Join the debate: Should old men be screened for prostate cancer?

Posted on by
2

Joe Biden’s office reported last week that he has been diagnosed with prostate cancer that has metastasized to his bones. They’ve also reported that he went the previous 11 years without a PSA test to screen for it.

At this point, his treatment options are limited. It’s impossible to cure metastasized prostate cancer. Hormone treatment can slow the cancer, but such treatment has side effects – it’s essentially reversible chemical castration, which reduces testosterone to about 5-10% of normal or less.

We’ll never know how much, if at all, Biden’s cancer is related to his cognitive impairments that are now widely acknowledged.  

As for his failure to get PSA tests for 11 years, his office and his media allies point out that some (but not most) medical authorities recommend against PSA tests for men over a certain age, typically something like 70 or 75.

In my opinion, that cutoff, even if adopted, should not apply to a person tasked with Joe Biden’s responsibilities, but that’s a different column. This column is about using such a cutoff for ordinary men.

Here are some of the pros and cons of skipping PSA tests for ordinary old men. Join the debate in the comments section below if you wish.

Cons for the PSA test in old men:

*Prostate cancer usually grows slowly. It’s a fact that more men die with prostate cancer than of it. The expected life span of a 75-year-old American man according to the actuarial tables is about 12 years. The expected life span of that man newly diagnosed with prostate cancer, if not treated, is not much shorter. It’s about 8 years, though the quality of the last few of those years is very poor.

*Given that prostate cancer is usually slow-growing, some cases are overtreated. The man winds up with the trouble of treatment, but no lengthening of his life span, because he dies anyway of something else. If the PSA test is not given to a man, and so the cancer is not discovered, then we can be assured that he will not be overtreated for it.  

*Treating prostate cancer costs taxpayers. The usual treatment is a prostatectomy or radiation therapy or sometimes both. In the case of men over 70, these costs are borne mainly by the Medicare system. It’s reasonable to assume that treating a man with prostate cancer costs somewhere between several tens of thousands of dollars up to a hundred thousand dollars or more.

*The PSA test sometimes produces a “false positive.” That is, a man will have an elevated PSA level suggestive of prostate cancer when, in fact, he does not have the cancer. This will lead to further testing to disprove the cancer. That testing would not have been necessary if the PSA test had not been given.

Pros for the PSA test:

*The PSA test itself costs hardly anything. The retail cost of a PSA test at LabCorp is $69. Medicare gets it for less.

*The PSA test is easy. It’s just one more little vial of blood filled from the same blood draw as the rest of an ordinary blood panel at a man’s annual physical.

*False positives are easily addressed. It is sometimes said that the occasional false positives of a PSA test result in “unnecessary treatment” but that’s not true. What it results in is further investigation in the form of non-invasive imaging and perhaps a tissue biopsy. The imaging is painless, though the biopsy is less so.

*Some prostate cancers kill quickly. The quick-killing ones, once discovered, can be distinguished from the slow-growing ones by ongoing monitoring. If warranted, they can be treated. If Joe Biden had received PSA tests as part of his ordinary annual medical exams, his rapidly advancing cancer would have been detected and would have been treated. Such treatment probably would have saved him from the cancer.

*Overtreatment in a minority of cases does not justify ignorance and non-treatment in the majority of cases. The solution to the problem of overtreatment of slow-growing cancers is not to stay ignorant of all cancers; it’s to avoid overtreating the slow-growing ones.

*Prostate cancer does kill. While it is true that the majority of men survive prostate cancer, it remains the number two cancer killer among American men (second only to lung cancer) simply because it’s very wide spread. It’s true that death by prostate cancer is usually slow but, to me, that makes it all the worse.

My personal opinion is that we should give the PSA test to old men, but use common sense in treating the cancers that are found. A slow-growing prostate cancer in a 78-year-old man with numerous co-morbidities and a life expectancy three years is a different story from a fast-growing prostate cancer in an otherwise healthy 73-year-old man with a life expectancy of 15 years.

Feel free to weigh in with your thoughts.

The Bidens must have known about his cancer for years

Posted on by
3

First, my sympathies for the Biden family. I’ve been there.

Now, here’s my puzzlement. Prostate cancer is notoriously slow-growing. Although prostate cancer is the second-leading cause of cancer deaths among men (second to only lung cancer), that’s not because it’s so deadly, but because it’s so common. It’s a fact that more men die with prostate cancer than of it.

Of those who die, the typical mechanism of death is by the cancer cells metastasizing to other organs and/or to the bones. It takes years for that to happen – typically something like 5-10 years even without treatment, and even longer with treatment.

Even after the metastasizing occurs, death is usually half a dozen years away or more. After all, the cancer cells are still slow-growing prostate cancer cells, even though they’re now in a new home in another organ or in the bones.

The usual treatment for prostate cancer is to remove the prostate gland, a walnut-sized gland “down there” whose main function is to provide the ejaculate that is the vehicle for sperm cells produced in the testicles. After a prostatectomy, a man can still have an orgasm, and it’s a much tidier affair. The surgery is usually done with what’s often called a “robot” but, in reality, is a human-operated arthroscopic system that utilizes fine motor controls and a viewing system.  

An alternative treatment that is often elected is radiation treatment. The prostate is irradiated five times a week for about six weeks. In one of nature’s happy coincidences, prostate cancer cells are more vulnerable to radiation than normal cells. The intended result is for the prostate cancer cells to die (or, more accurately, be sufficiently damaged that they cannot reproduce) while the other cells survive.

In practice, the radiation damages other cells to some extent, which sometimes inconveniences the patient with regard to, for example, urinary and sexual functions.

Neither approach is thought to directly impact a man’s cognitive function. But it should be mentioned that prostate cancer is a disease of older men. Radiation five times a week for six weeks has an effect on older men, even when the radiation is all below the waist. And being under anesthetic for four hours for a prostatectomy is not trivial trauma for a 75-year-old man.

Both treatments are effective, but recurrences are common. A prostatectomy tends to leave at least a few viable cancer cells behind in the prostate “bed” from which the prostate gland is removed. Radiation treatment, too, is known not to kill all the prostate cancer cells. The hope is that it kills enough of them that the man dies of something else before the remaining ones regroup and reproduce.

If the cancer has spread beyond the prostate – i.e., it has metastasized – then all bets are off. Neither a prostatectomy nor radiation treatment are directed toward anything other than the prostate gland.

The announcement from the Bidens is that he has “an aggressive form” of prostate cancer which has metastasized to his bones. The particular bones are not specified, but the hips and pelvis are the most likely. Nor is it specified to what extent the bone metastasis has taken place.

In advanced stages, metastasizing will spread to many bones. The common symptom is worsening bone pain, a deep, achy, persistent and ultimately agonizing sensation.  

Prostate cancer is usually detected long before any symptoms are noticeable. A routine blood test, which is part of every older man’s annual physical, measures a compound called “prostate specific antigen” or PSA.

Elevated levels of PSA suggest, but do not prove, prostate cancer. The doctor typically orders up further tests to confirm the suspicions. The ultimate confirming test is a biopsy.

Here’s my puzzlement. How is it that Biden’s first inkling that he has prostate cancer is when it has metastasized to his bones, given that metastasizing takes years and he presumably has been getting PSA tests at least annually?

My guess is that the Bidens have known of his cancer for a long time. It’s quite possible – nay, it’s likely – that he has undergone radiation treatment for it. (Prostatectomy treatment appears out of the question, because reports are that a nodule was discovered on his prostate; so it’s still there.)

The radiation treatment appears to have ultimately failed, as it not infrequently does. When the cancer became detectable again, it would have produced elevated PSA levels. By the time it was metastasizing, those levels would be very high.

Again, this does not happen in a matter of weeks or months, but years. It’s inconceivable that the Bidens were unaware of this cancer last November.

To generate book sales, the former Director of the FBI advocates 86’ing the President

Posted on by
4

James Comey has a book coming out, so he’s looking for attention. He got it.

He posted on Instagram a photo of shells on the beach arranged in the numbers “86 47,” the last two numbers being a little separate and bigger than the first two so as to differentiate them. His accompanying comment was:

“Cool shell formation on my beach walk.”

In case you were born yesterday, the number “86” is slang for terminating a person or thing. If a gangster talks about “86’ing” you, you’re toast. The number “47” of course corresponds to President Trump as the 47th President.

Comey got the attention he sought, and then some. Then he deleted the Instagram post, and put up a new post “explaining” that:

“I posted earlier a picture of some shells I saw today on a beach walk, which I assumed were a political message. I didn’t realize some folks associate those numbers with violence. It never occurred to me but I oppose violence of any kind so I took the post down.”

Wait a minute. In his first post, Comey pretends that the numbers were merely a “cool shell formation” while they were obviously much more than that; they were the numbers “86” and “47.”

So why did he pretend they were just a shell formation in the first post?

In his second message, he contradicts his first in admitting that he was aware it was a “political message” but contends he was not aware that it was a violent one. Really? This is the former Director of the FBI.

Then what did he think it meant? He never says.

The Secret Service charged with protecting the President takes seriously threats to his safety. The latest reports are that they’ve interviewed Comey.

That presents a problem for Comey. It appears likely that Comey himself arranged the shells on the beach. If he maintained his story that he simply stumbled across them, he was probably lying.

Such a lie could be uncovered by the contents of his phone. Multiple pictures of his “shell formation” could be on his phone showing various iterations until he settled on the one he liked.

Such a lie to the Secret Service investigators would constitute perjury, as Comey well knows – since he put people in jail for that.

On the other hand, if he told the truth to investigators, he revealed himself for what he apparently is: A former Director of the FBI who is willing to encourage harm to the President in order to sell books.

In today’s sordid world, it will probably indeed work to sell books. Fellow travelers on the left will buy his book with no intention of reading it, just to support his advocacy of violence. After all, they’ve normalized calls for political assassination, as we saw when they lionized a maniac who murdered a health insurance CEO on the street.

And it may work to accomplish more, too. It may work to achieve its stated goal of 86’ing the President. These are dangerous times, and this sick former FBI Director isn’t helping matters.

The only hotness in Hogg is that he’ll soon be bacon

Posted on by
3

The Democrat who goes by the initials AOC is the hottest Democrat in Congress. I know that’s a low bar, but still.

It’s the main reason Democrats like her. Be honest: Who would you like to share a voting booth with – AOC or Nancy Pelosi? And then there’s also the possibility of voting from home . . . .

I’ll admit it’s a bit creepy to see Her Hotness and 163-year-old Bernie Sanders together on a stage performing Dem-porn acts such as “the rich don’t pay taxes” and “Republicans are a threat to Democracy” before at least one of them gets driven to one of Bernie’s mansions.

But in creepy cradle-robbing and grave-robbing stunts, they have nothing on the Republicans. Have you seen Bill Belichick’s new 24-year-old girlfriend? (I thought the guy was just a great football coach. Turns out, he’s a god!)

And then there’s a new kid on the block named David Hogg. He’s a hero because he was at school one day when a nutcase went ballistic with a gun.

Hogg saved several students. Well, no, he didn’t.

Hogg disarmed the gunman. Well, no he didn’t.

Hogg went to confront the gunman. Well, no he didn’t.

Hogg hid in a closet. Yes, he did.

Hogg has made a living selling the day he hid in a closet. His pitch is that we should ban guns. Forget about police protection in the schools. Forget about mental health issues. Forget about arming the teachers. No, we should ban guns.

Because then, the gunmen couldn’t get a gun legally at a gun store, and they’d have to get them illegally instead. They’d have to get one or more of the 400 million that are in circulation in America.

Democrats love this pitch. Not because it would reduce gun violence – remember the 400 million guns already out there?

No, Dems love the pitch for two reasons. One, it punishes gun owners, and they hate gun owners. Or at least they think they do. They forget that most gun owners are not pickup-drivin’ beer-drinkin’ tobacky-chewin’ GOP-votin’ rednecks. Most don’t drop their drawers or even their g’s. Most are people like you and me. Well, at least me.

Two, banning guns makes Dems feel virtuous. It means they’re doing something and, more importantly, it means they can say they’re doing something. In the world of Democrats, it doesn’t matter if what you do is effective. It only matters that you do it and talk about doing it.

Hogg rode this pitch all the way to the Democrat National Committee Vice Chairmanship. (I won’t make a comment about the Chairman of Vice, not with Belichick on the page.) Hogg became a male AOC. White smoke rose from the DNC office, and it wasn’t because they were burning emails. They all but christened him “His Hotness.”

Then he started saying some things apart from his DNC-approved gun-taking pitch. He suggested that the old Democrats should retire to make way for young ones. He himself, coincidentally, happens to be a young one.

But not all old Democrats should retire, he said. Only the powerless ones he thought he could risk offending. That wouldn’t include 85-year-old Nancy. She’s fine, he assured us. Really not even old!

He miscalculated. Turns out, the old powerless ones he said should retire do, in fact, have some power.

Hogg is now being ousted from his Chairman of Vice position. He’s cooked. He’s fried. He’s bacon.

But he’s still got his gun-taking schtick. Expect more books and speeches.

Joe, don’t go!

Posted on by
3

On those rare occasions when I’m in need of an emetic, I’d rather have a finger stuck down my throat than have the image of Joe Biden stuck through my retina.

But he’s baaaaaack anyway. Democrats hate that he’s back.

What my enemy hates, I should like.  And so, I do. Even though it hurts my eyes and turns my stomach.

Democrats hate it for the same reasons that I like it. Every Joe sighting reminds people of why they voted against him. He demonstrates that he’s a creaky, corrupt, cardboard cutout that is incapable of thought and practically incapable of reading a teleprompter containing the thoughts of people who do his thinking for him.

Every appearance reminds people that the Democrats lied that he was “sharp as a tack” right up to the minute that he proved beyond a reasonable doubt that he was dull as a dullard, at which time they dumped him like a stained, plaid Laz-Z-Boy from the 70s and declared that their hand-picked replacement (why bother with primaries to ascertain the people’s preference when you have Nancy, Chuck and Barack?) was

. . . wait for it . . .

. . . “sharp as a tack.”

And joyous, to boot. And no known hair plugs, capped teeth, or criminal family.

I almost feel bad for Joe that the Democrats are not even pretending to welcome him. Almost.

“Joe, please go” Is their typical greeting. Guffaws are their typical reaction to his tiresome contention that he would have won the election (if only he’d had the courage not to quit). Yawns are elicited by his warnings that the Republicans want to end Social Security, end motherhood, and end the world.

Rage is the emotion generated by him reminding Democrats of his truculent, selfish refusal to quit when the quitting was good – back when the primaries were playing out and a competent new candidate could be chosen in the way they’re supposed to be. Embarrassment is what they feel when they see him stumbling, bumbling, humbling and crumbling on a stage.

Mind you, I don’t blame Joe for being semi-senile. Lots of people wind up there. Supreme Court Justice Ruth Bader Ginsburg in her final years comes to mind.

Ginsburg is another person whom I adore because she screwed the Democrats by quitting long after the quitting was good. Ginsburg’s encroaching senility so clouded her judgment that she could not see it encroaching, and so she failed to quit in time for Barack Obama to name her replacement.

She died at age 87 while still on the bench (when she was not in the hospital). After decades of reliably liberal votes, the legacy she left is that her replacement is Amy Coney Barrett, nominated by Republican President Trump and confirmed by a Republican Senate.  

Back to Joe being back. Surely, he can still distinguish between friends and enemies. Given that his friends wish he’d go away for good, and his enemies are happy he doesn’t, one might ask, why doesn’t he go away?

This might shock you, but politicians have big egos. They crave attention. It’s not exactly a monastic profession.

I don’t hold that against them. The need for attention is fundamental to mankind (and, to a slightly lesser extent, womenkind). Some people achieve it by being loved, others achieve it by being hated, and still others achieve it by writing stupid blogs where they weave themselves into the narrative.

What I hold against Joe is not his basic need for attention. What I hold against him is his terrible policies, his family corruption, his gross incompetence, and his shameless lies.

I’m glad he’s back to remind Americans of those things. As he continues to decline, I hope he sticks around. Cement that legacy, Joe.

Is the American Pope a case of follow-the-money?

Posted on by
1

To everyone’s surprise, the new Pope is an American. Like almost everyone else in the world, I’d never heard of him before yesterday. But he looks like a straight shooter and a stand-up guy. And, as popes go, he looks pretty healthy.

For readers in my tribe who are dismayed that he once expressed some passing criticism of President Trump’s summary deportation of illegal aliens, I ask you: What’s a clergyman supposed to say – kick the SOBs out?

I did not expect to see this – an American Pope – now or ever. Reports are that the smoke-watchers crowding the Vatican grounds didn’t either, and were a bit disappointed.

That’s not because Europeans hate or even dislike Americans. The practice of scorning American tourists ended at least a generation ago. The days of ugly Americans are now replaced by the days of rich Americans – and everyone likes customers who are rich.  (That said, it doesn’t hurt to greet people in their language when you’re in their country. “Buenos dias” and “bonjour” fetch a lot more smiles than “Hey, howya doin?”)

So don’t be fooled by Americans who sanctimoniously advertise to fellow Americans that they identify themselves as Canadians, not Americans, when they go to Europe, ostensibly to trick the Europeans into liking them. Those Americans are revealing a dislike for Americans alright – by themselves. Those Americans hate America, and they project that hatred onto the world.

Although Europeans don’t hate Americans the way some Americans hate Americans, I still wouldn’t expect the sun-drunk, ecstasy-filled citizens of Rome milling about St. Peter’s Square this week to be whispering, “Let’s pray they elect an Americano!”

And they weren’t. So why did the Cardinals elect an Americano?

Here’s a relevant factoid: The Vatican has deep financial problems.

Here’s another relevant factoid: When the Notre Dame burned a few years ago, guess who donated the greatest amount for the rebuilding, apart from the French themselves (several of whom were extraordinarily generous). It was the Americanos.

Connect the dots. 

I hope the strategy pans out. We need the Catholic Church more than ever before – and I say that as a Protestant.

This is a heckuva way to run a Church, but on the other hand . . .

Posted on by
8
Nero’s Bathtub at the Vatican

Why do Catholics still worship an old king in a palace?

I understand why they did in the old days. Everybody did. (Well, except Christ didn’t.) There was Henry VIII, Louis XIV, Charlemagne and, in folklore, King Arthur. There were also king-like rulers called emperors, such as Julius Caesar, Peter the Great, and Napoleon Bonaparte.

It was way back in the olden days that Catholics set up the papacy, their kingship. Their first Pope was said to be the Apostle named Peter, who used to be called Simon.

By the way, the names of the Apostles always have confused me. There was Paul, who was really Saul. There was Mark, who sometimes went by John. There was John, who always went by John even though Mark sometimes did, too. There was the aforementioned Simon whom Jesus called Peter even though that wasn’t his name and there was another Simon whom Jesus called Simon even though that was his name.

There were two James’s. One was James the Greater about whom we know a great deal of apocrypha and the other was James the Lesser about whom we know much less. James the Lesser went by Jim. (OK, that part is made up.)

Jesus must have had the patience of Job, considering how many times he had to say “No, the other one.”

As if Apostles are not complicated enough, let’s get back to popes. In case you encounter a pope, the proper form of address is not “Your Majesty.” That’s for kings and queens. Popes get addressed instead as “Your Holiness.” You see, kings and queens may be majestic, but popes are holy.

In fact, papal pronouncements on matters of Church doctrine are said to be “infallible.” Never mind that Church doctrine changes from time to time. The old doctrine was infallible when it was in effect, and the new, different one is infallible when it’s in effect.

As for all things, for infallibility there’s a season.

So, popes are holy. But there’s a bit of majesty in them, too. For a long time, infallible popes were also effectively the rulers of the Holy Roman Empire, an area that stretched from Rome to the Baltic Sea.

Wars and intrigue gradually chipped away at the Empire. The establishment of the nation of Italy in the 1800s cost the Vatican almost all of the little land they still held. The earthly territory of the Holy Roman Empire now comprises 0.2 square miles within the city limits of downtown Rome.

But that 0.2 square miles holds some good stuff, such as Michelangelo’s Sistine Chapel, priceless art works, and St Peter’s Basilica.

And Nero’s Bathtub. Nero’s Bathtub is a massive bathtub about 25’ long made of stone quarried in Egypt and brought to Rome for Emperor Nero. What better place to fiddle through a fire than in a bathtub? The value of Nero’s Bathtub is estimated at around two billion dollars. That’s $2,000,000,000. (I’m not making this part up.)

Altogether, the Vatican is the most valuable 0.2 square miles this side of Heaven. Don’t ask how they acquired all this treasure, and don’t ask how to reconcile such material acquisitiveness with their incorporeal mission. We’re talking infallible, remember?

These material riches of the Vatican’s balance sheet are oddly juxtaposed with the sorry condition of its income statement. They’re rich but they spend far more than they make. In fact, their finances have been in bad shape for many years. They have fallible finances.

In their defense, back in those olden days they had a lot of expenses such as wars to fight and bribes to pay. But now they don’t fight earthly wars, and bribes have not been reported for years. Even so, well into modern times they’ve still had sloppy finances, money-laundering allegations, and what might be called, um, corruption.

During the tenure of newly departed Pope Francis, the Vatican’s operating deficit tripled. Maybe ballooning budgets come with the territory from which he originated – Argentina.

Whatever the reason, finance types warn that this Latin American spendathon cannot continue unless the Vatican sells off assets, which will fix finances only for a while, or resumes selling indulgences – to a flock that is no longer accustomed to having to pay for them.

In contrast to the papacy, the aforementioned kingships and empires of Europe have evolved. They’ve been replaced by indirectly elected technocrat parliamentarians in such countries as Great Britain, Germany, France, Italy and most everywhere else. Only the throne of Peter the Great is still occupied by a despot.

So, what’s with the black smoke/white smoke ritual (“smoke-filled room” takes on a new meaning here) by a politburo of old men that are attired in plush red robes and lamp shade hats (let’s trust they’re not chomping cigars) to choose a new, infallible, male, old, dear leader in the richest corner of the globe even as that corner – and the globe – drift inexorably toward bankruptcy?

This is a heckuva way to save souls.

On the other hand . . .

The Catholic Church has probably been the greatest force for good in the history of the world. It has brought Good News to billions of people to enrich their lives if not save their souls.

The lucre and treasures the Church acquired along the way were from a different era, when that’s what powerful people did. It’s difficult for them to give it all away now, just because some Protestant blogger mocks Nero’s Bathtub.

And to whom would they give it? Secularist governments?

Sheesh, after the Notre Dame burned, the secular government of France proposed replacing it with a temple that would not offend (i.e., would pander to) the burgeoning Muslim population that seeks control of Europe. They backed down only when the remaining Catholic population of Paris (and France and the world) made a fuss.

My brother, a very smart guy with a Ph.D. in Physics, was a convert to Catholicism. I never really talked with him about his faith, but I respected his judgment. In that way, he reminds me of another very smart convert, JD Vance.

I confess that on my two long walks of the Camino de Santiago, there were times when I, too, considered converting to Catholicism. (There have been times when I’ve also thought about converting to Judaism, but that’s another column.) For now, I’m a die-hard Protestant.

So, the Church on balance has been a very good thing over the millennia.

Still, it has its quirks.

The Wall Street Journal debases itself in a misleading Trump headline

Posted on by
5

I’ve read the Wall Street Journal for many years. I’ve even had a piece published in the Journal. The opinion page is excellent (even when I disagree with the opinions expressed there) and the news page is reliable (though it has drifted leftward over the years).

I was therefore surprised and disappointed to see the Journal’s coverage of a recent interview that President Trump gave to NBC News.

Trump was asked about the due process protections he should afford illegal aliens being deported. Here’s the transcript of the relevant part, as presented by NBC News itself:

“But even given those numbers [of illegals] that you’re talking about, don’t you need to uphold the Constitution of the United States as president?” Welker asked.

“I don’t know,” Trump replied. “I have to respond by saying, again, I have brilliant lawyers that work for me, and they are going to obviously follow what the Supreme Court said.”

A fair reading of that exchange is: (1) the interviewer asked Trump whether he would uphold the Constitution in connection with his deportation of illegals, (2) he replied that he’s not a lawyer, so he doesn’t know what the legal requirements are, (3) he has many brilliant lawyers who will tell him, and (4) they’ll “obviously follow what the Supreme Court” says.

The Journal presented the clip, but accompanied it with a very misleading headline. The headline read,

“Asked if He Has to Uphold the Constitution, Trump Says ‘I Don’t Know’”

That headline was misleading in at least three ways. First, it leaves out the context, thereby implying a context much broader.

The question asked of Trump was not the general question of whether he “has to uphold the Constitution.” Rather, it was a very specific question: It was whether Trump has to afford due process protections to illegals being deported.

Second, the headline omits the rest of Trump’s answer. He immediately went on to note in connection with this Constitutional issue that he is not a lawyer.

That’s not just a quibble. Even most lawyers would struggle to define the necessary due process protections for illegals. Do they get a full-blown jury trial? Do they get summary adjudication by an administrative judge? Do they get something in-between? Even the Supreme Court has not been crystal clear on this point.

Third, Trump wound up his answer by explicitly stating that he would defer to whatever the Supreme Court says.

In context, it’s hard to see what Trump said wrong. He did indeed start his answer with “I don’t know” but immediately explained why he didn’t know, and gave assurance that he would do as told by people who do know — namely, the Supreme Court.

The Journal’s headline parrots a similar headline from the outlet that did the interview, NBC News. I was not surprised to see NBC sink this low to rake up muck, but I was indeed surprised to see the Journal follow them down there.

Glenn Beaton practiced law in the federal courts, including the Supreme Court.

Put this on your bucket list: open heart surgery

Posted on by
11

“I can hardly wait to see your nine-incher, Glenn!” Those were the words of a dear hiking buddy with whom I’ve had a long platonic friendship.

But I’m getting ahead of myself.

Beginning last summer, I felt less than my usual acerbic, aerobic self, especially when hiking at altitude with my group around Aspen. I finally awoke one morning feeling downright crappy, and a little light-headed. I’m not prone to illness. I haven’t vomited for at least 30 years, and my last cold was over ten years ago. I figured something was wrong.

I drove myself to the local emergency room. Cleverly, or so I thought, I skipped breakfast because I figured they’d want to draw blood for tests.

They did draw blood, and did lots of imaging. They found nothing wrong.

Except I passed out. That alarmed me and everyone else until we figured out it was due to plummeting glucose levels. That’s what happens in early afternoon if you haven’t eaten a thing for 20 hours. So much for my cleverness in skipping breakfast.

Over the next two months, I became a regular in the ER and in the medical offices. Each time was with the same symptoms: Intense fatigue, light-headedness, and now some cognitive and memory issues. Each time, they found nothing wrong.

They did notice my bicuspid aortic valve – a defect that I was born with and have been aware of for many years. The aortic valve is the exit from the heart to the aortic artery. All the blood pumped to your body goes through it. It’s supposed to be three-leafed, but about one percent of the population gets short-changed in the aortic valve line at birth and gets only a two-leafed version.

A bicuspid aortic valve is usually not fatal. Many people never realize they have it. But it’s not as efficient, and it can deteriorate over time.

They saw my bicuspid aortic valve through a routine echocardiogram. They apply an echo transducer to the chest, something like the transducers applied to a woman’s belly to generate an image of a baby in the womb.

The echocardiogram showed that I had “mild regurgitation” through my bicuspid aortic valve, and would need to have it replaced sometime in the next few years. But it was not an emergency and did not account for my symptoms.

I was starting to think my symptoms were imagined, and the docs probably were too.

Almost on a lark, I saw yet another cardiologist. This one was suspicious about the echocardiogram images showing only mild regurgitation at my defective aortic valve. He ordered up a different sort of echocardiogram. For this one, they put me under an anesthetic and put the transducer down my trachea to get a view of the valve from a different angle.  

That angle showed the regurgitation at the bicuspid aortic valve was not mild, but “severe.” The valve had deteriorated to the point that blood was backflowing from the aorta back into the heart. They checked me into the hospital that very day and performed open heart surgery to replace the valve as soon as they could round up a surgical team.

The lead surgeon happened to be a petite blond woman. Her blondness was of no consequence, medically speaking, but I noticed her small, strong fingers that would soon be fishing around in my chest. I thought, “That makes sense – all surgeons should be petite women.”

For the replacement valve, they can use a mechanical prosthesis or a biological one. We chose the biological one. It’s fabricated from natural bovine heart tissue. So, I have a bit of Bessy in me. At least it wasn’t porcine tissue.

Surgery entails a nine-inch incision lengthwise over the sternum (hence the remark by my friend which I quoted above). Then they cut through the sternum, still lengthwise, and pry open the split sternum and chest cavity with a steel prying cage that looks like something from a tire store.

That exposes the beating heart. A vein and an artery are accessed with catheters connected to a heart-lung bypass machine to maintain the oxygenation of the blood. The heart is then stopped with drugs, and remains stopped for an hour or two during the next steps.

The surgeon cuts into the heart to expose the aortic valve, carves it out, takes measurements, and sews in the prosthetic valve of the right size. Then the heart is closed with stiches, the bypass machine is disconnected from its arterial and venous access points, the heart is restarted, the prying cage is closed and removed, the sternum is stapled or wired together, and the skin incision is stitched up. The whole operation usually takes 4-6 hours.

I once had simple knee surgery where they used an epidural to numb me from the hip down. I elected to stay conscious the whole time and observed the surgery on a video monitor.

That was not an option for the heart surgery.

I awoke that evening with a tube down my throat. My first assigned task was to convince them that I was well enough for them to remove it. I succeeded, and they did.

I spent another four nights in the hospital. With encouragement, I was able to walk to the bathroom right away, and each day I walked a bit farther down the hallway. By the last day, I was walking a single flight of the stairwell. It wasn’t exactly the Matterhorn, but you have to start somewhere.

At home, it was tricky to get around without feeling pain in the sternum and thereabouts. After about three months, the direct pain was pretty much gone, except there would be odd bouts of intense pain or cramps in the intercostals between the ribs.

Heart arrhythmias are common after open heart surgery because the surgical incisions cut through established electrical pathways. The body finds alternative pathways that are incorrect and mistimed.

I got the full measure of arrhythmias. Atrial fibrillation was first, where the heart races and flutters. My heart rate would be 64, then 42, then 163, then 81, all in the span of a few seconds.

For that, I underwent the usual treatment of “cardioversion” where the patient is anaesthetized and the heart is shocked with a high-voltage current to reset the proper electrical synchronization. The burn marks left on the chest are usually small and heal quickly.

Then there were the premature ventricular contractions, or PVCs, where the sensation is that the heart is skipping a beat. All people get a few PVCs now and then, and they tend not to be dangerous, but mine would go on for hours or days. They were typically loud enough to keep me awake all night. Eventually, they subsided (I think).

The whole experience is disruptive to one’s metabolism, one’s head, and one’s emotions. I sincerely believe I’m a different person now.

That person is not yet as mentally acute. There’s a name for the symptom of brain fog after heart surgery involving a heart-lung bypass pump. They call it “pump head.” I confess to having a bit of pump head. It often improves over time.

I’m also not as aerobically strong. That, too, may improve – especially now that I have a proper and efficient aortic valve for the first time in my life. I’m not ready to hang up my hiking boots quite yet, or my spurs.

And I’m different in my personality. I’m relearning things, relearning people, and relearning myself. I choose to see it as a blessing. How many people get the chance to reinvent themselves, free of the baggage of who they were?

Meanwhile, I’ve got this nine-incher. Got that going for me.

Liberal judges to violent, criminal illegals: “You’re Trump’s enemy, so that makes you my friend”

Posted on by
5

Judges lately often exhibit acute cases of TDS. One in Milwaukee was preparing to preside over the trial of an illegal who’d been charged with domestic abuse. In layman’s language, he was charged with beating his girlfriend and others to the point that some required hospitalization. Federal agents showed up outside the judge’s courtroom with a warrant to arrest the man, presumably to deport him.

The judge stalled the agents for a bit by sending them down the hall, then returned to the courtroom. While the agents were away, she spirited the violent illegal out the side door.

The agents suspected a ruse, and went outside. They intercepted the man on the street, though it took a potentially dangerous rundown to catch him.

A judge in New Mexico was harboring three illegals who were apparently members of a notorious Venezuelan gang. The judge gave them guns. The judge also took a hammer to the phone belonging to one, evidently because it contained pictures of beheaded victims. He didn’t want the incriminating evidence to be discovered.

These acts by judges are not just intemperate and illustrative of bad, well, judgment. They’re also crimes. It’s a federal crime to conceal illegal immigrants. It’s a federal crime to interfere with the investigations of federal law enforcement officials. It’s a federal crime to lie to them. It’s a federal crime to destroy relevant evidence of a crime. The statutory punishment can involve decades in the federal penitentiary.

Ordinarily, these judges would not side with a wife-beater, or with a gang member with photos of his beheaded victims on his phone. Even judges who are Democrats are not that loony.

So why did the judges do so in these cases? Here’s my theory.

The reason the judges sided with criminals in these cases was because the person who was after them was Donald Trump.

These Democrat judges perceive Trump as their enemy (probably correctly) and they perceive these criminals as Trump’s enemy (certainly correctly) and so that makes the criminals their friend.

“My enemy’s enemy is my friend” is a crude and amoral way to pick friends, but I suppose people have the prerogative to use whatever criteria they like in such personal matters.

But judges sitting in their courtroom are not engaged in personal matters. They’re engaged in public matters. Their job is to judge, and they’ve sworn to do so in accordance with the law. They don’t have the luxury of putting the law aside in favor of personal prejudices such as “the enemy of my enemy is my friend.” If they did, then they could decide that criminals are innocent simply because they happen to dislike the prosecutor. Or guilty because they happen to like the prosecutor.

I’m from the old-fashioned school, and so are almost all other lawyers and almost all judges and almost all civilized legal systems. In that school, the guilt or innocence of a defendant is based on what he did, not who he’s a friend or enemy of.

These judges know that, and they would agree with it – in the abstract. If offered a hypothetical where the evidence shows the defendant is guilty but the prosecutor is someone the judge abhors, the judges would say that’s the way the cookie crumbles. The defendant would be convicted on the basis of the good evidence presented, not exonerated on the basis of the bad prosecutor presenting it.

But in these particular cases – the real-life ones in Milwaukee and New Mexico mentioned above – the judges have become prisoners to their emotions. Their hate for Trump is so strong that they literally cannot think straight.

The judge’s best defense to the charges against them for aiding the criminal illegals, therefore, is a plea of insanity. And I think that plea is a pretty good one.

They’re deranged, and I mean that in a clinical way. Donald Trump has a way of doing that to Democrats. This derangement is not helping them with voters.

Glenn Beaton practiced law in the federal courts, including the Supreme Court.