A Whole Month Off, for Good Reason!

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I have a lot of friends and readers who have emailed me over the month.

The recurring comments: "Has the DTCG field run you off of your blog?"

The answer: "Uh No"

Why I have I stopped blogging so much? For multiple reasons.

1. DTCG has been put on the Radar of the FDA and Government. I have nothing more to say about that.
2. Journalists and Genomics aficionados have been correctly pointing out the hype behind some tests. Most notably lately with the ADHD stuff, which BTW should not have been put out there in the press....Maybe, I need to blog more.....
3. My practice and patients have really taken up my time. I am working to apply personalized medicine daily. Because that is what is needed. We need to show the public and the press how it is done on a daily basis.

I will be back soon, to dissect shotty science and poor clinical studies. But for now, our boots are on the ground and we are climbing the mountain....

See you soon!

Kif 6, Genetic Findings = Useful Medicine 1 in 1000 times

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Way back in 2008 I mentioned an article, which I hoped would pan out. Or at least I hoped it would point the way to a model of PGx research which would be followed by pharma and alike to find associations to help us target the right medication for the right patient.
While the similar model followed through with Plavix, the initial study did not.
Which is why when the Berkeley Heart Lab guy came last week, I told him I would not be testing for Kif6. It had not been replicated in further GWAS.

Heck, I don't even use the 9p21.3 test......Why?
A VAP cholesterol panel, a HsCRP, a family history and a blood pressure can help me predict risk much better.
The problem and backlash facing DTCG and DTMD genetic test purveyors is
the 'Ol "Your million dollar major study now rushed to market has just been refuted"
Yes this happens in biomedical science and in medicine ALL THE TIME.

Bed rest for MI anyone?Low Dose Dopamine?I could go on and on, but I won't
Put simply, the majority of the genome is NOT ready for clinical medicine or clinical decision making.
It won't be for 20 years.
That doesn't mean there aren't some things we can use.
1. BRCA1/22. MMR genes3. CYP2C194. CYP2D6, sometimes.....5. SCD genes6. Counsyl universal carrier screening
That is why the FDA is all hepped up about DTCG and even DTMD.
If a gene test comes to market that purports disease risk it had better be studied for at least 5 years before it comes to market.
Post market surveillance did not protect all those patients on Statins, "just because" of Kif6 risk.
Get it? These tests can lead to incorrect medical decisions....
Which can lead to risk.
Yes, even the DTCG tests can fool doctors and patients.
The Sherpa Says: If 2008 was the year of the GWAS, will 2011 be the year of the overturned GWAS?

Barbara Evans is Right! Sliding scale of regulation.

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As the FDA debates what they should do, Barbara Evans at the University of Houston Law School and Amy L. McGuire of the Center for Medical Ethics and Health Policy at Baylor College of Medicine in Houston, also includes, Canadian legal expert Timothy Caulfield and Wylie Burke, M.D., of the University of Washington School of Medicine post some guidelines for regulation of DTCG/LDT genetic testing.

I love this sort of handicapping.

You have absolutely brilliant people posing ideas for regulations. I have read a ton. There are those from industry insiders, Ones from industry "Advisors", Ones from politicians who receive funding from industry, Ones from academic centers that do LDT testing. Ones from bioethicists...

But I have paid attention to the mixed group that includes pragmatist Wylie Burke and Barb Evans

In an article I just read from Science published October 8th. They propose rules for DTCG, but I am certain they also would work for LDT.

What they propose is a "sliding scale of potential harm"

Which is sort of what I had been saying for years, which perhaps is why it rings true.

If this is for earwax type, let it go to market, if it is for medically related decision making, probably needs some regulation.

The proponents for a wild west DTCG (WWDTCG), which BTW includes a "registry" say
"Well, there is no proof of harm or risk"

I say, well, this is not about psychologic risk.

Instead, it is about medically actionable risk.

I say this because recently, Kif6 testing has fallen into question, despite a company promoting these tests to physicians.

The test is marketed as a "Statin response" genetic test.

Can you imagine how many people were started on statins? Well, 250,000 tests had been ordered. Even if 10% were started it would be nearly as many people as DCTG 23andMe have tested.

The real problem here: Pharmacogenomics tests are not something you hide, you ask your doctor to use these results. Unless you are a doctor, you can't use these results to dose medications.......

That is a real risk. Despite what WWDTCG proponents say.

Another risk, BRCA testing. I cringe at the thought that a doctor would use 23andMe results and only those results to infer carrier status of BRCA 1/2
The same goes for CF carrier status.

These DTCG medical tests aren't recreational. These companies added these tests because NO ONE wanted to pay hundreds, hell thousands of dollars to find out these risks.....

In a business decision, they fell short of looking at the medical risks.

So yes, a sliding scale of regulation is likely coming. But not because of Wylie, because of the FDA.

It is obvious. Again, medical testing will be regulated as medical. Ear Wax as ear wax. Will LDT be forced to go through pre-market review? Probably not if they can only be ordered by licensed professionals.....

It's not a form a rent seeking, it is a form of guidance and protection for consumers. That's why physicians are licensed and malpractice covered.

Yes, yes. Someday everyone will have these genomes done and everyone will be educated enough to know what they mean. And all humans will have medical education and we can replace the oligarchy of physicians and the tyrannical healthcare system once and for all........

But until that day, we will have to rely on trained professionals who don't have their retirements tied to their company's new genetic test......

The Sherpa Says: Handicapping of the FDA by the Sherpa. If it has any medical utility it will be regulated as either Class II or III. If only ordered via physician it will more likely be Class II. If not, will need Class III.

23andMe Buyer Beware, The Internet doesn't equal hippocrates

To contact us Click HERE
Ok, ok. I am not gonna tell you I told you so. But, I did.
Did anyone read my article in Nature Biotechnology? Did ya? 


Here is your freaking reality check. 23andME has your DNA. It has it hostage and it has your datapoints. And it can do whatever the hell it pleases. Including locking or cancelling your account.


They have enough data points for their robust database. They only need you sheep to keep paying 9 dollars per month or 108 dollars per year and 99 to start. 10 years? 1080 dollars. Even more than the first 999 USD they started with.


Well guess what? People everywhere are waking up to the charlatanism that was peddled by Silicon Valley Overlords.....


They have you, you are stuck. You have to pay FOREVER!!!!! BWAHAHAHAHAHAHAHAHAHAHAHA!!!!!!


Even if you quit, they don't care. They Pwned you. And they still do. 


So what did the Sherpa say all of those years? Huh? No, not that their health reports are bull $hi!. But I did say that. No not that I was done posting on 23andMe. Clearly I am not.


But I told you about the Master Plan!


Even if you pull out your data, they still have it. End of story. You are powerless and have been duped. I am sorry. I wish you had listened


The Sherpa Says: Buyer Beware web sites giving you tests and testing your DNA. 23andMe and its company are not  to be trusted. Sorry, but the web has not  take the hippocratic oath!

What's the Sherpa Up To?

To contact us Click HERE
I have decided to write an update to what the Sherpa is Up To. Why? Well, after 5 years of hard work, Lee Gutkind is about to publish a work of creative nonfiction. I am one of the main characters. The other characters are also very compelling. 


I was able to preview a copy and am very excited. 


But, after reading, I thought I should give you an update on what the Sherpa is doing. Let me explain my madness. Here is my thought. As my good friend John Setaro MD would say. 


"There isn't any genetic advantage that can't be overcome with aggressive environmental modification."


This was me. I was overweight, the practice was stressing me and killing me. I needed to lose weight. I did. 30 pounds of weight. Mostly fat. This changed my life. How did I do it? FitBit, metabolic testing using gas exchange, calorie tracking, some things that a guy like Eric Topol MD would call mobile health.


I began to pay attention to obesity. I noticed that obesity is a huge familial disease and an epidemic in the US. But, the genetic markers soft at best. So I say again, family history matters more. I studied fat metabolism and began to realize this disease was very similar to some mitochondrial deficiencies. I began to align genetics, family history, obesity and preventative care. Truly personalized medicine. I will sit for the obesity boards this year.


I understand the future of medicine and the potential of personalized medicine to enhance disease cure and prevention. In this case, I have been able use my understanding of metabolic genetics, clinical genetics, bariatric medicine, pedigree analysis, mobile health, medicine and wellness, to help cure diabetes, hypertension and depression. It is amazing how people feel better when they are no longer obese.


I along with 2 other physicians, my 3 nurse practitioners and our 3 offices (yes, a long way from a genetic counselor and a part time office on Park Avenue, NYC) devote every day to early detection of disease and prevention of disease.


You will soon be able to see the fruits of our labors. We are modifying environment aggressively to overcome genetic and familial risks. We take family history, environmental history, genetic testing (if indicated), mobile health tools, technology, social history and use these tools to maximize human life.


A concept we call Arete (R-eh-Tee). The Sherpa is creating the best system to cure disease, using the model developed from his own 30 pounds of weight loss and journey to health. Come see us, we are still in Greenwich, 115 East Putnam Avenue, 23 Maple Avenue, 49 Lake Avenue. 203-869-0451.


The Sherpa Says: We have made camp, 1/3rd up the mountain, beans and lamb are on the fire, with quite an ascent coming. Genomes, Environmental, Technology. Coming soon! But for now, go buy Lee's book!

Unregulated DTCG saved my life.

To contact us Click HERE

Ok, so if Ellen Matloff hasn't flipped her bobbed haircut, 99245 without 60 min of MD care-insurance billing head yet, then this story will make her and the rest of the counselors who get mad when untrained MDs do BRCA testing flip out.
A woman's husband on DNADay takes advantage of 23andMe's rock bottom 99 USD fee. Clearly intended to double their database.....which it did
Only to have her HUSBAND open her results and
WHAMMO! You are a BRCA1 carrier! Mazel Tov! Not exactly the "fun" he had been looking for when he saw that flyer.....
Why does Myriad market to doctors? Their stance "We are missing a ton of BRCA mutations out there"
I agree.
So you would think I am happy that an unregulated DTCG testing company that the FDA pilloried finds a medically valid BRCA1 mutation that wasn't suggested by doctors.
Well, here's the shocker.
I am glad they found it. Yes, thank god someone did before she had ovarian or breast cancer! If she would have, penetrance here is NOT 100% guys......
I am also glad that the woman who had the test was mentally stable enough and smart enough to seek professional help. I wonder what her husband and her do for a living? I wonder if they are college educated. I wonder if there demographic is anything like the majority of the United States.....probably not....Oh wait. Princeton Grad, Prior Google Grad, CEO....yeah sounds just like my cousin Billy in Dushore PA (FYI I don't have a cousin Billy) But Dushore is in BFE.....
I am not glad that everyone is NOT like Mrs. Steinberg or her husband. In the right hands and with easy access to health professionals this works, sometimes........That is why the FDA has stepped in. Not everyone lives like the Steinberg's
Without professionals and without a level head, this could be a problem.
But the news story re-emphasizes what is crystal clear. This is an unregulated company that delivered a medical diagnostic. This result then drove clinical decision making.
Seriously. The DTCG BRCA test is a medical test. I think the FDA gets that part. Despite what DTCG says.
The Sherpa Says: I am happy for this woman. We need more testing, I agree with Myriad. I also think CGCs should be out teaching doctors rather than letting pharma reps do it. In fact excellent CGCs like Ms. Matloff should never see patients and should instead teach doctors how to do cancer counseling everyday. That is what is needed here, more education given to those who need it. Because clearly the doctors who told Mrs Steinberg (I assume she is AJ) that she wouldn't "need" genetic testing despite the family history of cancer are likely in need of some schooling.

For Personalized Medicine CPMC is the Gold Standard Study

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Ok,
So I just wrapped up a meeting with some, well, nearly all of the most brilliant minds in Pharmacogenomics. Where was I? Yes, on the cover of USA Today's life section.....But where was I really?
Conference? No.
VC event? No.
I was at the Coriell Personalized Medicine Collaborative (CPMC) Pharmacogenomics Advisory Group meeting.
Yes, that sleepy 'Ol Cell Line joint in Camden New Jersey.
I am certain you all know about the CPMC now. But in case you have been sleeping.
Coriell is climbing the mountain, gaining collaborators, building camps. They are essentially doing all the hard work of study analysis so that you don't have to.
Brilliant if you ask me.
Who in the world has the time or money to cull data, looking for important findings?
Google funded "projects", Academic Programs and Not For Profits.
Who do you trust to give you unbiased reports?
NFPs.
Who is the NFP here? Coriell.
Are you curious what the CPMC does?
Why will CPMC win this battle? Even 23andSerge agree that CPMC is the gold standard

1. They have independent advisors and scientists
2. They have nearly all the best independent advisors and scientists
3. They have the support of the government, the community and oh yeah, the FDA isn't investigating them......
4. They have Mike Christman.
5. They have a team who believe in this moral imperative, not a pay check or stock options.

I vowed never to post what transpires at these meetings, but rest assured, it was truly academic heated debate with egos left at the door. This is precisely what you want when someone is going to tell you what your genetic material means for you. The Sherpa Says: Coriell is on to something here. Something so valuable when the 1000 genomes and the rest of the genomes go public. Someone has to make sense of it all and study what it means......I am proud to be a part of it.

Family History Better than Navigenics/DTCG Shill for Cancer Genes?

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Yes,
You heard it here. A recent study abstract and pressed about from my friend Charis Eng MD PhD, Clinical Geneticist, Internist and all around really smart lady spoke today about her findings of a head to head, DTCG vs Family History at discovering cancer risk. You can watch the webcast about it here!
I actually sent some data Ken Offit's way about a similar thing way back when, Ken is yet another, really smart guy. He wasn't surprised. Nor was I when I heard Dr. Eng's findings.
First, Caveat Emptor
This is an abstract! Repeat after me......
What does that mean?
1. It is not peer reviewed fully
2. It is not published yet
3. It is preliminary data
This test was Navigenics Compass vs Family History in 22 females with breast cancer, 22 males with prostate cancer and 44 people with colorectal cancer.

What was the result? Family History placed far more people in the proper high risk category. 8:1
Family History put 22 people in the appropriate High Risk Hereditary Category, DTCG only one.

Further, it looks to me that the Navi "Gene" Scan missed several high risk patients who actually had MMR mutations (I.E. Genetic Cancer).....D'Oh.
First off, this is like a case study. But it signals a HUGE shortcoming of DTCG. False reassurance.
I have been beating this over the head for 3 years now! These tests that have "medical" relevance need to be couched with proper medical guidance.
I told Mary Carmichael of Newsweek this!
This stuff is medical data and I Told Thomas Goetz of Wired this!
Even the WSJ has gotten it!
There are huge shortcomings in the current offering of DTCG tests and those offering medical information need to be regulated as medical. This is a classic case in point of potential and REAL missed cases.

Not Good.
That being said. It is November AKA Family History Month. You should absolutely take your family history and bring it to your doctor. If they don't know what to do with it, call us. We do.

The Sherpa Says: No surprises Charis, I saw this with some DTC cases I have had, passed it on to Ken who passed it on to NIH and The IOM. This is the huge problem with hype and over promise. It always fails to deliver, unfortunately in this case at a great risk to consumers.

23andMe Buyer Beware, The Internet doesn't equal hippocrates

To contact us Click HERE
Ok, ok. I am not gonna tell you I told you so. But, I did.
Did anyone read my article in Nature Biotechnology? Did ya? 


Here is your freaking reality check. 23andME has your DNA. It has it hostage and it has your datapoints. And it can do whatever the hell it pleases. Including locking or cancelling your account.


They have enough data points for their robust database. They only need you sheep to keep paying 9 dollars per month or 108 dollars per year and 99 to start. 10 years? 1080 dollars. Even more than the first 999 USD they started with.


Well guess what? People everywhere are waking up to the charlatanism that was peddled by Silicon Valley Overlords.....


They have you, you are stuck. You have to pay FOREVER!!!!! BWAHAHAHAHAHAHAHAHAHAHAHA!!!!!!


Even if you quit, they don't care. They Pwned you. And they still do. 


So what did the Sherpa say all of those years? Huh? No, not that their health reports are bull $hi!. But I did say that. No not that I was done posting on 23andMe. Clearly I am not.


But I told you about the Master Plan!


Even if you pull out your data, they still have it. End of story. You are powerless and have been duped. I am sorry. I wish you had listened


The Sherpa Says: Buyer Beware web sites giving you tests and testing your DNA. 23andMe and its company are not  to be trusted. Sorry, but the web has not  take the hippocratic oath!

What's the Sherpa Up To?

To contact us Click HERE
I have decided to write an update to what the Sherpa is Up To. Why? Well, after 5 years of hard work, Lee Gutkind is about to publish a work of creative nonfiction. I am one of the main characters. The other characters are also very compelling. 


I was able to preview a copy and am very excited. 


But, after reading, I thought I should give you an update on what the Sherpa is doing. Let me explain my madness. Here is my thought. As my good friend John Setaro MD would say. 


"There isn't any genetic advantage that can't be overcome with aggressive environmental modification."


This was me. I was overweight, the practice was stressing me and killing me. I needed to lose weight. I did. 30 pounds of weight. Mostly fat. This changed my life. How did I do it? FitBit, metabolic testing using gas exchange, calorie tracking, some things that a guy like Eric Topol MD would call mobile health.


I began to pay attention to obesity. I noticed that obesity is a huge familial disease and an epidemic in the US. But, the genetic markers soft at best. So I say again, family history matters more. I studied fat metabolism and began to realize this disease was very similar to some mitochondrial deficiencies. I began to align genetics, family history, obesity and preventative care. Truly personalized medicine. I will sit for the obesity boards this year.


I understand the future of medicine and the potential of personalized medicine to enhance disease cure and prevention. In this case, I have been able use my understanding of metabolic genetics, clinical genetics, bariatric medicine, pedigree analysis, mobile health, medicine and wellness, to help cure diabetes, hypertension and depression. It is amazing how people feel better when they are no longer obese.


I along with 2 other physicians, my 3 nurse practitioners and our 3 offices (yes, a long way from a genetic counselor and a part time office on Park Avenue, NYC) devote every day to early detection of disease and prevention of disease.


You will soon be able to see the fruits of our labors. We are modifying environment aggressively to overcome genetic and familial risks. We take family history, environmental history, genetic testing (if indicated), mobile health tools, technology, social history and use these tools to maximize human life.


A concept we call Arete (R-eh-Tee). The Sherpa is creating the best system to cure disease, using the model developed from his own 30 pounds of weight loss and journey to health. Come see us, we are still in Greenwich, 115 East Putnam Avenue, 23 Maple Avenue, 49 Lake Avenue. 203-869-0451.


The Sherpa Says: We have made camp, 1/3rd up the mountain, beans and lamb are on the fire, with quite an ascent coming. Genomes, Environmental, Technology. Coming soon! But for now, go buy Lee's book!

Symptoms of Acute sinusitis

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Acute sinusitis symptoms typically include:

• Drainage of a thick, yellow or greenish discharge from the nose or down the rear of the throat
• Nasal obstruction or congestion, inflicting issue respiration through your nose
• Pain, tenderness, swelling and pressure around your eyes, cheeks, nose or forehead
• Aching in your higher jaw and teeth
• Reduced sense of smell and style
• Cough, which can be worse at midnight

Other signs and symptoms will include:

• Ear pain
• Headache
• Sore throat
• dangerous breath (halitosis)
• Fatigue
• Fever

When to see a doctor
If you've got delicate symptoms of sinusitis, attempt self-care.

Contact your doctor if you've got any of the following:

• Symptoms that do not improve at intervals some days or symptoms that worsen
• A persistent fever
• A history of recurrent or chronic sinusitis

See a doctor immediately if you've got signs or symptoms which will indicate a significant infection:

• Pain or swelling around your eyes
• Swollen forehead
• Severe headache
• Confusion
• Double vision or different vision changes
• Stiff neck
• Shortness of breath

Addison's Disease

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Addison's disease is a disorder that happens when your body produces insufficient amounts of bound hormones created by your adrenal glands. In Addison's disease, your adrenal glands manufacture too very little cortisol and infrequently insufficient levels of aldosterone furthermore.

Also referred to as adrenal insufficiency or hypocortisolism, Addison's disease happens in all age teams and affects each sexes. Addison's disease is life-threatening.

Treatment for Addison's disease involves taking hormones to interchange the insufficient amounts being created by your adrenal glands, so as to mimic the useful effects those naturally created hormones would normally manufacture.

Symptoms of Addison's disease

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Addison's disease symptoms sometimes develop slowly, usually over many months, and should include:

• Muscle weakness and fatigue
• Weight loss and decreased appetite
• Darkening of your skin (hyperpigmentation)
• Low blood pressure, even fainting
• Salt craving
• Low blood sugar (hypoglycemia)
• Nausea, diarrhea or vomiting
• Muscle or joint pains
• Irritability
• Depression

Acute adrenal failure (addisonian crisis)
Sometimes, however, the signs and symptoms of Addison's disease could seem suddenly. In acute adrenal failure (addisonian crisis), the signs and symptoms might also include:

• Pain in your lower back, abdomen or legs
• Severe vomiting and diarrhea, resulting in dehydration
• Low blood pressure
• Loss of consciousness
• High potassium (hyperkalemia)

When to see a doctor
See your doctor if you've got signs and symptoms that commonly occur in folks with Addison's disease, such as:

• Darkening areas of skin (hyperpigmentation)
• Severe fatigue
• Unintentional weight loss
• Gastrointestinal issues, like nausea, vomiting and abdominal pain
• Dizziness or fainting
• Salt cravings
• Muscle or joint pains

Your doctor will verify whether or not Addison's disease or another medical condition could also be inflicting these issues.

Causes of Addison's disease

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Addison's disease results when your adrenal glands are broken, manufacturing insufficient amounts of the hormone cortisol and infrequently aldosterone similarly. These glands are located simply higher than your kidneys. As a part of your endocrine system, they turn out hormones that offer directions to nearly each organ and tissue in your body.

Your adrenal glands are composed of 2 sections. the inside (medulla) produces adrenaline-like hormones. The outer layer (cortex) produces a bunch of hormones referred to as corticosteroids, that embrace glucocorticoids, mineralocorticoids and male sex hormones (androgens).

Some of the hormones the cortex produces are essential forever — the glucocorticoids and therefore the mineralocorticoids.

• Glucocorticoids. These hormones, that embrace cortisol, influence your body's ability to convert food fuels into energy, play a task in your immune system's inflammatory response and facilitate your body answer stress.
• Mineralocorticoids. These hormones, that embrace aldosterone, maintain your body's balance of sodium and potassium to stay your blood pressure traditional.
• Androgens. These male sex hormones are made in little amounts by the adrenal glands in each men and ladies. They cause sexual development in men and influence muscle mass, libido and a way of well-being in men and ladies.

Primary adrenal insufficiency
Addison's disease happens when the cortex is broken and does not turn out its hormones in adequate quantities. Doctors confer with the condition involving harm to the adrenal glands as primary adrenal insufficiency.

The failure of your adrenal glands to provide adrenocortical hormones is most typically the results of the body attacking itself (autoimmune disease). For unknown reasons, your immune system views the adrenal cortex as foreign, one thing to attack and destroy.
 Other causes of adrenal gland failure might include:

• Tuberculosis
• different infections of the adrenal glands
• unfold of cancer to the adrenal glands
• Bleeding into the adrenal glands

Secondary adrenal insufficiency
Adrenal insufficiency may occur if your pituitary gland is diseased. The pituitary gland makes a hormone referred to as adrenocorticotropic hormone (ACTH),

that stimulates the adrenal cortex to provide its hormones. Inadequate production of ACTH will cause insufficient production of hormones normally made by your adrenal glands, albeit your adrenal glands are not broken. Doctors decision this condition secondary adrenal insufficiency.

Another additional common reason behind secondary adrenal insufficiency happens when folks that take corticosteroids for treatment of chronic conditions, like asthma or arthritis, abruptly stop taking the corticosteroids.

Addisonian crisis
If you've got untreated Addison's disease, an addisonian crisis could also be provoked by physical stress, like an injury, infection or illness.

Treatment of Addison's disease

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All treatment for Addison's disease involves hormone replacement therapy to correct the amount of steroid hormones your body is not manufacturing. Some choices for treatment include:

• Oral corticosteroids. Your doctor might prescribe fludrocortisones (Florinef) to replaces aldosterone. Hydrocortisone (Cortef), prednisone or cortisone acetate is also used to switch cortisol.
• Corticosteroid injections. If you are unwell with vomiting and cannot retain oral medications, injections are an choice.
• Androgen replacement therapy. To treat androgen deficiency in ladies, dehydroepiandrosterone will be prescribed. Some studies recommend that this therapy might improve overall sense of well-being, libido and sexual satisfaction.

An ample intake of sodium is usually recommended, particularly throughout significant exercise, when the weather is hot, or if you've got gastrointestinal upsets, like diarrhea. Your doctor also will recommend a short lived increase in your dosage if you are facing a stressful state of affairs, like an operation, an infection or a minor illness.

Addisonian crisis
An addisonian crisis could be a life-threatening state of affairs that leads to low blood pressure, low blood levels of sugar and high blood levels of potassium. this case needs immediate medical care. Treatment usually includes intravenous injections of:

• Hydrocortisone
• Saline resolution
• Sugar (dextrose)

Why the US healthcare system is ridiculous

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Andrew got bitten by one of the feral kittens a few weeks ago, and the little shit managed to bite through one of Andrew's fingernails (amongst other puncture wounds in his hands).

Cat bites are notoriously dangerous because of the way the tooth is shaped - they are like needles injecting bacteria under the skin, and it heals over fast, which causes an infection, and before you know it you have blood poisoning.

I was worried that we wouldn't be able to clean out the puncture in his fingernail properly, so tried to book into the doctor to get onto a course of antibiotics. They couldn't squeeze us in, so we tried going to "Urgent Care", and they were closing, so told us just to go up to the ER.

If we had have got into the doctor it would have cost $10. We just got the hospital bill, and we are responsible for $415 of the total of $4000 or so. We spent maybe 10 minutes in there, and got a prescription for antibiotics and some antiseptic put on the puncture wounds. How the hell can that cost over $4000????? And how can they charge us $415 just for that??

We paid about $1200 for my open heart surgery - apparently a prescription and antibiotics is worth 1/3 of open heart surgery, ICU and a 5 day hospital stay...

If anyone wants to contribute to the Andrew and Sarah kitten fund - feel free to!

Dealing with other people's pregnancies

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This is something I've been asked about a few times, and something I was just thinking about, so thought I'd share. In the months after Joshua's death, some people were hesitant to tell us they were pregnant in case they upset us, some tell us before anyone else because they want to tell us in person rather than on the grapevine. That really didn't bother me, I'm generally excited to hear about friends pregnancies. Ultrasounds were hard to look at, and baby showers were hard to go to, and still are. Joshua died 2 days after our baby shower, so baby showers just don't have that same level of fun anymore, memories of our loss just come flooding back.

The other thing that's hard to deal with is other people's loss, but for a slightly different reason - my heart just aches for them. A very close friend had an early miscarriage a few months ago, and my heart ached for her. Another good friend who has also had a rough year has just suffered a 2nd trimester loss, and it breaks my heart. I don't want anyone to ever feel the weight of loss like we did. I know a loss earlier in the pregnancy is probably a bit easier to deal with, but it's never easy, and once you start planning names, planning how the room will look, what you'll need, changes you'll need to make, and start thinking about the future they're going to have, it's so hard to have it all ripped away.

It's something that really affects you for a long time, and I think it's important for people to understand that.

Catching up (yes I'm still alive)

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It's been a really busy few months! I'll go back to September.

We went on holiday to the Seychelles and Dubai for 2 weeks in September which was fabulous. My aunt Vicki lives there with her husband Chris and their two boys, Jack and Harry. Chris has a job as part of the United Nations, which is based in the Seychelles and they've been living there about 4 years now.

The Seychelles was fascinating. The economy is completely broken - they have the highest level of debt of any other country, and since we were there the International Monetary Fund has agreed on a $26 million rescue package, and the currency has floated and been devalued. A lot of things were run down, the roads were terrible, there's a big divide between the rich and poor and everything has to be imported, so the black market is rife.

But the beaches were gorgeous, the weather was fabulous, the sky was oh so clear at night, and the stars were stunning. Sitting out on Vicki and Chris' deck every evening watching the night sky was an amazing way to relax. We were a very short walk from the beach, and just enjoyed our 10 days there relaxing.

It was great to spend quality time with Vicki, Chris and the boys. Vicki lived with us for a few years when I was younger, so I've always felt very close to her, and Jack and Harry are such great kids, we had a lot of fun with them.

Here's a few pics from the trip:

The markets



Amazingly clear water



Full moon over the fishing boats that were at port due to the worries over the Somalian pirates



We hiked to a beach called Anse Major, which was quiet, and so pretty



On our way to Anse Major




View from Vicki and Chris' balcony



Everyone. Vicki doesn't usually look so grim, and no, Andrew didn't bother with shaving while away :)



A couple of gorgeous sunrises







After Seychelles we spent a few days in Dubai on the way home since we were flying with Emirates (best airline I've ever flown with by a long shot), and stopping in Dubai anyway.

It was Ramadan, so we couldn't eat or drink in public during daylight hours, and a number of places were either closed for the month, or closed for a few hours in the afternoon, but it wasn't a big deal. We had a really nice hotel which we got a great deal on due it being Ramadan, and therefore the low season, the city in general wasn't too busy, and we just did a double decker open top tour bus tour the 2 days we were there, which supplied us with complimentary cold bottles of water which we guzzled as soon as we got on the bus - so we probably drank more water than we would have otherwise.

It was stinking hot - over 40 c, and about 90% humidity, and the heat was disgustingly oppressive. We had a fabulous time though. It was such an interesting place, and there was so much to see and do. And being so hot, it made us very aware that we were in a desert, and the regular calls to prayer from the temples made the whole experience more authentic. It's a place I would like to go back to some time to further explore - 2 and a bit days definitely wasn't enough!

Some pics:

Down on the water - there were boats coming and going loading up with goods to be transported to other nearby countries, carrying tourists around, and general water taxis for transport.




A small selection of gold in one of the windows at the Gold Souk (market)



A shopping centre called Wafi - it had designer shops, and an upmarket "traditional" souk area - the place was deserted due to Ramadan, and most of the shops weren't opening the entire month.



One of the water taxis



Dubai is a construction zone! There were cranes everywhere you looked. The sky was never clear, it's pretty much one big sand storm. And this highway made American highways look tame!



The new Metro system they are building which will make a huge difference to traffic - you can see Burj Dubai in the background which will be the world's tallest building



In front of Burj Al Arab, Jumeirah - the water there was toasty warm!



And then Ski Dubai... so bizarre!



One of the big mosques



One of the mosques near us. They were having the evening iftar buffet (breaking of the daily fast)



And Andrew on Dubai Creek at sunset



The rest of the photos are here

I'm a Golden Retriever!

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According to this website, if I was a dog breed, I'd be a Golden Retriever :)



Yep, sounds like me :)

Golden Retriever

The Charmer

Laid-back, sociable and well-groomed, you've got your own hip little pack of groupies who just love to be around you. You have a brain inside that adorable little head of yours, though you use it mostly to organize your hectic social calendar. You never poop out at parties, and since you're popular with ladies and men, as well as children and adults, you dish out your wit, charm and luck to whomever is close enough to bask in it. The top dog likes you and wants to be your best friend, despite the fact that he doesn't really know what the heck you do. No one does, in fact, but everyone loves you all the same. A true foodie, you’ve got your keen ears fine-tuned to make sure you don't miss out on the opening of a trendy new place to nosh. But your youthful days of being able to wolf down food 24-7 are wagging behind you, meaning you've got to watch what you eat so you don’t pull a Brando and outgrow your coats.

The kitties and their Valentine's Day dates!

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The girls had a lovely time for Valentine's Day. They all had very handsome dates, and they dined on caviar, drank the worlds finest milk, and indulged in some catnip to top off the evening ;)

This is Lily, my middle girl, and her date Stoli, a handsome Russian Blue





Smudge, and her date, Luxor who is an Egyptian Mau.





Stoli and Luxor are brothers and best friends, and Smudge and Lily are sisters and best friends, so they double dated :-) Their mum, Renovia, does amazing art work, particularly cat sculptures, so check out her Etsy store if you're looking for a good present.

And last, but not least - Stumpy and her date, Dorian Grey aka Dorky. They make a good pair!