In hot weather, should we drink copious amounts of water even if we're not thirsty?

Even without considering the scientific evidence related to this essential question, one would have to believe it remarkable that the human species would exist if thirst were inadequate to guide drinking during exercise. Martin D. Hoffman M.D., et al.

It may seem like a small matter: who cares if one drinks too much water to avoid dehydration? No one ever died from too much water, right? Wrong. But there's more going on here: if drinking a lot of water during hot weather is not a good idea, if it can, in some cases be dangerous, why are so many reporters getting the story wrong?

I read newspapers and watch television news to learn. And I expect the stuff that I learn to be right, to be checked for accuracy by professional reporters, professional fact-gatherer. When I discover a reporter did little more than unquestioningly repeat what he or she had been told, possibly because it was a good story, I feel cheated. Information in newspapers should be vetted; it should be accurate; it should be right.

There are lots of myths out there. There's even a successful television program based on questioning these stories. It's amazing how many stories are revealed by MythBusters to be just that: stories.

Which bring us to the question of how much and of what should we be drinking during hot spells. Do you believe the news stories? Do you drink a lot of water without waiting until you feel thirsty. Do you try to belt back eight glasses of water a day?

If you question the accepted story, a reporter might respond by sending you a link to Oregon Occupational Safety and Health. The OOSH claims in a hot environment one should drink water frequently, even when not thirsty.

It may seem straight forward but wait. In response, you can site the Loyola Stritch School of Medicine:

In recent years, at least 14 deaths of marathon runners, football players and other athletes have been attributed to exercise-associated hyponatremia, a condition that results from drinking too much water or sports drinks.

But there’s an easy way to prevent hyponatremia, according to Loyola University Medical Center sports medicine physician James Winger, MD. Drink only when you’re thirsty.

Whom do you believe? And why should you even have to ask? Some years ago, I got very ill during a trip to the Sahara desert in southern Tunisia. I followed all the hydration advice. I made sure I drank even when not thirsty. And I got damn sick. When I got home my doctors told me I may well have had hyponatremia or water intoxication.

Since then, the doctors I have talked to have told me much of the advice surrounding the drinking of fluids during heatwaves is wrong. The media reports are often urban myths, I'm told. My doctors have warned me, excessive water intake can be dangerous for folk like, folk with a heart condition.

They remind me that I get water from many sources. Vegetables are often mostly water. For instance, cauliflower is about 92% water. If you drink coffee, I like a brew made from a mix of caffeinated and
decaffeinated, then each cup of coffee is equal to a eight ounces of water. And yes, the warning about not drinking coffee during hot weather is another myth but I'll leave that for another post.

Drinking to quell thirst is the correct way to go in almost all situations. A conference in California found there was an overemphasis on high fluid consumption. Athletes should be advised of the risks associated with over drinking. Decreasing the number of fluid stations at long distance running events might be counter intuitive but it might be necessary to reduce the number of incidences of exercise associated hyponatremia (EAH).

And here is where it gets interesting: dissemination of appropriate drinking advice alone has been shown to reduce the incidence of EAH. It's time journalists spent some time getting this story right. It should not be that hard for a professional fact-gatherer, professional story detective, a finder, a discerner and teller of truths.

And then these journalists can employ these investigative methods, honed tracking down the truth when it comes to water consumption during heatwaves, to uncovering the truths going unrevealed in other, more important, stories. Look out Donald Trump question-asking journalists could soon be on your trail.
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Would you like to read more? Try this article:  Is Drinking to Thirst Adequate to Appropriately Maintain Hydration Status During Prolonged Endurance Exercise? Yes.

Do you need to drink 8 glasses of water a day?

Journalists should not be storytellers

Recently, I read a tweet from a former newspaper editor who now expounds on journalism to students taking his class at a nearby college. He tweeted that he was training young people to be storytellers. I replied: Journalists are not storytellers but reporters.

He disagreed. A story lies at the heart of what a reporter tries to convey, he tweeted. Who's right?

According to Lee Wilkins, professor and communications department chair at Wayne State University in Detroit, faculty emeritus and curator’s teaching professor at the University of Missouri:

Journalists are not storytellers but reporters.

According to Wilkins, a local government reporter before she began teaching: "When we started thinking of ourselves as storytellers was when we ran into a problem." The problem? Journalism changed from an "objective process" to one focused on "storytelling." Wilkins believes this emphasis on story over reporting entered American newsrooms in the 1980s. And I concur.

Sadly, when a journalist puts the story first, all too often it means facts become subservient to the story. I can give a solid example of this but, if I do, I risk losing you. You will immediately know I am wrong because you have seen and heard the story on television, maybe on 60 Minutes, or CBC Marketplace. You have read it in your local paper and in magazines. You know the truth. You know the story. And I will have a damn near impossible time changing your mind.

The story? The threat posed by the urea formaldehyde foam insulation or UFFI was created by the media. Before you quit reading, think about this:

Source: The London Free Press, Saturday Homes Section

When homes with UFFI were tested, the tested homes were found, on average, to have formaldehyde levels only slightly less than that of homes of similar age without UFFI. Also, there was no UFFI caused damage to house framing nor were other UFFI-caused defects found.

Why was the true story not told until years after the damage had been done? Because stories, good stories have legs and when told by good storytellers, by journalists, such stories are hard to resist. I believe it was 60 Minutes in the States that originally broke the erroneous scare story. Then CBC's Marketplace, not to be outdone, did their take on the same story. And the UFFI wildfire was lit and fanned. Newspapers across North American felt forced to run UFFI stories as well.

I covered a lot of UFFI stories and I am ashamed of the part I played in promoting that story. I met a lot of people, many seniors, who had massive amounts of their life savings tied up in their homes and the media-spread myth destroyed much of the equity that had accumulated in the family home. All too sad. Now, there is a story. Will it displace the mythical stories? I doubt it. Marketplace is still bragging about their major contribution to the original UFFI coverage.

Marketplace is proud of the part it played in the banning of urea formaldehyde foam insulation.

As I edited this, I wondered if scare stories involving UFFI were still being printed. It took but a moment to turn up this story from the Cornwall-Standard Freeholder on "toxic spray foam insulation."

I shake my head and a feeling of shame washes over me. I had a hand in pushing this story and the story is still influencing decision making. This is despite the fact that, and this is from the Freeholder story, "Canada is one of the only countries in the world that bans the use of UFFI . . . it (is) being used widely in many other countries including the United States."

If the reporter every decides to focus on that last sentence and explain why a "toxic" foam is only toxic in Canada, the reporter might have an award winning story and an easy one to tell.

According to CMHC, "UFFI is not a source of over-exposure to formaldehyde . . . Houses with UFFI show no higher formaldehyde levels than those without it."

So, are high levels of formaldehyde ever found in homes in Canada today? Not often but, again according to CMHC, "in new or other well-sealed houses, significant indoor formaldehyde levels may still occur (thanks to) new carpets." If the folk in the justice building are worried, maybe they should concentrate on new carpeting and not decades-old insulation.

How not to report a story: The Current goes for false balance with negative overtones

Weight Watchers promotes healthy eating. The accent is not on weight loss.

The Current on CBC radio, featuring host Anna Maria Tremonti, recently claimed to be examining the offer of six weeks of free Weight Watchers memberships to teens between the ages of 13 and 17 this summer..

It was not much of an examination. To learn more, I googled the offer, but I failed to find the original announcement. It would have been nice if CBC had thought to post a link.

Weight Watchers apparently stated right up front that this offer was not about dieting and not about weight loss. No, Weight Watchers was offering to help teens develop the healthy eating habits so necessary at there time of life. And let's make one thing clear: today, this is very important. There is a serious problem with how our kids are learning to eat.

For the most part, the CBC and Anna Maria Tremonti ignored this very important and very believable claim by WW. I can understand why; there was a time that I, too, believed Weight Watchers was just a dieting program, a weight loss program.

Then, in 2010 I had a heart event that changed my life forever. I suffered a V-tach event, my heart went into overdrive hitting 300 beats per minute and I was rushed to the hospital. There, doctors placed defibrillator paddles on my chest and jolted my heart back into sinus rhythm. I now have an ICD/pacemaker in my chest. ICD stands for implantable cardioverter defibrillator. If my heart rate heads for the stratosphere again, and it has, my ICD shocks it back into its proper rhythm.

Roasted Madras Curry Cauliflower with Raita

I take oodles of meds and watch my diet carefully. At one point, I weighed almost 220 pounds. Not good. My doctors told me to get my weight down. Something under 170 pounds would be a fine goal.

My stroke doctor gave me a package of recipes and told me not to think of this not as a diet but as a whole new way of eating and quite possibly a better, more enjoyable, way of eating.

Coincidentally my wife was starting Weight Watchers at the same time. It was immediately clear that her diet and mine were quite similar. We embarked on the Weight Watchers approach to dining well together.

We counted points, don't ask, and slowly we lost weight. It took a lot of months, more than a year, but I got down to 165 pounds and I've stayed close to this weight ever since. And this success is, in no small measure, thanks to the Weight Watchers program. We didn't feel we had to cutback on our food but instead we expanded our food choices. We learned to eat wisely and well.

Following my doctors' and Weight Watchers instructions, we have discovered  a whole new way of eating, just as promised. I wish I'd been offered this program when I was a teen. I've always loved food and I find our new approach to dining is for food lovers.

So, how did CBC handle this story. Well, the broadcaster almost immediately cut to an interview with a holistic health coach, trained at the Institute for Integrative Nutrition. And what exactly is the IIN? I googled it and learned many call the online school a diploma mill.

The accusations must be awfully common as the IIN defends itself by stating clearly online that they are not a scam. They point out that much of the criticism of the school is of the strawman variety. Their health coach graduates are not registered dietitians and do not claim to be. A search of the U.S. Dep't of Education database confirms the IIN is telling the truth: its graduates are not registered dietitians.

There is a story here. The Weight Watchers offer deserves examination. That said, I don't find the debate, if not manufactured by the CBC, certainly promoted by it, to be the correct angle. Journalists can do better. I know. I worked for almost four decades in the media.

This is an important matter and our public broadcaster let us down. Just today I saw an article in The Harvard Gazette: a "comprehensive national strategy (is needed) across all relevant segments of society to prevent a looming public health disaster." This was written for Americans but the problem is also prevalent in Canada. In my lifetime, obesity among the young has increased two, possibly even three fold in Canada.

The CBC should have sent reporters to numerous Weight Watcher centres across the country. They could have learned whether or not a consistent approach is going to be taken by all WW leaders. As the Harvard article points out:

We have deep knowledge of the biological drivers of obesity, which include:

• poor diet quality
• excessive sedentary time
• inadequate physical activity
• stress
• leep deprivation
• perinatal factors
• and probably environmental endocrine-disrupting chemicals

What is lacking is an effective strategy to address these drivers with sufficient intensity, consistency, and persistence, according to David Ludwig, professor in Department of Nutrition at Harvard T.H. Chan School of Public Health and founding director of the Optimal Weight for Life program at Boston Children’s Hospital.

CBC had a chance to be part of the solution; they chose to be part of the problem.

Fake News (Tweets) and CBC Ontario Morning

Donald Trump likes to call the mainstream media "fake news." He's wrong but that doesn't mean the MSM can ignore his charge. Those in the media must take those words to heart and attempt to never lend any credence to Trump's accusation.

Sadly, almost all of us have had a contact with the media that went poorly. I have often met folk who have told me that a story with which they were closely associated was reported incorrectly. They may have even talked directly to the reporter behind the story. By the time the reporter condensed the story to a sound bite for television or radio, or boiled the information down to an eight-inch story in the daily paper, the story was corrupted, changed, shaded with error.

Check out this tweet from CBC Ontario Morning:

It makes the claim that giving a child "a taste" or "even a sip" of alcohol is "not a good idea." It is important to note the shortness of this tweet. No attempt has been made to convey the complexities of the story.

This is a story that has been reported in the past and sometimes it has been reported very poorly. That said, let's cut right to the chase.

New Orleans magazine reported on this story. Allow me to quote a paragraph from that article.

“First sipping isn’t an early indicator of issues that would be of concern to parents,” wrote one of the psychologists in an August 2014 press release about an updated look at the same group of children. They showed that taking the first sip before age 12 correlated with a family’s permissiveness towards alcohol rather than predicting that a child was slated for abuse problems in young adulthood. There is no evidence that earlier sippers have more alcohol dependence, delinquent behavior, marijuana smoking, misuse of other illicit drugs, risky sexual behavior, car crashes or interruption of planned schooling than the late sippers."

If you want to stop reading now, you can. But, for those who want to read more, please, read on as I take a look at what some of the studies actually say:

For instance: adolescents who have consumed at least a full glass of alcohol or more are significantly different from adolescents who have simply had a sip of alcohol. And one might ask what the researchers define as a sip. But the important point is that adolescents benefiting from greater parental discipline, living with better rule enforcement and more comprehensive monitoring and enjoying positive family relations are less likely to have consumed a full glass of alcohol. 

And just how extensive is the problem of children consuming full glasses of wine, similar what is shown in the picture accompanying the tweet? According to the studies I found, it is not as extensive as we might expect. Many children consume no alcohol at all: almost 40% at 11 years of age have never tried alcohol and almost 60% have had only a sip or less. The little girl shown represents a little more than 2% of 11 year olds. If she is less than 11, she represents an even smaller proportion of children from her age group. Perhaps we should pity the little girl pictured. She appears to need improved parental monitoring. Going by the studies that I have found, there is a good chance her parents are not even aware she is engaging in a toast.

Screen grab: story discusses taking an early sip of alcohol.

So, if sipping, and only sipping, has not been implicated in future dangerous behaviour, why are we even discussing sipping. The answer is simple: the children who have had only a sip of alcohol and those who have had a full glass or more, have been combined in some reports into a single category. The whole issue has been muddied.

It appears there may be only one study explicitly investigating sipping of wine and beer in early adolesecence and that is Children’s Introduction to Alcohol Use: Sips and Tastes. And what was the conclusion of this study?

A young child’s sipping/tasting of alcohol . . . appears NOT to be an early indicator of the likelihood of future problem behavior.

It actually appears that parents are doing a fine job of keep alcohol away from their kids. There may well be no problem here. Most children only get to sip alcohol but once or twice, implying that this was opportunistic behavior rather than an attempt by parents to introduce their children’s to alcohol use. It may not be the sip that is the problem but the parental attitude.

Bolstering this interpretation is this fact: fully a third of the mothers and over half of the fathers did not even know that their child had ever had a sip or a taste of alcohol. Most sippers either sneaked their solitary sip when their parents were not watching or were given the single sip on the sly by someone such as an older brother or sister.

The public deserves better than this tweet. Our media must take advantage of every one of the 280 characters Twitter tweets offer. Teenage abuse of alcohol is a problem. The link between a young child having had a taste or a sip and having problems as a teen with alcohol is a link that researchers are still disputing.

Lastly, here is a link to the Lancet article that has been causing the recent stir. Association of parental supply of alcohol with adolescent drinking, alcohol-related harms, and alcohol use disorder symptoms: a prospective cohort study.

The Lancet article has a lot of negative things to say about parents supplying drinks to their children and this should come as no surprise. What is interesting is that the article reports under "Findings":

"Parental supply of alcohol was not significantly associated with the odds of reporting symptoms of either alcohol abuse or dependence, compared with no supply from any source."

I have to admit, I found the above statement out of place in the context of the Lancet article considered in its entirety. Putting all the info together is the job of the media, the job of the journalist. Sadly, all too often, the media handles complexity very poorly. (I would guess that Ontario Morning did not spend a number of days, possibly weeks, putting together their take on the research into underage drinking. It's an interesting story and I bet that it was sent to air as quickly as possible.)

Maybe in a future broadcast, Ontario Morning can investigate the role of the media in underage drinking. Yes, in researching this post I came across research claiming the depiction of alcohol in movies, on television and in social media can be linked to early alcohol abuse. This sounds like a great scare story. 

I can see the tweet now: "Let your child watch CBC dramas? We reveal why this is not a good idea, not even a glimpse. Research shows it could lead to alcohol abuse."

The above is a screen grab from the Huffington Post, Australian Edition.

Out of 11 Countries Surveyed, U.S. Seniors the Most Likely to be Both Sick and Unable to Afford Care

Despite Medicare coverage, older adults in the United States are sicker than those in other countries and face more financial barriers to health care. Note: When it comes to the problem of high cost preventing access to treatment, Canada rates 6th out of 11 countries surveyed. The U.S. is last by a good margin.

Read more: Commonwealth Fund 2017 International Health Policy Seniors Survey

VW Jetta TDI buyback completed and VW made an I'm-sorry-payment, as well.

Important Numbers: 2017 VW Jetta TSI Wolfsburg Edition as of Sept. 25, 2022

• Fuel cost per km: .09 cents (Canada, southwestern Ontario)
• Total cost to run car per km: $0.42*
• Fuel consumption: 7.86 litres/100 kms (This may climb as I do more in-city driving in the winter.)

Present distance traveled: 54,553 kms
Fuel used: 4,552.02 litres
Fuel cost: $2,288.82
Total out-of-pocket expenses: $22,713.71*
(* The above includes car payments, auto insurance charges, fuel costs, all maintenance charges, car washes, parking, etc.)
* Will change over time as distance traveled increases.
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Now, to my original post...

It's gone. VW has repurchased my 2011 VW Jetta TDI. Plus, the German automobile maker paid me a cash penalty to make amends for their TDI sins. All in all, I got $16,700. I put it all into the purchase of a 2017 VW Jetta Wolfsburg Edition TSI.

Fuel economy: 8.22 litres/100 kms at 17,561 kms.

My new car comes complete with Wolfsburg Edition badges on the sides, a TSI badge on the rear of the trunk lid and a TSI four-cylinder engine under the hood. TSI stands for turbocharged stratified injection. This is a technically sophisticated 1.4 litre turbocharged direct injection engine. VW claims it is state-of-the-art engineering. Hmmm. I recall similar claims when I bought my TDI clean diesel.

So, let's cut to the chase. What was the total out-of-pocket cost to put a Wolfsburg VW in my garage and send the oil-burner packing? The short answer: $2500. That's it. And what will it cost to keep it there? That's a good question. For a start, as a gasoline tends to cost more than diesel in London, I expect my fuel bill to grow. As well, I now have a monthly $139.44 car payment for the next 84 months. This payment also includes an extended warranty option. No unforeseen charges for the life of the car.

Originally, I had agreed to an interest rate of .99% with a shorter payback period. But, when the deal was finalized the interest rate rate had fallen to zero. I decided to keep my money in the bank where it can earn some interest in a ScotiaBank Momentum account. I can see no advantage in tying up cash to purchase this car.

What are my first impressions of my new Jetta? Good but then I liked my old Jetta. The two cars are very similar. Where there is a difference, often I see little advantage in the new vs. the old. For instance, I can see no great advantage to the keyless door lock system. And there are some dangers. See: Deadly Convenience: Keyless Cars and Their Carbon Monoxide Toll.

My new radio seems to have possible safety issues as well. It encourages a driver to play with the touch-control screen rather than paying complete attention to the road. To change the sound system volume, a set of controls can be found on the steering wheel. This encourages more gadget fiddling. If the government thinks cell phones are bad, they should take a look at radios like this one in my new Jetta.

Professor David Strayer, at the University of Utah, found in-vehicle information systems — including SatNav, MP3 players, radios, cellphones and messaging devices — take drivers’ attention off the road for too long to be safe, much like texting.

In the following weeks and months, I'll keep my readers posted as to the total cost to keep my VW Jetta on the road. (If you notice anything amiss, feel free to question my figures. I can make errors. I'm not perfect.)

Paint and Clear Coat Warning

If you own, or are buying a VW, pay careful attention to the paint. Mine is terrible. I knew I had a problem right from the moment my wife and I picked up the car. It was almost a day late in being delivered as it took a lot of effort by the dealer to get my new car into ready-for-delivery condition.

Swirls, holograms and oxidation mar surface of my new VW.

The paint has swirls in the finish, left, I assume, by the power buffer used to quickly detail the car before delivery. I thought I could polish these out in the spring. It is now spring and I'm finding removing these difficult.

But there's more. The top of the rear bumper has faulty paint. It looks like there are dried water marks etched into the surface. It won't wash off. I'm worried it may be oxidization.

And it gets worse. There are small, pinhead sized spots that I thought were rust appearing on the lower, passenger-side door. I took the car to a local paint shop for an evaluation. The owner said it was the worst detailing of a new car that he had ever seen. He noted swirls in the paint from the front bumper to the back, plus hundreds of ugly, dull spots in the surface of the paint. On the bright side he said the rust was not rust but large, flecks of dirt deeply embedded into the paint finish. I told him that VW had sent me a block of clay for detailing the car. He said he had never heard of a car manufacturer doing this. Very odd.

Insurance

When I got the auto insurance bill for my new car, I was in for a pleasant surprise. My annual insurance bill went down $86.00. This left a December insurance installment of $272.50.
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I have opened a spread sheet for tracking and calculating all costs. This is far easier and more accurate than trying to do it with pencil and paper as I was doing. The latest numbers are at the top of the post.

CBC Marketplace and Busting Superfoods

Superfood: a term too good to be true? I thought so. I never bought into the hype. But I guess some folks do and CBC Marketplace set out to burst their bubble: Busting Superfoods.

For the most part, it seemed to be a good show but there were statements that I questioned and not because I am a believer in superfoods. For instance, the program presented a Canadian alternative to some superfood. And what was the alternative: the potato.

I was once a big booster of the potato. Hey, the Irish apparently got by quite nicely on potatoes until the potato famine struck. The lesson seemed to be: oodles of potatoes good, no potatoes, or anything else for that matter, bad.

Well, I was wrong. Oodles of potatoes are not good. One should have a balanced diet. No surprise here. But, and here comes the surprise, potatoes do not necessarily make up a large portion of a correctly balanced diet.

Read this article from the Harvard T. H. Chan School of Public Health: The problem with potatoes.

The article, to which I linked, warns "a cup of potatoes has a similar effect on blood sugar as a can of cola or a handful of jelly beans." This is something that I've been told during my visits to various doctors related to my fight against heart disease. Go easy on the potatoes, I'm told.

I'm 70. My body does not need more stress and potatoes, especially a good helping of potatoes without the skins, could put my body under stress as it struggles to cope with the resulting surge in blood sugar level.

So, do I avoid potatoes? No. Potatoes, especially with the skins, are a good source of potassium, vitamin C, fibre and magnesium, plus potatoes are low in fat and inexpensive. Just go lightly on the full fat sour cream and pats of butter. Berkeley Wellness, University of California, has a good article looking at the positive side of the potato debate: Don't Drop the Potato.

CBC Marketplace, like potatoes, not bad, but not super either.

Does the Watchman LAA closure device offer a new approach to fighting strokes?

Remember, I am just a heart patient sharing his story, plus some info gathered during my recent medical treatment. I am NOT providing medical advice. Talk with your doctor if you find anything here of interest. Cheers! 

When I first posted this, I was slated to have a Watchman left atrial appendage (LAA) closure device implanted. To prepare for this heart procedure, I had a transesophageal echocardiogram (TEE) performed last Friday. The doctors discovered my LAA had already been modified. It was surgically "obliterated." Clearly, I am no longer a candidate for a Watchman. It is impossible to insert the device into my surgically modified LAA.

I was the first person in Canada to have a leaking mitral valve repaired with the aid of a DaVinci robot. I now know my surgeon not only repaired my valve but, at the same time, he "obliterated" my LAA as well. This was done in the belief that modifying the LAA would lesson my chances of having a stroke caused by a blood clot originating in the left atrial appendage. Up to 90% of blood clots originating from the heart form in the LAA.

I was facing LAA closure to lessen my chance of suffering more transient ischemic attacks (TIAs). Over the last few years, I have suffered a lot of TIAs, also known as mini-strokes. I take Pradaxa, an anticoagulant, plus Aspirin, an anti-platelet drug. This dual drug approach has worked wonderfully at preventing serious blood clot related problems. I must compliment my doctor at the Stroke Prevention & Atherosclerosis Research Centre (SPARC) in London, Ontario, Canada.

So, if my drug therapy is working so well, why implant a Watchman, a foreign object, in my heart? Because I also suffer from cerebral micro-bleeds (MBs). These are small, bleeding areas in the brain that raise the risk of hemorrhagic stroke. A hemorrhagic brain event in the presence of an anticoagulant is fatal in many cases. For this reason, all my doctors agree: stopping my anticoagulant therapy is a reasonable goal.

After a lot of consultation among my many specialists, it was decided to put the Watchman Left Atrial Appendage closure device into my heart. A lot of risks and benefits were weighed and everyone was unanimous in approving the Watchman. Now, that route is closed. Here is an interesting link: Summing up the current data, LAA occlusion is a very promising treatment to prevent AF-related strokes due to its safety, cost-effectiveness and therapeutic success.

Discovering that my appendage has been "obliterated" raises a big question: Why am I having so many TIAs if the surgical alteration of my LAA lowered my risk? One answer: my surgical closure may not have been 100% successful. Many now believe that incomplete LAA closure can actually increase the risk of clots forming in the heart; the clots form in what remains of the LAA. And how often do surgical closures fail? Answer: In some studies the failure rate has hit 80%. The LAA has proven to be a tough beast to tame. Read: Incomplete surgical ligation of the left atrial appendage—time for a new look at an old problem.

Am I worried? Surprisingly, no. I have gone years suffering numerous TIAs and have not had a full-blown stroke. Perhaps the attempted "obliteration" of my LAA, teamed with my anticoagulant therapy, is having some beneficial affects. It is impossible to say anything for certain. It's Christmas and I'm going to go with an upbeat view.

“Problems are the price you pay for progress.”—Wesley Branch Rickey

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The following is my original post, written before I learned I would have a Watchman implanted and then learned I wouldn't, and couldn't, have one implanted.



I have TIAs. TIA stands for Transient Ischemic Attack. And what, you may ask, is that? Let's just call a TIA a mini-stroke and leave it at that.

My attacks usually last less than five minutes and do not amount to much, at least not individually. But, if one has enough TIAs, the damage can be additive. I have suffered minor memory loss as a result of my numerous mini-strokes. 

Having a TIA can be frightening, and rightly so. One particular attack, called an amaurosis fugax, leaves one or both eyes blind or partially blind for a number of minutes. Although there is usually no permanent brain damage, the blindness is temporary, such an event can be a precursor to a full-blown, life-altering, stroke. I've had close to a dozen of these dramatic, visual events.

TIAs and strokes are often caused by small blood clots, formed in the heart, traveling to the brain and lodging there. These small clots can block the blood flow to the brain. With TIAs the clot is unstable and quickly disintegrates. Blood flow is soon restored. With a brain-damaging stroke, the clot does not break-up and medical attention is needed immediately to prevent permanent brain damage.

Attempting to prevent the formation of these small blood clots is the usual response to frequent TIAs. This can mean taking an anti-coagulant for life. This, of course, comes with its own host of associated risks. 

And ironically, one of the increased risks from taking anti-coagulants can be a type of stroke - a hemorrhagic stroke. A stroke resulting from bleeding in the brain: a hemorrhage.

I take Pradaxa, one of the newer anti-coagulants. Many people rely on warfarin. That's right, the chemical used in rat poison.

I am not an ideal candidate for Pradaxa, or any anticoagulant, as I have micro-bleeding in the brain. I live with threats from both types of strokes mentioned previously. 

Now, there is a new approach to fighting the blood clots that have traveled from my heart to my brain and caused my TIAs. It's a surgical solution but minimally invasive. I learned about this new method of combating TIAs, in cases such as mine, from one of my doctors at the London Health Sciences Centre.

Because I have micro-bleeding in the brain, I am not a great candidate for anti-coagulants. That's why I don't take warfarin, also known as Coumadin. Pradaxa is not as prone to causing a hemorrhagic stroke as warfarin but, that said, there is still an increased risk of bleeding. Not good. And, of the two types of stroke, hemorrhagic strokes are more often fatal and, if one survives, the lasting damage more severe.

Why do some hearts generate clots and not others? Often the answer is atrial fibrillation or AFib. Some hearts, the ones producing clots, often have a quivering, irregular heartbeat. The blood tends to pool and swirl inside the heart before being pumped out to the body. This pooling and swirling in the heart encourages the formation of blood clots.

It is now believe the clots coming from the heart are originating, for the most part, in a small sack on the left side of the heart known as the left atrial appendage (LAA). Blood gets into the small sack and remains trapped there long enough for small but dangerous clots to form. These clots eventually leave the LAA to be pumped out of the heart and to the brain where they may cause a TIA or stroke.

If this theory is right, and there appears to be good reason to believe it is, then preventing blood from collecting in the LAA appears to be a partial answer. 

Some cardiac surgeons are now plugging the LAA with a small closure device. There are a number of competing implants, among them is the Watchman from Boston Scientific Corporation.

This is what the FDA, U.S. Food and Drug Administration, has to say:

The Watchman LAA Closure Device is permanently implanted in the left atrial appendage (LAA) of the heart to prevent LAA blood clots from entering the bloodstream and potentially causing a stroke.

The cardiac-surgeon inserts the delivery catheter into the body through a vein in the leg. The catheter is threaded through the body until it reaches the right atrium of the heart. The physician makes a small hole through the wall between the two upper chambers of the heart (atrial septum) so the catheter can reach the LAA. The physician then pushes the device through the delivery catheter into the LAA where it opens up like an umbrella and is permanently implanted. Once in place, a thin layer of tissue grows over it in about 45 days.

The FDA notes that the device is used in patients who have atrial fibrillation, AFib, that is not related to heart valve disease.

Some time after the insertion of the device,  a patient may be taken off the riskiest anti-coagulants. This action should cut the patient's risk of having a hemorrhagic stroke. I believe this is the big benefit from having an LAA closure device implanted.

I understand that even with the Watchman implanted, taking low-dose Aspirin, also known by the generic name of ASA in Canada, may be necessary for the rest of the patient's life. ASA is a far less risky drug than warfarin, Pradaxa, Xarelto and the other common anti-coagulants. And it is far less costly. My Pradaxa therapy is not cheap. Taking sophisticated drugs for life can be awfully expensive.

Will I have a Watchman or similar device inserted in my LAA? I don't know. The idea has been raised and my doctors are in consultation. I would not be surprised to have this new solution to AFib caused TIAs and strokes applied in my case. The Watchman is not a perfect solution. One can still suffer a stroke from a clot originating in another part of the heart. The Watchman only stops the clots coming from the LAA.

As I have made clear, the use of anticoagulants is contraindicated in folk like me. For that reason, the Watchman looks good despite its shortcomings.

I was the first person in Canada to have a failed mitral valve repaired robotically using the da Vinci system, and I was one of the first patients to benefit from the use of the experimental T7 MRI unit at LHSC. I've had good luck with new procedures in the past.

As I learn more, I'll repost or add to this post. Cheers!

Let me end with this final video. If you have AFib but are not an ideal candidate for anticoagulants, for whatever reason, you might find the following video interesting. Talk with you cardiologist.

Remember, I am just a heart patient sharing his story. This is NOT medical advice. Cheers!

Bowring goblets may be flawed

This is an add-on. I heard from Bowring and so far my wife and I are the only folk to have encountered problems with these glasses. The local store may have been sent a bad batch. At least, that is the working premise at the moment.
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Recently, my wife and I bought some glass goblets from the Bowring store in Northwest London, Ontario. Before we had even paid for the ones we had removed from the shelves and carried to the checkout, we discovered three of the glasses had serious and potentially dangerous flaws. The rims were unfinished, jagged, rough and slightly sharp.

Tonight one of the glasses we did buy broke while my wife was drinking from it. She noticed a line near the top of the bowl. When she inspected it, the top lifted free. The wine glass had broken. The break was so sharp, one might have thought it had been done with a glass cutter.

I've written Bowring warning them that one of the wine glass lines they are carrying may be seriously flawed. If I hear back from the Bowring customer service, I will add their response to this post.

Note the shape of the glass, it is made in China and sold at Bowring. Don't buy any. You have been warned.

A murder, followed by an indignity to the body, featured in the Centennial film Helicopter Canada

Misrepresentation at core of opinion piece.

It’s five a.m. and I can’t sleep. I’m upset, haunted by the horrifying story brought to my attention by my local paper, The London Free Press. 

An “Indian” was murdered, the body desecrated and the local journalist called the nation-shaming incident simply “crude talk.”

Why do I say nation-shaming? Because the incident is a featured vignette in Helicopter Canada, the film released by the National Film Board to celebrate Canada's Centennial.

I watched Helicopter Canada and haven’t been able to get it out of my mind. If you’d like to stop here, go ahead. The following is difficult to write and it will be difficult to read.

At the 40:50 minute mark, while a honky-tonk piano plays in the background, the narrator of the film tells us:

The Canadian West is still pretty well strung out but it's held together by legends. (Here a new voice is heard, that of an aged, Western man, possibly a cowboy or an oil man, relating one of the region-binding tales.)

“And they started to shoot up ‘round the fort, that is, they were shooting all around the fort and raisin’ cane there. And at that time they killed an Indian an’ scalped him. They took seven scalps off the one Indian. Now many people think when you talk about a scalp, it’s the whole thing but it’s not. It’s only about the size of a 25-cent piece with a strand of hair. That’s just about the size of it.”

WHAT THE HELL?!

 

I’m numb. Absolutely numb. And my local newspaper headlines its story on this film with “Lights, camera - misrepresentation!” Misrepresentation? We all wish. And the newspaper story talks about the roundabout, crude terms used in the film. Roundabout? A man was killed. Murdered. The body mutilated, desecrated, scalped. And the entire squalid episode driven by racial bigotry and hatred.

I'd like to say the journalist simply didn't view the film, but he clearly did. He tells his readers “an old-timer explains that a ‘scalp’ taken from a skull was only about the size of a quarter.” It is the local paper that is unable to address the horror in anything but the most roundabout way.

The writer found the film, Helicopter Canada, “now badly dated.” When the Globe and Mail revisited the 50-year-old National Film Board production, that newspaper called the film “cringe worthy.” That's it?

Eugene Boyko, the film's editor/cinematographer, delivered a film that on the surface is pretty light fare: a tongue-in-cheek narrative accompanies often spectacular film footage shot entirely from a helicopter. But this film is clearly not just high-end visual fluff, it is not, and never was, just a light-hearted look at Canada. 

At its core, this film is subversive. One of the hidden messages that slipped past the sponsoring Centennial Commission in 1967 is things are not always what they seem. Here, I could list example after example supporting this contention but let's move on to another clear message: “there are none so blind as those who will not see.”

I am absolutely stunned that so many saw this film on its release and so many more have viewed it over the years but no one, as far as I can tell, has ever gotten passed the honky tonk piano to see, to question, to discuss the horrific way Canada and Canadians treated people of the First Nations.

Eugene Boyko is simply too good a filmmaker to have included this incident simply to entertain us. I believe Boyko is holding a mirror up to Canadians and what they see is not always what they thought they would see. Boyko's film is not ignoble as one opinion writer wrote. It is us, us Canadians, who are ignoble.

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This post could end here but, if it did, it would not be a complete look at the little, aging, documentary film: Helicopter Canada.

Shooting a film entirely from a helicopter is an awesome undertaking, which director-cinematographer Eugene Boyko pulls it off with great skill and style. 

Remember, Boyko worked before most of the technical advances that have made shooting aerials like these easy. He used big, heavy, Panavision equipment to record his inspiring images. Amazing!

Next, the choice of the little vignettes could be seen as simply veering toward the quirky but I see more. Sadly, what opinion column writer Larry Cornies calls “whimsical” is the tone that causes most folk to miss the underlying problems being addressed.

And there are some fine cinematic moments in Helicopter Canada. Moments that slip by journalist-reviewers unnoticed. The little segment featuring the Bluenose is wonderful. The filming and editing is first rate and the music accompanying the episode is provided by The Mountain City Four featuring Kate and Anna McGarrigle. To have included the McGarrigle sisters in a 1967 film was a stroke of genius.

I talked to film buffs about the movie and the criticism claiming it's dated. Of course, it’s dated, I was told. It’s a visual time capsule. It is meant to grow old. It was a look at Canada “warts and all.” It carried the message “we have problems but we can solve them.”

God, I hope so.

Lastly, I could not believe what I was hearing when the honky tonk piano started and the talk of the casual murder and mutilation of a First Nations man began. I contacted the National Film Board and they sent me their transcript of the soundtrack. I believe the transcript has errors but nevertheless it does contain the murder-mutilation story.

I don't hear the name Grayson. I hear "and raisin' cane there."

When will London act on the ReThink promise?

London, ON, endured a time consuming process called ReThink London. It was an urban planning exercise that invited community participation. ReThink was going to put this large, southwest Ontario city on the path to a denser future city.

It was, in my opinion, a lot of smoke with very little fire. Despite the claims of massive community involvement, I believe the participation numbers are quite questionable. But, all that aside, what I find most interesting is that the future envisioned by ReThink is not the future in many places but is reality today.

This is a great improvement on the big-box shopping mall.

Check the posted image on the right and below. Both are screen grabs from Google Streetviews. These images from Georgia are not artist's conceptions. These images show a mixed use development in existence today.

The development, a traditional retail and residential blend, even has a movie theatre in the mix.
  

In compact developments, stores front onto streets rather than parking lots.

Such mixed use developments are springing up throughout the world but not in London. London talks the talk but that's where it stops.

ReThink London promised an end to urban sprawl but unfortunately the ReThink ideas are little more than a gleam in our city planners' eyes.

Lots of parking with a wall separating much of the residential from the commercial.

More than a decade ago, journalist Christine Dirks told readers of The London Free Press about a new urbanist development planned for southwest London. It would be a first for the city. Talbot Village was the name of the new suburban community. Today the development is nearing completion and the only part of the dream that has survived is the name: Talbot Village.

ReThink London? Humbug.

Addendum: And yes, I know the new city plan was not in place when much of Talbot Village was being built. But, mixed use communities are now being built globally by those I would call enlightened. Why? Because mix use creates sensible, profitable developments.

Should you eat eggs? Do you feel lucky?

Where do I stand on eggs? Are they safe to eat or not? The answer is "yes and no." It really is. And that is the difficulty. There is no one-size-fits-all answer to the egg question.

The answer depends on you and your actions depend on how you answer the famous question asked by Clint Eastwood in Dirty Harry: "Do I feel lucky?"

You see, eggs are safe to eat if you do not suffer from cardiovascular disease, from a build up of plaque in the arteries which carry blood to your heart, brain and elsewhere. But how does one know if their arteries are clear? Well, until tests show they are plugging up, most of us believe our arteries are clear. Often we believe wrong.

Even though cardiovascular disease afflicts or kills as many as one in two adults in developed countries, we feel lucky. Until, that is, a heart attack or a stroke occurs. Dying from this is not a long shot. This is not a lottery with long odds. It is not even a dice throw. It is more a coin flip.

The Harvard T.H. Chan School of Public Health reports:

A healthy lifestyle pattern may prevent more than 50% of deaths due to ischemic strokes, 80% of sudden cardiac deaths, and 75% of all deaths due to cardiovascular disease. And what exactly is a "healthy lifestyle pattern?"

• Not smoking
• Maintaining a healthy weight
• Staying active
• Choosing a healthy diet

And where do eggs fit in a healthy diet? That depends. Again, from the T.H. Chan school:

People who have difficulty controlling their total and LDL cholesterol may want to be cautious about eating egg yolks and instead choose foods made with egg whites. The same is true for people with diabetes. 

Unfortunately, one year you may test well for cholesterol but move into the danger zone in the future. For many of us, as our age increases so does our cholesterol. I had good readings until I didn't. And I found out that I didn't a little late in the game. I thought I was lucky. I wasn't. I no longer eat eggs, or at least not egg yolks. This is at the urging of my heart and stroke specialist.

If you are young and healthy and at little risk of  cardiovascular disease, you can take solace in the fact that  research has shown eating one egg a day is not associated with increased heart disease risk in healthy individuals. But note those last words: "healthy individuals." Read the fine print.

I believe my heart and stroke doctor would tell you not to flip a coin when it comes to your health. You can never be totally confident that you are "healthy." Don't smoke, maintain a healthy weight, exercise and eat a healthy diet by keeping saturated fat consumption low. And, to further increase your odds of avoiding what is commonly called heart disease, minimize your consumption of eggs.

http://www.sciencemag.org/news/2014/03/scientists-fix-errors-controversial-paper-about-saturated-fats

Breitbart/Fox contributor found on Opinion page of The London Free Press

Before getting into this post, I'd like to say that I am a retired newspaper staff photographer. I've had connections to newspapers since I was boy. I love newspapers. And many of the seniors with whom I associate are also newspaper junkies. But, and this is the sad part, The London Free Press as operated by Sun Media, and now by Post Media, has broken some of these people's life-long attachments to a daily paper.

They say the paper is too thin. It doesn't have enough local news. These at-one-time-readers are not interested in what happens in Windsor or in other cities with a Post Media paper. And they feel The London Free Press has veered too far to the right. These seniors miss what isn't there and are often offended by what is.

The opinion piece at the core of this post is an example of what is chasing the folk I know away from the paper. And the sad thing is the folk running the paper don't appear to care. The opinion piece contained phrases that to folks who follow this stuff, and my friends do, say beware of  the hidden right wing agenda.

It is one thing for the local paper to carry a cost-saving right-wing insert. But when the paper itself has its opinion page contaminated with cheap, head-office bumpf, then readers stop reading The London Free Press. All too sad.

Now, on to my post.
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It's tough being a journalist at a small, daily newspaper today. The staff is thin and threatens to get even thinner. The worries concerning job security and even worries about the future of the paper itself are palpable. No one wants to join the ranks of the unemployed. Everyone does their job, no one criticizes and all keep quiet. If I still worked at The London Free Press, even mouthy me might find myself self-muzzling.

With that confession out of the way, I'd like to believe I'd be in Joe Ruscitti's office right now telling him that Peter Morici does not belong on the paper's Opinion page. Ruscitti is the editor in chief at the local paper. Peter Morici is the type of columnist who repels my senior friends.

Recently, the newspaper called for a boycott of L. L. Bean. Why? Because, according to the local journalist behind the call, Morris Dalla Costa, it doesn't support anyone who supports the policies of Donald Trump. I thought a boycott was an action demanding a fair amount of thought and deliberation and not just a quick tweet. He assured me that it was "not a difficult concept." (I say the newspaper called for the boycott because the Twitter username attached to the tweet ended with ...atLFPress. If the paper is going to allow their name to be part of a username, the paper must take some responsibility for the tweet.)

Peter Morici is a vocal supporter of many of Donald Trump's positions. He was identified in the paper as "an economist and business professor at the University of Maryland." All true. But he is also a contributor to Breitbart News and Fox News. This important background  information was not forthcoming.

Should Morici's opinion be in my local paper? Certainly, but not on the local Opinion page. It should be in the Post Media section. And Morici should be clearly identified as also appearing in Breitbart News. Steve Bannon, said to be the strategist behind Trump's travel ban, was the former head of Breitbart News. It should also be mentioned that Morici is a frequent on-air contributor to Fox News. Need I say more?

Now, will Morris Dalla Costa be so bold as to tweet out a call to boycott The London Free Press? I doubt it. And yet, by Dalla Costa's logic, he should be calling out the paper, his employer. As he said, it's "not a difficult concept."