How many ’second’ opinions do you seek? Do you keep asking, keep looking until you hear a diagnosis you can live with ~ figuratively and literally? Or do you stay with the original verdict, no matter how harsh, worrying yourself grey over the ‘what ifs’ and ‘whys?’

Do you throw out the first conclusion because you don’t like the person who gave it ~ abrasive, unsympathetic, aloof? Or do you hope the one who made you laugh is right, and you can sleep again because it’s a word you can understand?

Or is it somewhere in-between? And, how do you know?

We have strayed from our foreseen path. It may be that this is only a diversion and we will merge back onto that long and lonely road, grateful for a brief moment of hope. But, there is a detour on our map showing a different destination. One with, if not a happy ending, at least one more bearable.

It is still a roller coaster I want to exit.

This is necessarily cryptic, it is not my story to tell. I am merely a companion on this journey, a passage that is both private and undefinable.

“A Veterinarian Advises How to Speak for Spot”

Monday, August 31, 2009

This week will be “Animal Week” on the popular NPR show, Fresh Air with Terry Gross.  The lead interview will feature Dr. Nancy Kay and her book, Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life.  This interview originally aired in March and earned the #1 spot on NPR’s “most recommended” list.

Dr. Kay’s interview will be broadcast on August 31^st by your local NPR station and streamed via the NPR website (http://freshair.npr.org).  In the future you can readily access the interview as a Fresh Air archived podcast and via ITunes. 

Visit http://www.npr.org/audiohelp/progstream.html to access links for each of these options. 

Please feel free to share this information with friends and relatives along with any organizations devoted to the well being of animals.

Dr. Nancy Kay
Specialist, American College of Veterinary Internal Medicine

Please visit http://www.speakingforspot.com to read excerpts from Speaking for Spot. There you will also find “Advocacy Aids”- helpful health forms you can download and use for your own dog, and a collection of published articles on advocating for your pet’s health. Speaking for Spot is available at Amazon.com, local bookstores, or your favorite online book seller.

Join our email list – http://speakingforspot.com/joinemaillist.html

Look for us on Twitter – http://twitter.com/speakingforspot

Become a Fan of Speaking for Spot on Facebook

Listen to Dr. Kay’s interview – A Veterinarian Advises “How to Speak for Spot” on NPR’s Fresh Air with Terry Gross

I am a “regular” at the local corner coffee stop, so much so that my drink is often ready for me before I’ve had a chance to order it.  Amongst the eclectic group of shmoozers gathered most mornings are the schmoozers’ dogs.  This morning while waiting for my coffee, Molly, a massive Rottweiler mix, greeted me.  As usual, her voice and body language told me in no uncertain terms that she expected me to toss her a cookie (a bin full of dog biscuits resides beneath the shelf holding Half-n-Half, sugar, and other coffee accoutrements). Today, I noticed that Molly’s demands were less vigorous than usual.  My veterinary antennae began to quiver and I paused for closer inspection.  I was aghast to see one of Molly’s eyes almost closed and filled with pus; the other had a completely cloudy cornea.  Jill observed my startled expression and explained that she had taken her darling Molly to see the vet three times in the past couple of weeks.  In spite of treatment with various ointments, her eye problems were clearly worsening. 

I bit my tongue for approximately one millisecond before my concern for Molly forced me to question, “Have you considered getting a second opinion?”  Jill responded that the thought had crossed her mind, but she’d not acted on this impulse- she didn’t want to hurt her veterinarian’s feelings.  After some serious coaching-  “A second opinion results in a new diagnosis as often as 30 percent of the time.” “Veterinarians are used to people desiring second opinions.”  “What’s more important, Molly’s health or your vet’s feelings?”- Jill agreed that it was time to contact our local board certified ophthalmologist. 

Is Jill’s story unusual? No, but I wish it were. When it comes to our own health issues or those of a beloved four-legged family member it’s not uncommon that, even when our gut tells us it’s time to consider a second opinion, we ignore the feeling.  I believe that this gut feeling, sixth sense, intuition, or experiential wisdom- whatever one chooses to call it- is a true gift.  In fact it is one of the few things that actually seem to improve as we age. All we need to do is pay attention to this gift rather than ignore it.  Second opinions are invaluable for our health and our peace of mind.  

I’m keeping my fingers crossed that Molly and her eyes will be sparkling and bright the next time I see her.   

Wishing you and your four-legged family members good health, 

Dr. Nancy Kay

Specialist, American College of Veterinary Internal Medicine 

Please visit http://www.speakingforspot.com to read excerpts from Speaking for Spot. There you will also find “Advocacy Aids”- helpful health forms you can download and use for your own dog, and a collection of published articles on advocating for your pet’s health. Speaking for Spot is available at Amazon.com, local bookstores, or your favorite online book seller. 

Look for us on Twitter – http://twitter.com/speakingforspot

Become a Fan of Speaking for Spot on Facebook

Listen to Dr. Kay’s interview – A Veterinarian Advises “How to Speak for Spot” on NPR’s Fresh Air with Terry Gross –

I’m interested in astronomy but know little about the subject. Two books and one TV series have made all the difference there is in my knowledge. The books are The Sleepwalkers (1959) by Arthur Koestler, and The Soul of the Night (1985) by Chet Raymo; the series was Carl Sagan’s Cosmos (1980). I found all three extremely beautiful and moving.

I watched a NOVA episode recently called Runaway Universe. I found out that astronomers, in order to explain the results of their observations, have posited the existence of two factors, dark energy and dark matter, which together make up 99% of the universe we inhabit (dark as in unknown, like the Dark Ages, not as in colour). The observable universe, the stars and galaxies and planets and people and birds and trees, make up the other 1%. The laws that govern the universe, the product of observation and theories of scientists over a 2,500 year period, only affect the observable 1%.

Great. So I live in a universe consisting of millions of galaxies. The one I’m a part of, the Milky Way, contains an estimated 200 billion stars. The number of planets that might support life there, not necessarily carbon based life, is unknown but might well be in the millions. This universe is expanding and whether space is expanding too is also unknown. What if there are other universes, differently constituted to this one? It’s quite clear that if god said, “let there be light”, he (it really but habit rules) wasn’t talking to man when he said it.

Now I find I live in a universe where there are no known physical laws, no way of observation and experiment, no conclusions possible to be made, for 99% of its content.

It makes me think a lot about faith. How much of our information we take on faith.

We believe the news because someone on TV tells us it’s happened. We believe in the law of gravity and the interaction of chemical elements because we are told about these things in school. We believe in the scandalous behaviour of our neighbour because he’s been gossiped about. That god is good because the good book tells us so. What do we directly know? Probably only about 1% of what we believe to be true.

So this is just as much an age of faith as any previous century. We’ve just changed the matter in which we have faith. Heisenberg’s well known uncertainty principle for subatomic particles, energy and time etc has replaced the scholastic philosophers’ debate on the number of angels who can dance on the head of a needle.

Of course everybody needs faith in order to survive. Starting with the brain’s astonishing ability to create a meaningful world out of the millions of bits of data it receives from the senses, each person’s primal act of faith, we go out each day and interact with many different people, and receive the data they send us, a secondary act of faith. We’re not too good on direct observation, as Sherlock Holmes was fond of pointing out (notice how many people have no idea of what’s behind them when they’re walking in the street, for instance). We don’t have the skills to carry out direct examination on all the matters we need to know about, nor the time to do so.

Science, the habit of testing behaviour against accepted principles by an attempt at detached observation and measurement and recording the results according to an accepted formula, may well be a minority occupation. Just as thinking, the attempt to look rationally at matters without being influenced by the powerful emotions we are all subject to, may be a minority occupation. 99% of us are driven by emotion clouds, led by faith, not unlike that 99% of the universe of dark matter and dark energy.

From the Columbia Encyclopedia:
dark energy, repulsive force that opposes the self-attraction of matter (see gravitation) and causes the expansion of the universe to accelerate. The search for dark energy was triggered by the discovery (1998) in images from the Hubble Space Telescope of a distant supernova that implied an accelerating, expanding universe, which in turn required a new cosmological model (see cosmology). Although dark energy is predicted in particle physics, it has never been directly observed. It is generally agreed, however, that dark energy dominates the universe, which is projected to have a composition of c.70% dark energy, c.30% dark matter, and c.0.5% bright stars.

dark matter, material that is believed to make up (along with dark energy) more than 90% of the mass of the universe but is not readily visible because it neither emits nor reflects electromagnetic radiation, such as light or radio signals. Its existence would explain gravitational anomalies seen in the motion and distribution of galaxies. Dark matter can be detected only indirectly, e.g., through the bending of light rays from distant stars by its gravity. Dark matter may consist of dust, planets, intergalactic gas formed of ordinary matter, or of MACHOs [Massive Astrophysical Compact Halo Objects], nonluminous bodies such as burned-out stars, black holes, and brown dwarfs; these are the so-called hot dark matter and would be dispersed uniformly throughout the universe.

both religious and non-religious folk get some things confused (don’t we all?).

Text: the bible is a collection of books, has many authors even within the same ‘book’, was transmitted at first orally and then copied by hand over several centuries and finally translated into many languages other than Hewbrew/Aramaic/Greek. It thus represents an account of the Jewish people made by many writers over many centuries living in many different cultures and representing many different viewpoints and insights. Why would it be consistent? No one individual is, so why this book?

Faith: the bible contains some truly inspiring passages in which sense it can be called the ‘word of god’ (as well as some passages that are offensive and some that are irrelevant to all but first century AD Jews). As such it has enabled many to live better lives and follow a moral code that benefits their fellow humans (and enables some to be illiberal and persecute their fellow humans). God (whatever god is) can speak through the bible just as surely as through the sunset or any other aspect of the world.

The ‘word-of-god’ aspect of the bible is surely in the truth it contains (logos=word/self-knowledge/wisdom) rather than any ‘word’, sentence, opinion that has been written by biblical authors. Many passages in the bible are simply not understandable (Revelations anyone?). In fact ‘christian’ history shows how fallacious the literal approach has been, with groups who have extracted one meaning from one passage trying zealously to kill other groups who have extracted another meaning from another passage. And someone who said ‘love your enemies’ has been studiously ignored. Too confronting I guess.

Personally I believe that one’s moral code should be formulated from within, not imposed from without. I cannot forget that some of the greatest wrongs of European history: the death of seven million negroes in the 18th century slave trade; the 15 million native americans destroyed by the Spanish in South America ; the horrors of the various Inquisitions; have all been justified, bible in hand, as according to the word of god. A little caution seems in order.

Textual criticism of the bible can be truly educational and should be encouraged not repressed. But it doesn’t (or shouldn’t) disprove the validity of anyone’s faith. That is validated by how each person lives and acts.

Then again what would I know?

Warning:  I’m about to write down some very controversial thoughts regarding my ever-increasing belief in what I have come to realize is either a major cause and/or hindrance in the realm of food allergies….Immunizations.

Before my second child was born, you probably could not have convinced me that immunizations were bad for a child.  I had heard some ranting and raving on the topic, but never knew anyone that had a personally ‘bad’ experience from it.  However, when my second child was diagnosed with life-threatening food allergies at the age of one, I immediately began to investigate every single thing that could possibly harm my daughter due to those particular allergens.  Only 3 months after her diagnosis of food allergies, she was due for her 15 month vaccinations which included the MMR & the Chicken Pox vaccine.  Red flags went off in my mind.  It seemed to me that I had heard or read somewhere that children with egg allergies should not have a particular vaccine, but which one was it?  I thought it might have been the Chicken Pox vaccine, but wasn’t sure.  So, I asked the nurse.  She said she thought it was the MMR and not the Chicken Pox one.  Right away, she went out into the hall and asked the doctor – I could hear them.  He assured her that there was no problem with allergies and the MMR.  Coming from the doctor, I hoped he was right.  Unfortunately, he was dead wrong.  Not even an hour after the MMR, she began scratching her tummy like crazy.  I checked it out and sure enough she had hives all over her abdomen.  The hives would start to fade, then they’d come back.  This occurred for 3 WEEKS.  I got online and researched allergies and the MMR and sure enough – one site suggested that children with egg allergies should not have the MMR.  I was so upset that her doctor, a pediatrician, would not know that the MMR not only would not be okay for my daughter, but that it could actually be life-threatening to her.  Since that day, I do not trust what doctors say to me.  I research just about every issue that arises in my children and myself.  I make sure to be studied up on any possible condition before I talk to a doctor so that I can ask the appropriate questions and be more informed.  I hate having to self-diagnose and be distrusting, but my children’s lives require me to be this way.  My second child will never have another immunization as long as she is under my care.  That’s the way it has to be whether she outgrows her allergies or not.  I was willing to give immunizations another try when my 3rd child came along, although I was a lot more informed and educated on the subject which made me more leary of them, as well.  However, my first child never had issues with her immunizations and to this day has been fine, so I was kind of on the fence about totally going crazy and getting all riled up about all immunizations in general.  I decided to go ahead and start immunizations with my 3rd child, albeit a little reluctantly because of the experience I had the last go around, but she did fine….until her 12 month check.  I took her in and she was due for the Hep A, Pneumonia one and Chicken Pox.  I was nervous about it, but prayed and asked God to give me peace.  I really wasn’t sure whether to withhold immunizations or to continue.  She had done fine the whole time.  I felt peace about her getting the vaccines (afterall, the MMR isn’t until 15 months) so I let them do it.  She had the typical knot and soreness in her leg where the first two were done and really no reaction to the Chicken Pox on the other leg…until a week later.  She developed a raw patch of skin behind her right knee (same leg as the Chicken Pox vaccine) – it looks like eczema and lasted over a week.  In fact, it is just now beginning to fade.  Then, a few days after that, she got hive-like bumps on her right thigh that evidently were very itchy because she scratched them and broke the skin. I rubbed Benadryl cream on it to help the itch, but the bumps are still there.  They have not gone away yet.  That spot was also hot to touch and that lasted a day or so.  I know without one doubt that these are reactions to the Chicken Pox vaccine.  I know my children and take notice of every little change that takes place with their bodies, especially as they relate to vaccines and new foods, etc.  Now, my 3rd child will not be getting anymore immunizations while under my care.  I am more convinced now than I ever have been that the chemicals, animal products, hidden foods, etc. that are put in these vaccines  are harmful to any body.  Some bodies are able to handle them, at least as far as the naked eye can see, but there are MANY that cannot handle it.  Every parent has to decide what they truly believe is best for their children, but I can tell you there will be no more vaccines given to my children regardless of what any ‘professional’ says.

I understand that vaccinations have helped keep our country free from certain diseases like Polio for years and years, but I believe that there are way too many vaccines ‘required’ for our children these days and new ones are being made every year.  It’s absolutely ridiculous.  These pharmaceutical companies are making big bucks with no regard for the well-being of our children.  I didn’t get to see ‘The Doctor’s’ show on TV yesterday, but my mom told me about it and I went online and read the synopsis.  Jenny McCarthy is a huge advocate for children with autism (which she believes is caused by vaccinations).  If you haven’t heard her story, you should definitely read it.

Bottom line here is:  You are the only one that truly knows and cares about you child’s well-being.  It’s your responsibility to be informed so that you can make the best decisions possible for your children.  Don’t leave it to the ‘professionals’. 

Disclaimer: Admittedly, there are some doctors/professionals who truly care more for your well-being than their wallet, but you are the one who knows more about your child’s needs.  So, choose carefully.  If you’re not satisfied with what your pediatrician is telling you, find a new one.  Don’t just settle. Be your child’s advocate and find the answers that you are looking for. It might take a long time, but you can do it!

Thanks again for your interest in moggie, my kitty who’s had a traumatic experience. Indeed, it’s been traumatic for me as her kittymom too. I generally don’t take to bitching about services, and prefer entertaining you, but this past week has made me realize I have to say something.

I took my cat to a certain vet in Pinelands, Cape Town, who immediately said she’s really, really in a bad way and not sure if anything can be done and if it can, it’ll be pricey. We said fuck that, please see what can be done. So the kitty was shipped off to a Hospital branch close by. The doctor spoke to me after the x-rays and said it’s really bad and you have two options: take her to the recommended specialist and pay about 10 grand for the op, straight up, or have her put down. Now she’s a perfectly healthy kitty, other than the broken jaw. She’s also a young kitty, just over a year old. She’s also my baby. I don’t have kids, and those who know me know I don’t want kids. My cats are my kids. So those who have children, think of a doctor giving you this kind of ultimatum regarding your child.

I don’t have that money at the moment. It’s too far from pay day, but with infection setting in, her op couldn’t wait. After many tears, the mommy in me took hold, and wouldn’t accept no for an answer. Phoned around, and eventually found a comforting and positive answer I was looking for. Dr De Klerk at Blue Cross Veterinary Hospital in Claremont/Newlands said to bring her in, that 10 grand is crazy and that they allow for folks to pay off accounts.

Tuesday I was facing the possibility of putting my kitty down, today she’s coming home with me after a successful and comparatively WAY CHEAPER op. Yay and cheers and tears of happiness etc..but the thing is, we don’t always know any better when it comes to injuries and illness of those under our care, be it a child or a pet, we put our TRUST in these people. To think, the very people that have studied to try and help the sick and helpless work on a ‘money or die’ basis, when it comes down to it, is really disheartening.

Moggie protecting her scared sweetheart, DonVito at a previous visit to the vet

Besides the cute pic of precious moggie, I’ll leave you with this: Don’t take no for an answer, get a SECOND OPINION. Thank God I did.A big thank you to Blue Cross, and Dr De Klerk. That’s what real care is about.

I guarantee more laughs soon xxx kitty

The PhD commenter below has refused to understand that the actions of Presidents Carter and Clinton, in cooperation with a young lawyer named Barack Obama, more than ten years ago could have caused a legal and moral situation that built up over time and finally fed upon itself in the financial excesses that are destroying the entire world today.

This PhD believed that, since the thirty year trend of building, self-nourishing, moral and financial disease, combined with Carter’s CRA that requires banks to lend more and more to unqualified buyers, reached a fevered peak during Bush’s administration, that Bush was the cause of the disaster.

He cannot comprehend that CCCCO (CuCoo Carter Clinton and Obama) created the legal framework and regulatory environment that enabled and even DEMANDED the financial misbehavior of the apocalypse.

While Bush is certainly guilty of being too stupid to perceive the disease and cut it short, so are all the people that Obama has appointed to cure it. For example, Tim Geithner, whom Obama calls the only man who can save us, was in fact asleep at the switch when he, as head of the New York Federal Reserve Bank,  was in charge on preventing the collapse, and DID NOT. Yet Obama relies on Timmie for our salvation?

Here is the medical educator argueing with me on the efficiency of our medical system. Is it no wonder that the students who come out of our current educational system vote for the food stamp president?

Medical Second Opinions

PhD Commenter: Since I have a Ph.D., it doesn’t intimidate me in the least. (that I disagreed with him)

Host: That you claim a PhD is not surprising – you should get a refund from your schools, undergraduate and high schools, as well as PhD factories.

Don’t get me started on the incompetence of doctors and the failures of the US Medical Educational System.

PhD Commenter:  Sure, go on about the medical education system, as if you really know anything about it. The most you have is a few personal anecdotes. Let’s hear them, and I’m sure they’ll have nothing to do with the doctor’s education or medical knowledge, but what the heck.

Host: Regarding doctors’ competency and the state of the medical profession, more than one third of the time we get a second opinion, it recommends different treatment.

That is not acceptable.

PhD Commenter:  And yes, it is acceptable. It is very acceptable. For one thing, when a second opinion is sought, either the diagnosis or the treatment is in question. For any given set of symptoms and test results, there is often more than one possible diagnosis. For any given diagnosis, there is almost always more than one option for treatment. That is just the way it is and will continue to be as long as medicine is advancing. It is even the truth that one medical institution gets better results with one treatment and another gets better results with another.

Host: One of my biggest gripes is how dysfunctional our college system is, and how our Food Stamp President keeps throwing more money into it instead of shutting it down and starting all over

Well, you certainly make me feel better.

Thanks for that treatment.

But seriously, if I understand your comment, if I am receiving a treatment from one facility and am not getting good results, then I could go to another doctor and get the same treatment with a different result?

And if I go for a second opinion, then I might get another variety of treatment from a third facility.

And if that does not go well, perhaps a fourth facility could give the second treatment with different results than the third facility?

Is there a limit on the number of places/doctors I need to see/pay before I get cured? Or before I get killed?

Does the scientific principle of replicable results enter into this?

By the way, four doctors and four treatment/outcomes for the same medical condition/disease are not as unusual as anyone might think/fear!

 Many patients see more than four doctors before getting correctly diagnosed and cured.

The newspapers, golf clubs, condo associations, country clubs and the internet are full of histories that take many, many doctors before a cure is encountered.

It is not acceptable to dismiss such things as “that is the way it is” or as merely “anecdotal evidence.”

Actually, many doctors admit that three or more doctors may be required before finding the working/curing treatment for 15 to 20 percent of patients.

My own family’s “anecdotal” evidence consists of more than thirty doctors for four people covering 95 years, and includes three instances (for four people) where doctors insisted on immediate operations that were not necessary or appropriate. Did they teach the spelling of “malpractice” in your PhD thesis?

One doctor screamed at me at the top of his voice that if I did not let him operate on me tomorrow, I would die.

I refused and am living very happily. Another doctor cured the condition with antibiotics costing $47 compared to the $30,000 the surgeon wanted to waste, forget the pain, suffering, and risks of surgery, including the very real risk of infection in our filthy hospitals.

Our family declined all three operations, and has lived very healthily without them, although it did take three doctors a bit longer to pay off their yachts.

I believe our medical schools, doctors, and medical boards are in need of even more drastic reform than our financial and governmental systems, all of which are so broken they cannot be fixed, but need to be totally discarded and reinvented.

PS Later the “Educator Of Doctors” Replied that one way to improve medicine was to give doctors free magazine subscriptions.

Presumably they might read them on their yachts bought with unnecessary operations.

This question comes from a comment from Ingrid.  Have you gone for a second opinion?  How do you reconcile when you get two conflicting opinions from two doctors? – Ann Z

Just on a different topic. I would love to hear peoples opinions on getting a second opinion! I explained this to Paris’s optometrist and he said “well I probably wouldn’t have done that, Dr Smith would not appreciate it I am sure!” I was quite taken aback as I am sure a lot of concedrned parents do the same! What do you think?

Playing online is nothing new! I remember years ago playing Starcraft on Battle.net, both “pwning noobs” and being called a “noob” myself. Online gameplay even traces back to the 80’s with Multi-User Dungeons. But few can argue that online gameplay won’t be part of the future of video games.

I’m used to playing games by myself. My younger sister dislikes playing anything that’s not My Sims or Harvest Moon and when I hang out with my friends, we hardly spend that time playing video games; online play really opens up my horizons by letting me play with other people.

Many of you reading this will probably be thinking “Geez, this guy is master of the obvious!” or “Man, this is old news!”, but I was just recently exposed to Xbox Live and that gave me some inspiration to write a piece on online gaming. It’s almost like this is a brand new thing to me, so bear with me!

First, what types of online games are there? There are ones that have versus modes, cooperative play, leaderboards, and there are some that have a combination of these and more! And then there are Masively Multiplayer Online games (MMOs), which can be the classified into several other subcategories like MMORPG’s, Racing MMO’s, FPSMMO’s, and more! There’s plenty of things to do online in games!

Online play, like everything else in life, doesn’t exactly come for free. Believe it or not, you need to have the internet and be connected online in order to play online! Those who don’t have wireless might have to shell out extra moolah for internet cable cords or wireless adapters. Even if you have wireless, you might have to shell out more money! (I spent $99 on the Xbox 360 Wireless Adapter!) On top of that, you might need to spend money on a monthly or yearly subscription. In the case of Nintendo’s Wi-Fi, even though it is free, many have complained about its friend code system and plenty of problems on Nintendo’s servers.

Having friends to play with is certainly a welcome aspect, but for those without friends, you can always play with strangers. The trade off is that not everyone online will be buddy-buddy with you and some have nothing better to do than berate those of lesser skills. Having an earpiece isn’t always a good thing; I could always do without those snobby 13 year olds telling me what to do.

MMO’s can certainly be addicting! I messed around in MapleStory for a year and a half before I finally quit. Ragnarok Online has several private servers that lots of people play on daily. World of Warcraft is one of the most, if not the most, popular MMO’s out there! Personally, I’ve never tried it out, but I’ve heard plenty of stories about people being addicted. With plenty of expansions and 11.5 million monthly subscribers, this is definitely Blizzard’s cashcrop. I can’t vouch for how fun it is and I don’t plan on starting any time soon, but lots of people I know are into it, so it definitely has its impact. Social MMO’s like Habbo Hotel or Club Penguin have attracted the crowds of a younger audience, while an MMO like Second Life brings an older audience.

Some MMO’s rely on subscriptions, while others are Free to Play (F2P). The F2P MMO’s may be heavily supported by ads or they may have points that you can purchase to affect your in-game avatar. I know I dropped $40 on MapleStory, which didn’t seem like such a bad idea back then, but it only lasted about 3 months. What a waste!

But what is an online game without a community? After all, if there was no online, you would have no one to play with! Without a community, games can die out and be forgotten. For instance, the fairly recent Tabula Rasa did not receive as much support and it’s closing soon. However, older games like Starcraft or Diablo II still have active communities to this day!

Communities online almost constantly need some adjusting and tweaking. There are those who find and exploit glitches (like Gears of War 2 glitches), or perhaps adding new content is what keeps players coming back. Sometimes in-game economies experience inflation and a patch is needed to fix that! Most of all, patches mean that the game developers are actually paying attention to and responding to the community.

One of the things that I’ve been introduced to recently was the concept of a Gamerscore or Trophies. They certainly add some gameplay time because plenty of others like myself might feel compelled to get all of them. However, they do nothing but add to your bragging rights and your e-penis. I also dislike the fact that some Achievements/Trophies may be linked to online play and those achievements can be impossible if the online community is defunct.

But it’s not like all games need an online function in order to be fun. Where were online games for the NES or the SNES and were they any less fun without online functionality? Of course not. Some games feel like they just tack on an online mode just for the sake of having an online mode.

Whatever the future of online gaming will be, it seems definite that it will be here to stay! While we should welcome online play, I don’t think it’ll ever beat having someone play right beside you where you can both be there for the moments of screaming, frustration, and joy.

Regardless of what people say about Kotaku, I still find it very interesting to read. Among the articles I read recently while browsing the site was the news of Shigeru Miyamoto filing this patent. Basically, this “Kind Code” allows for players to choose jump out of the action and have a video of the game character automatically playing for them. From there, the player can jump in at any time with the press of a button. However, saving is not allowed in this mode. Furthermore, a “scene menu” allows the player to directly skip to a scene.

This opens up gaming to whole new ways of playing! Perhaps the days of grinding in RPGs are over? Or maybe tedious dungeons are a thing of the past? I know there have been plenty of video games that I’ve played through just for the sake of beating it; for those times, I think it would have been handy for someone to do all the dirty work for me.

This could potentially bring “casual gamers” to playing games they would have traditionally not played for several reasons. Now they can simply view the in-game hint system for parts they would have struggled at and put the controller down.

Are games turning into just big interactive movie? Several people bashed Final Fantasy XII on its innovative battle system, but all it did was take out the tediousness of selecting the “Attack” button hundreds of times.

It’s not like there aren’t enough ways to check how to get through a puzzle. There might be several FAQs on the internet or even a YouTube video of it. And games as of lately have been getting progressively easier, in my opinion. Some games already have a built-in hint system that points players in the right direction. (HAY LISTEN)

I think there’s something satisfying in beating the game yourself. Just like beating a game without looking at a guide, there’s that self-gratification you get from achieving something on your own. Maybe this will be what seperates the truly “hardcore” gamers from the “casual” crowd?

Could this revolutionize gaming as we know it, or will it just be another gimmick? Will people love or hate this? Only time can tell.

So I go to another sleep doctor today for a second opinion regarding my sleep apnea. Boy am I glad I did. It has been a long time since I enjoyed going to a doctor of any type, but today was actually fun. The office was wild and the doctor looked like he stepped out of a old television series. What counts is the end result, and it is 500 times better than I could have dreamed.

As it turns out, this doctor helped develop sleep labs and has an independent lab with the most sterling reputation in the area. He personally has trained the personnel at other labs, including the one I had my study at. He is currently the medical director of the sleep lab he founded.

I told him that I didn’t want to become addicted to “klonopin” as a way to relax to handle wearing a CPAP or BIPAP mask. He didn’t blame me. I told him the previous doctor had said I had the worst study results he had ever seen. Today’s doctor said, “he must not have seen too many”.

After looking over my study results he said I was only moderately severe and most of my episodes were “obstructive” apneas in the supine position. On my side, I had only a few episodes and they were more “central apnea”. He looked at the results of the study again and then stated that he thought it would be a waste of time and insurance money to repeat the test or to do it to “desensitize” me so I could handle the CPAP mask. He had a better solution.

He suggested my wife sew a pocket on the back of my sleep shirt with a way to close the pocket. I am to get a tennis ball and put in the pocket each night. Each time during the night when my body wants to roll over from the side to the back, it would feel the tennis ball and roll back on the side. He said this type of training lasts a short time and the habit of sleeping on ones back is broken.

That was it. That was the extent of treatment recommended by someone who was a pioneer in the field of sleep apnea. No CPAP machines, no threats of impending death if I didn’t get hooked on tranquilizers to handle a mask and no wearing political buttons on his white doctor’s coat either. Just good and sound medical advice.

The lesson I learned through all this is that sometimes it is a very good thing to seek out a second opinion on medical matters. Sometimes it is vital to seek out a second opinion. I know of people where it is a matter of life and death to get a second opinion. I have had close friends die of cancer that was not treated soon enough because of the lax attitude of their family doctor. I have had close friends endure painful treatment for diseases they never had due to mistakes being made reading test results.

If anyone reading this has obstructive sleep apnea that is far worse sleeping on your back vs. your side; I urge you to try the tennis ball approach to train the body to stay off its back. If it means being set free from the bondage of a CPAP machine, it would be worth a try. Of course if the apnea is “central” in nature, all the tennis balls at Wimbledon wouldn’t help. Good luck and good night.

I received this question from a concerned consumer last week . . .

A week ago I was prescribed gabapentin, an anti-epileptic drug, for the off-label use of social anxiety and “affective mood disorder.” I have been concerned about this ever since I began my research on it a few days ago. Most of what I have read says that it should remain a second-tier drug until more controlled studies are conducted. While I am not sure if your comments on Trileptal holds true for gabapentin, it seems probable that they would. My concern is because although most of the studies I have read say that gabapentin, and other drugs of its type, are used off-label only when other medications have proved intractable, my psychiatrist prescribed them right off…as a first-line drug. “Front-line experience” is well and good, but it is still anecdotal. I feel rather like I am part of an informal experiment, sort of like a guinnea pig. He also did not inquire at all into my past to see if there were psychological roots to my anxieties. He said we would try the medicine first and then determine if “talking therapy” was needed. Should it not be the other way around? Should we not be trying to avoid medicinal intervention whenever possible? I am of the opinion that I need a second opinion…do you agree? I apologize if I am rambling. I actually did begin the medication and THEN began my research, so I am under the influence of its side-effects. I am at odds with myself as to how best to proceed. Thank you for your patience.

Well . . . not really a guinea pig.  The use of neurontin as a first line agent is not typical for the industry.  Not that neurontin is a big scary drug that will make you spout horns like some of the poisons we use.  More because it doesn’t work that well.  Neurontin is a medicine looking for a cause.  It got caught up in the wave of anti-seizure medicines being used for psychiatric purposes. Medicines like Depakote and Lamictal have earned their stripes and are commonly used and approved by the FDA.  Trileptal has not been approved, but has become a staple in our arsenal of medications because it works well.  Neurontin . . . well . . . it’s kind of that medicine that is used when you don’t know what else to do.  Despite initial claims of efficacy, there is virtually no data showing it can be helpful for psychiatric purposes.  When it is used (and, yes, I have used it this way) it is most often to address anxiety issues such as social anxiety or generalized anxiety AFTER other treatments have failed.  Because it has some efficacy for chronic pain syndromes (such as fibromyalgia), it is sometimes used in that population of patients earlier rather than later.  It is not used as a treatment for “affective mood disorder” . . . whatever that is . . .

My biggest concern is not that the medicine will put you at risk.  Neurontin is an innocuous drug that does not have a significant side effect profile.  Untreated anxiety, however, will put you at risk, as will untreated depression.  I am also concerned that you were told that “talk therapy” was a second line treatment.  It is VERY clear that social anxiety and depression are amenable to intervention with appropriate therapies (cognitive therapy is best), and I personally EXPECT my patients on medicines to be in therapy.  

Sounds like you might need a second opinion.

–Dan Hartman, MD

A very special friend was recently confiding in me that she had not been intentional around creating her company; she had let several several months go by and was now staring into the dragons mouth of her financial obligations without a knight in shining armor; not that she was looking for one. She knew that she could easily take care of her financial concerns. It was the though of having to put her dreams on hold to deal with the dragon that was upsetting.

So what to do?

As if I should know. I really wish I was the oracle of Gales, and this time – as you’ll see – I clearly was not.

In my manly, and practical “wisdom” I advised her that she had to deal with the reality of her circumstance in order to move forward. Therefore, she might have to face the “karma” of her prior inaction and get a temporary job. She was not very happy, yet she acknowledged that this might be the only way.

Lucky for her, I’m not the only oracle she consults.

She called me the other day, all pumped up and bursting with enthusiasm, to tell me that she was focusing 100% on her business. She had abandoned any search for a traditional, albeit temporary job, as a solution to her current financial dilemma.

This revelation, from her “other” oracle – I know I’m not the only one – got her to see that giving anything less than 100% to her dreams was a sell-out, and would not only delay or derail her dreams but would make her miserable.

It’s funny when you know something is right for you how you feel inside, and it was clear that my friend was bursting with joy. Deep inside she already knew following her bliss was the only course for her, and was only looking to have it validated by someone she trusts. Not hearing it from me, she turned to someone else to get that validation. This was all she needed to really cast off from all that she knows and sail into the uncharted waters of her future.

I was and am very happy for her, and especially that someone else was there to focus her on what her own soul was telling her. She also shared a particularly fitting quote which I’ll share with you here:

“One does not discover new lands without consenting to lose sight of the shore for a very long time.”

Adre Gide

Through this experience with my friend I learned a valuable lesson for myself:

It is a gift to have a dream, and there is no greater expression of love for yourself and life than to follow that dream.

Hmmmm! That may be quotable.

And a lesson for you: Always have your back up oracle. Always get a second opinion when it comes to medicine and matters for the soul.

I’m realizing this site is evolving and I have received many email from people recently diagnosed.  So I’m going to start a thread of advice I’ve learned along the way.

Cancer counsel #1 is to get a second opinion.  Not necessarily to determine if you have cancer, because biopsies are generally pretty reliable.  I’m talking about treatment here.  There are a lot of variations in treatment and it’s good to know your doctor and other doctors are in agreement.  When I first talked to my oncologist I was relieved when she told me that second opinions were standard for her line of work.  We went over to U of M to meet with a doctor there and I go meet with her periodically to get her opinions.  Throughout my treatment both cancer centers have been very willing to work together.  My doctors will talk on the phone and send test results back and forth.

Kris Carr from Crazy Sexy Cancer Tips sites a study that people who travel the farthest for treatment are more likely to recover.  So get in your car and go meet people who know about your cancer.  Get on the internet and find where they are and go to them!  If you’re too dazed by this diagnosis to drive, get your family or a friend to take you.  In my experience the cancer centers will make every effort to get you appointments quickly.

If you find a doctor who isn’t willing to work with others you may want to look around.  Not that they don’t have different opinions….that’s OK.  But all my doctors wanted me better and their egos didn’t get in the way.  They were open to discussion.  That’s the right doctor!

Here’s a story of failure turning into success. From Wikipedia:

Silly Putty was invented by James Wright of General Electric when he dropped boric acid into silicone oil. He was looking for a substitute for rubber. GE supplied the newly discovered dilatant compound to researchers around the world. None found a use for it, but they all loved playing with it.

In 1943, Dr. Earl Warrick left the Mellon Institute of Industrial Research to join the newly formed Dow Corning Corporation. His research was refocused: help the war effort by developing a synthetic rubber substitute. Although he failed to produce a suitable rubber before the end of the war, one result of his experiments was a silicone bouncing putty. (“Forty Years of Firsts: The Recollections of a Dow Corning Pioneer,” by Dr. Earl L. Warrick, McGraw-Hill Publishing Company, New York, 1990, pp. 27-28.)

The product was then commercialized by Peter Hodgson in 1949 after the marketing expert attended an informal “nutty putty” party where chemists were playing with the substance after hours. Renamed “Silly Putty” because of its main ingredient, silicone, the product was a smash hit.

Failure can be devastating if you let it. More so if you don’t expect it. Other times is can be down right silly.

 PS – Here’s another article on second opinions. Five diagnoses that call for a second opinion
PPS- Here’s a great article on how trying to be happy can make you miserable. Happy to be unhappy

Medicine has had a long history of positive negativity. The fact you go to the doctor at all is to prevent health issues or stop an illness. Positive thinkers would just assume everything is all right and never go to the doctors until it was too late. So by taking that first step into the doctor’s office, you’ve taken a negative one.

When doctors examine you, it is to rule out things first. He might have an idea what the problem may be, but he needs to eliminate other possibilities to narrow down what it actually is. If you’ve ever watched House (not my basis for medical knowledge, but a fun show nonetheless) they write down all the symptoms and try to eliminate the causes down to one, or at least a few.

Side note: I’ve yet to understand why Dr. Gregory House is supposed to be this great diagnostician. For the first 40-45 minutes of the show, he continually gives the wrong diagnosis, until the end of the show when a completely unrelated event unlocks the key in his head and he figures it out.

When a doctor prescribes medication, he has to take in account any other medications or allergies so there won’t be an adverse effect on the patient. The medication itself is clinically tested over and over again to
1. Ensure safety
2. Document any side effects and the severity of them

And sometimes those side effects themselves can accidentally create a whole new treatment. Viagra was a medication for heart patients until they discovered that it didn’t just get the heart rate up.

Side note: When did people start asking their doctors if they should take medication. Isn’t the doctor supposed to tell you what you need to take? If we ask them for medication, don’t they just become drug dealers?

And finally (though there are still plenty of great negative things in medicine) the key to any diagnosis…get a second opinion. It’s always best to get a second opinion. Doctor’s (despite their own complexes) are not god. They make mistakes. Heck, they amputate the wrong limbs, prescribe the wrong medication and just make misdiagnosis all the time. A second opinion not only protects you from harm, it also reassures you that the right steps are being taken.

You always want to think positive that a treatment will work. Evidence shows a positive attitude will help recovery. But medicine can’t become a happy, positive, look on the bright side of life profession. Too many lives depend on it to think otherwise.