All the colour makes this a spectacular dinner

I added the pepper. The two chefs may give me a good scolding for being a bit too generous.

Sunday my wife and I had dinner with friends. The husband and wife are a both whizzes in the kitchen. Together they created an absolutely superb Sunday dinner. Actually, meals at their place are usually superb but this Sunday's meal was spectacular at first sight. It was gorgeous with an incredible mix of colour.

I had taken a picture and was setting the camera aside when my granddaughter passed me the heritage tomatoes topped with a sprinkle of chopped basil and slices of buffalo milk mozzarella. She insisted I take another picture. Forgive me but I already had generously peppered my dinner. Not the best move when taking food pictures.

The pork loin was gently grilled and served in slivers on the avocado mixed salad. A vegetarian could make this dinner by simply eliminating the pork loin. I don't believe the meal would suffer.

Since writing this post, I 've heard from the cooks. The recipe is not theirs. It is the Island Pork Tenderloin Salad posted on Epicurious. Check out the link. Just look at my picture and tell me that this isn't a great presentation. As a further bonus, my heart doctor would certainly approve - just go light on the pork.

Expanding one's world

Photo of sculptures by Carolo taken by Marc Grenet (www.marcgrenetphotographe.com)

 
I've been asked why I watch TV5 almost every morning. The answer is simple. It broadens my world.

This morning my wife and I caught a story about a young sculptor in France, going by the name of Carolo, whose medium of choice is cow dung. And yes, there is a lot more to be said for this artist's work than just the material used in making her sculptures. The cow dung is simply her "hook" so to speak.

If you'd like to know more about Carole Chanard (Carolo), read the piece on the artist by Zelda Meyer and posted by La Terre. My link should take you to a Google English translation of the French Internet site.

As someone who studied sculpture in the '60s, I still have a small nude hiding in my garage, I loved much of what I saw of her work. I believe she is untutored but she clearly has a much better grasp of working in a three dimensions than I ever had back in my art student days.

I find some of her pieces have a certain Picasso feel but without the obvious threatening edge. The tension may be there in some pieces but it is subdued. Many of the works exhibit dry humour -- an understated comic undertone. Like sugar in food, humour in art can easily be overdone. In lesser hands it can become cloying. Carolo has a deft hand and a clear artistic vision.

Carolo spent some of her mid-teens living with her parents in the West African country of Burkina Faso. Apparently it was there she discovered mud huts can be made from material other than mud. Meyer quotes Carolo: "If we can make mud houses with dung, you can also make sculptures!"

If you have the time, do some Googling of Carolo. Don't let the fact that most of the stuff posted is in French. Use Google translate. And check out the posted work of Marc Grenet. His portraiture is absolutely wonderful.

And this is all stuff that I never would have discovered had I not been watching TV5.

Cheers!

A soft toothbrush, floss and mouthwash keep a mouth healthy

My dentist gives me a new toothbrush every time I visit, which is normally every six months. A few years ago he went on a soft toothbrush kick. As I understand it, a small group of Canadian dentists decided they didn't like any of the toothbrushes on the market -- all had bristles which were too thick and too hard, in their estimation. They feared that over time the harsh bristles would damage teeth and gums.

The dentists had a toothbrush manufactured to their specifications. It was a very traditional design. No sharply bent neck, no coloured bristles that fade with use. The big difference between this new toothbrush and all the others in the market were the very thin, soft bristles. My dentist got a number of the first toothbrushes and gave them to his patients. I loved mine. My wife hated hers. A soft bristled toothbrush may or may not be better, the jury is still out, but the ultra soft bristles definitely don't please everyone.

The last time I visited my dentist I got a standard Oral B toothbrush. It claimed to be soft but it was downright hard compared to that special, soft-bristled toothbrush. I tried keeping my old brush but it was clearly worn out. Regretfully I tossed my unique toothbrush.

I take an anticoagulant daily to reduce my risk of stroke. The blood thinner makes bleeding gums more of a problem for me than for the average person. I try to take good care of my gums and my new Oral B toothbrush was too hard. No matter how lightly I brushed my teeth, I had bleeding.

I searched the Internet for a new toothbrush and discovered Colgate is making a brush similar the one given out by my dentist. If anything, the new Colgate SlimSoft toothbrush is a little lighter and slimmer with more bristles than other brush. This is possible because each bristle is thinner and more tapered. I bought a SlimSoft and I love it. I'm going to buy a number. I don't want to run out. I've already watched as one good brush was withdrawn from the market.

When one has had some types of heart valve surgery, the risk of endocarditis, a heart infection, increases. Although endocarditis is rare, affecting less than 20,000 people in the States annually, it is serious. Those affected can die.

I've had the mitral valve in my heart repaired. Whenever I had a dental procedure performed I was required to take 2 grams of amoxicillin an hour prior to my appointment. Taking a walloping big dose of antibiotic to possibly protect one against a very low risk infection is controversial. Personally, I side with those who argue the risks associated with taking a massive dose of amoxicillin are greater than the risk of developing endocarditis from having one's teeth cleaned.

I saw this preventive use as an abuse of a powerful antibiotic. After the first few dental visits, I refused to take the amoxicillin. My dentist allowed me to refuse but I have heard that some dentists told patients that they had a choice: take the meds or take the door.

In the past year or so, the tide has turned. The American Heart Association admits "there is a concern that widespread use of antibiotics for this purpose might contribute to promoting antibiotic resistance, an important issue today, as well as needlessly expose patients to antibiotic side effects such as allergic reactions."

What is agreed upon is that it is important to try and prevent the development of endocarditis. Good oral hygiene, daily brushing and flossing followed by the use of a good mouthwash is believed to offer a fair degree of protection. To this end, I have added a thirty second mouth rinse using Listerine Total Care to my daily oral health ritual.

Total Care is not the only suitable mouthwash but it is the one that I have settled upon. A few years ago Listerine ran into problems when the manufacturer claimed Listerine could replace flossing. It can't.

I know I am at risk of endocarditis but I honestly believe I have lessened that risk by adopting the use of the new Colgate SlimSoft toothbrush and teaming it with the daily use of dental floss followed by a morning and night 30-second cleansing slosh of Listerine Total Care.

At my next check-up the dentist is going to measure the pockets at the base of my teeth. I'll have a better idea at that time of how successful this three tiered assault on periodontal disease has been.
___________________________________________________________
Today was check-up day. My pockets measured mostly 1s and 2s. I had some 3s and two 4s. 4s are bad while 1s and 2s are good. Pretty good for an old geezer in his late 60s. Clearly, I am doing something right.

If a layoff goes down and no one hears . . .

The e-mail to The London Free Press failed. Using Twitter, I publicized the layoff.

I have it on good authority that Sun Media informed its staff at the former Bowes Publishers operation in northwest London that a major layoff will take place at the end of the month (May 2014).

Reportedly someone from The London Free Press made the announcement to a staff left shocked by the news. Many of those working at the facility on Gainsborough Road just west of Hyde Park Road had felt their jobs were secure. Just hours before the announcement one staffer had signed on the dotted line to buy a new house. Now, that sale has been scuttled.

How many jobs are being loss? I have heard numbers ranging as high as thirty. That's a lot of good, jobs -- well paying jobs. This is but another blow to the  London economy which has not recovered from the recession now officially some years in the past.

Jim Bowes worked for The London Free Press and branched out into publishing in his off hours. With his publishing business flourishing, Walter Blackburn, Free Press owner, gave Bowes a choice. Either work for The Free Press or leave and devote all his time to his own expanding publishing business. Bowes left the paper and, in the end, left London.

Bowes moved to Grande Prairie, Alberta, where he added the weekly Herald Tribune to his growing chain of small newspapers and niche publications. At the same time, he kept his publishing operation in London going and growing. By 1988, when Sun Media Corporation acquired a 60 percent interest, Bowes Publishers had 22 business units. Two years later Sun Media took complete control of the now not-so-little publishing operation started in London, Ontario. And now Sun Media is slashing employment at the London facility and moving many, if not most, of the work to Barrie.

What do Londoners think of this sad turn of events? Nothing. Most have no clue that it is even happening. It may have been a honcho from The Free Press who announced the layoff to the Hyde Park workers but the paper has been strangely mum about the impending layoff when it comes to informing the public.

I have called the paper and left messages. I have send a tweet hoping Hank Daniszewski, the business reporter, would notice. Nothing. No response. (To be completely accurate, a local Londoner who seems to stay abreast of everything retweeted my Twitter post. Score one for a very alert Butch McLarty.)

A neat way for kids to make art

If you know a young child who likes to paint, I have a tip on teaching a child to create art like that shown.

Fiona, my four-year-old granddaughter, loves the Children's Museum in London, Ontario. One of the activities that brings her back time and time again is the art instruction. Each time we have gone they have had a class demonstrating a new art technique designed with little children in mind.

The piece shown is actually circular and not rectangular. I cropped the subject in the camera. It is circular shape is a result of the fact that the art is on a round, white paper, pie plate that had been jammed into a salad spinner. The plate's diameter was a little larger than that of the plastic spinner insert. This large size is important as the tight fit keeps the paper plate firmly anchored.

After pushing the plate into the spinner, the instructor had Fiona place dabs and gobs of colourful paint in the centre of the plate. When the mix of colours was just right, she put the top on the spinner and turned the crank as fast as she could. Inside centrifugal force thrust the paint out to the sides.

I'm going to try this at home with both Fiona, 4, and Eloise, 3, my oldest granddaughters. I'll use Crayola non-staining, washable water colours. These will wash out of the spinner with a little warm water and dish soap, plus Crayola paints are clean and bright with good density.

French potato salad; No egg

I had to make a potato salad today. It was my contribution to a Mother's Day dinner. Bill, the gentleman hosting the party, requested the potato salad as he loves my wife's cold potato salad made with hard boiled eggs and mayonnaise. He figured I could use Judy's recipe.

The problem with Bill's request was the egg. Egg is off limits for me as it is for Bill's brother. He has heart problems as I do. Eggs are exceedingly high in cholesterol and dietary cholesterol is a no-no to those with heart disease.

I found a recipe for French potato salad posted by a Swedish blogger by the name of Ewa (Eva). She lives in Seattle, WA., and enjoys sharing her recipes. I don't believe she'd mind my posting a link to her site and her recipe for French potato salad: Delishhh.

I made some small changes to the recipe. I used a little less olive oil and a little less salt than called for and I added some roasted, chopped walnuts immediately before serving. I used my Cuisinart blender to mix the olive oil, champagne vinegar, Dijon mustard, salt and pepper into an emulsion. I tried whipping it manually but failed. The blender was the perfect answer.

I put the scallions, dill, parsley and basil in a bowl and mixed all together before adding all to the salad. As I mixed the salad, I salted and peppered it to taste but on the conservative side. I figure folk can always add more salt and pepper at the table. It is impossible to remove if added with too heavy a hand.

So, what was the verdict? Was my, or should I say Ewa's, recipe as good as my wife's? I believe it was. Bill, a tough critic at times, said the best two potato salads he has every tasted both came from my home. One was Judy's and the other was mine (Ewa's).

This potato salad is not for who fear calories. The olive oil adds fat and calories. This is one reason that I cut back on the olive oil in my version. But for those on a heart healthy diet, a serving of this squeaks by on the heart healthy side. This salad contains no saturated fat and no cholesterol.

Homemade soup: Easy to make, nutritious to enjoy

I've modified this recipe. For one thing, I've increased the amount of cauliflower used. Click on the link to see the new recipe: Elegant soup for about a dollar.

I'm not overly fond of cauliflower. I don't dislike it but it is not in my usual veggie rotation. Still, I found the idea of making a thick, creamy cauliflower soup without resorting to heavy cream appealing. And it gave me a chance to use my newest toy: A Cuisinart blender.

I've come to believe that it is almost impossible to make a poor soup at home. The canned stuff is just so boring, the makers seem to rely on salt to kick up the flavour. Homemade soups seem almost magically in comparison.

Judy and I had this soup the other evening. It was good. I can see making a big batch a day in advance and serving it to guests at the next holiday dinner.

Cauliflower Soup

2 teaspoons olive oil
1 small, chopped onion
1 chopped celery stalk
12 oz. chicken stock or vegetable stock
6 oz. 1% milk
10 oz. cauliflower florets
1 bay leaf
1 sprig of thyme
a little nutmeg to taste (just a few pinches)
2 tablespoons of chopped chives
pinch of freshly grated pepper - I like black for the flavour and colour

• Put olive oil in a deep fry pan and place over medium heat. Add the chopped onion and chopped celery. Cook until celery beginning to soften and onion looks translucent. Do not brown.
• Add chicken or vegetable stock, milk, cauliflower florets, bay leaf and sprig of thyme. Heat until simmering and then place a lid over the pan. Simmer for about 25 minutes or until cauliflower is tender. When done, remove from heat and let cool.
• Remove the bay leaf and the thyme sprig and pour the soup into a power blender. Blend until smooth.
• Pour the soup into a medium sized pot and reheat. Do not boil. Let soup quietly simmer until the right degree of thickness is obtained. Stir in the nutmeg and let simmer for another couple of minutes. All this reheating and thickening should not take more than 30 minutes. If it is not thick enough, I understand adding a small amount of potato flakes should quickly thicken this soup without damaging the flavour.
• Serve with sprinkles of  chopped chives and a couple of passes of the pepper mill. These add a little flavour and some much needed colour.

The next time I make this, I'm adding a clove of crushed garlic to the finely chopped onion and celery. I may oven roast a small number of cauliflower florets in a little olive oil. When the florets are almost done, I'll sprinkle on a little Parmesan cheese and return all to the oven until the cheese is just melted. I'll add these flavoured florets to the soup moments before serving. I think some little bursts of concentrated flavour hiding and floating in the soup might add extra presence.

I'd try this soup straight the first time, though, and leave the tarting up with roasted cheese-flavoured florets to later.

Just asking for a basic level of journalistic integrity

I went to a breakfast this morning in London, Ontario. The monthly social event is attended by those who once worked for the media in town but who have now, for whatever reason, found themselves put out to pasture.

It is always fun catching up on the latest media rumours, but this morning was a little more interesting than usual. I learned that Joe Warmington, the award-winning Toronto Sun columnist, wrote a story and posted it to the Internet before the event had occurred. Oops!

According to Now, a weekly news and entertainment tabloid serving Toronto, The Toronto Sun declared Rob Ford's appearance on the Jimmy Kimmel show a "victory for Ford" even before the writer, Joe Warmington could have seen the program. The Ford segment was taped at approximately 9:40 p.m. Eastern Standard Time but the date stamp on Warmington's first report was 9:13 p.m.

In talking about a program he couldn't possibly have seen, Warmington said the Toronto mayor's appearance "was vintage Rob Ford."

The Now report goes on to say that Canada.com's Marc Weisblott first tweeted out the column at 10:31 ("Joe Warmington reviews a show before it airs"). Fifteen minutes later, amid suggestions from those in studio that the appearance had been a disaster, the Sun pulled it down. (It has disappeared as well from Google's cache.)

One exchange that hasn't gone missing is the Twitter tweets between National Post columnist Bruce Arthur and Toronto Sun staffer Cynthia McLeod.

In the ensuing conversation I thought the responses by Alex Colangelo and Stan the Man Chan were among the best. Colangelo offered, "So I guess perfection is waiting for an event to occur before writing about it?" Stan clarified the problem that McLeod seemed unable to fathom: "No one's asking for perfection. We're just asking for a basic level of journalistic integrity."

Seeking solutions to the housing crisis

Streetscape from Hong Kong shows dense residential does not have to be boring.

 
This is an intro to a link to a New York Times piece on the housing crisis facing cities around the globe. I really liked some of the stuff the writer said.

As someone who attended many of the ReThink London meetings, I believe cities may well lack  the fortitude to deal head-on with the numerous problems encountered trying to supply decent, while also affordable, housing.

Housing policy can be very tricky to get right. “Success is going to be in the eye of the beholder,” says Eric Belsky, the managing director of the Joint Center for Housing Studies at Harvard. “If success means building more homes at greater densities, you’ll end up with some neighbors not happy . .  .

Personally, I find the London, Ontario, solution of embracing sprawl to be totally unacceptable. That said, I feel quite alone in my opposition. Oh, lots of folk talk the end-the-sprawl talk but they fail to walk the end-the-sprawl walk.

Here is the link to Rent Too High? Move to Singapore. Read it, let it make you think and don't get hung up on statements like the following: "It seems the only solution would be to level all of, say, North Brooklyn and put up monolithic prefab tower blocks. But New Yorkers don’t want to live in Singapore." (And there is no demand to emulate Singapore housing in either London, Ontario, or New York, New York.)

When it comes to housing, Singapore and Hong Kong are guideposts and not final destinations.

Eating healthy despite being miles from home

Lunch in St. Jacobs: A delicious stir-fry on a bed of Basmati rice.

Today was a meatless day. No beef, no chicken, no fish -- nothing but veggies. Today was also escape-to-St. Jacobs day. St. Jacobs is a small town about an hour from London. At one time, it was famous for its Mennonite shops.

Then a couple of small malls moved to town and it became a shopping magnet. The town paved the land behind main street and put in parking for the tour buses filled with visiting shoppers. But times have changed. Many of the once popular mall shops have disappeared. For instance, Dansk -- a once popular retail destination -- has closed all its factory outlet stores.

With the downtown mall emptying of stores, the small mall has now been converted to another use. But the town still has Mennonites and, even without the presence of lots of out-of-town retail, it may be able to return to its small town retail roots.

The little stores my wife and I visited were filled with great stuff, much of it locally made. We picked up a loaf of freshly baked sour dough bread in the local bakery and for lunch we enjoyed a non-chain restaurant meal.

I must confess, I miss the Dansk store. But I don't miss McDonald's, Wendy's, et al. My meatless day lunch was great. So far, Dr. Spence has been right: Meatless days can be absolutely delightful.

Leftovers

Leftovers don't have to be second best. Tonight we had left over ratatouille. Judy punched it up with, what else, some other leftovers.

She added roasted red peppers and canned artichoke hearts. It was delicious. (Before Judy served this, she added a sprinkle of Parmesan but it hid the look of the dish. You will have to use your imagination.)

For a ratatouille recipe, just cruise the Internet. There are lots of recipes posted. And if you make too much, punch it up the next day and enjoy it all over again. Weight Watchers rates this dinner as a five and my heart doctor would call this a wonderful Mediterranean dish. Lose weight and possibly arterial plaque all at the same time.

What a great idea. Pass the red wine, please.

Is the CPP Investment Portfolio Struggling?

Maybe my headline is a little too strong -- and maybe not. A financial expert by the name of Mark McQueen has strong feelings about the running of our Canada Pension Plan (CPP). His feelings are not good.

I started thinking about how the CPP is managed after hearing some comments made on the CBC morning news show with Heather Hiscox. The comments seemed to be throw-away filler and not thoughtful insights.

I've followed McQueen online as well as on BNN and he makes a good case for concern. I decided to see if he has published anything recently on the CPP. I found an online post from February of this year (2014): CPP Investment Board’s External Private Equity Managers Continue to Drag Returns.

McQueen tells us: "The CPP Investment Board reports that our hand-picked team produced $1.8 billion of negative value add over four fiscal years . . . " Go to McQueen's post on his Wellington Financial blog for the whole story or at least as much of the story as McQueen is able to report. You see the CPP Investment Board is terribly secretive about its investments and returns. Much of the financial date provided to the Canadian public is intentionally useless, according to McQueen.

CBC's Hiscox needs to widen her reach when it comes to connecting with folk in the business world and in the financial arena. She should stop with the almost daily fawning over Kevin O'Leary and move on. I nominate Mark McQueen as an on-air financial expert willing, and more than able, to point the news organization in the direction of some newsworthy stuff.

Random testing vs. fasting for cholesterol tests

I got a call this afternoon. It was the nurse at my family doctor's office. She told me my doctor wanted me to have some blood work done and soon. No need to fast, I was told, just get to the lab for some cholesterol tests and others. I went immediately.

In the past, I've puzzled over the fasting instructions that have always been part of having these tests. Would there be any to be gained in having test numbers reflective of cholesterol levels occurring after a meal rather than after 8 to 12 hours of fasting? Once I mistakenly had a little coffee before going to the lab. The lab staff insisted I put the test off for a day. Just how damaging can a few sips of coffee be to one's numbers, I wondered.

Today at the lab, I asked a technician about the change from fasting to random testing. She told me she could see advantages and disadvantages in both. She thought it best not to adhere to either approach in all situations. She herself has cholesterol problems she confessed. In her case, it was genetically caused. For her, she knew it was best to have both fasting and random testing done.

I googled the question and learned:

If nonfasting lipid profiles for cardiovascular risk prediction were used, it would simplify clinical care for patients worldwide. Because only minimal, and clinically unimportant, changes in levels of lipids, lipoproteins, and apolipoproteins have been noted in response to normal food intake in the general population and because nonfasting levels predict cardiovascular events, fasting may not be necessary before determining lipid profiles for predicting cardiovascular risk.

For more on this, read: Fasting and Nonfasting Lipid Levels in the American Heart Association publication Circulation.

Personally, I feel more comfortable having my cardiovascular risks calculated from random tests. First, I am not part of the general populace. I have known cardiovascular problems. The average person doesn't have an ICD hidden in their chest and hardwired to their heart. The average person doesn't have a history of relatively frequent TIAs. The average person doesn't have plaque building up in the carotid artery. How the average person's lipid profile changes, or doesn't, after a meal may not be relevant in my case. I'll leave that to my doctors.

My lipid profile, created from years of blood work done in the morning after a night of fasting, has developed some solid numbers. It will be interesting to see what profile modifications will ensue now that my tests are being based on blood work taken randomly.

Whole Wheat Fusilli with Roasted Red Peppers, Turkey and Goat Cheese

This past weekend was Easter. My wife made a large Easter dinner but she made concessions based on the recent advice I received from my London doctor. As red meat is now just about out, Judy made her stuffing using locally-make low fat turkey sausage. Her potato and leek soup was lighter this year as it contained no heavy cream. Judy took advantage of every opportunity to lighten up on animal fats. The dinner was large but not ridiculously large and we'll work through the leftovers in just a few days.

Today, I uses some of the leftover turkey in a whole wheat fusilli with roasted red peppers, turkey and soft goat cheese concoction. I like the fusilli shape as it offers sauces a surface with good grip. Sauces easily slip free from the twirling fusilli shape.

I served broccoli as the side vegetable. I like the way trimmed broccoli curves along the edge of a pasta bowl. It's too bad I didn't include the broccoli in the picture. It would have added a nice splash of green.

Whole Wheat Fusilli with Roasted Red Peppers, Turkey and Goat Cheese

Serves 2

• 1 Tbsp extra virgin olive oil or canola oil
• 1 small onion, diced
• 1 garlic clove chopped
• 8 oz. of roasted red peppers*
• ¼ cup vegetable broth
• 3-4 oz. roast turkey
• 200g of whole-wheat fusilli
• 3 oz. soft goat cheese
• Fresh ground black pepper to taste
• 1 Tbsp chopped fresh Italian parsley
• 3/4 oz. grated Parmesan cheese 

* My wife bought local, fresh red peppers last fall, blackened them on the barbecue, stripped off the darkened skins and frozen them in freezer bags. If you don't want to roast your own red peppers, jars of roasted red peppers are available at the grocery store. I believe they come packed in both oil and in water.

Directions

Heat oil in heavy, deep skillet over medium heat. Fry onion and garlic until translucent. Add roasted peppers, vegetable broth, roast turkey and freshly ground pepper. Heat through, simmering until sauce thickens.

Cook pasta and drain. Remember to reserve 2 oz. of pasta water. Toss pasta with sauce and half the soft goat cheese. (I actually topped the pasta with the mixture but next time I may remember to toss with the pasta.) Add some pasta water if needed. Serve in pasta bowls with sprinkle of parsley, the remaining goat cheese and a little grated Parmesan.

Enjoy!

And if you're curious as to what, other than turkey, was on my wife's Easter menu, think memories. She made a beautiful bunny cake that simply delighted our two oldest granddaughters. They will always remember the Easter dinner at which grandma Judy served bunny cake. The cake, by the way, was somewhat heart healthy. The recipe called for egg whites only. No yokes.

Computers can be good for kids

Why a black flower, Fiona? It's a drawing, Gug. It can be any colour I want.

I've read articles claiming that young children should not be allowed to use computers. One story said "technology is damaging young children whose brains are not yet fully formed."

Not true, at least not in my experience. My granddaughter, Fiona, will not be five for months but already she knows how to turn on the computer, find her icon and open the paint program. The other day my wife asked, "What is Fiona doing? She is awfully quiet."

I found her sitting at the computer making art. It was clear that the computer in no way is damaging her ability to concentrate. She watches what happens when clicking on this icon or that icon and she learns. She knows more about the paint program than I do.

She loves to experiment with colour and form. The computer is perfect for doing this. If one doesn't like the result created by one colour, erase it and try another. Do you like to experiment with geometric forms? It's easy with a computer but almost impossible for a four-year-old using paint, brush and paper.

I've noticed her work with traditional paints often resembles the stuff she creates on the computer.
Many times there is no big divide between her work on the computer and her work done on paper.

Fiona's mother used a computer at a very young age. Not as young as Fiona, but under ten. I had one of the first Macs and I bought a typing program for the little computer. Her mother would sit in front of the little black and white screen blasting words tumbling down the monitor. To type faster, she learned where to place her hands to best use all her fingers. She was typing more than 60 words per minute while still in grade three or four.

Using computers to do dumb stuff is not a temptation unique to children. Maybe learning to ignore such temptations at an early age is an advantage of early computer use.

Can arterial plaque build-up be halted? Reversed? Maybe.

In keeping with my doctor's orders, I am now eating meat every other day. Red meat will only hit my plate once a month, if that. Fish is about to play a big role in my diet and chicken and turkey will fill in the remaining holes in my menus.

It sounds extreme, at least it did to me but it isn't. According to an article in the Huffington Post, President Bill Clinton is now on on a plant-based diet. He has cut all meat from his diet, except for the occasional fish, as well as dairy. Clinton told CNN that he lives on "beans, legumes, vegetables, fruit."

My doctor, Dr. J. David Spence, made no wild promises to me but he is clearly trying to arrest the build-up of plaque that is taking place in my arteries. He is confident the Mediterranean diet he recommends will be part of the answer. Dr. Spence is not alone in his thinking, there are many in the medical profession who agree with my London, Ontario, doctor. They all believe a plant-based diet can help put the brakes on the insidious growth of arterial plaque.

In the United States, Dr. Dean Ornish and Dr. Caldwell Esselstyn are two doctors gaining fame for the plant-based diets they promote. I believe, Bill Clinton is following Dr. Ornish's dietary advice. Another doctor publicizing a plant-based diet, this one with a bit of a twist, is Dr. Joel Fuhrman.

Dr. Fuhrman has gone so far as to write a cookbook, Eat to  Live, making the claim on the cover that inside are 200 recipes for "reversing disease." My doctor, Dr. Spence, has also written a book, How to Prevent Your Stroke. Dr. Spence makes it clear that although diet plays a major role in fighting stroke, once one is suffering from TIAs (mini-strokes) and has measurable amounts of plaque collecting in the arteries, a change in diet is not the compete answer.

Today doctors have a growing number of weapons in their arsenal for fighting stroke. But stroke research is showing that long before someone at risk sees a doctor, there are actions they could have taken on their own to cut their risk.

• Don't smoke
• Don't drink (to excess)
• Exercise daily
• If overweight, lose it
• Adopt a healthy diet to keep the weight off

I have never smoked. I have one 5 oz. glass of wine with dinner. But until recently, I didn't exercise enough, I was clearly overweight and that was partially because my diet was in need of a major overhaul. Would a better diet have kept my arteries free of plaque? Maybe.

According to a Harvard Medical School publication, "Visceral fat is directly linked with higher total cholesterol and LDL (bad) cholesterol, lower HDL (good) cholesterol . . . " And what would have kept that fat at bay? The Harvard publication says exercise and diet.

Pay attention to portion size, and emphasize complex carbohydrates (fruits, vegetables, and whole grains) and lean protein over simple carbohydrates such as white bread, refined-grain pasta, and sugary drinks. Replacing saturated fats and trans fats with polyunsaturated fats can also help.

In keeping with my new approach to eating, tonight I prepared curried vegetables on a bed of rice for dinner. The rice was white because, at the moment, all we have in our pantry is Indian basmati rice. As soon as this is gone, we will be switching to brown rice. It has a nice nutty flavour and I will make the switch with no fuss.

Recipe

• I put three teaspoons of extra virgin olive oil in a large, deep frying pan.
• I heated the oil for about 30 seconds and then added two teaspoons of mild curry and swirled the heating mixture around in the bottom of the pan. The next time I make this I will add three teaspoons of mild curry to give this dish a little extra pop.
• When the aroma of the heated curry could be clearly noted, I added two chopped onions and two diced garlic cloves to the oil.
• When the onions began to turn translucent, I added 10 oz. of cauliflowers florets and let the cauliflower absorb lots of the flavour of the curry.
• After a couple of minutes I added a 28 oz. can of diced tomatoes, 18 oz. of salt reduced chicken stock, four peeled, sliced carrots, a sliced zucchini about 8 oz. in size and one  medium sized potato cubed.
• I let the whole concoction simmer for about fifteen minutes.
• I added 8 oz. of sliced green beans, a 14 oz. can of chick peas and a small container of heritage cherry tomatoes which had been halved or quartered.
• I ground a little pepper on top and sprinkled some salt onto the bubbling mix and left all to gently simmer.
• Another fifteen minutes and the curried vegetables were ready to be spooned onto a bed of rice along with a little of the light sauce.

Was it good? Honestly, it needed a little more punch. As I said earlier, next time I'll add a third teaspoon of mild curry. The chicken stock I used was low in both sodium and fat but the next time I make this I will experiment with low salt vegetable stock, and I will keep an eye on the salt I add. Many of us consume too much salt.

So, was it healthy? Yes! It was a good choice for a meatless Monday. Will eating like this stop the build-up of plaque in my arteries from continuing? I can't say for sure but I have my fingers crossed and my spare tire on notice.

Treasures

For my 4-year-old granddaughter the world is a wonderful place filled with treasures. She has a little pink tricycle she calls her scooter. At the back there is a small tray — the trunk. Whenever we go to the park, the short journey is stretched by frequent stops to investigate a treasure.

The crabapple tree in front of my home is the source of many treasures. In the spring, the tree is covered with small, pink flowers attracting dozens of bumblebees bees at any one time. She stops, I hold her high and she picks the pretty, little flowers. Treasures.

The flowers disappear, leaving the ground littered with pink petals, more treasures. Soon little green apples replace the flowers and grown in size and number throughout the summer. By fall the boughs hang low with the weight of the fruit. The tree emits a low, steady hum, the result of hundreds of yellow jackets attracted by the fragrant, juice-filled fruit.

My granddaughter will stop her scooter and I will hold her high in order to pick the biggest, roundest, reddest apples. The ones undamaged by the wasps. She is careful not to bother the buzzing, yellow and black striped insects which appear to understand that we are not a threat. There are enough apples, enough treasures, for all.

Of course, a crabapple tree is not the only treasure to be found. I have two, small, smooth, flat, oval stones discovered by Fiona. They too are treasures and she gave them to me. I treasure them. I will make one into a broach, encircling it with a decorative band of silver. It will be a treasure for all forever.

What I find amazing, startling, even a little sad, is that as we grow older, as we mature, we don't see more treasures in our world but less. Fiona has opened my eyes to the treasures in my world and for this I thank her. I believe I can say, and most would agree, Fiona herself is a little treasure.

The Mediterranean diet is part of the answer

There is a misconception, often spread in the media, that dietary fats are no longer linked to cardiovascular disease. I have heard folks admit to great confusion when it comes to the question of diet as a result of all the conflicting stories boldly featured in the media.

One week it is reported doctors are claiming fat is bad for you and then the very next week, or so it seems, the reports flip, reporting dietary fat is of no consequence. The heart-disease-and-dietary-fat story flip flops in the media as often as a fish out of water.

According to one of my London, Ontario, doctors, J. David Spence, "Patients at risk of cardiovascular disease should limit their intake of cholesterol." Period. For Spence, this is not debatable. The well respected doctor and his co-researchers are certain that "Despite widespread belief to the contrary, it is simply not true that dietary cholesterol is harmless."

Instead of reading newspaper reports, I would suggest reading "Dietary cholesterol and egg yolks: Not for patients at risk of vascular disease." This report can be found in Pulse: The Canadian Journal of Cardiology and found posted online by the U.S. National Library of Medicine.

This report states, "A widespread misconception has been developing among the Canadian public and among physicians. It is increasingly believed that consumption of dietary cholesterol and egg yolks is harmless. There are good reasons for long-standing recommendations that dietary cholesterol should be limited to less than 200 mg/day; a single large egg yolk contains approximately 275 mg of cholesterol (more than a day’s worth of cholesterol)."

The report blames the confusing media stories on "the remarkable effectiveness of the sustained propaganda campaign of the egg producers' lobby. . . . In the past year, two studies funded by egg marketing agencies led to media reports promoting the benefits of eggs." Although Spence et al. agree egg white is a valuable source of high-quality protein, egg yolk, on the other hand, should not be eaten indiscriminately.

If eggs are bad, what about butter? I've had friends say that they once ate margarine for health reasons but have now switched back to butter. They honestly believe the fat in butter is superior to the fat used to produce soft margarine. Despite the media stories, this isn't the case.

One friend loves to say margarine is made from petroleum products, oil sands oil. It's plastic he says and he makes these false claims in front of his young granddaughter. This is a pointless urban legend according to Melissa Wdowik, a nutrition specialist at Colorado State University.

As a man battling arteriosclerosis, I shake my head. People are ignorant about the true position of most doctors when it comes to dietary fat. I lay the blame for this squarely on the media. Take this headline from the Daily Mail in Britain. "At last, the truth: Butter is GOOD for you - and margarine is chemical gunk" The story claims the public has been conned by profit-grabbing manufacturers ignoring decades of scientific evidence in order to peddle their tubs of margarine.

I'd list more links to media stories but I'll let you do the googling. You will be swamped. But approach this search by looking for university supported data rather than media stories. If you do this, you will learn that soft, non-hydrogenated margarine is best -- but like any fat that is being used as spread, it must be used sparingly.

Life is complicated and the media hates a complicated story. No one would dispute the fact that fat is essential in our diets. Medical researchers are concerned with both the total amount of fat in our diets and the type of fat. The recommendation is to avoid trans fats completely. This bans hard margarine from our diets

After eliminating trans fats, one should choose unsaturated fats over saturated ones. This cuts butter from our diets and severely restricts consumption of red meats. According to the American Heart Association, "In general, red meats (beef, pork and lamb) have more cholesterol and saturated (bad) fat than chicken and fish.

I like the attitude of Dr. J. David Spence. I first met Spence while covering a medical story for the local paper. I met Spence again recently when he sat down with my wife and me to discuss the plaque discovered in the arteries leading to my brain.

Dr. Spence laid out a battle plan for us to follow in fighting my increasing stroke risk. I don't want to give anyone the idea that the only weapon in our arsenal is a change in diet. Diet is but one arrow in a large and growing guiver. But, an improved diet, with the accompanying loss of excess weight will play an important role in the coming fight. I quote from Dr. Spence's book: How to Prevent Your Stroke.

"I encourage people to take a positive attitude, thinking of their meatless day every other day not as their punishment day but as their gourmet cooking-class day. You can learn to make chili, pasta, stir-fries, barbecued vegetables, and other dishes without meat, and to make them delicious not with butter and cheese, but with herbs, spices, onions, green peppers, lemon juice, balsamic vinegar, and so on."

The doctor swayed me. My wife and I are going to try the Mediterranean diet made famous by the cooks on the Isle of Crete. Before we head off for Chapters to find a Med-diet cookbook, I'm going to check out the foodie recipes posted by Elena Paravantes on her website "Olive Tomato." But my first foray into Mediterranean cooking will be one of recipes given to me and my wife by Dr. Spence. Stay tuned.

My first attempt at Mediterranean cooking, delicious on a bed of brown rice.

C'est la vie or caught between a rock and a hard place

A risky but bold work of art by Fiona, age 4. One cannot escape risk.

Wednesday my wife and I met with a doctor, an expert in stroke treatment. He is associated with both University Hospital and with the Robarts Research Institute. He laid out the detailed findings from the investigation into the health of my arteries down on the desk. He looked at us for a moment and then told me, "You are trapped between a rock and a hard place."

The tests revealed the arteries in my neck are laden with plaque. My arteries hold three times the amount of plaque as that found in healthy men of my age. This plaque can flake and the small bits can be carried in the blood to the brain. This explains the TIAs, transient ischemic attacks, I have been having. TIAs, also known as "mini-strokes", are taken very seriously by doctors as they can be harbingers of a massive stroke in one's future.

I already take some pretty powerful medications. If all had gone well with these recent tests, I might have had some of my meds cutback. Strong meds often carry risks. Instead, I was given another cholesterol fighting drug which will also boost the benefits gained from the statin I am already taking. These drugs can mess with some important chemicals in the body. To counter this I must add 200mg of another drug taken twice a day. Unfortunately, this drug can increase the bleeding potential resulting from taking the anticoagulant Pradaxa. I take Pradaxa.

My history of heart arrhythmia demands I take an anticoagulant. Arrhythmias increase the risk of blood clots forming in the heart. These can then travel to the brain. An anticoagulant cuts this risk. Unfortunately, because micro bleeding was discovered in my brain, I cannot take the common and inexpensive anticoagulant Coumadin. It would increase my risk of having an uncontrolled cranial bleed.

There is an alternative, the anticoagulant Pradaxa. It will lessen my chance of stroke without increasing my risk of bleeding in the brain. The downside is that Pradaxa is expensive, very expensive, and if I should have a serious bleeding problem, for any reason, the blood thinning achieved by Pradaxa cannot be as quickly reversed as it can with Coumadin.

Yes, I am trapped between a rock and a hard place. But, I am not alone. I am trapped there with my doctors. They have no perfect answers to my health problems. Try this and that may go wrong. Try that and this may go wrong. And either answer is accompanied by the risk of some truly awful side effects, of unwanted consequences.

Our blood clots for good reason. There is no mystery as to why anticoagulants carry risks. All my drugs mess with important functions in my body and messing with those functions is risky. Period. Being a doctor is all about balancing risk. Doctors do a damn amazing job at balancing those risks. I am in awe of the talents, the skills, the knowledge and the bold risk-taking of my doctors.

It was more than a decade ago that I had the mitral valve in my heart repaired robotically. I was the first person in Canada to have such an operation. It was risky but it was clearly worth the risk. My ICD/pacemaker was a risk, some doctors questioned whether I actually needed one. Today my heart is being paced 93 percent of the time. I have had my heart rebooted by my built-in defibrillator at least three times. My doctors and I have taken a lot of risks over the years and so far they have made the right calls.

As of today, I am taking a mixture of ten tables and capsules a day. I chew 'em; I wash 'em down with water; I take 'em with food; I take 'em on an empty stomach. I never did a lot of drugs as a young man growing up in the '60s, but as a senior my world is veering toward Jefferson Airplane country and the land of the white rabbit.

One pill makes you larger,
And one pill makes you small,
And the ones that mother gives you,
Don’t do anything at all (maybe but doubtful).

If I should have a stroke, I know my doctors will wonder what could they have done differently. If I am lucid after the event, I will tell them there is nothing they could have done differently. Nothing. They balanced the risks and we lost.

C'est la vie.

It's a wonderful life!

I'm pushing 67. I'm retired. My heart is failing — slowly. This is not the life I expected to be living in my senior years.

I planned on traveling in my retirement. I still long to visit Romania and Bulgaria. Yes, Romania and Bulgaria. Why? It's a long story and not too relevant today as my chances of actually visiting those countries is fading with each passing day. Getting insurance may be impossible and no insurance means no trip.

Still, I'm happy — exceedingly happy. I have found a sweet spot in life of which I had not an inkling when I was young. One's senior years are, to steal the words of Rod Serling, "A dimension not only of sight and sound, but of mind." With a positive outlook, a willingness to take delight in the moment, life is grand.

I have three grandchildren. It doesn't get any better than that — unless you have four.

I've read that we tend to dwell more on unpleasant events in our lives and to use stronger words to describe them than happy ones. Not me. Don't get me wrong. I love a good personal disaster story as much as anyone. Ask me about sailing. I can tell as good a terror-filled sailing tale as the next sailor but press me and I'll slip into wonderful memories from my days of solo sailing. I loved to sit at the front of my boat, legs straddling the sharply pointed bow and dangling so low that my feet got wet from the surge forward as the boat slashed through the waves of Lake Huron. I'd sit leaning forward with arms resting on the stainless steel bow pulpit.

I loved solo sailing. I'd put my one-degree robot at the helm, a black English autopilot, I'd grab a beer and relax. Drinking on a large sailboat was not illegal back then. Trust me, there is nothing like a cold one enjoyed all alone on a sailboat thrust by the wind into a darkening night. (And yes, I did wear a harness. Fall off a boat with Auto at the helm and the boat will simply sail away.)

I also recall my English roadster — a Morgan — another wonderful memory maker. My Morgan didn't just take me places, it took me to new places. Unheard of places. Places in need of discovery. And it didn't just take me there but it also reveled in revealing the people living in those hidden places. My Morgan spent its first years of our life together traveling the American South: Kentucky, Tennessee, Georgia, Alabama, Mississippi were among its favourite destinations.

I vividly recall one of my best Morgan adventures: Corinth, Mississippi. Need I say more? Back then the bars in the Deep South were among the greatest dive bars in the world. Cheap beer, even cheaper burgers, great music — the musicians were often back up players from Nashville earning a little extra cash — and did I say buckets of cheap beer?

I wore my hair long back then and when I entered the bar in Corinth I had just about the longest hair in the place. If it had been possible for the place to go quiet, my entrance would have done it. But it wasn't possible and it didn't. The rock and roll alternated with country and western and both pounded not just one's ear drums but one's whole body. Good time rock and roll pounded down the local's resistance to the long haired foreigner trespassing on their turf. I spent the night drinking and dancing and measuring my hair length against all comers. I bested a lot of women whose tightly bouffanted locks were teased high and tight on top of their heads. There wasn't a man who could compete with me, nor would have wanted to. When the bar closed the party didn't stop; It moved.

Away from the prying eyes at the bar, the women let their hair down, so to speak, and the who-has-the-longest hair contest began anew.

According to the New York Times, Roy F. Baumeister, a professor of social psychology at Florida State University, wrote a paper Bad Is Stronger Than Good after conducting research showing this is a basic and wide-ranging principle. Bad emotional experiences supposedly have more impact than good ones. They are quicker to form and harder to forget than good experiences. It is simply human nature, he claimed.

Not for me. I have to admit that I spent a lifetime rehashing bad times but no more. Time is short and getting shorter. I have discovered that not only do I no longer dwell on the bad stuff, I can hardly remember the worst stuff. It is all fading as well it should. Remembering the past so that history does not repeat itself has its place when one is younger, I guess, but now, in my senior years, there is little danger of repeating those painful missteps.

People make up the biggest chunk of my good memories. My friends from my childhood, my chums from my youth, my school buds. I have good memories of employers and neighbours and even passing acquaintances. As Maude positively tells Harold when talking about people: "They're my species."

I've know a lot of wonderful people. Some are famous and can easily be found by searching the Net — like the super-achieving Denny Wilcher who gained fame as a conscientious objector during the Second World War. I met Wilcher when he and his wife Ida were  living in Berkeley, California, along with their two youngest daughters. Another somewhat well known person from my past was photographer Andy Whipple who recently passed away. He had just completed a fine art book documenting the Columbia River. Another remarkable person I am proud to know is the Canadian author Joan Barfoot, author of numerous best-selling novels. (I first met Joan Barfoot when she was still an editor for The London Free Press.)

And then there are the wonderful people I have had the luck of knowing but who seem to have passed under the Internet radar. Think of John Hoffman, one of the founders of Big V pharmacies in Ontario. Today both Mr. Hoffman and Big V are gone. There is little to be found about Mr. Hoffman despite the role he played in creating one of the biggest, most successful drugstore chains in Ontario history.

For years, I ran a seminar for photojournalists. In my role as chair of the seminar I met people like Pulitzer Prize-winning photojournalist, Eddie Adams, who, in his role as a combat photographer in Vietnam, produced many powerful images of the war. The first evening of the annual seminar I sponsored a speakers' dinner. Sitting next to, and across from, some of the greatest news shooters in the world was an honour and a delight.

I believe my senior years are a time for both enjoying the present and savouring the past. At this late stage in my life, dwelling on the bad is of no value. It is time, as my granddaughter says, to "just let it go." In keeping with this suggestion, I'm going to go open a beer and think good if somewhat alcohol-blurred thoughts.

Cheers!

It's art!

About a month ago Mike Moffatt, an assistant professor at Ivey business school at Western University, in London, Ontario, discovered an apparently coded note tucked into a book in the university library. Curious as to the meaning, Moffatt offered a hundred dollars to anyone who could solve the riddle.

Today the riddle has been solved. The note found by Moffatt is art. Jordan Himelfarb, a member of the Toronto Star editorial board, followed the clues. They led him to the Western University fine art department and Kelly Jazvac.

Himelfarb traveled from Toronto to London to meet Jazvac at a London coffee shop:

She explained that the Weldon code was an art project that came out of a second-year sculpture and installation class she taught in 2012. The artist, then an undergraduate student, placed 121 letters in the Weldon stacks and moved on with her or his (but probably her) life. Jazvac told me the artist was shocked by the project’s recent fame and wished to remain anonymous lest she be treated unkindly in the media.

The reporter discovered the symbols correspond to capital and lower case letters but the order is random, making the code impossible to crack. For the full story read Himelfarb's interesting story in The Star: I cracked the code at the Western University library.

I'm not surprised at the outcome. Using the Internet and social media I contacted visual artists, writers and poets around the globe. Most of those contacted replied to my inquiry. The majority felt the apparently coded works were art. Some suggested that I google "asemic writing." The local paper, The London Free Press, was onto this art lead but failed to pursue this thread to its logical end.

A Free Press story reported Peter Schwenger of Western had contacted the paper. "I’m pretty sure that these are examples of asemic writing ­— that is, art that looks like writing but is not intended to communicate a meaning, only to represent the feel of writing," he told the paper in an e-mail.

A number of the artists I contacted said the works found in the Western library reminded them of the lettrist movement from the '50s. To my surprise, one artist attacked the concept of asemic writing. The works were lettrist as there is no such thing as asemic writing. "It's a philosophic misnomer," I was told.

As a retired newspaper photographer, an old geezer whose free time is being consumed by trips to the hospital as doctors investigate a genetic-based heart condition, I decided that a trip to the fine art department at Western was the next logical step but I simply didn't have the time. The Toronto Star writer did and I doff my hat to his stick-to-intuitiveness.

The big riddle left unanswered is why did it take a Toronto reporter to track down the answer at Western? The Toronto Star broke the story Saturday. The London Free Press reported the riddle was solved Sunday.

There are a number of online newspapers that essentially ripoff the mainstream media for stories, rewrite them and publish them online as their own. I find this practice disgusting but it is not unique to these online journalistic vultures. The MSM has done this for years, ripping off competing media outlets. It appears that Sunday the online version of The Free Press ripped off the Saturday Star and without so much as a credit in passing.

And here is one last riddle: Why are newspapers failing in this electronic age? Hint: There are clues in the media handling of the strange notes found in the Western library.

OER & Language Learning: Internet Specific Tools

I've mentioned this before but today I got an e-mail that brought the idea of open educational resources back into my mind. If such an online approach was well done, I can envision certain students completing a course online without ever attending a class. Later they could take an exam to prove their competency, earn a credit towards a degree and move on.

I knew a girl who entered high school fluent in at least four languages. Forcing her to take years of high school French was insane. She should have been offered the chance to write all the appropriate exams and put the entire French curriculum behind her. Heck, she spoke French better than some of her teachers. They asked her questions because she not only knew Parisienne French, she new Quebecois. She had lived in France and now that she lived in Canada she was spending her summers in Montreal.

A few years ago, I took a French language course from Western University in London. It was not a good experience. There were too many students and not enough instruction. It was an unfocused course that ran for a number of weeks and then just ended. There was no homework during the course and no exam at the end. The university took my money but gave me little in return. It was a no credit class and with good reason.

That course left me thinking: There must a better way to teach French to English-speaking Canadians. My curiosity led me to The Center for Open Educational Resources & Language Learning (COERLL) at The University of Texas. COERLL is one of 15 National Foreign Language Resource Centers funded by the US Department of Education.

COERLL creates educational materials designed for dissemination over the Internet. Called open educational resources (OERs), the online language tools (courses, reference grammars, assessment tools, etc.) are of great interest to me.

The material is free for anyone to use but may require permission to re-mix, improve, and redistribute. COERLL aims to promote a culture of collaboration. In addition, COERLL stated aims are to reframe foreign language education in terms of bilingualism and/or multilingualism.

I wish the university in London would host something similar. If offered in conjunction with a course such as the one that I took, possibly more could be accomplished. And, at the end of the course there could be an exam. Pass the exam and earn a credit from the university.

If you'd like to see what I am talking about, click the Le Vin de Vouvray link. This will take you to one of the COERLL French exercises posted by the University of Texas. I took the liberty of creating a vocabulary quiz in Quizlet using the vocabulary supplied with the Le Vin de Vouvray post.

I'm going to share a link to this post with one of the teachers at the French public school my granddaughter  attends. I'm seeking feedback on this open educational resource concept. I'm trying to decide whether I should proceed further in my attempt at interesting educators in London to offer something similar.

Are anticoagulants underused in Ontario?

In writing the following post, I came upon the paper How Can We Avoid a Stroke Crisis in Europe? If you do nothing more, read this paper. You found my blog because you were searching for information on anticoagulants, heart rhythm problems and risk of stroke. Read the linked paper. You may find it answers many of your questions.

When done, if you want to know more, read the rest of my post. There are also more links of interest.

Cheers,
Rockinon -- a patient with ongoing heart problems
___________________________________________________________________________

Are anticoagulants underused in Ontario? This is the question I asked myself upon learning that a friend in constant heart flutter was not taking an anticoagulant to lessen his chances of suffering a debilitating stroke.

I found an article in The American Journal of Medicine looking at this very question. I learned there are clear guidelines for managing atrial fibrillation and atrial flutter with recommendations for anticoagulation based on a patient's overall stroke risk. I also learned that the guidelines are not always being followed.

In a study of more than 170,000 patients in the States, less than 50% of high-risk patients were given anticoagulant therapy. The study concluded that the anticoagulation guidelines are not being routinely followed in clinical practice. The study did not conclude this was resulting in harm to untreated patients but decided another study, one looking at treatment outcomes, was warranted.

I can understand doctors being hesitant to immediately give anticoagulants to all patients with high CHADS₂ scores. Although I am now taking an anticoagulant daily, it was a tough call for my doctors.

I have microbleeding in the brain, discovered during an MRI scan. For a very good discussion of the significance of cerebral microbleeds read the article Cerebral microbleeds: a new dilemma in stroke medicine posted in the Journal of the Royal Society of Medicine. In my case, as in all cases, doctors must weight the risks vs. the benefits of various treatments. All too often the answer is a trade-off.

Clearly, a slightly elevated CHADS₂ score is not always enough to convince doctors anticoagulants are the best response. They see the risk/benefit ratio as not favouring the immediate use of a blood thinner (an inaccurate name for anticoagulants.) I don't envy doctors. They find themselves forced to choose between a rock and a hard place every day.

So, should more Ontario patients be on anticoagulants to protect them against stroke? It is hard to say for certain but the answer may well be yes. The Canadian doctors, like their American counterparts, may be too conservative, too timid. In steering their patients down a path that avoids the complications resulting from the use of blood thinners, their patients may be on the road to a stroke.

If you have a heart arrhythmia and are not on a blood thinner, you should ask your doctor why not. There may be good reasons for not giving you anticoagulant therapy but you should know what they are. To get a handle on your risk of a stroke, here is a link to a CHA₂DS₂-VASc Score calculator.

To better understand your risk of bleeding, here is a link to a HAS-BLED calculator. Taken together these two calculators point to the difficult decisions forced upon your doctor.

Lastly, not all abnormal heart rhythms are created equal. All arrhythmias do not result in equal risk of stroke. And atrial flutter, when occurring alone, does not carry the same increased risk of stroke as atrial fibrillation. That said, atrial flutter is often accompanied by periods of atrial fibrillation.

So, should my friend be taking an anticoagulant to lessen his risk of stroke? Maybe. He was on a blood thinner but stopped taking his medication on his own. Possibly his doctor senses his patient's fears and this tips the scales against recommending anticoagulants in the doctor's mind.

But atrial flutter is not benign. It is associated with an increase in overall mortality. According to a  posting on Patient.co.uk, persistent atrial flutter when left untreated can become chronic atrial fibrillation (AF). Even after treatment, I had my atrial flutter eradicated by undergoing an ablation procedure, I continue to take the powerful arrhythmia fighting drug sotalol to help insure my flutter does not return. I also continue to take Pradaxa, a blood thinner, twice a day.

Lastly, I wonder if the perceived dramatic increase in cost of anticoagulant therapy in recent years has influenced doctors, especially in the States. The old drug of choice, coumadin, is relatively inexpensive and safe. Unfortunately, it is also a fair amount of trouble. Regular blood work is necessary to insure the dosage is effective. The bothersome constant need for monitoring is one reason many patients quietly stop taking coumadin without consulting their doctors.

Newer drugs, like Pradaxa (dabigatran), cost more but do not require the expensive regular blood work. Some studies, such as one in Denmark, have found treatment with dabigatran only costs about 10% more than coumadin, with the increased cost of the medication the main driver of the added Pradaxa expense. I take Pradaxa to protect me against stroke while minimizing my chances of suffering a cranial bleed.

Minimizing the occurrence of strokes is a win-win situation. Both patients and society benefit from anticoagulant therapy in high-risk AF populations. A French study found the mean cost of a severe stroke was €34,809, and the risk of a severe stroke is what accompanies AF. The mean cost of a mild stroke in the study was €10,530. Clearly, dabigatran saves society money by preventing severe strokes in AF patients.

So, why do doctors shy away from prescribing blood thinners when the cost is not exorbitant and the benefits appear to be clear? One study pointed to a misplaced fear of bleeding, especially cranial bleeding. The fear of bleeding seems to trump the fear of stroke among medical professionals.

And so, in seeking treatment for heart rhythm problems there is one risk that is often overlooked: The risk that one's doctor has a personal aversion, an unsubstantiated fear, of the side-effects of the what should be one of the drugs of choice -- an anticoagulant.