PARKINSON’S, MRS. CLINTON?

September 26th, 2016

Rumors circulate claiming that Hillary Clinton is suffering from Parkinson’s Disease (PD). Even the slightest question in that regard should disqualify her from seeking the presidency.

PD is a chronic, debilitating, ultimately fatal disease of the brain that depletes the basal ganglia of a vital neurochemical, dopamine. Its signs and symptoms can be more — much more — than muscular rigidity, tremor at rest, and postural instability; awful as they themselves are. They also include severe depression and outright psychosis.

The etiology appears to be the switching to “ON” later in life of a genetic mechanism. Causal mechanism underlying the switching? Unknown.

There is no cure for PD. Treatments all are symptomatic, but none change the ultimate outcome or increase life-span. Prognosis is grim.

Tonight, Mrs. Clinton engages in a nationally televised debate. How will her health, such as it is, affect her performance. We know that she is taking medications. How will they affect her performance?

Whatever the case, would you want such a person in sole command of your next flight on an airliner? No? In that case, would you want such a person, as President, in the midst of a bout of severe depression with delusions, having her tremulous finger on the nuclear button?

In order to dismiss such medical rumors, Mrs. Clinton immediately should submit to neurological evaluation by an independent panel of neurologists with results made public. Will she? Not likely.

Forget not, Science tells us, “Behavior has its consequences.”

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ONE MAN’S BET

September 19th, 2016

“Whatsoever a man soweth, that shall he also reap.” -Galatians VI:7

“Sick again is she, Doc?”

“Apparently.”

“Pneumonia?”

“That’s what I read.”

“Viral?”

“Who knows? That’s what they claimed. Yet, her physician prescribed antibiotics.”

“I thought antibiotics aren’t helpful against viral pneumonia . . . only bacterial, true?”

“True! Actually, for the patient suffering from viral pneumonia there are no benefits only risks. Antibiotics are indicated when a secondary, bacterial infection occurs on top of the viral.”

“Did she have a secondary bacterial infection?”

“Who knows? If she did, one wonders if there is some, underlying pathology. After all, she’s had a chronic cough. Say, remember that bet I made with John several months ago?”

“Yeah, at the cigar salon.”

“What did I bet?”

“That Hillary Clinton wouldn’t be the Democratic candidate for President on November 8th.”

“Remember my thesis?”

“That she made a deal with Obama not to prosecute her for her deceitful lying and death-dealing sedition . . . among other things . . . in exchange for dropping out of the presidential race before the election but after the primaries ended in August.”

“What do you think of that thesis?”

“Possible but unlikely.”

“Why unlikely?”

“I dunno. Just seems farfetched. I can’t see that avaricious, self-centered bih . . . uh, witch . . . giving up for any reason her chance to reign from the White House.”

“Still, you admit that which I say is possible?”

“I guess so.”

“Only guess? Perhaps, then, you’d like to bet against me.”

Silence.

“I asked whether, like John, you’d like to bet against me?”

“Um . . . we’ll see what happens.”

“So we shall. So we shall.”

Discussion

Possible political intrigue notwithstanding, medically the question is if Hillary Clinton is fit to function as President of these United States of America? Let’s look at some established facts.

1) FACT: In recent years, she has suffered recurrent bouts of syncope (i.e., “fainting spells”). Why? Who knows? That which we do know is recurrent bouts of syncope, especially among the elderly — she is elderly — are alarming, raising the following question: Is there existent some underlying, ominous pathology (e.g., cardiac arrythmias or mini-strokes).

2) FACT: Currently, she is taking anti-coagulant medication to prevent blood-clots. Why? She suffers from deep vein thromboses (“DVT” — blood-clots) in her legs. DVT is a serious condition that can lead to sudden death from a clot shooting from the leg to the lung, a phenomenon known as pulmonary embolism.

3) FACT: Recently during a televised debate, Hillary exhibited masked facies (i.e., persistently flat, fixed, facial expression) and abnormally slowed speech, appearing to be drugged. Given her medical condition, these signs could reflect the medications that she is taking both acutely and chronically — or possibly something else. Who knows?

4) FACT: Her political handlers and she continually have lied, both by commission and omission, about her medical status. Healthy people rarely lie about their health unless they intentionally are malingering to achieve some ill-gotten gain such as undeserved payments for feigned disabilities. Why would her handlers and she lie unless they are hiding something unfavorable?

Will Hillary Clinton be on the ballot in November? Who knows?

Should she be on the ballot? From the medical perspective alone? No!

Behavior has its consequences. Since the ascension of Franklin Delano Roosevelt to that which, over the decades, has become the imperial, presidential throne, the consequences of the policies and programs of most sitting-presidents have been disastrous — economically, militarily, politically, and sociologically. Excepting the respite granted to us Americans unintentionally by Adolf Hitler and Hideki Tojo in the form of prosperity post-World War Two, this nation has been on a progressively downward slide since President Calvin Coolidge left office in 1929.

How much longer can this nation now on fire, figuratively and literally, absorb the punishment? A healthy Hillary Clinton would be sufficiently damaging. An unhealthy one, mentally and physically? When you vote this November, ideology notwithstanding, remember that it’s the consequences of your vote that will determine the quality of life for all of us and those who follow us. In the war between ideology and reality, ultimately reality always wins.

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ZIKA: UPDATE

August 29th, 2016

Note (12SEP2016): The politicians and bureaucrats quibble while the mosquitos nibble. Consequence? Nobody knows. As time passes, however, the potential for a truly unfavorable outcome increases.

Compared to some other infectious diseases, the importance of Zika seemingly pales. Last year, for example, there were 214,000,000 reported cases of malaria. Adding diarrheal diseases, HIV, pneumonia, and tuberculosis yields the startling figure of one in five deaths per year. Zika? Fewer than 500,000 reported cases with fewer than 60,000 confirmed although the numbers likely are much higher.

The official version of the current epidemic of viral infection from Zika is that it is a mild disorder characterized by fever, arthralgia, myalgia, conjunctivitis; and rash. As many as 80% of those infected suffer no clinical signs or symptoms. A question arises whether that official version is valid.

The Virus
The virus itself is a mosquito-borne RNA-based flavivirus. It firstly was identified in a monkey in Uganda in 1947. For the next sixty years, only a few human cases were reported. Then, in 2007, an outbreak occurred in Micronesia on the island of Yap, where more than 70% of islanders older than age-three were exposed to the virus. In Autumn 2013, a large outbreak occurred in French Polynesia, where more than 30,000 were exposed to the virus. The genome of this more virulent virus in Micronesia and possibly others in Asia and now in the Americas very likely are different from that of their forbear, the relatively indolent virus in Africa.

How did Zika travel to the Americas? Most likely, via a traveller to Brazil from the South Pacific. During the past year or so, 47 countries have reported initial cases of Zika. One of the many wonders of modern travel!

Indeed, modern travel has become a boon to pathological agents and their vectors. Aedes, for example, remained confined to western Africa until the 15th-century, long before travel by jet-propelled aircraft. Also boons to pathological agents have been massive urbanization coupled with poor sanitation — trends likely to continue.

The Vector
The vector for this arbovirus is the female Aedes mosquito, which does not thrive in colder climates. Two species, different in their respective ecologies and activities, carry the virus — A. aegypti and A. albopictus. The former is active diurnally, feeds outdoors, and travels distances. The latter is active at dawn and dusk, feeds indoors, and remains more homebound. Both, however, bite multiple times; thereby, facilitating multiple transmissions by a single female. Unlike other mosquitos harboring other flaviviruses that can thrive in cold climates, Aedes remains confined to warmer climates although its populations can vary with the seasons.

The Infection
Despite the official version, infection might be more serious than currently broadcast. Officials acknowledge that, for pregnant women, contracting the virus appears linked to a peculiar form of microcephaly in the fetus; thereby, rendering the often-severely defective and deformed offspring requiring intensive and expensive care for the rest of their lives — care largely unavailable in much of the world. Moreover, even those without microcephaly may suffer blindness or deafness.

Those neurological defects result from the virus penetrating neuronal stem-cells in the brains of fetuses. These cells allow for neurogenesis. The question is, Do the viruses penetrate the neuronal stem-cells of adults? Recent evidence suggests that the answer may be yes. The consequence could be a slowly progressive form of neurological degeneration as old neurons die but are not replaced.

Adding to concern is the issue of transmission by means other than the mosquito. Evidence documents the virus in human semen; thereby, allowing for human-to-human transmission via sexual activity; let us not forget that we humans are the most hyper-sexual animals on Earth. “Let’s make love?”

Another recent finding of the virus in saliva and urine renders human-to-human transmission by those means also possible. “Kiss me, you fool?”

Diagnosis
Three, different laboratory-based tests can detect Zika. The tests for Zika, however, are neither entirely definitive nor reliable. A case of triple infection with Zika, dengue, and chicungunya has been reported, for example; the latter two also are carried by Aedes and can compromise the testing for Zika.

That blood contains the virus raises concerns for those receiving transfusions. Given that testing remains problematic, hopefully testing blood for presence of the virus will be as effective in preventing use of contaminated blood as in reässuring the public.

Treatment
No vaccine exists for prevention, nor is it likely one will exist during the next, few years. No specific medications exist for treatment, which remains supportive only. Recently, the government has issued statements promising hope for treatments in the near future. Fortunately, at this time the risk of fatality appears very low with hospitalization rarely required.

PART TWO OF TWO
Future Risk
Despite its seemingly benign character, Zika is a RNA-based virus. Such viruses can mutate rapidly even during a single infection in a single victim; becoming more mild or more virulent, as the case may be. Concern arises if the virus is mutating into a progressively more virulent form with possibly severe residua or sequelae.

Can we trust official reporting? Given the scenario with the recent epidemic of Ebola Hemorrhagic Fever, the answer for many is a resounding — no!

Accordingly, a question arises. Is the clinical picture murkier than that being reported by officials and the media? Possibly.

Dengue Fever
Consider a viral cousin to Zika; one spread by the same mosquito — Dengue Fever. The clinical presentation for Zika Fever is similar to that of Dengue Fever also common in the Caribbean and Latin America and returned to these United States of America after many years.

Consider the potential for clinical complications, neurological and auto-immunological. Fortunately, they remain infrequent.

Experts know much more about dengue than about Zika. The dengue-virus also is a flavivirus. It comes in three variants. Recovery from one variant provides no cross-resistance to the other two. Uncomplicated infection with dengue rarely is fatal although the symptoms are painful, resulting in the common label for the disorder being “Breaking Bones”. Reïnfection with a different strain, however, can cause Hemorrhagic Dengue — the auto-immunologic complication that carries a mortality of 50%, especially among the young. Should Zika mutate into acquiring similar characteristics, the consequences could be alarming.

There exists no approved vaccine for prevention of Dengue Fever although a vaccine now exists and might be converted into one for Zika. Then again, there is no vaccine for the common head-cold. No specific medications exist for treatment of Dengue Fever; treatment remaining supportive only.

Guillain-Barré Syndrome
One potential and disturbing sequel of both Dengue Fever and Zika Fever is Guillain-Barré Syndrome (GBS) — highly suggested but, as yet, unproven. What is GBS?

GBS is an auto-immunlogical disorder occasionally following viral infections and, rarely, vaccinations. Generally, the interval is from one to three weeks after the onset of the preceding, viral infection.

Typically, GBS presents with paresthesia followed by muscular weakness followed by paralysis. The signs and symptoms can spread from the extremities upwards to the head or from the head downwards to the extremities. The latter variant, especially, often is associated with respiratory distress. The loss of motoric function accompanied by pain can progress over two to three weeks followed by a period of stability for one to two weeks. Recovery usually requires several months to a year; in severe cases, it may be incomplete.

The pathology of GBS appears to involve the viral infection with its accompanying inflammation eliciting the production of antibodies that attack the myelin sheath of nerves; thereby, interfering with the conduction of electrical impulses from the Central Nervous System to muscles. The body attacks not only the virus but itself. Damage to the nerves is not continuous but segmental between the nodes of Ranvier; severe inflammation can destroy the nerve itself.

A potentially effective treatment for GBS is the use of high doses intravenously of immunoglobulin administered over a period of five days. Other immune-suppressing drugs may be useful. The use of corticosteroids remains more controversial.

The most severe cases of GBS require a high level of intensive and expensive nursing care over a prolonged period. Should the expected number of cases of Zika Fever actually occur and should a higher than expected number of them become associated with GBS, the consequence could overwhelm the American system of medical delivery. Whereas such an eventuality seems remote at the moment, it represents a potential risk of alarming dimensions.

Prevention
“An ounce of prevention is worth a pound of cure.” -Benjamin Franklin (1706-1790)

The obvious, immediate response to the threat from Zika is control of its vector, mankind’s second-greatest enemy — the mosquito. Mankind’s greatest enemy? Time, at least for the individual.

Two questions arise. If current methods of controlling mosquitos prove inadequate, would we and should we resume the use of DDT? A promising alternative, currently delayed by the Food & Drug Administration, is the use of genetically-modified mosquitos to decrease the population of viable offspring. In fact, it may be possible to exterminate all mosquitos worldwide.

The basic point of this posting is to describe in some detail the potential devastation wreaked by viral and bacterial pandemics. Consider the recent threats posed by Ebola, HIV, SARS, and influenza. Many others lurk beyond our awareness. Controversial man-made, global warming notwithstanding, our proven, ecologically irresponsible behavior as a species is making Mother Nature angry — very angry.

To paraphrase an old commercial, “It’s not nice to make Mother Nature angry.”

If we humans do not reform our ways, she will punish us — guaranteed! The next epidemic may be less controllable and more virulent than recent ones. By then, reform will be too late.

Consider the scenario of Zika mutating; thereby, becoming strikingly more virulent with airborne transmission. The consequences could be horrific.

Hopefully, Zika will not represent a major hazard to public health. Even so, if not Zika, it will be another microbial agent. As a species, we are living on increasingly borrowed time, an inescapable consequence of our own behavior.

Science tells us, “In any given context, behaviors — and deficits of behavior — have their consequences .

Shall we listen? Be past prologue, the answer is clear.

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MR. GAFFE

August 15th, 2016

Note (22AUG2016): Did Mr. Trump read this posting last week? His change in rhetoric certainly reflects that which is written therein. Meanwhile “Crooked Hillary”, as he calls her, released another 15,000, problematic e-mails that she had hidden from authorities. Yet, with every announcement of her deceit, her status in the polls reportedly rises. If valid, what does this trend say about this nation on fire?

Is Donald Trump stupid? No.

Is he ignorant? No.

Is he incompetent? No.

Is he particularly corrupt? There is insufficient evidence that he is and, compared to the crooked Clintons, no.

Is he particularly dishonest? There is insufficient evidence that he is and, compared to the lying Clintons, no.

“An honest politician is one who, when he is bought, will stay bought.” -Simon Cameron (1799 – 1889)

Is he inexperienced in politics? No. Mr. Trump has plenty of experience buying favors from corrupt, dishonest politicians.

Ah, but is he inexperienced in his primary area of interest at the moment — politicking? Yes.

Mr. Trump never has held elected office; then again, four, previous presidents hadn’t either. He never has campaigned for political office. In politicking, Mr. Trump is a naíve neophyte; hence, he makes gaffes that even a first-term, municipal councilman wouldn’t make.

Yes, he frequently speaks his mind too freely. Yes, he easily and quickly falls into traps laid by his political opponents. Yes, not having scripted his lines, he sometimes contradicts himself even within the same speech.

So? That which his critics consider liabilities, others might consider assets. Why?

Those seeming liabilities reflect the man himself, such as the following:
1) He isn’t a member of the ruling, political, Democratic/Republican establishment dedicated to its own welfare at the expense of the rest of us, the American people.
2) He isn’t a polished, professional politician who holds the electorate to which he panders publicly in contempt privately.

From all appearances, Mr. Trump’s behavioral style is that of a narcissist who craves attention and adulation and is overly sensitive to unfavorable criticism and resistant to constructive criticism. As such, he became a successful showman with a successful, televised series. As such, during the political primaries he garnered billions of dollars of free publicity via statements considered by many to be outrageous even though often truthful.

Unfortunately for “The Donald”, his previous strategy has been failing him of late in the campaign for the presidency itself. The failing suggests that he needs to change his behavior to become not “more presidential” but more circumspect. “Presidential”? Think Barack Hussein Obama II and George W. Bush. Are those “presidential” types that which this nation on fire needs?

The change required actually would be small for most people but, perhaps, not for Mr. Trump. Given the apparent magnitude of his narcissism, he might be incapable of making it. If so, the consequences of his behavioral deficit likely will be inescapable. After all, behavior — including behavioral deficits — has its consequences. B = f(x) under c.

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