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iTunes sent notice I’ve been blocked from further attempts to log in as I have exhausted the number of allotted password attempts. In its flaunting of power Apple tells me it will send me some sort of ‘next step’ – in a few days. Meanwhile I stand out in the snow like Henry IV waiting for Gregory’s pardon. Oh the embarrassment.

Long time ago I took the advice of some great expert who said not to have a simple or ubiquitous password for on-line activities. I see his point. While “Urspo1234” was a memorable passe-partout, it got a ’10 for looks and a ‘0’ for security.  I went to using different passwords (each more complicated than the other) for every on-line activity. Now I can’t remember which one goes with Facebook vs. Create a Cookbook vs. Merrill Lynch etc. Some of these pass codes change regularly, which further complicates the matter. I suppose I should write all of them down on a piece of paper but I fear I will lose that too and be in desperate straits.*

Speaking of passwords I recently sent a terse email to my bosses remonstrating if they don’t do something about the office passcode I will do so myself. Cassandra-like I’ve lamented for years the clinic’s password is the worst:

  1. it is the same code unaltered for years.
  2. everyone uses the same code.
  3. It consists of a simple word; one could crack it quick as a quarter-note.

I hope the latest malware matter coming out of Europe is enough to get them to see sense. So far there is no response. Oh the pain.

Meanwhile I am at the mercy of Apple and its moods to give me a temporary code so I can establish a new one. According to ‘How safe is my password?’ my modest proposal of  Applscks&fu2  is good for 30,000 years and it is quite memorable.

 

* I’ve heard tell you can put all register all your passcodes at one website that works as  an on-line safety deposit box. What happens though when that gets hacked or (in an ironical moment) I can’t remember the password to enter it?

Spo-fans know Urs Truly is working on a cookbook. The tome is not exquisite nor original but pragmatic. It is to be a collection of my favorite recipes, which are presently scattered throughout a my cookbook collection. Some examples: Mother’s gingerbread is located in her church’s women’s cookbook. When Someone makes a pot pie, that recipe is in a  Betty Crocker cookbook. James Beard American cooking Cookbook has my recipe for Jam cake. You get the gist.  It would be nice to have them all in one book for easy reference.

Every year since I was a little boy Mother’s side gathers on the same summer weekend for a family reunion. Everyone brings food of course, and someone always makes a layer salad. This same dish, timeless and unaltered, has graced the buffet table for over 50 years. I want that recipe in my book, although I have never made it myself. “To the research” as my colleague says.

I soon became overwhelmed by the myriad of variations of this recipe. There are 5, 7, and even 9 layer versions. Throw in the recipes titled ‘Layered salad’ and there are enough to make one every night for years without a repeat. Oh the pain. Which one was is closest to the one in my memory? I’ve had it many times but never stopped to consider the ingredients.  Stinko.

Then I came to my senses. Nearly all my Facebook ‘friends’ are relations, so I posted the question which relation on Mother’s side makes this or who has the recipe.[1] It finally got around my mother’s cousin’s wife, Aunt Gail who is the maker of the dish. [2] She sent me the recipe, which I duplicated without editing :

Layered Salad:

1 head chopped lettuce 

3-4 stalks of celery finely chopped

2-3 carrots finely chopped

1 can drained sliced water chestnuts
1 small onion finely chopped
1 small bag frozen peas
(layer these items in pan, then spread top with mixture)
2 cups mayo
2 Tbs. sugar
(cover and let set in refrig. overnight…then add)
3-4 large tomatoes sliced thin
4-5 boiled eggs sliced thin
1 jar bacon bits
shake on Parmesan Cheese

This lovely dish captures the urtext of Midwestern cuisine. I plan to make it as soon as I am off my diet and I plan to eat it all myself. [3]

Meanwhile, other female relations on both side of my family tree sent me their versions of this mercurial entree.  Cousin/Aunt Joy sent me this one:

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What I adore most about this is the nostalgia of the typewrite on an index card, which is stained no doubt from use. I particularly find charming it the dropped letters.  The typist got to the end, made a typewriter boo-boo, and decided it was good enough and not worth typing the card over again.  The typist (probably her mother, my father’s cousin) had to compact the directions for the sake of space, hoping one would intuit the directions. I plan on making this one too; I am curious to see which better floats my boat, as it were. I suspect both will be enjoyable. [4] After all, there is nothing as comforting as food with family history as its main ingredient. It may not be haute cuisine but it made with love. [5]

Spo fans who have fabulous layer salads (7 or otherwise) are invited to share their recipe in the comment section.  I would be blithe to have them. 

 

layered salad

 

[1] A clever-dick Spo-fan from Canada, noticed for his good looks and wit, left the comment in his house 7-layer salad is called lasagna.

[2] I knew this but I had forgotten. Mother keeps in touch with all her cousins of which she has plenty. I used to know them all but now I get them confused. Just hate that.

[3] I will have to eat it all myself for Someone is highly adverse to mayonnaise and I don’t think using sour cream or yogurt will do the dish justice.

[4] I am already conjuring up my own Urspo-layer salad, using the best bits of each and with possible add-ons and higher quality ingredients – no rubbish.

[5] And maybe made with a slightly altered version that has a secret ingredient one keeps to oneself so the others can never make  it quite as good as you. 🙂

I got a request from a Spo-fan (who is well over four feet) to write about bipolar depression. Here are some basics.

Clinical depression comes in various types. “Unipolar” depression is the mood condition in which people go between states of depression and feeling OK/normal (rather than feeling happy). “Bipolar depression” as the name suggests means sometimes the moods go up and beyond ‘OK” into what is sometimes referred to as mania. In a manic mood state the person often feels euphoric with high energy; they sometimes feel they can do anything. They often do reckless activities such as driving too fast, spending money, or sexually act out – all in ways they would not do in a calmer mood. In a bipolar depression there is often irritable and labile mood swings, talking too loud a/or too fast, and little or no sleep.

The old term for bipolar depression is manic-depression. Either term is used by patients but clinicians tend to use the former.

Discriminating unipolar from bipolar depression is quite challenging, for the mood conditions fall on a spectrum rather than in clear either/or categories. I spend a lot of my job trying to figure out a patient’s depression type. Sometimes it takes years before someone is properly diagnosed with a bipolar depression, having had first a long time of being diagnosed and treated as unipolar. It makes a crucial difference to get the right diagnosis, for the treatments  are different. If I give a person with bipolar depression the wrong type of medicine, the prescription could actually make them worse or manic.

Alas, people don’t fall cleanly into clean either/or categories; bipolar depression is seldom clear cut. When I was trained only thems with ‘classic’ manic periods – followed by depressive states – were diagnosed ‘bipolar’. Now we know the majority of bipolar patients do not fit into this classic definition.

Sometimes a patient tells me once upon at time they took an antidepressant and it made them worse. This is a sign for me to sit up and consider the possibility of a bipolar type depression.

Lithium used to be the one and only Rx for bipolar depression. There are many others now, although lithium remains the ‘gold standard’. It’s a tough medication to take, and thems with ‘atypical’ or ‘mixed states’  or ‘rapid cycling’ types of bipolar depression don’t respond to lithium as well as ‘garden-variety manic depression” viz. clear and clean manic episodes.

It used to be people with bipolar depression were missed and underdosed. Now the pendulum has swung the other way and too many moody/irritable unipolar depressed folks are being diagnosed with bipolar type depression. Ironically, thems with true bipolar depression are still not being identified and treated.

There are no good physical exam findings or brain scans or blood work tests to make the diagnosis easy (at least not yet). There are some relatively good screening tests a doctor can do to help screen for such. In the end it is the history and timeline – and an expert like Urs Truly (hohoho) – to make the diagnosis. Even then I have to be mindful do I have the proper diagnosis or not.

I recently made a couple of shirts with giraffes for a couple of Spo-fans who adore them so.  Giraffes do not personally float my boat but I see the attraction. Any zoo or wildlife fund knows what gets people to open their wallets like nothing else is a charismatic megafauna A.K.A a cute animal. People go gaga over these critters with their big eyes and furry pelts. One just wants to hug them to bits.  If a nasty-looking reptile or insect is in danger of extinction no one cares, but if a panda-bear is in jeopardy than that’s a different story.  Urs Truly is no exception. I too have my favorites:

 

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Aardvark 

They are odd-looking creatures with an odd-sounding name. Merely saying the word makes me smile.  What’s not to love?

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Walrus

Fascinating!  Large blubbery sea-slugs with tusks of seemingly no use or sense. Someone was having a good time putting this one together.  They are almost as good as a Baku. You walrus hurt the one you love.

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Macaque

The dears! They seem to spend their entire lives sitting in hot tubs lost in a dwam and not bothered to do anything. They have a pained Jack Benny look to them as if  they have a deep thought or a sick headache.

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Kinkajou

It’s the eyes, and the sense they want to cuddle you to bits. Please don’t feed them buns and things.

 

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Bear

They are my favorite charismatic megafauna.

manpool  Aaron the pool man is a genius. The cement pond has gone from a semi-swamp to limpid blue. It is clean, cool, and refreshing, like my men. What a joy to come home after a hot day, strip of one’s trousers etc. and dive right in. I am actually enjoying the pool rather than seeing it as a problem. The pool light went out due to seepage. Aaron P. says he will have us a new light by week’s end. The new one will have chatoyant disco colors for swimming in red, purple, or green brilliance – guaranteed to keep away the evil things that lurk below in the dark wanting to drag me down as I can’t see them.

donald_trump_clown_anti_trump_2016_postcard-r85028c006e144aed9ba4d45d5d9f5c40_vgbaq_8byvr_324I am not one to write about politics but it’s quite painful watching the naufragous news coming out of the White House. I wonder if the GOP politicians will connect the dots if they continue to support such shenanigans spewing out you-know-who their political futures will go down the swanny.  Oh the pain.

This evening I ate dinner at a Mexican restaurant. I was pleased to read the menu and realize I understood most of it. My lessons must be working.  I recently found a Spanish lessons podcast quite fascinating. For one thing they teach Spanish as spoken in Spain. Words likes “thank you” are pronounced not like ‘grass-see-us’ but as ‘grathhhh-e-ess”. It makes me wonder if everyone in Madrid has a lisp. I tried some of these diphthongs and rolling Rs at work with thems who speak Spanish who learned their versions in Mexico and Cuba. They looked at me like I had had a stroke.  The two teachers, a man and a woman, are from Scotland. Their Scottish accents are sometimes harder for me to understand than their Spanish (which they speak well). If I keep this up I will be fluent in a Highlands-style Spanish no one will understand.

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The Board of Directors Here at Spo-Reflections sent me a deputation of the sort that causes people to lock the doors, hide the liquor, and pretend they aren’t at home. The accomplice email was full of the worst sounding language, excoriating me on yesterday’s entry. In their unanimous opinion Pablo Escobar nee The Clicking Device was the most boring entry they’ve read since the time I wrote about the dust bunnies under the bed. They extoled me not to fill the blog with rubbish about house and office objects (curious or otherwise) and to ‘put out’ as it were with something zany, exciting, and captivating – or else.

There is nothing like the threat of bodily harm to inspire writing.

Yesterday a scorpion was found in the knife drawer. Rather than crushing it under a 16 ton weight (the usual remedy for bugs among the utensils) I decided to use a blow torch hoping for 100% efficacy and cleansing by fire. The smoke and fire drove out a few more scorpions who were upset at the fuss, which agitated the Cup Fairies and Car Key Gnomes from their slumbers. They started a lamentation to rival an orchestra of scorched cats. Harper came into the kitchen thinking there must be something to eat in all this ruckus. Alas, the doggie-treats were incinerated along with several of the Cup Fairies. She added furtive howls to the disconsolate chorus  – and who do you suppose shows up next? Henrik the Ghost! I haven’t heard from him in ages; I thought he had skidooed.  He just stood there, lugubrious, looking at toaster, the mix-master, and the tea kettle as if he had never seen these things before, although this was hard to belief. He said something to the vociferous imps I didn’t catch (for it was quite noisy).  Whatever he said it was doing no good for hound and hobgoblins both became more agitated. I put Harper in the back yard and wondered if I should save the sewing machine.

I don’t know who called the fire department but by the time they showed up the ghost and fairies had all dissipated and I was left alone standing in a ruined kitchen with a barking dog and a pile of torched scorpions. The fine fellows asked a few questions to see if I was deranged. After concluding I wasn’t they gave me a stern lecture about using RAID next time.  One of the firemen (who was well over four feet) gave Harper a doggie-snack and she immediately calmed down. Mercifully there was no shooting.

I had the whole mess cleaned up before Someone came home for supper. I purposely burned the Blue Apron dinner, hoping to cover up the redolence of smoke and charred kitchen appliances. Happily this worked. All the same, our gourmet dinner was ruined so we went out that night to Pei Wei. I got extra vegetables on my Pad Thai to promote healthy digestion.

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This fine little object is my work buddy. I’m certain it has a precise if not too imaginative name, but I call it ‘The Clicking Device”.

In the bad old days (last month) if I were to write a prescription of a ‘controlled substance” nature, I had to either print it out on special paper or fax it to pharmacy, for I could not send it over the internet. All day long The Wonder Receptionist would print things for me to sign. Afterwards she would call the patients to come in to the office and pick them up. Even the most stable of patients had to trek in once a month to pick up prescriptions. A drag for all. Now that I have the software. I get to send such substance- scripts over the ether.

As they say in Monty Python “And there was much rejoicing”.

The Clicking Device is the grand finale in a procedure with more passwords than a Dan Brown novel. After I finish writing the prescription and entering the codes and passwords I press The Clicking Device. It magically reveals a randomly generated six-digit number which I enter and Bob’s your uncle! off it goes to CVS or Walgreens etc.

Someone assures me such random code generating devices are quite common when he was in banking. If some nasty hacker got into my medical system he could not finalize the prescription without the latest number.

I am mildly amused to see what number comes up when TCD is pressed. There are six numerals, 0-9, so any specific number has a one in a million chance of showing up. An as exercise in mathematics I plan to figure out the odds of getting a number with some meaning. These include: numbers with all with one digit (say all 7s) or today’s date or my birthday or a sequence such as 456789 – that sort of number.  I also fancy figuring out how long it will take to see one of these numbers pops up.

With practice I now can pull up a patient’s chart, renew the Rx, and send it out in less than thirty seconds. However, I need to be careful because if I bungle the electronic health record has apoplexy; it does not like mistakes. It shuts down and I have to wait The Clicking Device generates a new number, which feels a very long time indeed when you are trying to renew a dozen scripts before the next patient shows up.

It all reminds me of the cartoon with the caption “Give Alice some pencils and she will stay happy for ours”.

 

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This one was written in piecemeal as I sit through a weekend conference. It was mostly written during the talk on pediatric movement disorders.

I am glad to be in a medical specialty that is ever-learning and ever-changing. It is a bit humbling to learn much I believed tried and true is no longer so. It’s the Firesign Theatre slogan: “Everything You Know is Wrong”. It stings a bit, but it feels good to learn and grow, which is a sure sign of being alive.

I work in isolation so I don’t know any local colleagues. One of my goals of this conference was to meet and hob-nob with my fellow wizards. I’ve faced my social anxiety fears and attended the Friday night mixer, made. I purposely wore one my more loud and colorful Spo-shirts. This forbade me to stand in the corner unobserved. People approached me to ask about it. This gave me a sort-of springboard into dialogue. I met a handful of shrinks; I feel a sense of accomplishment. I emade a few business contacts. The President of the Arizona Psychiatric Association invited me to ‘get involved”.  Good for me!

Speaking of colleagues I am struck how diverse is my speciality. Surgery, for example, tends to be all white males (and pompous ones at that). Shrinks are male, female, old/young, and seem to come from all ethnic backgrounds. I like that.

Do I sound like a wicked old screw to write the psychiatric residents are beautiful? The young male doctors attending the lectures are all drop-dead gorgeous. Many of these lads have whiskers, all worthy of a Fearsome Beard post. I guess one of the admission criteria to residency nowadays is being woofy and handsome. I am grateful I was ‘grandfathered in” both literally and figuratively.

During the lecture breaks there is coffee and tea (albeit rubbish) and buns and things and pharmaceutical representatives. Many of them I recognize from Wednesday luncheons at work. As a group they change products and companies like participants in a fast-paced square-dance.

My liability insurance company also has a representative present. She is well over four feet. She told me she is pleased I am not afraid to call them with worries when my colleagues fear to do so lest they be labeled as a ‘problem doctor’. She gave me some notepads (the pharm reps no longer do so). On each sheet is a ‘tip’ how not to be sued. The top page suggests  I keep my prescription pad under lock and key so it isn’t pinched by the patients.  I will try to tell as many people as I can in town.

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Sean Breen (the dear!) is crackers for giraffes. He requested a Spo-shirt ‘with lots of giraffes” so here it is and just in time for his birthday. The shirt went relatively quick. Normally I make a shirt in bits and pieces in a stop-and-go time span, but this on was created in one weekend. Sean sent an email today to say the garment arrived safe and sound and he is pleased as punch with it. Another successful endeavor.

He’s now in debt to buy me a beer or bear my first child or something.

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It seems only yesterday I made a similar shirt for Ron (another dear!).  I don’t understand this mania for giraffes but hey whatever floats your boat.

Spo-fans can vote on which shirt best captures the ur-text of giraffe-ness.

I draw the line at aardvarks.

My stomach hurts and I am too tired to think of anything interesting.   Until I can think up something, here are some fantastic fantasticals who lurk around the Spo-house.

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Baku   The Baku was created by the gods after all the other animals were made, using the leftover parts. His diet consists of bad dreams. In Japan if a child has a nightmare they are told to call on The Baku to come take away their bad dream. The Baku is often put aside a sleeping child sort of like a teddy bear or night light. Mine does pretty good for I seldom have bad dreams, which are usually about being attacked by fantastic beasts.

Location:  Bedroom dresser

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Earl Imp  This michevious sprite likes to plop himself down in cups of hot water when your back is turned. His trousers are full of tea leaves which turns the water brown as he relaxes. It’s a bit unappetizing to consider but he does make a splendid cuppa.

Location: Among the tea things.

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The Mind Hag  She suddenly appears whenever I am facing a frustrating matter or a vexing problem like trying to find the corner in a round room or where on earth did I place my glasses which I can’t find as I can’t see to find them.

Location:  Urspo’s brain

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Henrik The Ghost  I don’t have a good photo of him for he is a ghost after all. Understudy for Henrik The Ghost is Henrik Ibsen The Playwright, who wrote a splendid play called “Ghosts” so you can imagine.

Location: The east side of the house / on the library shelf, respectively.

goblin

The Cup Fairy  He is forever moving my mugs about and placing half-consumed containers throughout the house.  Nothing gives him pleasure more, unless you count shifting about the car keys.

Location: oh lordy he and his cohorts are everywhere.

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Urs Truly  Technically he is not a fantastic beast but a psychiatrist (Board Certified). He’s a nice fellow really; please don’t feed him buns and things.

Location: Dunno. He doesn’t sit still long in the same spot.

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