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I Shed a Tear (orig. posted Memorial Day, 2010)


I originally posted this on Memorial Day, 2010, but the sentiment is the same. As you head out to the beach, the barbecue or the ballgame today, please take a moment to remember why you have this particular Monday off from school or work.

I awoke this morning to thoughts of old friends who left us too soon. It’s not an unusual occurrence; most mornings I wake thinking of the same men. When they died, they did not give in to fear; cowardice was not these men’s forte. Some died in battle, some preparing for battle. Two very good friends of mine died not in battle, but the wounds they sustained in defense of liberty hastened their untimely departure from our world. One man was known simply as Tank. He was a large man, but in his later years his body had been ravaged by the effects of two bullet wounds and prolonged exposure to Agent Orange during his two tours of duty in Vietnam. Today, I celebrate not only Memorial Day but the tenth anniversary of his passing. Although Tank never spoke of it, he was awarded a Bronze Star during his second tour. It wasn’t until his funeral that I learned how as a 23 year old platoon sergeant he ran back onto a hot LZ, taking a bullet in the back and one in the shoulder, in order to pull one of his men to the relative safety of a tree line. But anyone who knew the man wasn’t surprised to hear of his courage under fire.

This morning, as I thought of him, I shed a tear.

The other day, I watched my town’s annual Memorial Day parade. In addition to the Korean War and Vietnam vets, a detachment from the local Marine Corps reserve unit marched. As I looked at their eager young faces, I realized that most of those kids weren’t born when I earned my EGA in 1983. In fact, most of them hadn’t been born when I mustered out. Realizing that most of these young men will be shipped to Iraq or Afghanistan, I reflected on my own service. I joined to fight Communism, and like most of the world, I rejoiced when the Berlin War crashed to the ground. I truly thought my service had proven, in some small way, invaluable to the defense of the American way of life. Yet here I was, watching a new generation of Marines preparing to fight a new enemy. Had my service not been as valuable as I once thought? Had the men I had known during my service, men who had fought and died in battles around the world – had they died in vain? I decided that no, our service – their service – had been as important in our time as these brave young men’s service is today. And then I realized that none of those young men will return from their combat tours the same. Even if not scarred on the outside, even if they survive to return home physically intact, they will carry the memories of what they see and feel and endure for the rest of their lives.

And as I watched, I shed a tear.

Last night I watched the National Memorial Day Concert, broadcast from the National Mall on PBS. I listened as Gary Sinise and Dennis Haysbert recounted the final moments of Charlie Johnson’s life. I watched as a new generation of war widows were celebrated. I enjoyed the stylings of Brad Paisley. Like plenty of others, I rose to attention and sang the Marine Corps hymn during the Salute to the Services, and I rose to attention and sang again during “America the Beautiful.”

But many times during the concert, I stopped to shed a tear.

And I wondered, as I prepared to try and sleep, will anyone awake on Tuesday and remember the sacrifices of the men who have fought and died to preserve the United States? It’s terrific that we have a day set aside to pay tribute to those men. And I don’t mind that we celebrate by doing uniquely American things – backyard barbecues, trips to the beach, baseball games. But I wondered, when Tuesday comes will my fellow countrymen remember those who ensured that the backyard barbecues could continue?

A little earlier today, I went to the neighborhood bodega. It was a routine trip to pick up a few items needed for my own backyard barbecue. Like many veterans, I have a “Pride Hat.” You may have seen one perched on a veteran’s head – a baseball cap on which are pinned his campaign ribbons. Mine is nearing retirement. It’s 14 years of service are evidenced by its faded color and the only thing keeping it together are years of starch used to block it. As a result, I only wear it on special occasions. Today being one of those occasions, I wore it on my walk to the bodega. On my return trip, a neighborhood kid – maybe 6 or 7 years old – stopped me and said, “Were you really in the Army?” I smiled and said, no, I am a Marine and we’re better than the Army. The little boy sat on his bike for a minute, seeming to take in this bit of information. The he stood, and said “Thank you” before pedaling off down the street.

I shed a tear. In fact, I’m still shedding a few as write this. Because I have my answer. For as long as children like this can find my service honorable, they will keep the flame of liberty alive. In so doing, the most important thing we can do as Americans is to remember and honor the sacrifices that so many brave men have and  will endure. We will continue to live as Americans, preserving our republic as the beacon of freedom and liberty for the rest of the world.

Posted by  |  May 30, 2011 | Categories: Politics | Tags: , , , , | Leave a comment

Why is Everyone Afraid of the Debt Ceiling?


One of the things we keep hearing from “establishment” politicians, economists and others is that the US entered into the Great Abyss yesterday afternoon. “The sky is falling” they cry. “We’re doomed” they yell.

This guy is broke - and so are you!

You see, the United States of America just crossed the Rubicon. The debt ceiling – the amount of debt Congress authorizes the Treasury to accumulate – has been reached. The great fear is that the US government is about to default on our public debt, sending the world into an economic vortex never before witnessed. Every talking head and government official in DC is warning against not raising the debt ceiling. “We’ve never defaulted on our debt” is the common cry of alarm.

I would certainly be alarmed at this outcry, except for one thing. It isn’t true. Not a single word of it. In fact, the nation has defaulted on the debt at least twice in our history. The first was in 1790, when we couldn’t service the debt we accrued during the Revolutionary War, among other things. The second was in 1933.

In 1790, the Treasury realized it could not possibly repay the outstanding loans the Federal government assumed after the ratification of the Constitution. The solution was to unilaterally rewrite the terms of those loans, reducing the interest owed and deferring payments for ten years.

The scenario most applicable to today is the one enacted by FDR in 1933. The government, faced with a debt it could not repay unless taxes were raised to incomprehensible levels and wanting to inject some life (i.e, capital) into a lackluster economy, devalued the dollar by more than 40%. The problem was that US bonds were issued in gold: you bought x amount of bonds in dollars and in return you received y  amount of gold when the bond matured. The US didn’t own enough gold to cover the debt. The solution was Executive Order 6102, later codified as the Gold Reserve Act of 1934. It essentially confiscated all of the private gold holdings in the US (private citizens were allowed to have 5 troy ounces in their possession; or about $7500 worth in today’s standards).

The exact opposite of what we’ve been told by economists and politicians of all stripes happened: rather than market chaos and depression, the economy stabilized. Freed of the uncertainty spawned from over-indebtedness, the business community actually began expanding again. Yes, the Great Depression was so deep that it took additional government spending to make up for the slack in employment. But contrary to popular myth, it wasn’t the massive infusion of government capital with the outbreak of WWII that jolted the US to full productivity. By 1939, the nation’s economy was growing at 1928 levels again and by the end of 1940 had grown private sector employment to higher numbers than at the outset of the Great Depression. In fact, all of that debt from 1941-1945 precipitated a debt crisis in 1946 comparable to the one we’re now facing. Oh, and Congress took the appropriate actions then, too: they enacted a debt reduction plan that was adhered to by Presidents of both parties until LBJ’s “Great Society” spending in 1967.

Simply put: the US has defaulted on debt obligations before and the world went on as always. Look around you: the debt limit has passed, yet everything continues as on Monday. The real threat is that we continue to spend as profligately as a drunk sailor without any plan to tackle the debt. We can argue about the means to do so. We can inflate it away, as Russia, Argentina, Brazil – and the US in 1933 – did; we can unilaterally reorganize bond terms, as in 1790. We can reserve a greater share of federal revenues for debt service, as in 1946. We can even place tax increases and restructuring on the table. But scaring the citizenry about the implications of failing to to raise the debt ceiling is ludicrous, when raising the the ceiling is the most irresponsible thing the politicians now in Washington can do.

Posted by  |  May 17, 2011 | Categories: Economics, Politics | Tags: , , , , , , | Leave a comment

The Scarlet Knight to the Rescue?


The GOP is finally starting to get it’s act together. Some of the “headliners” are throwing their hats in the ring for the upcoming primaries. Over the past week, Newt Gingrich and Ron Paul have officially launched campaigns. They join Herman Cain, Tim Pawlenty and Rick Santorum as officially declared candidates. By  this evening we’ll know if Mike Huckabee is running and by the end of the month, we’ll have Donald Trump’s decision. Mitt Romney hasn’t officially declared yet, but he certainly acts as though he’s in the race. Then there are those who are playing coy and may yet run, such as Sarah Palin, Michelle Bachmann, Jon Huntsman and Buddy Roemer.

Color most rank-and-file Republicans unimpressed by their options. Each of the above carries significant baggage. The staunchest conservatives, such as Palin, Bachmann and Santorum, have negative ratings among the general electorate as high – or higher – than their positives and are generally considered “unelectable.” Romney and Gingrich are know commodities but known for the wrong reasons, namely, they change positions so often they’re perceived as standing for whatever will get them elected. Pawlenty and Huckabee are seen by many Republicans as not being conservative enough. Paul is a libertarian at heart; his stances on drug and foreign policy leave many Republicans cold. Everyone else in the race is a virtual unknown – except for Trump, who’s considered so Loony even Bugs Bunny wouldn’t vote for him.

So, the Republican base is still casting about for their dream candidate: someone who embodies conservative principles, wins in liberal regions and has the national name recognition needed if entering a national race. The names most often floated in conservative circles are Chris Christie and Mitch Daniels, governors of New Jersey and Indiana respectively, and Marco Rubio and Col. Allen West, Senator and Representative from Florida respectively. West would be a long-shot; while he meets the first two criteria, he doesn’t have national name recognition.

Of the remaining three, the rank-and-file and power brokers may be coalescing around one potential candidate in particular: Christie. Why Christie? He’s been on the national stage and fought many of the battles that others are now wading into. Public employee unions, school reform, budget reform; check, done all that. Additionally, his blunt speaking style and deft humor have drawn favorable comparisons to another Republican icon, Ronald Reagan. And like Reagan, regardless of where you align politically, the man is genuinely likable – the kind of guy the average Joe could picture himself having a beer with after a long day at work.

We’ll soon find out if the rubber is meeting the road here. A delegation of Iowa donors is coming to New Jersey at the end of the month to meet with Christie, presumably to persuade the New Jersey governor to enter the primary campaign. This is unique in recent political memory. Where once the primaries were mere formalities and the actual candidate was selected during the convention, that hasn’t been the case in a couple of generations. This could be the ultimate play for Christie, as well. He’s been adamant about not running for President, despite numerous speaking engagements around the country (including a memorable one in which he lambasted politicians for refusing to acknowledge the need to cut entitlement spending). But if he jumps in at the behest of party and country, then abandoning his first term could actually be cast as a positive: I didn’t want to, but was convinced the country needed me – and I can best serve my state by serving my country. Already, the establishment Republicans are lashing out at Christie, as evidenced by this article I came across. They know if he is in the race, then their chances are immediately dwarfed by a Tea Party darling.

Will Christie answer the siren song sung by the Iowans? Time will tell. And this story won’t be over before the convention, especially if the current field continues to uninspirationally march through the primaries and caucuses of 2012.

Posted by  |  May 14, 2011 | Categories: Politics | Tags: , , , , , , | Leave a comment

Crohn’s Disease: Know your symptoms


As a long time Crohn’s patient, I am often sought out for advice on handling the disease by newly diagnosed patients and their families. And while awareness of Crohn’s is much greater than it was twenty years ago, most people really don’t understand much about the disease or the way it impacts a patient’s life. So I’ve decided to write a four-part document that hopefully explains to new Crohn’s patients and the general public what to expect and how to cope. These posts cover the medical symptoms tips for patients living with the disease and tips for people who know someone living with Crohn’s.

In this post, I’ll cover symptoms.

Crohn’s Disease is, without a doubt, one of the more debilitating medical conditions around right now. For those unfamiliar with it, Crohn’s is an auto-immune disorder that affects the digestive tract. Symptoms include weight loss, frequent (and often uncontrollable) bowel movements, diarrhea, nausea, bloating, intestinal discomfort and pain (which can mimic appendicitis) and fatigue. Symptoms also include the typical aches, pains and fevers usually associated with the flu. Because it is an auto-immune disease, people with Crohn’s often find themselves later developing other auto-immune disorders – for instance, I have rheumatoid arthritis and developed hay fever about 7 years ago. I’ve met other patients who developed even more severe types of auto-immune disorders, such as lupus.

Very little is really understood about Crohn’s. Nobody knows why it occurs – there seems to be a genetic factor (an extra gene is found in about 90% of Crohn’s patients), but nothing has been completely ruled out. Ethnicity, diet and activities all may be related – or maybe not. Likewise, there isn’t a cure. What has advanced since I was first diagnosed 20 years ago is understanding how the disease functions and causes other functions of the body to stop. That has led to better treatment options and generally, a better quality of life for those of us affected. Once, the disease was thought more prevalent in women than men, but the rates of affliction, once adjusted for populations, are actually about the same. Almost every ethnic group is affected, although peoples of Asian and African descent have lower incidence rates than Caucasians.

Odds are if you’re a new patient, then you are in the 16-25 year old range: this is when about 80% of new cases are first diagnosed. (I was 6 weeks shy of my 26th birthday when first diagnosed). That being said, new cases are diagnosed in every age group. Since I’ve no personal experience with pediatric Crohn’s, I won’t pretend to offer advice for anyone looking for information about Crohn’s and young children.

Symptomatically, Crohn’s is similar to Ulcerative Colitis. The similarities often confuse a person only cursorily aware of both conditions, which often leads to them confusing the two. I’ve had past co-workers and current friends often assume that because Crohn’s and UC are related and so similar symptomatically, that they are the same. But when I’ve had severe flare-ups of the disease, they are often shocked when they come visit and find me hooked up to dozens of tubes and wires, all needed to keep me alive and stable.

The symptoms are where the similarities end. Both cause ulcerations (inflamed areas) to appear in the colon, but the ones from Crohn’s disease burrow deeper into the tissue and can appear anywhere in the digestive tract. In my particular case, the upper palate, gums, a section of the small intestine called the duodenum and another called the ileum are affected in addition to two spots in my large intestine and another in my colon. Another big difference: in severe cases of colitis, a type of surgery called an ostomy can be performed, curing the disease (although at a high price). For some severe cases of Crohn’s usually where the tissue is badly damaged), surgery is also done – but removing the affected areas doesn’t cure the disease. It will reappear in another area of the GI tract.

Since Crohn’s patients generally have difficulty digesting food, it isn’t uncommon to find them malnourished even when relatively symptom free (by the way, those of us in the Crohn’s community generally refer to these periods as being in remission). Unfortunately, the type of malnutrition can vary from patient to patient. The reason is because so many different parts of the digestive tract are affected and each part is responsible for processing different nutrients. Regardless, the malnutrition is a major contributor to all types of related problems. Since each part of the body relies on the digestive system to function properly, people with Crohn’s often suffer from other system breakdowns. Their hair, skin and nails can become dry and brittle; they may suffer anemia, dehydration, high blood pressure, osteoporosis – the list includes virtually every other organ in the body. Add in the side-effects from long-term use of some of the more common medications used to treat Crohn’s, and the results can be even more system breakdowns. For example, the use of Mesalamine drugs can lead to excessive (and particularly foul smelling gas). As for myself, repeated exposure to very high doses of corticosteroids has resulted in cataracts and osteopenia (the precursor to osteoporosis). The calcium deficiency from my Crohn’s along a Crohn’s inflammation in my upper palate and the drug cocktail I’m on, resulted in my losing all of my teeth before I was 30 (although, my dentures look damn good!).

Posted by  |  May 4, 2011 | Categories: Health | Tags: , , , , | Leave a comment

Crohn’s Disease: Living with a Patient


As a long time Crohn’s patient, I am often sought out for advice on handling the disease by newly diagnosed patients and their families. And while awareness of Crohn’s is much greater than it was twenty years ago, most people really don’t understand much about the disease or the way it impacts a patient’s life. So I’ve decided to write a four-part document that hopefully explains to new Crohn’s patients and the general public what to expect and how to cope. These posts cover the medical symptoms tips for patients living with the disease and tips for people who know someone living with Crohn’s.

So, you’ve just found out a friend or family member has Crohn’s Disease. You probably have a thousand questions swirling around your mind and no idea where to begin asking them. What do I do? Where do I go? Can I get it?

First, don’t worry about catching Crohn’s from someone who has it. While the origins of the disease are unknown, the one thing that is certain is that it isn’t communicable. Second, read the posts regarding symptoms and treatment to get an idea of what your loved one is experiencing – and what they’re likely to go through in the future.

One of the least understood aspects of Crohn’s Disease is the frequency and degree of pain that Crohn’s can inflict on those afflicted with the condition. I’ve compared it labor pains – and my wife has told she doesn’t think I’m far off. When flaring, the constant pain has a dual effect on patients: first, intense pain impairs anyone’s ability to think clearly. Second, the pain meds some doctors prescribe are narcotics which will cloud judgment even further. This relates to the first two things you can do for your Crohn’s patient.

You shouldn’t let them make important decisions alone. You won’t intrude in their personal business by simply asking, “Are you sure?” if you think they’re making a foolhardy choice. Chances are once they’ve achieved remission, they’ll thank you for dissuading them from buying the $5,000 TV. If you’re a close relative (such as wife, husband, mother, father, etc.) speak with their doctors often. If possible, go with your loved one for medical appointments. In this way, you can be an important resource for them, gathering information about treatment plan, medications, future tests and the like when they are at their most vulnerable. You can also gain peace of mind by being fully knowledgeable and participatory in their treatments.

Often, what Crohn’s patients need more than anything else are the simplest things. During a flare, they may not be hospitalized and can often appear “normal” to the casual observer. But they’ll experience extreme fatigue and intense pain when symptomatic and doing everyday tasks can take their toll. And since Crohn’s patients are susceptible to stress (even more so during a flare), the pressure of not being able to attend to those little things can compound an already difficult situation. Offering to pick up a meal or do the dry cleaning might take you an extra 5 minutes, but can relieve your friend of what may seem to them an impossible task.

Perhaps the simplest and easiest – yet one of the most important – things you can do for your friend is keep them in good spirits. Depression is common among people with Crohn’s. Stop to think about it for a moment: how would you respond if you were constantly in and out of hospitals, suffering through intense pain, having to run for a bathroom every ten minutes and getting poked and prodded by teams of doctors? A phone call; dropping by to say hi or simply sending the occasional “Hang in there” text message can do wonders.

It is also important to understand that even when all seems well, your friend may not feel 100% comfortable getting out and about as they once did. For a person with Crohn’s, one of our greatest fears is needing a restroom NOW and not being able to find one. You might want to go to the beach or to the park; they may not say so, but they’ll lack the confidence in their bowels to make such a trip feasible. It’s still important for them to get out of the house and socialize, though – think of an alternative they might enjoy. Shopping malls, movie theaters and other venues with easily accessible public toilets are all good.

There are also various references available for people who know someone with Crohn’s Disease. A great resource for families and friends is the Crohn’s & Colitis Foundation. They do tremendous work in assisting both Crohn’s patients and their support network. Another terrific resource is the Cleveland Clinic, one of the leading research centers in Crohn’s. Both organizations are non-profits; if you’re so inclined, they appreciate donations.

The important thing to remember is that your friend hasn’t changed. Yes, they now have a terrible illness – but the person inside is the same person they were the day before they were diagnosed. They still enjoy doing the same things, but they will need a little more reassurance, a little more compassion and a little more understanding going forward.

Posted by  |  May 4, 2011 | Categories: Politics | Tags: , , , , | Leave a comment

Crohn’s Disease: Coping


As a long time Crohn’s patient, I am often sought out for advice on handling the disease by newly diagnosed patients and their families. And while awareness of Crohn’s is much greater than it was twenty years ago, most people really don’t understand much about the disease or the way it impacts a patient’s life. So I’ve decided to write a four-part document that hopefully explains to new Crohn’s patients and the general public what to expect and how to cope. These posts cover the medical symptoms tips for patients living with the disease and tips for people who know someone living with Crohn’s.

In this post, I’ll cover what living with Crohn’s is like.

Once diagnosed with Crohn’s Disease, odds are your doctor gave you some version of “you’re going to need to make some changes.” They probably prescribed a bunch of new medications and told you that you’ll need to take them for the rest of your life. You were told that you’ll need to make some changes to what you eat and what you drink. Since the odds are you’re still young, you’re probably feeling as if life is essentially over. That’s normal, but as I and millions of other “Chronies” can tell you – life isn’t over. It just got more interesting. If you haven’t read through the posts on symptoms and treatments yet, take a few minutes and do so now. One of your best weapons in the fight against Crohn’s disease is education and this is good place to start. I also suggest going through the Crohn’s & Colitis Foundation’s website. It is an invaluable source for information.

Your first major change is that you and your doctors are about to become fast friends. Before my diagnosis, I didn’t have a regular doctor. I was a typical, healthy 25 year old and only went to see one if there was something really wrong – and it had to be really wrong before anyone could force me to step foot into a doctor’s office. The gastroenterologist who diagnosed me was as strange to me as an alien who dropped in from Mars. He was a nice enough guy, but I didn’t particularly like him and because of that, wasn’t sure I should how far I should trust him. So rule #1 about living with Crohn’s: find two doctors that you not only like but can absolutely trust with your life: a gastroenterologist (for your guts) and a general practitioner (for everything else). Because how you handle those relationships will go a long way in determining how well you live your life. In my case, I’ve had the same primary care physician for 10 years now and GI doctor for 8. The reason is not only are they very good doctors, but we have a great relationship. They know me by sight, including my medical history. How well? About three years ago, I had my left knee rebuilt and was in the hospital for the pre-op when my GI doctor was racing down the hall past my room. When she spotted me lying in bed, she put on the brakes, turned around and walked into my room – concerned I was having a flare. Then she made sure my chart mentioned my Crohn’s and that I’m allergic to tetracycline before continuing on to where she was headed. That type of relationship with your doctor is crucial to not only living with Crohn’s, but living well. Besides the peace of mind you get from that type of relationship, it has practical implications. When Cimzia was first approved for use, my GI doctor called me with the news and asked if I was interested in trying it. Had I waited for my scheduled appointment, I would have waited another four months before beginning treatment.

That brings up my next point: make certain you keep all of your medical appointments. Things come up that we never expect in our lives, but it is critical that seeing your doctor regularly. Even if you’re feeling well, your doctor may spot something and be able to put out the fire before it begins. Make certain you take all of your medications as prescribed. There’s a good chance some of them will need to be taken multiple times a day (mine do). A tip: nowadays, almost everyone carries a cell phone. And many of us carry a smartphone. A great way to remind yourself to take your meds is to set reminders on your phone. In many cases, you can synch those reminders with your computer, too.

It’s also important to have a good support network, other than the medical professionals. Friends and family are going to be important as you live with Crohn’s. Some of the people you consider friends won’t want to be bothered with helping out when you’re having a flare – it’s actually a fringe benefit to Crohn’s. You’ll find out who your real friends are and who was just a hanger on. Part of the reason is mental. Nobody may have told you this (although you might have suspected), but living with Crohn’s can have some very down moments. You need to mentally prepare yourself for frequent hospital stays and often feeling like – pardon the pun – crap. There are times when you will be so physically ill you can’t leave the house; having a friend or family member willing to run errands during those times is invaluable. Depressed feelings go hand-in-hand with so often being unable to do much more than run to the bathroom, with the frequent hospitalizations and being isolated. Having friends who are willing to drop by, make hospital visits and just generally keep your spirits up is more valuable than having a million dollars in the bank.

I also suggest finding a Crohn’s patient network, or if you’re ambitious starting one yourself. There are a lot of us Chronies out there – probably more than you imagined. Nobody has an exact count, but it’s estimated that as many as 43,000 people in the United States have Crohn’s. There are also on-line support groups available, such as the Crohn’s Disease Support Network, MD Junction and Daily Strength. Why join a support group? Because while having friends and family is important, it’s also important to be able to discuss how Crohn’s is affecting your life with other people who have experienced exactly what you’re going through. If you’re reading this, chances are you want to find out more from someone who’s been there and done that. Support groups offer that and more.

IF you’ve read this far, you are almost certainly wondering what in the world you did to deserve this. After all, all I’ve written about is that you can expect pain, hospital stays, frequent bathroom trips and finding people to talk to. None of that stuff is fun and you’re probably saying to yourself, “My life is OVER!” Well, now for the good news: your life is hardly over. You’ll need to make some changes, sure, but consider them course corrections. Having Crohn’s doesn’t preclude you from living a full, happy and productive life. If I’m not proof enough of that, Wikipedia has a list of some pretty famous people who also have Crohn’s Disease – and it includes athletes, actors, musicians, politicians and others. The steps I’ve outlined above are just preparatory to living the life you want. Here’s some common, everyday hints and tips for not only surviving but thriving with Crohn’s:

Work

While it’s true that some Crohn’s patients are permanently disabled, the vast majority of us work for a living. And most of our employers are glad to have us, even if it means having to make a few accommodations to allow us to work. The key is to make certain you let your employer know that you have Crohn’s Disease ahead of time. I obviously haven’t held the same job for the past 20 years (who has, nowadays?) and one of my keys to finding productive employment is to always let prospective employers know I have Crohn’s. I may have lost a few jobs because prospective employers didn’t want to bother with it, but I’ve always looked at it as their loss. Your co-workers will understand the reason you take a few extra bathroom breaks during the day, pop pills at odd times and are occasionally late arriving.

Eating Out

Eating out can pose a special challenge for Crohn’s patients. Rule #1 about eating out: avoid fast food. While McDonald’s, Taco Bell, Wendy’s and Burger King are cheap, quick and tasty dining alternatives they play havoc with our insides. They’re just as fast coming out as going in. Like everything related to our diets, you can’t necessarily rule them out forever. But it should be on your “last alternative” list. Rule #2: be proactive about asking how food is prepared and what ingredients are in a dish. I made the terrible mistake of not asking several weeks ago and paid for it for two days. Remember, it’s your health and your right to know what you’re eating. I’ve yet to find a restaurant that isn’t willing to tell me.

Along with eating out is drinking. Again, this is the “anything in moderation” meme. If your friends are going out to get hammered, volunteer to be the designated driver. If you’re having a beer after work with a couple of buddies, listen to your gut. If your symptomatic, it’s probably best to have a glass of water (or ginger ale) instead. If you’re otherwise healthy, one or two drinks is probably ok. But more than that and you will be asking for trouble. And if you’re drinking anything alcoholic, eat something – it helps slow the absorption of alcohol and your stomach will thank you. Trust me on this one – a hangover with Crohn’s is twice as bad as any you ever had without it.

Traveling

There might be no greater horror for a Chronie than being on the road and needing to find a bathroom – NOW – and not being able to find oneThis has happened to everyone with Crohn’s; you’re not alone in this experience. But there are a few tips that can reduce the chances of it happening. First, map your route and the public restrooms along the way. There are some great on-line resources for this, generally localized to your region. If you happen to have an iPhone or Blackberry, download the SitOrSquat app. It’s a terrific resource for finding a public toilet. (For the rest of us, you can text 368266 and get back a list of nearby bathrooms). Tip #2: check with your doctor if it’s ok to take an anti-diarrheal before heading out. If so, then go ahead and pop that Immodium® or Kaopectate®. Third, do your best to use a toilet before leaving.

Even doing all of this won’t prevent accidents from happening. They will, so it’s best to be prepared. I always carry an emergency pair of underwear in my briefcase, along with some baby wipes and one of those plastic bags you get from the grocery store. Most of my friends understand why my briefcase goes with me everywhere (even to the beach, although I don’t take it on the beach). Ladies, you can do the same with your purse.

Dating

Most of what I covered above applies to dating, as well. Your date will just need to be understanding if you need to excuse yourself from the table during dinner, or take a leave of absence during a movie. But one thing to note about Crohn’s is that stress can bring on symptoms – and dating can be a stressful event. As with work, let your date know ahead of time that you have Crohn’s. If they beg off or stand you up, well, then they definitely weren’t right for you, were they? Romantic situations can be difficult (after all, excusing yourself and running to the bathroom can ruin the mood), but you and your significant other will figure those out as you go along.

Starting a Family

One of the most important decisions a person ever makes is if and when to start a family. For a Crohn’s patient, the decision becomes even more difficult. I can’t tell you whether or not to have children, or when the time is right. I can only relate my personal experience and that I wouldn’t trade my three sons for all the tea in China. But things you definitely want to consider include the possibility of passing along Crohn’s (about 1 in 3 Cronies have a family member who suffers). You also need to take into account how well your Crohn’s is responding to treatment and how the additional stress of children may affect you. Finally, while all prospective patients need to take into account their financial situation, Crohn’s patients need to be especially mindful of the fact that as a result of their condition, they may face periods with reduced (or no) income.

Stress

Moderating your stress level is key to living well, either with Crohn’s or without. It’s just that for those of with Crohn’s, we need to pay a bit more attention to it than most people. If you perused that list of famed Cronies, then you’ll notice quite a few of them had stressful occupations. (Imagine the stress Dwight Eisenhower was under, first as the man tasked with defeating Hitler and later as President of the United States!). None of them could reach the pinnacles of their professions without learning to manager stress and the good news is you can, too. Whether it’s working out in a gym, running, prayer, meditation or something else, find it and practice it. For me, it’s a combination of prayer and working out. I work out at least three times a week and every morning starts off with a bible reading and prayer.

Outdoor Activities

If you’re anything like me, you probably enjoy being outdoors and doing things. And there’s absolutely no reason you can’t, even though you have Crohn’s. I played baseball until age and bad knees caught up to me, I’m still an avid bicyclist, I play golf and I still love taking hikes through the woods and spending time on the beach. If you enjoy the great outdoors, just follow the tips for traveling above and you should be fine. If you’re also into organized sports, most leagues are willing to grant you a “time-out” so you can use the restroom.

Ok, I think I covered most situations here. But if you have any other questions, feel free to drop me an email at rayrothfeldt@aol.com.

Posted by  |  May 4, 2011 | Categories: Health | Tags: , , , | Leave a comment

Crohn’s Disease: Treating the Symptoms


As a long time Crohn’s patient, I am often sought out for advice on handling the disease by newly diagnosed patients and their families. And while awareness of Crohn’s is much greater than it was twenty years ago, most people really don’t understand much about the disease or the way it impacts a patient’s life. So I’ve decided to write a four-part document that hopefully explains to new Crohn’s patients and the general public what to expect and how to cope. These posts cover the medical symptoms tips for patients living with the disease and tips for people who know someone living with Crohn’s.

In this post, I’ll cover some of the treatment options available and the improvements made since I was first diagnosed. But before deciding on a treatment or treatments, discuss all of these options with your doctor. You may want to read to read the section on symptoms before reading this post, so that you understand why certain treatments are used.

When I was first diagnosed in April 1991, there weren’t any truly effective treatments for Crohn’s Disease. The treatments were either drastic – an ostomy – or did their best to mask the symptoms . Medications included a form of sulfa, antibiotics, oral steroids and anti-diarrhea solutions. Since these medications rarely induced remission of the disease (that is, a significant reduction of symptoms), most of us with Crohn’s were hospitalized often. Between 1991 and 2000, I was hospitalized 18 times for Crohn’s or Crohn’s related symptoms. All told, I spent 318 days in a hospital bed during those ten years.

The principle reason treatments were so ineffective was that so little was understood about the disease or how it functions. Fortunately, great strides have been made over the past ten years. Thanks to the work of researchers, current treatments are much more effective. I’ll go through each of these.

Corticosteroids

Corticosteroids are artificial hormones often given to patients in during “flare-ups” (periods of extreme disease activity). During a flare, what happens is the tissue surrounding the disease inflames, causing the extreme pains for which Crohn’s is noted (I’ve joked that I know what labor pains must feel like – my wife actually agrees!). Corticosteroids such as Prednisone, Prednisolone and Deltasone work by reducing the inflammation. These drugs are artificial replacements for the corticosteroids generated by the human body, but are given in much higher doses than the body normally makes. I’ve received as much as 120mg of prednisone a day, or about 60x the body’s normal production. While they are as close to a miracle drug as any for ending flare-ups, they pose serious risks with extended or frequent use. The first is dependence; when receiving such massive doses the body stops producing its own. This is why they are usually prescribed for short periods and ramped down while prescribed. Prolonged use can also lead to cardiovascular disease, osteoarthritis and cataracts. Also, patients taking corticosteroids should note that weight gain and mood changes are common when taking them.

Sulfonamides

This type of medicine is used to help maintain remission. It’s been used since I was first diagnosed, but the delivery of the active ingredients in sulfonamides has improved greatly in that time – meaning lower and less frequent doses are needed for the same effect. The first medication I was prescribed was Sulfasalazine; I had to ingest three 600mg tablets 4 times a day. If you’re not interested in doing the math, I was taking 7200mg every day, without much positive effect. Today, I take 1200mg of Lialda daily. The most commonly prescribed sulfonamide for Crohn’s today is Asacol (or its generic equivalents, Mesalamine and 5-ASA ), usually at a 800mg dose three times daily. The side effects are relatively minor, such as excessive gas and bloating. In rare cases, it can exacerbate pre-existing heart and lung cases. And some studies link these drugs to reduced fertility in men.

Antibiotics

Everyone has bacteria lining their digestive tract. We actually need them to help with proper digestion. But during Crohn’s flare-ups, the bacterial populations literally explode. Nobody is quite sure why, or what the connection may be. Regardless, most gastroenterologists will prescribe one or more antibiotics during a flare-up. The most common is flagyl, given intravenously.

Anti-TNF medications

The first major advance was in understanding the role an antigen called tumor necrosis factor
 (or TNF) plays in Crohn’s and the use of anti-TNF drugs in fighting Crohn’s. TNF forms naturally within the body and is one of our immune system’s defense mechanisms against cancer. It works by inflaming the cells around the cancer cells, in essence choking them. Nobody is quite sure why Crohn’s patients suffer this type of inflammation, but studies in the mid and late 1990’s showed that anti-TNF drugs actually reduced the chronic tissue inflammation. Since then, drugs like Imuran or 6-Mercapturine (6-MP) have been introduced. They can’t actually induce remission, but they are effective in maintaining remission once it’s been achieved. The big downside is since they reduce the body’s principle anti-cancer agent, patients taking them are at much higher risk for developing cancers. Recent studies show the possibility that Crohn’s patients who have been on one of the anti-TNF medications for extended periods are at substantially higher risk for a type of leukemia.

Biologics (TNF-A inhibitors)

An offshoot of anti-TNF medications, biologics as used in Crohn’s treatment are designed to essentially “turn-off” the immune system. There are three currently in use: Remicade, Humira and Cimzia. Each has some unique side-effects; ask your doctor about them. In 1998, Remicade was the first of these drugs approved for use in Crohn’s, so it has the longest track record. However, it also has the most common allergic reactions and needs to be administered by IV over a course of several hours. Humira and Cimzia are similar to one another, but whereas a Cimzia injection can last 4 weeks, Humira needs to be injected every other week. Generally speaking, since the immune system is kept in a very depressed state while taking these, the patient is very susceptible to any airborne illness and contracting one can be deadly. If you are planning to take one of these, know the risks and make certain you discuss them with your doctor. I’ve been taking Cimzia for close to a year and it has made a HUGE difference in my quality of life.

Surgery

Crohn’s patients often require surgical procedures. These can range from the relatively benign (colonoscopy for examining the lower GI tract and removing polyps for closer examination) to a full-blown ostomy. Before undergoing any surgical procedure, make certain you discuss all of the implications with your GI doctor and meet the surgical team. You should also try to have a trusted friend or family member with you for these consultations – odds are if you’ve reached this point, the pain has also become nearly unbearable. Whether you’re fighting the pain au natural or with painkillers, you won’t be in the best command of your mental faculties.

Diet

For Crohn’s patients, diet is truly a four-letter word. We obviously need to eat, but many foods (including what can seem like most of the yummy ones) will cause an exacerbation of symptoms. Eat too many of them and you may wind up with a full-blown flare. Match that with the fact that as a Crohn’s patient, you need to ensure good nutrition even more so than most people and you stand a good chance of being baffled by your diet – or going insane J. Your best bet is to avoid foods that are hard to digest, such as nuts, popcorn and seeds. As for everything else, keep a log of everything you eat and if you experience increased symptoms, then avoid it in the future. Personally, I try not to exclude anything unless I’m in a flare – I just make certain my “avoidance” foods aren’t a constant part of my diet.

Also, you may want to consider nutritional supplements if you find you can’t get enough nutrients from eating. These can range from vitamin supplements to more robust liquid supplement shakes, like Ensure or Boost. In any case, working with a registered nutritionist is always a good idea. And one more thing: most Crohn’s patients find eating large meals tend to make them symptomatic. Try to eat smaller meals and eat more often. For instance, I typically eat 6 times a day – I cover this in more detail in the lifecyle adjustments post.

Alternative Medicines

There are quite a few alternative (or herbal) therapies out there for Crohn’s patients. I do not recommend any of them, although parts of them can be helpful. For instance, I find mint tea can help calm my stomach if I overdue it. Regardless, before trying any of them, be sure to check with your doctor and investigate them fully to find out how they can interact with your medications or each other. Just because they’re herbal or all-natural doesn’t mean they can’t have side-effects.

Ongoing Care

Perhaps the most important part of treatment is your ongoing care. Your doctor will likely send you for seemingly endless tests. CAT scans, GI studies, barium enemas, X-rays, colonoscopies, blood tests and more are part of the typical “Crohnie’s” regimen. Undergoing these and maintaining your relationship with your doctor are crucial in keeping Crohn’s at bay.

Posted by  |  May 4, 2011 | Categories: Health | Tags: , , , | 2 Comments

The Medicare Mess


Yesterday, I documented how the nation’s fixation with “soaking the rich” is not only bad economics but bad public policy. To recap briefly, those who are better off are already providing the federal treasury with far more than their share. The top 400 earners comprise less than 1% of the population, yet their taxes provide more than 2% of total take – while some 45% of Americans don’t pay any income tax. The best way to improve the revenue side of the fiscal equation is to get those 45% to start paying their taxes again.

Of course, we all know that we can’t tax our way out of the debt hole. It’s too deep and deepening every second; even if we close all the tax loopholes and get those 45% to ante up we still won’t close the projected budget deficits for any year over the next ten. Spending needs cutting, although liberals are typically offended by that notion. But it’s the 800 pound gorilla in the room and finally people are noticing.

While the Washingtonians had their fun earlier with whittling away at discretionary spending, the fact is that chopping away at 12% of the annual budget isn’t going to make enough of a difference. (And the reality is, they chopped very little – about $352 million according to CBO). To really tackle our deficit – which needs to be done before we get to paying down the debt – we have to tackle entitlements.

The President’s seriousness about tackling entitlement spending was summed up by this line from his April 13th speech:

“We don’t have to choose between a future of spiraling debt and one where we forfeit investments in our people and our country. To meet our fiscal challenge, we will need to make reforms. We will all need to make sacrifices. But we do not have to sacrifice the America we believe in. And as long as I’m President, we won’t.“

Gee, Mr. President. Sure glad you reiterated for us your commitment to maintaining the status quo.

The small part of the speech he did dedicate to his Medicare reformation plan was filled with smoke and mirrors. There weren’t any concrete details, only a pledge to reduce Medicare costs by $500 billion over the next 12 years. In case you’re wondering, that is less than $45 billion per year – or less than the budget cuts enacted this year. Talk about fiddling while Rome burns! To accomplish that meager goal, the administration proposes to focus on cutting waste and fraud – laudable goals and an admission that the government is doing a terrible job at administering the program. If there is $45 billion in abuse, somebody needs to be fired. The rest is the smoke and mirrors part – relying on the IPAB to force reductions in payments. Grandma will certainly be happy when her doctor tells he can’t see her anymore because the government won’t pay him enough to make it worth his while.

The Republican plan put forth by Paul Ryan kicks the can down the road for another 10 years, then applies an indexed government co-payment to a private plan. While that does provide some cost certainty in the future, it does nothing to address the spiraling debt created today by the program. It also does absolutely nothing to address the cost inflation in health care. In short, it’s more smoke and mirrors accounting.

So if both plans are nothing more than speaking points and fall well short of actually tackling the problem of entitlements, where do we go from here?

The answer is to address the very idea of government entitlements. The very word “entitlement” means that a right to a specific benefit is granted by…somebody. What’s more, expectation of entitlements are often tied to narcissistic attitudes. If you don’t think the two are related, consider what your visceral reaction is to the idea that entitlements need to be cut: odds are that like most people in the Western world, you recoiled at the thought. What, take away my benefits?

The President danced around this very issue in his speech. Namely, what kind of society do we want to be and where do we to place our priorities? The President, along with most liberals, envision a society in which regardless of circumstance you will always be taken care of. To enable this vision, they propose that the productive members of society take care of the unproductive – the misfortunate, as the termed it. Most Republicans also think entitlements are just dandy, although they would prefer the private sector pony up to those responsibilities. In other words, they’re perfectly happy to let businesses handle society’s ills. Anyone who has ever read Dickens can tell you what kind of world that is.

It seems like a horrible quandary, doesn’t it? On the one hand, we’re faced with the prospect of a federal takeover of society; on the other, a return to Merry Olde England of the 1850’s. But there is another way – one that Americans throughout our history relied upon.

Tune in on Saturday to find out what that might be. J

Posted by  |  April 21, 2011 | Categories: Economics, Politics | Tags: , , , , , | Leave a comment

How to twist taxes to your (political) advantage


A positive development in our politics is that attention is finally turning to the debt and the annual deficit. In case you aren’t aware of the raw numbers, the deficit for the past two years has ballooned to more than an aggregated $3 trillion. That has raised the national debt to more than $14 trillion – or, about $123,000 for every household in the United States. I give President Obama credit for finally listening to the nation and recognizing the seriousness of the problem. It marks a dramatic turn for him, seeing as how he spent more in his first two years in office than his predecessor did in eight.

In his speech last week, the President didn’t mince words: he expects the “wealthy” to pay substantially more than they currently do while he continues to spend like a drunken sailor on things only a drunken politician would consider necessary. Lo, the blogosphere and networks have focused on the President’s new Medicare proposal (more on that tomorrow) and how yes, the “rich” should pay more. After all, the argument goes, the middle class is paying higher rates than the wealthy and that is just unfair. It certainly seems a winning political argument; after all, who isn’t for soaking the rich?

This makes for good sound bites and good politics, but bad policy. I realize that in some regions the Democrats definition of “wealthy” (a family earning $250,000/year) might make sense. But in others, $250,000 per year is simply middle class. Upper middle class, to be sure, but hardly wealthy. In the New York metro area, a family easily achieves a combined $250,000 in income with two public sector workers. It is even easier to reach if one person sells cars and the other works in the local bodega. The same holds true for San Francisco, Los Angeles and other major metro areas around the country. This is really a call to arms in class warfare, the destructive political game played by Andrew Jackson and Teddy Roosevelt, with disastrous effects for the nation – though those effects weren’t felt until decades later. Even liberal icon FDR understood the dangers of the game and generally shied away from playing it.

Fortunately, the IRS keeps records on the truly wealthy and the rest of us. The latest data they have is from 2007; but since the one tax policy liberals love to hate – the “Bush Tax Cuts” were already in effect – it makes a good statistical reference point. You can find it here. In it, the IRS keeps tabs on the 400 wealthiest taxpayers in the country and compares their rates to the rest of the taxpaying public. They began tracking the data in 1992, so we have a 15 year window in the way tax policy evolved through both the Bush and Clinton eras.

At first blush, it seems as though liberals may be on to something. The IRS calculated the effective tax rate on the top 400 earners as 26.38% in 1992, rising to a high of 29.93% by 1995, and then steadily dropping to 16.62% by 2007. But statistics are wonderful things; anyone can quote a number out of context to prove an argument and this is exactly what the liberal media is doing.

First, I give credit to the IRS for doing what nobody to the left of center has bothered doing in their arguments. Their numbers reflect 1990 dollars ,thereby accounting for inflation (in mathematical terms, they normalized values). So, if the truly wealthy were paying lower effective rates, then the government should have been taking in less money from them, right? Not so fast: in 1992, the IRS collected about $4.5 trillion; by 2007 that figure rose to $14.5 trillion. Why? Well, in 1992 not a single one of those 400 returns reflected an effective tax rate over 31%. By 2007, even with the hated “Bush Tax Cuts”, 55% of the top 400 had an effective tax rate of at least 35%. The lower overall tax rate for these taxpayers is reflected in the fact that 35 of them paid no tax – an effective rate of 0%.

Overall, the truly wealthy combined to pay 2.05% of the taxes in 2007, nearly double the 1.04% they contributed in 1992. In actual dollars, they contributed nearly $23 billion of the government’s total tax take of $1.1 trillion. Those who make up this class are certainly already paying their share and the administrations attempts to paint them as sore winners can only result in flat out class warfare.

We do have a revenue problem, since we’re spending more than 4 times what the government is taking in. A better focus would be on the 45% of Americans who currently do not pay any income tax. Certainly, if you’re gross income is below the poverty line for your region, you shouldn’t be expected to pay, but I doubt 45% of Americans are living in poverty. That certainly seems much fairer and also guarantees that those currently benefiting from living here also gain equity in the system.

However, I doubt we’re going to find $1.6 trillion in revenue by asking everyone to pay their taxes. We still need deep spending cuts just to get the 2012 budget balanced. Tune in as I tackle those issues throughout the week.

Posted by  |  April 20, 2011 | Categories: Economics, Politics | Tags: , , , , , , , , , , | 1 Comment

State Government Run Amok


Be afraid. Be very afraid.

In the past, I’ve written about all kinds of government ineptitude. Mass Transit agencies that can’t get

passengers where they’re going. Local governments warring over heliports. Billions wasted on projects nobody wants or needs. Bureaucracies duplicating tasks.

Like all Americans, I may pay for government fecklessness through higher taxes and astounding regulations that often don’t make sense, even to those charged with enforcing them. Rarely am I directly impacted, as with most of us.

Enter the New Jersey Motor Vehicle Commission. But I offer fair warning: before doing so, suspend all belief in reality and sanity.

My story begins innocuously enough. In accordance with state law, I needed to renew my drivers license. Aside from having to spend an hour or so of my time in line at the Jersey City MVC office, this task generally isn’t painful. I go in, I fill out a form, a stand in a line, I pay my licensing fee, get issued my renewed license and I’m on my way. I imagine for 98% of New Jersey residents, the story is much the same. So you can imagine my shock at being told:

“I’m sorry, but your driving privileges were revoked in January.“

Thus began a saga that is now ongoing for a full month. Over that time, I’ve discovered more about the way government agencies fail to communicate, audit their records properly, admit errors and update said records than I ever imagined was possible. My journey through the empty vastness of government sanctimoniousness isn’t over yet, so neither is my growing frustration with the way such incompetence can seriously impede normal commerce. Over the course of the next few days, I’ll fill you in the details and keep you abreast of further developments.

Suffice it to say, this bit of personal experience makes for a far better story than any piece of fiction I could ever dream up. Feel free to drop comments and current updates by following me on Twitter.

Posted by  |  March 29, 2011 | Categories: Politics | Tags: , , , | Leave a comment