay under 2500 calories a day, but every day but one (out of ten or so) I’ve come in under 2000. Despite the fact that my rules explicitly state I can eat whatever I want.

What I’ve learned most immediately is when I was mindlessly eating. Like I’d get a piece of cheese of Lain and then I’d get one for myself since I was right there. I also managed to, without much effort, figure out where I could scale back when preparing a sandwich for example. I also found out which foods are good at filling me up without taking up much in the way of calories. That last one could backfire because eggs are one of the good filler foods, but progress is progress.

What I find most noteworthy about this is how consistent I’ve been. In all but a couple of days, I’ve eaten between 1800 and 1900 calories. That’s a pretty range, made more interesting by the fact that I had no target in that range. To the extent that I had a goal, it was going to be 2500. Now I am for below 2000 – but no rules – and I not getting all the way up to 1990 or anything. My body apparently needs 1800-1900 to function and to stave off hunger.

It actually makes me wonder if my pre-monitoring calculations were similarly reliable. If I was eating between 2800-3000 calories, somewhat reliably, day-after-day.

I have been listening to the works of Harlan Coben lately. On the whole, he’s a great storyteller and his novels are very gripping. My main complaint is that at the end of each standalone novel, he has one last twist that makes things worse rather than better. In two of the three cases, it’s a left-field “you were never going to guess that” sort of thing, which is fine… but one of the reasons you never would have guessed it is that the behavior of the characters prior to the revelation makes less rather than more sense. In one case, it turns out throughout the entire novel the narrator had very pertinent information to the case never affected his thinking throughout. In all three cases, the story would have been better if they’d gone with the penultimate theory of crime (or equivalent).

For Linky Friday, I had an item about the c-section rate and whether it may promote evolution towards big heads. In the comments, Kristin Devine linked to this article, about c-section rates:

Experts say that even total C-section rates—which include cesareans for all births, not just the low-risk ones we focused on—should rarely be high. “Once cesarean rates get well above the 20s and into the 30s, there’s probably a lot of non-medically indicated cesareans being done,” says Aaron B. Caughey, M.D., chair of the Department of Obstetrics and Gynecology at Oregon Health & Science University School of Medicine in Portland and a lead author of the new ACOG/SMFM recommendations. “That’s not good medicine,” he says.

When asked to explain their high C-section rates, hospitals offered several responses.

Mark Rabson, corporate director of public affairs at Jersey City Medical Center, described how his hospital, which serves “a diverse metropolitan area with many socio-economic issues,” was working to lower C-section rates by, for example, reviewing the care of all providers whose cesarean rates are above 30 percent and offering them assistance in how they manage patients during labor. In addition, he says the hospital is now using midwives, healthcare professionals trained to avoid intervening in childbirth unless medically necessary, and people fluent in multiple languages to educate patients about cesareans.

Patricia Villa, a spokeswoman for Hialeah Hospital, told us “while there are many factors that impact a woman’s decision to have a cesarean section, we are focused on driving improvement in this area.” She also noted that the hospital had been recognized by the March of Dimes for it’s efforts to prevent elective early deliveries before 39 weeks.

Most people know that hospitals and obstetricians have incentives towards c-sections, but it’s hard to fully appreciate just how many incentives there are unless you see it at work (or, like me, hear regular testimony). The fact that the hospitals get more money is only a part of the equation. The time physicians get back isn’t just for playing golf. When Clancy was in Arapaho, she was regularly faced with one of two options. She could hover over a mother all night, extracting all sorts of costly resources from the hospital along the way. She would be staying there, not seeing her daughter or her husband and not getting much goodsleep. She wouldn’t be generating any other revenue while there because she has to be on stand-by. If she delivered the baby before 6am, she would then finish her paperwork, get maybe an hour of rest, and spend the next day seeing clinic patients. If it is after 6am, then she gets the morning off. Which allows her to get some sleep, but forces patients to reschedule and means less revenue for the hospital/clinic. Alternately, she could reach for the scalpel at 8pm be done with everything before 9, come home, get rest, see all of her patients the next day. And, if she cares, make more money for the hospital and possibly herself (through bonus structures) or at least have better efficiency numbers when it came time for the performance review.

My wife is the type of person to hold the line. I’m frankly not sure that I wouldn’t find some sort of way to rationalize interventions.

But while people know about that aspect of it, and probably know that a lot of women pressure their obstetricians for c-sections, that’s really only a part of the equation. The other part involves decisions that the OB makes well prior to the c-section decision. Intervention begets intervention. If a woman gets an appointment for induced labor, a future c-section becomes more likely. If she gets an epidural, a c-section becomes more likely. If labor is sped along through other interventions, c-sections become more likely. Why? Well, as best as I can figure, the more that a hospital intervenes, the less control the body has over the process. So even if two physicians have the exact same philosophy towards c-sections specifically, their philosophy on earlier interventions may lead to different c-section rates. And a woman’s chances of getting a c-section may depend not just on the obstetrician or the hospital, but the specific anesthesiologist on duty and how aggressive their philosophy is.

In the map on Kristin’s article, you notice that a lot of rural states have lower c-section rates. That’s at least part of why. Clancy’s employer in Arapaho didn’t even offer epidurals. The less resources, the less earlier intervention. The less earlier intervention, the less likely a c-section is to become necessary in the first place. My wife’s c-section rate isn’t just low because she views it as the Option of Last Resort, but because she’s not an interventionist generally (in obstetrics and elsewhere).

So it’s not just a question of whether a c-section is medically necessary, but also whether it becomes medically necessary along the way. Both of these things are going to depend on a lot of things like obstetrician philosophy, hospital policy, resources, other personnel, and (as important as anything else) patient philosophy. Whether they want an epidural has a cultural context, and that’s going to vary from place to place. Whether a woman will be the only person she knows that had a c-section, or whether she’s been told that’s the way to go. Whether she lives in a place where people read Mother Jones, or Newsweek.

Right now we live in a culture where, in addition to all sorts of other incentives, c-sections are normal and giving birth on hands and knees or underwater is considered weird and unnatural. Because intervention begets intervention (both psychologically and medically), and our health care system is an interventionist one from top to bottom, I am skeptical that we’re going to see change any time soon.