Category Archives: medical thoughts


I first ran across the word gestalt in my early 20’s reading an Ayn Rand book.  I may have tripped over the term a couple of times since, not sure.  The last time of note though was from the surgeon who performed my delicate ‘foot in mouth’ transplant (actually leg in mouth).

Pain can be a welcome feeling.  It tells us when, and where, corrective action needs to happen.  During the time I submitted to a couple of surgical operations, each involving trach holes and feeding tubes, it was important that I was able to describe the pain.  The surgeon told me that I was unique among his patients in that I distinguish pain with gestalt.  When I asked him what he meant, he said, that unlike most patients, I could explain in detail, the pain composition of an area of discomfort.  Maybe that was his way of telling me I was making a mountain out of molehills. Continue reading

Why Buddhism is True — a review

Disclaimer:  I am not a Buddhist.  And by admission, neither is the author.

The main title, Why Buddhism is True, is a bit misleading.  Throughout most of the book, the author threads interesting, up-to-date, and digestible logic as to the (potentially huge) benefits of practicing mindful meditation.  As a beginning meditator, Wright’s reasoning was compelling enough to have me hooked from the start.

If only we could all start young with this practice.

But you don’t need to be attracted to meditation to be captivated by the book.  In fairness, Wright does provide an abundance of thought-provoking (no pun) data not only from science, but also from modern psychology which seems to coincide with basic Buddhists concepts of not-self/emptiness, liberation from delusion (how we see ourselves is largely an illusion), and our thinking mind’s “default mode network.”

If anyone is, (shouldn’t we all be), interested in understanding the mechanics behind how feelings shape thoughts, behaviors, and perceptions, and how, through practice, we can become aware of “things in our environment that affect those feelings,” than the book is well worth the investment.  Some feelings, he says “are good guiding lights,” while others can “push us around.”  He provides first-hand examples of how we might successfully manipulate the feelings that may not be benefiting us.

Even Newark’s airport has a meditation room.

Wright speckles the book with his own experiences, mainly with dry, relatable, yet subtlely perky humor.  I found myself laughing out loud several times throughout the book.

The value of meditation, he says, is its use as a fundamental tool, one that enables us to see the stories we build and how we can more clearly separate illusion from truth.  In other words, he says, mindfulness meditation helps us change our perception of the world, even with potentially simple annoyances like crabgrass, the buzzsaw of construction noise, or the impulse to respond to a pricky email.  He also describes the benefit of continued meditation as an evolving capacity of “seeing things with higher resolution.”

The key, he says, through daily practices of mindful meditation, is becoming more aware of “what causes what,” (causality).  But, he explains, the fruits of meditation is more than just awareness.  It’s active learning how to change negative into positive.

The crux of the book and Wright’s principal argument for our feelings, he outlines, is the  “conditioning” of natural selection, which is built into our core from millions of years of evolution.  But many “natural tendencies” which served our species well over time may also be working against us (in our relatively recent, densely populated global community).  He describes, through meditation, how we can “subvert the programming of (the undesirable aspects of) natural selection,” to achieve a measurable, positive impact in our lives and of those around us.  In effect, he is saying that Darwin confirmed the truth behind Buddhism.

After listening to his book (twice) it’s hard not to believe him.

Sweet Thais

In more ways than one.

As a generalization, the Thai people are more outwardly sweet than most cultures.  It’s evident in the way they greet others, including their own, by folding their hands while slightly bowing their heads.  They are typically smiling, pleasant, and respectful.  Compared to other societies, the sweetness of the Thai people stands out.  The Land of Smiles, while it may be an outward appearance, is one of the many charms of Thailand.

One of the other attractions is the distinctiveness of their food.  But, and it’s a big but, over the past couple of generations, Thai’s have embraced the use of sugar in most of their meals.  Almost every prepared dish has sugar as an added ingredient.  Even sautéed vegetables are sugared.  Most savory dishes have added sugar.  It’s a phenomenon.

These buckets of sugars (and msg) are at the ready for all Thai street food.

When I see young school-age Thai folk, it’s evident that a large chunk does not appear in ideal physical condition.  A bulk of them look out of shape, with more extra weight in the wrong places than young people should have, especially youthful Asians.  If I didn’t know better, I’d predict that Thailand is headed for a health crisis in the next few generations.

Out of interest, I took several Thai cooking courses at different Bangkok schools.  In each, the students prepare and eat their individual dishes.  In each, I declared that I  wanted to cook without sugar.  I was the oddball out in every workshop.  In one class, six students were grouped together to prepare a dish, but I was castigated on my own due to my sugarless request.  The chef in that school tasted the sugar-free chili paste, peanut sauce, and Tom Yam soup I had prepared and liked them all.  Of course, she could have been fibbing to be polite.  But then again she admitted she had eliminated sugar from her diet the prior year to slim down.  An instructor in another school disclosed that her sister, a doctor, recommended that she stop cooking with sugar because it was unhealthy.  (Hmm,…yet she continues to instruct cooking with sugar).

Pad Thai Noodles, may be prepared with a double dose of sweetness.

When I ask Thai chefs/cooks why they add sugar to most dishes, the answer almost uniformly is “it makes the food tastes better.”  Really?  Adding sweetness to already flavorful food so it tastes even better?  Couldn’t that be considered a form of crafty trickery?

As a fan of Thai food, it’s more than a little disconcerting to know that sugar is being added to most dishes.   To be clear, I’m not referring to desserts and sweet treats, of which, as in most cultures these days, there are plenty.  In Thai dishes, sugar is added to main meal dishes, those that typically don’t have, or need, added sugar.  Popular dishes such as Pad Thai and green papaya salad, (Som Tum) — both have added sugar.  Peanut sauce used for sauteés — added sugar.   Stir-fried vegetables — added sugar.  Savory soups — added sugar.

Stir-fried vegetables with sugar. Really?

The Thai food on the street is damn tasty.  But to order a dish with no sugar is a challenge.  When I do, the smile is replaced by forehead wrinkles.  If sugar is left out, the tendency is to add more msg, Maggie seasoning, and/or honey.  It’s become reflexive to add processed flavoring to the food.  There are so many natural spices available that adding a tablespoon or two of sugar and msg seems like overkill.  And indeed it might be.

Smart people who study cognitive neuroscience know that sugar is a deceptive drug and acts on the brain the same way that cocaine, opioids, and for that matter, any other pleasure substance does.  The more we have, the more we want, and the more it takes to satisfy us.  Credible researchers have shown that the world’s consumption of sugar has grown almost exponentially over the last few hundred years.  Concerning evolution, that means we’ve just started gorging (overdosing?) on sweetness.  During that same time, we’ve seen a parallel increase in lifestyle diseases, as well as epigenetic disorders (which we now know are hereditary).

In a savory dish, it can be hard to detect the addition of a teaspoon of white sugar.  Sure the dish tastes good.  Everyone in the world loves a subtle touch of sweetness.  We gobble down good tasting food without a second thought.  But if we are to believe an extensive body of recent evidence showing that processed sugar in our diet promotes toxicity and has detrimental long-term health effects, then it may be prudent to pay attention.  All foods have natural trace amounts of sugars.  So if food can’t stand on its own without the added sweetness, then the results may eventually turn slightly sour.

In the ideal world, we’d see a revolution in Thailand with the elimination of sugar as a key ingredient.  But given that won’t happen anytime soon, the Thai’s will stay double sweet.

Not to pick on Thais, this sign on 23rd Street in Manhattan last week says it all.

10% Happier,…a review

An Audible book review — 10% Happier, by Dan Harris

Stories have a way of capturing us.  Given that the author is in the story-making business, he creatively loops several facets of meditation, vis-a-vis a series of real-life tales, into a mainstream mindset.  Overall, I found 10% Happier entertaining and well worth the listen.

Admittedly, I didn’t know who the author was when I came across this book.  Being part of a major news network contributed a degree of credibility to the narrative, especially since he had the ability, and apparently, the desire, to interview a broad cross-section of leaders on the ‘spiritual’ side of the self-help business.  He, therefore, brings an objective, albeit at times somewhat inelastic, perspective to the concept of meditation.

It was slightly off-putting, for example, that he needed to dis Eckhart Tolle right out of the gate, even though Tolle’s book, A New Earth, which he admittedly read three times before he started his journey, opened the door into a life-changing, philosophical shift in his thinking.  His curious derision for Tolle seemed to be affected not only by concepts he evidently couldn’t grasp but also by his wardrobe.  Thankfully, Harris somewhat redeemed himself in the epilogue, reluctantly giving Tolle (some) credit.

At times, it seemed like he was writing the book for his colleagues at ABC, perhaps to explain spats of conduct as well as elucidate the logic for his path into the quasi-spiritual world.  Still, the book was highly engaging, with humorous bouts of self-deprecation and a partial inside view of the high-stress world of network news.

Apart from his highly skeptical nature — if there is no proof, and it’s not mainstream, then it borders fringe or beyond unless someone he respects provides scientific and logical evidence — Harris comes across relatively open, honest, with hefty doses of witty tongue-in-cheek, which adds to his likability.

For anyone wanting to increase their English vocabulary, I’d recommend the written book.  Because I listened to the narrated version, I was (slightly) better able to understand, if only in context, the abundance of unfamiliar flowery words and phrases peppered throughout.  Reading such a bounty of unusual words would have stopped me in my tracks more often than I would have liked (but that may be a good thing).

What I particularly liked about the book, besides the evocative anecdotes, is his method of spreading the value of meditation, which, because of his unique media role and presentation style, takes some of the mysteriousness out of an opaque topic.  I’ve been on the cusp of starting this lifestyle practice for too long.  After listening to the book, I’m a convert.  Meditation, as it’s evidently been scientifically proven, is an exercise with only constructive upside benefits.

Even though I was slightly annoyed about the Tolle dissing, (it was useful mindfulness practice anyhow), I found myself wanting more when it ended.  Hence, I’ve already pre-ordered his new guidelines coming out in Dec 2017.  I’m at least 10% more motivated.

Suggestion: Harris closed the book with a self-developed list of ten useful “precepts.”  I’d recommend changing #1 from “don’t be a jerk” to “be kind.”  It’s easier to be something than not being something.  Besides, jerk is relative, and kindness precludes jerkness.

A slice of half-baked pie

It’s tricky being in the advice business, especially the “what is right to eat” one.  There are thousands of diet books enthusiastically embracing a “correct way to eat.”  I’ve read a few recently published, written by smart, educated, scientific minds, several with medical degrees — strongly advising us what we ‘should eat’ to be our healthiest, giving us our best chance to avoid disease.  They all agree on one thing:  we should be eating real whole food and avoiding highly processed (junk).  That makes sense to any dummy.  Eating an apple, they agree, is healthier than a Snickers bar.  Duh.  

Since we are all so “food group” conscious, what the books don’t agree on are the ideal proportions of those whole food groups.  Some are polar opposites over saturated fats, particularly from meats and dairy, whether they are good or harmful.  One camp exposes a strictly plant based diet, showing studies of how animal fats are directly related to our maladies.  Others point to similar studies showing why animal fats and good dairy may help cure them.  Some champion low fat in general.  Others high fat.  Some encourage whole grains, yet others endorse avoiding them.  There are loads of conflicting beliefs and recommendations.  How can smart, educated, studied, professionals be so at odds about what whole foods we should eat?  They all can’t be right.  Or can they?

We’ve all been somewhat dimwitted when it comes to what we’ve been sticking in our mouths over the last century as we’ve radically changed our diets away from natural whole to processed food.  We gain weight and have health problems, then try to reverse years of bad habits, so we listen to what we hope is smart advice.  The thing is, most well-intentioned smart, nutritional advice givers, dedicated to helping people, don’t really know what is the best formula for eating. They can only look at slices of the pie.

We know that our bodies are a collection of atoms, too numerous to put a number to.  We’ve learned that atoms join together to form molecules and that these molecules are in constant communication with each other.  Life at the molecular level is highly dynamic and interactive.  What we eat and breath, ends up communicating with our cells, made up of those molecules.  Throw in coded messages from our non-stop thoughts and the quality of sleep, and our internal systems, from brain to toes, are constantly buzzing with vibrant interactions.

In affect, the advice-business folks make blanket claims about what is good or bad with blinders on.  We are learning that our molecular messaging system is so complex that  effects are sometimes not known for decades, or even generations, leaving us little choice but to make assumptions by looking at slices.

As a complex species we are somewhat the same, but each with unique messaging systems.  Is there a “best diet” for everyone?  From a logical perspective it’s highly unlikely.  At the same time, what is also logical is that food (including the food’s source) which has been manipulated (altering the original intended message) is most probably sending less-than-desirable information to our cells, whether that food is processed, whole fruits and vegetables, or animal origin.

So a hearty thanks to those doing the hard research and giving sound advice, particularly those warning that vegetable oils and sugars are highly toxic.  At the same time, it might be helpful for certain advise givers to qualify their advice and offer caveats, that studies have limitations and that their advice may not be for everyone.  Anything less is a half-baked slice of delicious home-made pie.

Duh,..I can’t remember

And I’m not sure if it’s buried, misfiled, or purged.  After all, there’s only so much memory space, right?

Kind of.  As much as memory storage is relative to overall health, which is affected by all the stuff we are familiar with, like diet, exercise, sleep, and stress.

Memory serves us well, as long as we don’t live in the storage bins.  But what is memory? (Don’t worry, you won’t learn that here.)  As we know it, it is simply a dynamic process of neurons encoded by conscious and unconscious thought, with a measure of observation and dash of awareness.

Supposedly, we can train and expand our recollection ability through learning.  There are volumes written about theories and methods for the most efficient ways to build the encoding, storing, and recalling process.  The thing is though, memories are not frozen in time, but rather experiences and associations which change over time.  I can’t recall who (duh), but someone in the know described remembering as creative reimagination. 

Talking to one of my sisters yesterday, we joked that when remembering events, we don’t know whether we remember what actually happened, or remember what we remembered.  In either case, remembering is, at best, a reconstruction colored by our own (unique) awareness.

Memories, or what we remember, isn’t stored in some kind of brain ether.  Memories are stored in specialized, information-transmitting cells.  But those cells, like all our cells, are constantly changing.  In a real sense, we are completely different people than we were 10 years ago.  Cells that make up our body are not the same cells of 10 years ago.  Which means life is fluid (duh).  And so is our memory (double duh).

The storage and retrieval function ends up corrupted from time to time.

For those so inclined. the good news is, they say, that a healthy mix of aerobic and anaerobic exercise improves oxygen and nutrient delivery to the brain, increasing neurotransmitter levels (slowing down normal decay), and giving us our best chance to recollect what we care to remember.

Now if only I could remember what that was, duh.

Four Books

That just may enrich your life.  Sure, there’s an avalanche of perspective-changing books floating around.  But the following four are damn worthy of a read or listen if you are up for possible improvement.

A New Earth — Eckhart Tolle a-new-earth

Mentioned in a post last year, this book helps put spirituality in context.  Grounded in logic with valuable pointers for almost anyone, of any point of view, to be better humans.  The last couple of chapters are especially profound.  We alone posess ownership of our  “happiness” destiny.  If you are not a highly-developed spiritual yogi, this book is a perspective-expander for the everyday hu-man.

Deep Nutrition — Catherine Shanahan, Luke Shanahan


Just out this year, this book breaks down, in detail, how our diets have changed dramatically over the last hundred years, which coincide to the rise in the majority of health problems, and why.  This is pertinent to societies anywhere in the world as it becomes increasingly challenging to avoid industrially prepared (altered) food.  The authors explain how the two biggest culprits, vegetable oils and sugar, have combined to create wide-scale toxic damage which is having compromising physical effects not only on us, but also detrimental hereditary effects.  The medical community at large is considerably fuzzy over how alterted food has chromosonal and molecular effects (look no further than what almost every hospital serves its patients). If you can stomach the details, this is a must read.

Extra Virginity — Tom Muellerextra-virginity

Getting past the history at the beginning, this book explains how much of the olive oil in the market today, the world’s oldest and most prized “healthy” oil, has been corrupted by mafia organizations, and more recently by global food congolermates.  Extra Virgin Olive Oil,  actually a fruit juice, is known to have complex antioxidant properties with an abundance of health benefits.  Unfortunately, the majority of Extra Virgin Olive Oil sold in supermarkets around the world has been bastardized (contaminated), mixed with cheap seed oil and perfumed, almost impossible to detect without thorough testing.  The EU and the FDA are virtually powerless to stop the blatant misrepresentation.  It’s simply too costly.  For anyone who doesn’t use (real) olive oil, well, too bad for them.  For anyone who does, it’s an engrossing and educational read for buyer beware.

sapiensSapiens, (A Brief History of Mankind) — Yuval Noah Harari

You might not be able to take individual action based on this book, but the author eloquently lays out the history of man, offering a bird’s eye perspective of how humankind has evolved.  We think what is going on in our individual worlds and societies as all-important.  This book provides an intelligent, macro frame of reference, helping to contextualize how we, civilizations, and now nations, have transformed to interact with each other (and are continuing to do so).




Bangkok Dental

It must be a karmic debt that I’ve had issues inside my mouth since I can remember. The first recallable episode was at five years old. While carrying a sledge hammer up the outdoor concrete basement stairs at our home in Baltimore, I slipped on a step which somehow resulted in a deep slice in my tongue. The tongue scar is still there. Why the sledgehammer? Must have been my workout at that time. At ten or eleven, while sledding downhill after a snowfall, I ran into a stone wall, teeth first. A few years later, an elbow during a pick-up basketball game had me spitting out another piece of front tooth. And so on, and so on.

Sure, every kid has their accident stories. Mine seemed to involve the mouth and lots dentists.

Most dentists have good intentions. What I didn’t realize soon enough, is that the medical community in general is paid, not for brilliant fixes, but for the amount of work they perform. When I first went away to college after high school, the ache from an impacted wisdom tooth took me to a nearby dentist. He said it needed to be pulled. He also explained that pulling all four wisdom teeth at once would be as easy as pulling one. Not only would I avoid an additional pulling process later, but it would also eliminate the issue with the opposing tooth coming loose. I’d be preventing future issues with a one-shot deal, he said. So like a naive 18 year old, I submitted to his laughing gas and walked out an hour later with four holes in my mouth, one in each quadrant.

Much later, in my early 30’s when I lived in San Francisco, the west coast hare-krishna-like dentist I visited in the Marina District recommended that the last bottom molar come out. It was just a bad tooth, he said. Like I never learned my lesson, I agreed. He struggled getting it out. He was sweating so much he had to take a ‘tooth pulling’ break. It wasn’t a pleasant feeling seeing him sweating and wrestling with a tooth in my mouth, or seeing he needed a breather, and worse, the sudden realization that because it was so difficult to remove that maybe it didn’t need to be extracted. When it was all said and done, he recommended shaving the tooth next to the vacancy and installing a cantilever bridge in gold metal. What could I say, “go pound sand?” I negotiated with him for the next several weeks until he agreed to a two-for-one price since it was a one-piece bridge. That bridge held for the next 25 years, until this past week.

It must have been a yen for comfort food, as dear ole mom used to put it, that I found a pint of organic New Zealand ice-cream packed with chocolate chunks. As soon as I (too eagerly) dug into the not-quite-at-ideal thaw temperature pre-bed treat three nights ago, the bond that had lasted so many years finally gave way while clamping down on the cold, hard chocolate. I was thankful, at least, that I didn’t swallow the gold piece.

Internet to the rescue. I didn’t want to wait until I was back in New York and preferred to avoid getting the fix done in China. I felt fortunate it happened in Bangkok.

After a quick search, there were several recommendations, but Dental Hospital, in Soi 49 of Sukhumvit, was not far from where I am staying. I emailed them details of the issue the following morning and received a response within the hour complete with an explanation of their process, prices, and tentative appointment times with two doctors set up for that afternoon. I had overall evaluation, an X-ray of the tooth in question, the tooth and the bridge cleaned of old cement, and the bridge re-cemented — all for $40 usd. In New York, it would have been $40 just for greeting the receptionist.

you could do laps in this pool if it wasn't a soothing waterfall

you could do laps in this pool if it wasn’t a soothing waterfall in the hospital lobby

The place was impressive — five stories, with a large waterfall pool in the lobby. It appeared that everyone working there, from administration, to assistants to the dentists were female — all smart, professional, and efficient. The place was alive with patients. If you can feel at ease about having dental work done, they’ve created that environment.

Bottom line, it’s comforting to know that if a dental issue comes up while in Bangkok, Dental Hospital is an option certainly worth checking out.

P.S. I had no problem bridgelessly finishing the pint NZ organic cream.

“what a racket,”

says the surgeon specialists during our last appointment in October.  He wants me to have (another) CT scan, this time of the mandible, (to compare structural stability from six months ago).  Since he is affiliated with NYU (New York University Medical Center), the scans are automatically scheduled at the NYU hospital.  Procedures like this need to be authorized by the insurance company, so the one I use called me to explain that since my deductible is quite high, the scan cost would be out-of-pocket.  Therefore, they said, I might want to consider options for the same scan at other nearby locations were costs are considerably lower.  At NYU hospital the cost is $1,000 for the mandible scan.  Not much, as scans go, but the alternate locations had list prices for the same scan between $200-300.

I had asked the doctor’s assistant prior to our appointment if there was a problem using one of these alternative scan locations and the response was “the doctor prefers the scans done at NYU hospital.”  I also checked to make sure that the scans were equal in quality machine and results.  They are.  And, since spending $700-800 more for the same thing doesn’t seem prudent, I brought this up again at my appointment in front of the doctor and his assistants.  His response, as he shook his head from side to side, was “what a racket.”  I was puzzled by his reaction as I thought the comparable pricing the insurance company gave me was a good service to protect the consumer (from the racket).

I really like the doctor and have known him now for five years.  He’s fairly young, but not too young, and serious.  I’ve been under his knife at least three times so far (unfortunately).  His speciality is head and neck micro-vascular surgery.  Usually during our appointments we talk about cycling and physical fitness.  I’ve shared some good cycling information with him since he enjoys serious cycling as I do.  So when he made the “what a racket” comment, I reacted with, “doc, with all due respect, you want to know what a racket is?  Let me show you your bill from my last office visit when you checked my ear.”

During a trip home in July, GV and I spent a few days at the Connecticut shoreline.  One of those days while GV was out running, I was reading by the surf and a bee flew into my ear.  I could hear the buzzing for a few seconds and couldn’t do anything as my finger could only push the bug in further.  I pounded on the side of my head which was tilted over, but I was alone in the sand and one one could really help me.  I picked inside my ear with a small stick and eventually the buzzing stopped.  When GV joined me about an hour later I asked her if she could see anything in my ear and she could not.  (It’s hard to see inside an ear without proper light.)  I then forgot about the episode as all felt normal again.

About a week later I had a follow up appointment with the doc.  Since he is a head/neck specialist, I asked him to do me a favor and look in my ear.  With his ear light-scope and tweezers he pulled out the body and wing of a dead bee.  “Wow,” he said, “good thing you had wax in your ears or the bee could have gone further in and created a problem.”  He also pulled out a chunk of wax.  The entire procedure took less than two minutes.  I thanked him and was relieved that the bee and wax were no longer in my head.  It didn’t register that there would be an extra cost to this as I assumed it would be part of the cost of the routine visit. I thought wrong.

Itemized on the surprise bill, beside the $400 routine visit cost, were line item costs for; 1) removing impacted ear wax @ $580, and 2) removing a foreign body from ear canal @ $1,457.  In other words, the tweezer operation which took less than two minutes was costing $2,037, or $17 per second.

When I asked him about the exorbitant charge(s), he said he just writes down what he does during the appointments and the billing coordinator makes the invoices from codes.  I chided him and said, “look doc, I thought this was a favor and it took less than two minutes.  Had I known it was going to cost this much I would have gone to a regular ENT as my insurance isn’t paying for this.”  He shrugged his shoulders and told me to duke it out with the billing coordinator, which I’m still doing.

No doubt most of the medical community does great things — healing (what they think) needs healing.  At the same time though, for most, it’s a business — and indeed, quite a racket.