Michael O`Halloran, MD, FAAP - American Academy of Pediatrics

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Michael O`Halloran, MD, FAAP - American Academy of Pediatrics
SENIOR BULLETIN
AAP Section for Senior Members
Editor:
Associate Editor:
Advocacy for Children Editors:
Travel & Leisure Editor:
Financial Planning Editor:
Health Maintenance Editor:
Computers Editor:
General Senior Issues Editors:
Outdoors Editor:
Joan Hodgman, MD, FAAP
Arthur Maron, MD, MPA, FAAP
Lucy Crain, MD, MPH, FAAP
Burris Duncan, MD, FAAP
Donald Schiff, MD, FAAP
Herbert Winograd, MD, FAAP
James Reynolds, MD FAAP
Avrum Katcher, MD, FAAP
Jerold Aronson, MD, FAAP
Avrum Katcher, MD, FAAP
Eugene Wynsen, MD, FAAP
John Bolton, MD, FAAP
Vo l u m e 1 7 N o . 1 – W i n t e r 2 0 0 8
Opinions expressed are those of the authors and not necessarily those of the American Academy
of Pediatrics. The recommendations in this publication do not indicate an exclusive course of
treatment or serve as a standard of medical care. Variations, taking into account individual
circumstances, may be appropriate.
Message from the
Chairperson
Avrum L. Katcher, MD, FAAP
Chairperson, Section for Senior Members
Welcome to all members of the Section for Senior
Members. The state of the world, and our health care
system, reminds me of a commentary that appeared
in Lancet, 51 years ago. It went something like this:
“Once upon a time there was a very poor country,
where nobody had enough to eat and the average
expectation of life was 24 years. In another place, a
very rich country, everyone had plenty to eat and the
average expectation of life was 64 years. In this country, people saved extra milk and butter and cream
and eggs and sent them to the very poor country,
where they were distributed, especially to the children, who would otherwise have had none. In this
way the expectation of life in the very poor country
was raised from 24 to 27 years.
Meanwhile the expectation of life in the very rich
country rose too, from 64 up to 67 years. Everyone
who did not die of cancer of the lung from smoking
cigarettes died of cardiovascular disease. Then someone discovered that this was due to eating and drinking too much milk and butter and cream and eggs. So
they stopped eating and drinking milk and butter and
cream and eggs in the rich country, and sent all to the
very poor country. As a result the expectation of life in
the very poor country was raised high enough for
them to start dying of cardiovascular disease so that
they, too, could stop eating and drinking milk and
butter and cream and eggs.”
What’s Inside?
Message from the Chairperson . . . . . . . . . . . 1-2
Executive Committee/Subcommittee Chairs . . . 2
Announcing the 2008 Seniors NCE. . . . . . . . . . 3
2007 SENIOR EDUCATION PROGRAM . . . . . . 3
Michael O’Halloran, MD, FAAP . . . . . . . . . . . . 4
Dr. Silverman Awarded Seidal Career Award. . . 5
Cross-Cultural Solutions . . . . . . . . . . . . . . . . . . 5
The End of the Year and the Battle Goes On . 5-6
2008 Computer Safety Update . . . . . . . . . . . 6-8
Senior Membership Categories . . . . . . . . . . . 8-9
Dr. Anders Receives Child Advocacy Award 10-11
One Fine Golden Ager’s Favorite Things. . . . . 12
ADVOCACY IN ACTION . . . . . . . . . . . . . 13-15
Exploring Remedies for Long-Term Care . . 15-16
Retirement “In Toto” . . . . . . . . . . . . . . . . 16-18
Retirement “In Toto” Part 2 . . . . . . . . . . . 18-19
A woman called a local hospital . . . . . . . . . . . 19
Parenting a Different Paradigm . . . . . . . . . . . 20
TRIPLE BOOK REVIEW . . . . . . . . . . . . . . . 21-22
Promoting the Value of Pediatrics. . . . . . . . . . 22
Reminds me of what I was told years ago, be careful
what you ask for, because it may come with consequences you had not expected.
LUCIANISSIMO AND THE HIGH C . . . . . . 23-24
Well, thus far we have had only positive consequences
Title: Age of Reason . . . . . . . . . . . . . . . . . . . . 24
Editors Note: . . . . . . . . . . . . . . . . . . . . . . . . . 24
Continued on Page 2
Copyright© 2008 American Academy of Pediatrics Section for Senior Members
Executive Committee
Avrum L. Katcher, MD, FAAP
Chair
Flemington, NJ
David Annunziato, MD, FAAP
Immediate Past Chair
East Meadow, NY
Michael O’Halloran, MD, FAAP
Eau Claire, WI
George Cohen, MD, FAAP
Rockville, MD
Lucy Crain, MD, MPH, FAAP
San Francisco, CA
John Bolton, MD, FAAP
Mill Valley, CA
Arthur Maron,
MD, MPA, FAAP
Boca Raton, FL
Subcommittee Chairs
Program
Lucy Crain, MD, FAAP
Financial Planning
James Reynolds, MD, FAAP
Membership
George Cohen, MD, FAAP
History Center/Archives
David Annunziato, MD, FAAP
Newsletter Editor
Joan Hodgman, MD, FAAP
323/226-3400
[email protected]edu
Associate Editor
Arthur Maron, MD, FAAP
561/394-6114
[email protected]
Staff
Jackie Burke,
Sections Manager
800/433-9016, ext. 4759
[email protected]
Tracey Coletta,
Sections Coordinator
800/433-9016, ext. 4926
[email protected]
Mark A. Krajecki,
Pre-Press Production Specialist
847/434-7866
[email protected]
2
Message from the Chairperson Continued from Page 1
from all the hard work our members have contributed. Joan Hodgman
and Arthur Maron continue their wonderful work on the Bulletin, whose
latest issue you are reading. Jerry Aronson has even further expanded our
Web page, where as you probably know there is an enormous amount of
information for Seniors related to many aspects of aging and life, as well
as opportunities to work with the AAP.
We have been very pleased with the responses of the AAP chapters on the
encouragement to form chapter senior committees. Dr. Annunziato and
Jackie Burke have completed a total revision of the splendid Chapter
Guide, to aid Chapters who desire to create or expand such committees.
Your chapter officers and executive directors have copies of the Chapter
Guide. If not, please contact Jackie Burke at the AAP office in Elk Grove
Village, IL, at [email protected] If you have any questions or desire further
advice, contact one or more of the Chapters who have very positive programs. These include: ARIZONA, CALIFORNIA I, DELAWARE, FLORIDA,
IOWA, LOUISIANA, MARYLAND, MISSOURI, NEW MEXICO, NEW YORK
II, SOUTH CAROLINA, TEXAS, VIRGINIA, and WISCONSIN. Other
Chapters are considering establishment of Senior Committees or programs as well.
An even larger group are calling on Senior members to work in the area
of advocacy, often in dealing with legislators and administrators.
Wisconsin has formed a joint venture with the state AARP Chapter, to
work with grandparents who find themselves parenting again, teaching
healthy diets, and offering screening tests. The two groups have also
supported the SCHIP venture.
Our Executive Committee, led by Lucy Crain, Michael O’Halloran and
Jerry Aronson, are working closely with Jackie Burke and Ken Slaw and
his staff at the national AAP headquarters on a strategic planning initiative. What goals should we pursue? What may we realistically be able to
accomplish? What will most benefit children, and simultaneously meet
the needs and wishes of our membership? The Executive Committee
will devote a large proportion of time to this topic at the Spring Meeting
with the data that is being gathered. We had a similar venture a number
of years ago and we hope to progress even further now.
It was noted by the executive committee that AAP membership categories
and options for seniors do not appear to be widely advertised. The feeling is that many seniors are not aware of emeritus and retired membership categories. If you are unsure on this point, suggest you communicate
with Jackie Burke or the membership division at AAP.
The Executive Committee also believes that a major goal for the Section
for Senior Members is to aid our members to “develop” and “grow” well.
The comparability with the role of the pediatrician in child development is not entirely facetious. The life cycle changes through which we
all must progress are similar in principle to those of any other age. We
have the advantage of our training as pediatricians in this area, and of our
life experience. Look on our web page for more information on this topic.
Edward R. Murrow, the broadcaster who brought such vivid images to us
via his nightly radio comments from Britain, would sign off with “Good
night and good luck.” I’d close with “Good health and good luck!”
Avrum L. Katcher, MD, FAAP
Chairperson, Section for Senior Members
American Academy of Pediatrics
Senior Bulletin - AAP Section for Senior Members - Winter 2008
Announcing the 2008 Section for Seniors Education
Program at the NCE in Boston October 11-14, 2008:
Monday, October 13 • 1:30-5:30 pm
CRUCIAL CONSIDERATIONS FOR GRANDPARENTING
• Tax Exempt Investment Options to Assure College Educations for Your Grandchildren: Lorna Meyer,
Senior Vice President, President of Private Banking & Investment Group, Merrill Lynch.
• Foster Parenting & Grandparenting 101: Another Way to Stay Young?: Dr. Errol and Mrs. Judy Alden, Office
of Executive Director, American Academy of Pediatrics.
• Impact of Adult Diet, Health, and Lifestyle on Future Generations: Lisa Hark, Ph.D., R.D., Director,
Nutrition Education Program, University of Pennsylvania School of Medicine.
EDUCATION PROGRAM OF AAP SECTION FOR SENIORS
2007 NCE SAN FRANCISCO
by Lucy S. Crain, MD, MPH, FAAP, Chair, Section Education Committee
More than 60 section members and guests attending the 2007 Section for Seniors CME program, PROMOTING LONGEVITY IN THE ERA OF STEM CELL RESEARCH, submitted very positive evaluations, indicating their
regret that more section members weren’t in attendance at this remarkably informative session. Since our
Section budget does not permit recording the program for others unable to attend, the following is a summary
of this year’s presentations.
• GENES, AGING, & DISEASE: Dale Bredesen, M.D. is Professor of Neurology at the University of California,
San Francisco (UCSF) and President and CEO of the Buck Institute for Age Research in Novato, California.
Dr. Bredesen’s research has revealed alternatives to apoptosis for programmed cell death. He described
studies showing cancer development ensuing as malignant cells fail to commit suicide and explained paraptosis, consisting of complementary pathways providing fail-safe mechanisms to ensure that cell death occurs
when and where required. In addition to his erudite explanations of complex scientific research, he amused
the audience with his description of his laboratory’s creation of transgenic mice, which model Alzheimer’s
disease (or “Mausheimer’s”). This research has demonstrated a single point mutation sufficient to rescue the
major phenotypic abnormalities of synaptic loss, atrophy of dentate gyri, and electrophisiologic abnormalities.
• DIAGNOSIS & TREATMENT OF MEMORY DISORDERS: Bruce Miller, M.D. is Professor of Neurology at UCSF,
where he is Director of the Center on Memory & Aging. Dr. Miller spoke as a clinician and neuro-cognitive
researcher, defining various types of dementias, their diagnosis and treatment options. He spoke of emerging research on apoproteins, which may have clinical applicability for pediatric populations to assist in longterm memory retention. He also reviewed various factors which increase risk for memory loss, including head
injury, cerebrovascular accidents, neoplasms, and advised diet, exercise, and active creative activities, as well
as judicious attention to good health. He reviewed additional research on promising medications for augmenting memory, advising that preventive efforts are at this time more promising than current pharmaceutical options.
• STEM CELL RESEARCH & TECHNOLOGY 101: Martin Pera, Ph.D., is a Research Professor and Director of the
Center for Stem Cell and Regenerative Medicine at Keck School of Medicine at the University of Southern
California in Los Angeles. He presented a superb overview of stem cell research, describing isolation and characterization of pluri-potential stem cells. He hypothesized how stem cell cultures representing different cell
types can be controlled to express different cell types in vitro, and defined possible future clinical applications, predicated by propagation of stem cells on a large scale under defined conditions for large scare
research projects and clinical trials. Noting the numerous practical and ethical questions remaining, he gave
a promising outlook.
Senior Bulletin - AAP Section for Senior Members - Winter 2008
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Michael O’Halloran, MD, FAAP
AAP Section for Senior Members • Executive Committee Member
Five years ago, I retired after 30+
years of practice in front-line general pediatrics for Midelfort
Clinic-Mayo Health System in
Eau Claire, Wisconsin. My retirement found me increasingly
involved with the American
Academy of Pediatrics. I had not
been particularly active in the
academy during my years in practice other than
maintaining my membership. I did, however, strongly
believe in the efforts of the academy directed toward
the education of pediatricians, the support of profession in general, and the Academy’s overriding interest in the welfare of children.
Retirement changed my focus. Beginning with a bit of
a shove from a mentor, Dr. Carl Eisenberg, a recent
past president of the Wisconsin Chapter of the AAP, I
agreed to chair the new senior committee on the
Wisconsin chapter. As a committee chair I was a
member of the chapter executive committee, which
is advisory to the board. Since then I’ve become webmaster for the chapter web site, a situation that I, and
many of my friends, can barely believe. Again with
encouragement from Dr. Eisenberg, I’ve become
interested in our chapter history and have made a
couple of trips to the AAP archives in Elk GroveVillage,
Illinois. I have also become one of the trained oral
interviewers for the AAP. In 2006, I began service to the
academy as a newly elected member of the Executive
Committee of the AAP Section for Senior Members.
I was born, the oldest of six children, to Pat and Ray
O’Halloran and raised in a west Minneapolis suburb.
Sometime in junior high, I decided I’d like to become
a physician and kept at it in spite of some mixed messages from a beloved family doctor. The education
track went from Benilde High School in St. Louis Park,
Minnesota to undergrad at John Carroll University in
Cleveland, Ohio, to Medical school at Creighton
University in Omaha Nebraska, to a rotating internship in Portland Oregon. During medical school, I
met and married Marty. My marriage to her was, and
continues to be, a matter of profound wonder to me.
Then my career was detoured by the doctor draft in
1968. While in the Army, I was initially an artillery
Battalion Surgeon near theVietnam DMZ and then an
emergency room (receiving) physician with the 95th
Evacuation Hospital in Da Nang, Vietnam.
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Finally, then, with my two year obligation with the
Army finished, I began my pediatric residency with
Good Samaritan Hospital and the four hospital residency program in Phoenix, AZ. My wife and I decided
that we were Upper-Midwesterners at heart and we
headed back north with our three children, Teresa,
Patrick and Peggy. I wanted to be part of a multispecialty group practice and found a perfect fit with the
Midelfort Clinic in Eau Claire, Wisconsin, less than 2
hours from the Twin Cities in Minnesota.
I loved my career in general pediatrics at Midelfort
clinic. Other activities during those years included
membership on Midelfort Clinic board of directors;
membership on the first board of directors of the
clinic’s prepaid health plan; teaching responsibilities
with the University of Wisconsin Medical School, the
University of Minnesota Medical School, and the
Pediatric Nurse Practitioner program at the College of
St Catherine in Saint Paul, Minnesota; consultant for
a western Wisconsin head start program; chair of
clinic and hospital pediatric departments; secretary
of our county medical society; and 17 years as medical director of a neurodevelopment evaluation clinic
serving nine counties of northern Wisconsin.
In my hometown of Eau Claire, Wisconsin, I’m still
involved with Luther Hospital, now integrated with
Midelfort Clinic. I’m a member of the Library
Committee, I’m a Physician Adviser for the hospital
coding section of the Medical Records Department
and I’ve organized our retired physicians into a quasiofficial section of our clinic. In the community, I’m on
the board of directors of the local Institute for
Learning in Retirement, responsible for arranging
classes to offer the 500 retired persons on the mailing
list and recently I’m a volunteer for the local hospice
program.
I consider it a privilege to help with the goals of the
AAP Section for Senior Members as a member of the
Board of Directors. I believe these goals to include:
pre-retirement help for soon-to-retire pediatricians,
involvement with the AAP history project, fostering
volunteerism, mentoring pediatricians just starting
practice, assisting the AAP with advocacy, and helping pediatricians stay connected to the AAP as a way
to continue their career-long interest in promoting
the welfare of children.
Senior Bulletin - AAP Section for Senior Members - Winter 2008
Dr. Silverman Awarded Seidal Career Award
The Senior Bulletin is pleased to announce that Dr. Benjamin Silverman MD, FAAP has been awarded the
James Seidel Career Award for Distinguished Service by the Section on Emergency Medicine. The award is
named in honor of Jim Seidel who was an early mover and shaker in the field when there was no organized
Emergency Medicine for Children. We wish to congratulate Dr. Silverman on this prestigious award. Further
details can be found by visiting the Section’s web site.
Cross-Cultural Solutions
Operates volunteer programs around the world in partnership with sustainable community initiatives in
the areas of health, education, and social services. Programs available in 12 countries with start dates
offered year-round and lengths of stay from 1-12 weeks. We are an international not-for-profit organization
with no political or religious affiliations. See our website for more information.
I checked the Cross-Cultural Solutions web site and it appears like a very good group. I didn’t see anything
in the site saying a physician would have a role as a physician so I emailed them. I found out they do in fact
have a some opportunities for hands on medical care and some others in health education. Even without
those things, I suspect it will be of interest to some of our members for non-medical jobs.
Michael O’Halloran, MD, FAAP
The End of the Year and the Battle Goes On
by Donald Schiff, MD, FAAP
As the tiresome campaigns for the
nominations of the major political parties for President continues, the nation limps along with a
growing frustration among child
advocates who had hoped that
2007 would be a year of progress.
The attempt by the majority party
in Congress to improve the SCHIP program and reduce the
number of uninsured children
went down to defeat by a combination of repeated Presidential
vetoes and filibusters in the
Senate. The S-CHIP will probably
survive in a depleted state by
means of funding through continuing resolutions. AAP leaders hope
that a new administration and
new Congress in 2009 will appreciate the critical importance of having all of our nation’s children have
quality health insurance and the
need to restructure the program
to provide insurance for an additional four million currently unin-
sured children.
S-CHIP is only one of the federal
programs affecting children currently in danger of losing funds
and thereby providing fewer services to children. The Supplemental Nutrition program for
Women and Children ( WIC),
which since 1974 has been providing valuable nutritional services
to mothers and children, is being
revised. Some of the recommended changes appear to be
advantageous, with improved
availability of fruits, vegetables
and whole grains, but just as SCHIP was caught in the contentious budget negotiations, WIC
is also facing, according to an
analysis by the Center on Budget
Policy and Priorities, a reduction
in the number of children served
by this program by 500,000, if the
administration’s budget proposals
are adopted. WIC, which has
enjoyed bipartisan support previ-
Senior Bulletin - AAP Section for Senior Members - Winter 2008
ously and served 8.2 million poor
people in 2007, has been acclaimed as improving health and
nutrition programs and reducing
the number of low birth weight
infants. Its future rests in the
hands of the Administration and
the Senate.
A review of health care reforms frequently is referenced back to the
1930’s and the feeble efforts of
FDR and Harry Truman. Most
readers are surprised to find that
Richard Nixon in 1971, in order to
forestall a single payer national
health insurance program, proposed a mandate which would
require all employers to cover their
workers with a Medicaid type program which all Americans could
join by paying a sliding scale premium based upon income.
More recently, many states unwilling to wait for a comprehensive
Continued on Page 6
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The End of the Year and the Battle Goes On Continued from Page 5
national program, have attempted
to produce a statewide plan,
which would not only serve their
state, but also serve as a potential
model for a future national plan.
Massachusetts has tried twice
in 1988 and 2006, Minnesota,
Tennessee, Vermont and Washington have created statewide
plans which have been unable to
significantly reduce their number
of uninsured, and the national
total has increased to over 47
million.
In 2008, we can anticipate health
care reform to become one of the
major issues of discourse between
the candidates and the voters. The
Democratic proposals for changing the tax structure to pay for
health care for the currently uninsured is certain to be met with a
massive effort to counter any such
restructure.
The National Federation of Independent Business, a powerful
opponent of any health insurance
mandate for small business, has
again restated their strong opposition to any employer mandate in
any future health care legislation.
The possibility of a new alignment
of administration and Congress in
2009 provides hope that the lack of
progress in securing health insurance for all of our children can
end, and that we can finally
achieve that goal, which will certainly make us a stronger as well as
healthier nation.
Powerful efforts by pediatricians
in coalition with the other child
advocates will be needed to
succeed. This is our shared responsibility.
Please contact me with
your thoughts and ideas at
[email protected]
2008 Computer Safety Update
by Jerald Aronson, MD, FAAP
Preventive care applies to your computer, as well as
yourself. As you immunize yourself against preventable infections, immunize and protect your computer
from virus and “trojan horse” infections. Failure to
do so may cause you significant time and money to
repair your PC, and subject you to a significant loss of
data that you may not be able to replace.
A computer virus is a program designed to infect executable files or the system areas of hard and floppy
disks, and then make copies and spread itself.
Executable files are the software applications that run
your program applications, e.g. word-processing, web
surfing, etc. Viruses usually operate without the
knowledge or desire of the computer user.
Viruses have the potential to infect any type of executable code, not just the files that are commonly
called ‘program files’. For example, some viruses infect
executable code in the boot sector of your computer
hard drive. Another type of virus, known as a ‘macro’
virus, can infect word processing (e.g. WORD) and
spreadsheet (EXCEL) documents that use macros
(templates). It’s also possible for HTML (common
web files) documents containing JavaScript often
downloaded from the Internet to contain and spread
viruses or other malicious code. Sharing an infected
file with another PC can infect the other computer.
Thus, in addition to primary protection of your computer with anti-virus software (more on this later), it
is a good idea to run an antivirus scan of a disk that
you receive from someone else before running any
programs or accessing any files on that disk.
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Remember, simply downloading a file to your computer won’t activate a virus or Trojan horse. You have
to execute the hidden code in the file to trigger it.
This could mean running a program file, or opening
a Word/Excel document in a program (such as Word
or Excel) that can execute any macros in the document. We’ll discuss virus and Trojan horse prevention strategies later.
Usually, your data files are safe from virus and Trojan
horse infection. Data files are the specific files that
store the information generated by your use of application programs, e.g. word processing, picture editing, etc. Data files include graphics and sound files
such as .gif, .jpg, .mp3, .wav, etc., as well as plain text
in .txt files. For example, just viewing picture files
won’t infect your computer with a virus. The virus
code has to be in a form, such as an .exe program file
or a Word .doc file that the computer will actually try
to execute.
A Trojan Horse is different. It is a destructive program
that masquerades as a benign application. Unlike
viruses, Trojan horses do not replicate themselves but
they can be just as destructive. One of the most insidious types of Trojan horse is a program that claims to
rid your computer of viruses but instead introduces
viruses onto your computer.
Trojan horses place your computer at risk and can do
significant damage. For example, Trojan Horse programs can:
Continued on Page 7
Senior Bulletin - AAP Section for Senior Members - Winter 2008
2008 Computer Safety Update Continued from Page 6
• Provide the attacker with complete control of the
victim’s system. Attackers usually hide these Trojan
horses in games and other small programs that
unsuspecting users then execute on their PCs.
• Provide the attacker with sensitive data such as
passwords, credit card information, log files, e-mail
address or Instant Messenger (IM) contact lists
and/or install a key logger that will send all recorded
keystrokes back to the attacker stealing private, confidential information like financial information and
passwords.
• Destroy and delete files,
• Use your computer as a proxy server or by allowing
an attacker to connect to your computer. This gives
the attacker the opportunity to do everything from
your computer, including the possibility of conducting credit card fraud and other illegal activities,
or even to use your system to launch malicious
attacks against other networks.
• Stop or kill security programs such as an antivirus
program or firewall without the user knowing.
• Attack a network to bring the network to its knees
by flooding it with useless traffic. This is called a
“denial of service” attack.
What should you do if you think that your PC is
“infected”?
Remember, just because your computer is acting
strangely or one of your programs doesn’t work right,
this does NOT mean that your computer has a virus.
If you haven’t used a good, up-to-date anti-virus program on your computer, do that first. Many problems
blamed on viruses are actually caused by software
configuration errors or other problems that have
nothing to do with a virus.
1. Go online and download Updates to the anti-virus
program that is on your PC. In general, the antivirus software companies update their software
very quickly to publicly known dissemination of
virus threats.
2. Physically disconnect (remove the cable or telephone line) your computer from the Internet.
Depending upon what type of virus or Trojan Horse
your computer has, intruders may have access to
your personal information or be using your PC to
communicate with others. Disconnecting the PC
from the Internet will prevent this from happening.
3. Run your updated anti-virus software!
4. If you do NOT have anti-virus software installed, go
out and buy a program, immediately. Install it from
the CD and Scan your computer prior to installing
the software.
5. Back up your important files. Place all of your picSenior Bulletin - AAP Section for Senior Members - Winter 2008
tures, documents, email address books, financial
files on an external device (portable hard drive) or
CD. NOTE – you should run new anti-virus software on these files before using them again. They
should not be trusted since they are potentially
infected.
6. If the previous steps failed to clean up your computer, consider getting professional, technical help
at a computer store, e.g. Best Buy, Circuit City. They
may have software and techniques available that
will work and prevent the next step from being
necessary.
7. Reformat your hard drive and reinstall your operating system. Note – this will result in the loss of all
of your programs and files! It is important that you
have the original Install discs for the software that
you will need to re-install.
a. Re-install your anti-virus software and other
programs
b. Scan the discs containing your back-ups. If
clean, then restore to the hard drive of your PC.
More importantly, protect your computer and
prevent infections in the first place!
• Install anti-virus software from a well-known, reputable company,
• Select the Auto-Update feature as you install the
software and allow the anti-virus software to
UPDATE regularly.
• USE anti-virus software regularly. Set the anti-virus
Scheduling function to routinely scan your PC. I
allow my software to automatically scan my PC each
night. Once per week is a common default in antivirus software.
• Use the anti-virus software Default settings unless
you have a good reason to not do so. The default setting will usually maximally protect your system. For
example, it will set your PC to Scan on bootup, autoscan all executable program files, scan incoming
and out-going email, etc. Unfortunately, depending
upon the speed of your PC, the use of default settings may slow things down a bit.
• Use an Internet firewall.Windows XP SP2 andVISTA
have one built in. However, you must assure that it
is turned on. From the Start Menu, Select Control
Panel, and View the Security Center Firewall setting. Assure that it is on. To view a demo of the way
to set up your Windows XP firewall, click on the following: Window’s XP http://security.getnetwise.
org/tools/firewallxp-instruct. This video tutorial
shows you how to enable the firewall option built
into the Microsoft XP operating system.
Continued on Page 8
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2008 Computer Safety Update Continued from Page 7
• Some purchased programs provide many different
types of protection, including Firewall protection.
You still need to assure that the default setting of ON
is actually in place.
• Set your Windows Operating System to AutoUpdate. Microsoft regularly identifies hacker
“holes” and security vulnerabilities in its software
protection. Auto-Update will assure that you maintain your Operating System and/or other Microsoft
products in the most up-to-date configuration to
protect your computer.
• Do Not open documents or attachments from an
email unless you can positively verify what it is,
whom it came from, and why it was sent to you.
• Do NOT follow unsolicited links in emails or
unknown web pages. Intruders may be “phishing”
for your data or access to your computer.
• Use “Strong” passwords to protect your personal
information. Tips for a “Strong” password are:
• Using passwords that have at least eight characters and include numerals and symbols.
• Avoiding common words: some hackers use programs that can try every word in the dictionary.
• Not using your personal information, your login
name, or adjacent keys on the keyboard as passwords.
• Change your passwords and/or PINs regularly (at
minimum, every 90 days) and keep them in a secure
place out of plain view. Don’t share your passwords
on the Internet, over email, or on the phone.
Remember, reputable merchants, banks, and
Internet Service Providers will not ask you for your
Social Security number or other identifying information to prevent identify fraud preferring to rely
on “Strong” passwords to protect your account.
• Using a different password for each online account
you access (or at least a variety of passwords with
difficulty based on the value of the information contained in each.
• Avoid online CHAT rooms! They may provide you
with some nasty surprises.
• Backup, Backup, Backup your system regularly. If
your PC becomes infected, a recent backup may be
the only way to re-create your archived data files.
For additional information, please read the Computer
Security article in the Senior Bulletin Fall 2005 edition
at www.aap.org/seniors under Senior Bulletin. For
additional questions and comments, please email me
at [email protected]
Membership Categories for Retired and Senior AAP Members
by Michael O’Halloran, MD, FAAP
Many pediatricians are unaware that, in addition to the membership category of “Fellow”, “Specialty Fellow”,
etc., there are two other categories of membership designed especially for retired pediatricians and senior pediatricians. The idea is to make it easy for us to stay connected to the AAP as a way for us to continue our lifelong interest in the welfare of children. And, not incidentally, our academy needs us. The two categories
created to accomplish this are “Retired Fellow” and “Emeritus Fellow”. Both categories involve a decrease in
dues and they both have some conditions, which need to be met to qualify.
The Retired Fellow category requires that a fellow, specialty fellow, dual fellow, or corresponding fellow must
be at least fifty five years old, must have been an AAP member for 5 years or more, and must no longer derive
income from professional activities. Retired Fellows may not hold national AAP office. The dues for this category, as of this writing (December 2007) are $176, a considerable savings. One can add a subscription to
Pediatrics for an additional $68.
The Emeritus Fellow category requires that a fellow, specialty fellow, dual fellow, or corresponding fellow must
be at least 65 years of age and have been an AAP member for 30 years or more. Emeritus Fellows may not hold
national AAP office. One need not be retired for this category. The dues for this category are $63. One can also
add a subscription to Pediatrics for an additional $68.
If you believe you are eligible to take advantage of either of these membership categories, please call AAP
Member Services at 800/ 433-9016 x. 5897.
The following are lists of the privileges and benefits associated with belonging to either of these categories.
Continued on Page 9
8
Senior Bulletin - AAP Section for Senior Members - Winter 2008
Membership Categories for Retired and Senior AAP Members Continued from Page 8
Retired Fellow
Privileges:
• Vote in National Elections
• Use of “FAAP” Designation
• Serve on Committees
• Section Membership
• Chapter Membership
• Listing in AAP Online Membership Directory
Benefits:
• Pediatrics subscription at the discounted member price - optional
• AAP News subscription
• Red Book™ 2006: Report of the Committee on Infectious Diseases
• Access to Members Center, PediaLink.org™, and PedJobs
• A copy of select AAP manuals and samples of patient literature†
• Discount member pricing on publications, subscriptions, CME courses including the National Conference
& Exhibition
• Pediatric Insurance Consultants (PIC), Inc Group Insurance Plans
• GEICO Auto Insurance
• Bank of America WorldPoints credit card
• Annual Report
• Hertz Car Rental Discounts
• ResX.com, internet based travel booking engine
Emeritus Fellow
Privileges:
• Vote in National Elections
• Use of “FAAP” Designation
• Serve on Committees
• Section Membership
• Chapter Membership
• Listing in AAP Online Membership Directory
Benefits:
• Pediatrics subscription at the discounted member price - optional
• AAP News subscription
• Red Book™ 2006: Report of the Committee on Infectious Diseases
• Access to Members Center, PediaLink.org™, and PedJobs
• A copy of select AAP manuals and samples of patient literature†
• Discount member pricing on publications, subscriptions, CME courses including the National Conference
& Exhibition
• Pediatric Insurance Consultants (PIC), Inc Group Insurance Plans
• GEICO Auto Insurance
• Bank of America WorldPoints credit card
• Annual Report
• Hertz Car Rental Discounts
• ResX.com, internet based travel booking engine
Senior Bulletin - AAP Section for Senior Members - Winter 2008
9
Dr. Anders Receives Child Advocacy Award
The following is the acceptance speech given from Dr.
Bronwen J. Anders, MD, FAAP, Child Advocacy Award
recipient:
I am deeply honored and touched by this advocacy
award from the Seniors Section. I believe my
California Chapter 3 nominated me (perhaps because
I am the only old foguey of the group), but to have
been chosen by you is indeed flattering. We do what
we like doing in our little corners of the world and are
very pleased when our work is recognized and
deemed important.
Advocacy means many things to many people and
different frameworks have been devised to attempt to
understand better the concept. Dr. Judy Palfrey in
her new book, Child Health in America; Making a
Difference through Advocacy, describes; 4 types of
advocacy clinical, group, legislative, and professional.
I am going to choose a framework which moves from
championing individual patients to gradually include
all the children of the world. Looking back over my
career, this has been the path I myself have followed.
I believe all pediatricians know how to advocate for
individual patients, children and adolescents, in their
offices. They help to interpret results from hazy lab or
x-ray reports. They demand sooner appointments
from specialists who state the first available opening
is 6 months hence. They work out ways to achieve
confidentiality with teens and encourage them to discuss their issues with their parents. They might even
know how to direct patients to cost effective ways to
get medicines, and to access health insurance if they
have none.
The next step is learning how to advocate for support
for families. This facility comes with time and familiarity with resources available outside the office. This
might involve knowing about support groups for families with a new baby with Down’s syndrome or parents of a newly diagnosed child with cancer or even
ADHD. It might mean trying to refer single parents up
to resources for childcare, or helping homeless families to look for opportunities. The ability to provide
“family-centered care” has taken on a life of its own,
with models that work and resources. The Medical
Home model described and then institutionalized by
Dr. Cal Sia, includes incorporating parents as partners
in the therapeutic programs planned especially for
Children with Special Health Care needs. The powerful political role of Family Voices is a reflection of this
growing awareness as families have joined together
with their pediatricians to advocate for their children
The science of community pediatrics along with the
AAP policy paper for all of us in this new role has only
10
Shown are: Advocacy for Children Editor, Lucy Crain,
MD, MPH, FAAP alongside Advocacy Award recipient,
Bronwen J. Anders, MD, FAAP.
evolved in the past decade. Collaborating with other
community members to define barriers to access and
equity deficiencies for ALL children is a relatively new
phenomenon. Understanding that teachers, school
nurses, after-hours programs, Park and Recs officials,
and even businesses can be our partners in the effort
leading to healthier children, has greatly enhanced
our work advocating for children at the community
level.
John McNights book, Building Communities from the
Inside Out, defined the new paradigm of asset based
community mapping, or ABCD. This emphasizes the
hidden strengths of a community as opposed to the
old and depressing method of needs assessments. He
furthermore had the insight to look for informal associations and their members as partners in improving
children’s health, in contrast to the more traditional
institutions such as schools and health departments.
An important development in community pediatrics
for me was the introduction of the CATCH program.
This 12 year old program has helped pediatricians to
find a fellowship of like-minded colleagues, looking
to step outside of their offices and collaborate with
community members and organizations, and to gain
funding to build programs that enhance the health of
children. With just 10,000 dollars of seed money more
than 900 pediatricians have been helped to develop
programs for children. Dr. John Duffee of Springfield,
Ohio has recently taken a 7,000 dollar CATCH grant
Continued on Page 11
Senior Bulletin - AAP Section for Senior Members - Winter 2008
Dr. Anders receives Child Advocacy Award Continued from Page 10
and leveraged it into a 3 million dollar operation,
increasing access to care for low-income children and
their families in his neighborhood. Out of a small
coalition of activists including the mayor, a local minister and Dr. Duffee a center of excellence was built in
the southern poor area of the city.
I personally am very grateful to Dr. Ed Rushton, who
was the first director of the CATCH program, and who
mentored me into early CATCH work. I wrote the first
funded CATCH grant to establish a Pediatric
Tuberculosis Task Force to ensure that all children
with TB infection and disease in San Diego County
had access to quality diagnosis and medication
throughout their treatment. This was written on a
napkin in one of the early CATCH meetings as Dr.
Rushton was describing the new program, designed
to be easy for busy pediatricians. This resulted in a
collaboration between the Health Department,
Children’s Hospital, San Diego City Schools and
UCSD, which is still going strong.We also collaborated
with pediatricians in Tijuana to share insights into
keeping continuity for those children living on both
sides of the border. Dr. Tom Tonniges took over from
Ed Rushton and went on to greatly enhance support
for the CATCH program. It is fitting that Ed’s son,
Francis Rushton is the current director of the Council
on Community Pediatrics.
Legislative advocacy is a step which doesn’t come
naturally to many shy pediatricians. I have been
greatly supported in efforts to learn legislative advocacy from the quality staffs of the Academy’s Chicago
and Washington offices. Both of these offices, in addition to our California district staff have done a formidable job of helping us to know about important
legislation affecting children and giving us effective
methods to carry our messages to legislators. I have
been to Washington and to Sacramento several times
to learn about legislative advocacy. We have learned
how to teach advocacy to residents in training, in person with legislators or perhaps more practically at
home from their computers.
Anne E. Dyson was a pediatrician who understood the
importance of the CATCH program for pediatricians
and had a vision of innovative ways of teaching child
advocacy to residents. Out of this was born the Dyson
Initiative. We at UCSD were one of the fortunate first
10 sites to be funded in this effort. My ability to continue teaching residents in underserved multicultural
sites on both sides of the US-Mexico border was
greatly facilitated because of this initiative. Once
again we had partners across the other Dyson sites
defining the community pediatrics curriculum for
residents, including advocacy at all levels.
Senior Bulletin - AAP Section for Senior Members - Winter 2008
And now, as I finally try to free myself up from clinical responsibilities there is the allure of International
Child Health. This is the next logical step from community pediatrics, looking towards the health of ALL
children and seeing our community as the world.
We have had a work collaborative called the Equity
group consisting of pediatricians from Great Britain
and the US, in which we have sought ways to teach
and implement the Convention of the Rights of the
Child in our pediatric practices. This relevant document, setting standards of rights for all the world’s
children has been largely ignored in our country and
we are the only country who has not ratified it. The
British pediatricians see such problems as globalization, pollution, international trafficking of children as
being challenges which we have to begin to deal with,
having direct effects on children’s health.
The Tsunami and its devastating loss of lives, homes,
and communities galvanized many pediatricians for
humanitarian work. I was struck with the difficulties
many had finding the right niche to be successful.
Like many other chapters we have begun a committee to help colleagues and residents to prepare themselves for this kind of work and to know the
organizations and funding sources for such work.
Pediatricians and residents need to learn skill sets for
humanitarian work and to know about opportunities for work abroad. Many residency programs are
developing global health curricula.
The Section on International Child Health (SOICH)
provides a wonderful fellowship of pediatricians
around the world, interested in sharing research, and
success stories, and implementing the Convention
of the Rights of the Child. The newest program is ICATCH, which has just funded its first 4 programs in
Pakistan, Uganda, the Philippines and El Salvador.
And perhaps as we retire from regular clinical work
(always with regrets, since taking care of individual
children is what we are all about), we can begin to
advocate for ourselves, and if we are lucky to appreciate our marital partners of many years, our children and grandchildren. Some of the programs which
we have been involved in will be carried on by
inspired residents or younger colleagues. Others will
have failed to have devoted successors.
We, on the other hand can now:
• Enjoy a Tuesday midday nap without guilt.
• Spend an hour getting fleeting smiles out of a
newborn grandchild.
• Watch sandhill cranes do their mating dance.
11
One Fine Golden Ager’s Favorite Things
To commemorate her 69th birthday on October 1, 2007 actress/vocalist, Julie Andrews made a special appearance at Manhattan’s Radio City Music Hall for the benefit of the AARP. One of the musical numbers she performed was ‘My Favorite Things’ from the legendary movie ‘Sound Of Music.’ Here are the lyrics she used:
Maalox and nose drops and needles for knitting,
Walkers and handrails and new dental fittings,
Bundles of magazines tied up in string,
These are a few of my favorite things.
Cadillac’s and cataracts, hearing aids and glasses,
Polident and Fixodent and false teeth in glasses,
Pacemakers, golf carts and porches with swings,
These are a few of my favorite things.
When the pipes leak, when the bones creak, when the knees go bad,
I simply remember my favorite things, and then I don’t feel so bad.
Hot tea and crumpets and corn pads for bunions,
No spicy hot food or food cooked with onions,
Bathrobes and heating pads and hot meals they bring,
These are a few of my favorite things.
Back pains, confused brains, and no need for “sinnin”,
Thin bones and fractures and hair that is thinnin’,
And we won’t mention our short, shrunken frames,
When we remember our favorite things.
When the joints ache, when the hips break, when the eyes grow dim,
Then I remember the great life I’ve had, and then I don’t feel so bad.
Ms. Andrews received a standing ovation from the crowd that lasted over four minutes and repeated encores. Ms.
Andrews’ clever wit and humor strikes a strong chord with all of us.
“Nor will we proceed with force against him, or send others to do so, except by the lawful
judgment of his equal, or by the law of the land....
To no one will we sell, to no one deny or delay right of justice.”
From: Letter Patent of King John, in Latin, at Runnymede, 15 June 1215.
From: Cotten Manuscript in British Library, London.
One wonders, if the Brits could do this almost 900 years ago, why we cannot do this in the
United States of America today.
Avrum L. Katcher, MD, FAAP
12
Senior Bulletin - AAP Section for Senior Members - Winter 2008
Lucy Crain’s Note:
Ann Parker, MD, FAAP is a developmental and behavioral pediatrician in private practice in Berkeley, CA. In addition to a busy practice working with patients with learning disabilities, developmental disabilities, and behavioral issues, she has become an expert on infant deafness and severe hearing loss in childhood. She demonstrates
advocacy in action and is a real champion for children with hearing impairment, caring for as well as teaching
about this little appreciated area of disability for which so many recent advances make all the difference in lives
of young children diagnosed early.
ADVOCACY IN ACTION
by Ann Parker, MD, FAAP, Berkeley, CA
Regarding my becoming involved
in advocacy for children with deafness, my interest came from caring for patients. As an ambulatory
pediatrician, I was haunted by the
fear of having a deaf child go
unnoticed in my practice. It is estimated that pediatricians encounter approximately a dozen
children with severe hearing
impairments over the course of
their practice lifetime. During the
period in which I practiced general pediatrics (1976-1994), deafness in children was on the
average not detected until three
years of age. Thus, children were
not being identified or receiving
interventions until long after early
formative stages of language
development.
A long-time interest in neuroscience and child development
and in the stories of others drew
me to pediatrics. Eventually, the
concerns of the families of
children with developmental disabilities drew me to neurodevelopmental and behavioral
pediatrics. Working with children
with developmental differences, I
was impressed by the number of
youngsters presenting with identified and unidentified hearing loss.
My awareness of the need to monitor for deafness throughout childhood developed when, following a
mild case of chickenpox, one of
my pediatric patients developed a
permanent and disabling profound unilateral hearing loss. A
growing interest in deafness and
the awe and respect I had for the
deaf youngsters I was encountering led to my visiting The Center
for the Education of the Infant
Deaf (CEID), a place I passed daily
on my way to work. I stopped in to
see what was happening at CEID
in the early 1990s and have been
visiting regularly and advocating
for toddlers and preschool children ever since. CEID is an early
intervention program for hearingimpaired children. Early intervention services provided to
youngsters and their families
include: identifying deafness, parent support and education including sign language classes, a home
visitation program for deaf and
multiply handicapped infants and
preschool children and an active
total communication toddler and
preschool program for deaf children associated with an onsite
mainstream daycare program.
Acting as medical consultant for
CEID allowed me to get to know
these remarkable children directly
and to learn of the courage and
concerns of their families. In the
1990s family after family presented with a heart-wrenching
story about how their child’s deafness was detected or rather “went
undetected”. In most cases, parents suspected deafness long
before professionals and fought to
be heard and have their concerns
validated. Some were told their
children had “selective deafness”,
a phrase invented to suggest that
their children consistently chose
not to hear loud noises such as the
banging of a hammer or the slam-
Senior Bulletin - AAP Section for Senior Members - Winter 2008
ming of an elevator door. Some
were told that their children must
be hearing because they were babbling at 6-9 months of age – something we know all children do
whether or not they are hearingimpaired. And some were told that
there was little to be done before
the age at which most children
begin to talk, thus just be patient.
The parents I met were determined to hear something else
from their pediatricians, such as,
“Let’s check hearing and if appropriate let’s intervene”. Many parents of syndromic children with
genetic conditions associated with
deafness or parents of ICN graduates who had taken antibiotics or
undergone ECMO also felt ignored
when they voiced their concerns.
The parents I met were my inspiration. I began talking with
colleagues, with residents and
with community leaders who
expressed an interest in issues
related to children. Each time I
mentioned that age three was the
average age at which a deaf child
was identified I began to realize
that I was part of the problem. I
was accepting the statistic but not
advocating for change. Change
through developing, monitoring
and funding early screening and
diagnostic programs, change
through early intervention programs, change through change
through education and through
legislation.
My career in pediatrics has correContinued on Page 14
13
ADVOCACY IN ACTION Continued from Page 13
sponded to a period during which
the fields of neuroscience, genetics and development have blossomed. This has heightened our
awareness of children with neurosensory and neurodevelopmental deficits and our ability to
effectively intervene in their lives.
It is currently estimated that 50
percent of children with deafness
have a genetic condition and of
those children 30% demonstrate
a syndromic condition – a tip off
when looking for deafness.
However, 70% do not present with
currently identified syndromic
features and thus a high level of
suspicion and a commitment to
universal newborn hearing
screening is needed to pick up
their deafness. 50% of deafness in
children appears related to environmental factors which again
points to the need for a high level
of suspicion early and as well as
ongoing screening for progressive
deafness.
There have been significant
advances in identifying, tracking,
and supporting deaf youngsters
since the early 1990s, when Hawaii
and Rhode Island were the only
states with legislation regarding
early hearing detection and intervention programs. In 1993, fewer
than 5% of all infants were
screened for hearing loss prior to
hospital discharge. Currently
approximately 68% of all infants
born in the United States are
screened. Certainly progress but
still far below true universal
screening. Though there was initially significant resistance to
embracing the idea of newborn
hearing screening programs, currently 42 states and the District of
Columbia have legislated though
not necessarily mandated or
funded, newborn screening and
intervention programs.
14
Most state programs were established after the federal Newborn
Hearing Screening and Intervention Act was signed into law in
1999 which granted three years of
funding to states for development
of screening and intervention programs. The AAP 1999 policy statement Early Identification of
Hearing Impairment in Infants
and Young Children furthered the
cause and the position statement
by the National Joint Committee
on Hearing in the year 2000
expanded the concept of hearing
screening to include “ early hearing detection and intervention”
(EHDI) through integrated and
family centered interventions.
Recommendations included 1)
screening all newborns not merely
those identified as high risk
infants which would only identify
50% of infants born with significant hearing loss 2) a specific
schedule for screening, assessment, and intervention including
family support in a timely fashion
before 6 months of age 3) periodic
monitoring of infants passing
newborn screening but demonstrating risks for unilateral or bilateral hearing impairment.
This commitment to early detection of deafness and early intervention has resulted in a drop in
the age at which children with significant hearing loss are identified,
a drop from 30 to about 12 months
of age. The significance of early
intervention, education and support is no longer in question and
great technological advances are
being made. Infants as young as a
month of age are being identified,
fitted with effective hearing aids
and receiving early intervention
services. Advances in the technology and procedures for cochlear
implantation and an increasing
understanding of the risks and
benefits of cochlear implants and
the training and support required
to benefit from implantation
has increased the number of
children regarded as candidates
for implantation and decreased
the age recommended for
implantation.
Progress has certainly been made;
however, many of our children are
still not being identified or served.
Of the 30 plus infants born daily
with significant hearing loss,
many are not being screened and
many who are screened are at risk
of not being tracked, monitored
or provided with beneficial interventions. In many states the term
“universal”? is a misnomer. When
I ask pediatric residents what percent of newborns in California are
screened for hearing I see looks of
confusion and hear grunts of
disbelief when I reveal that our
universal newborn screening program merely requires screening of
the 70% of children born in acute
care hospitals receiving CCS
(California Children’s Services or
Title V ) funding in California.
Though a majority of states have
legislation recommending or
mandating early hearing screening programs, funding for these
programs is mandated in only
thirteen states and the District of
Columbia. Insurance companies
generally have an option as to
whether or not newborn hearing
screening is a covered benefit and
parents can decline screening for
financial, religious or cultural reasons even when hospitals are
mandated to screen. Tracking and
monitoring systems are still inadequate in many states. Many families do not have access to hearing
aids due to lack of funding from
state agencies or private insurance
companies. Though the effectiveness of early intervention programs has become clear, many
Continued on Page 15
Senior Bulletin - AAP Section for Senior Members - Winter 2008
ADVOCACY IN ACTION Continued from Page 14
professionals and families are not
adequately aware of local early
intervention programs for deaf
children or how they might access
appropriate services through a
child’s Individualized Family
Service Plan (IFEP) as outlined in
part C of IDEA. Further advocacy
and education is needed to
address these issues.
With an increasing recognition of
the prevalence of progressive and
late onset hearing loss and the significance of unilateral hearing loss
it has become clear that advocacy
for ongoing hearing screening and
intervention programs throughout childhood must become a priority. It is necessary to guard the
gains that have been made and to
advocate for interventions that
truly benefit our children and our
society. Through advocacy, I
believe we are honoring and acting upon the trust placed in us by
our patients.
References:
1. Pediatric Resource Guide to Infant and Childhood Hearing Loss 2nd Edition
CEID, 1035 Grayson St. Berkeley, CA 94710. www.ceid.org.
2. Health Resources and Services Administration, U.S. Department of health
and Human Services National Conference of State Legislatures report: updated
May 2007.
3. National Assessment for Hearing Assessment and Management Utah State
University. www.infanthearing.org/research/summary/accuracy.html.
4. American Academy of Pediatrics: www.aap.org.
Exploring Remedies for Long-Term Care
by Joel M. Blau, CFP™ and Ronald J. Paprocki, JD, CFP™
MEDIQUS Asset Advisors, Inc.
“Results. One client at a time.”(sm)
Long-term care (LTC) issues are becoming an even
greater part of physicians’ risk management plans.
As more and more baby boomers approach retirement age, concerns about their own potential disability and illness as well as that of their elderly
parents have taken center stage.
The need for long-term care is generally defined by an
individual’s inability to perform the most basic activities of daily living (ADL) such as bathing, dressing,
eating, toileting, continence and generally moving
around. There are many ways to pay long-term care
costs, the simplest being payment “out of pocket”.
Unfortunately, with long-term care costs dramatically on the rise, the economic burden of paying for
long-term care expenses on an out of pocket basis
may be devastating.
To further complicate matters, governmental
resources such as Medicare and Medicaid may not be
sufficient for most physicians. A limited amount of
nursing home care or home health care is available for
those over age 65 under Medicare Part A Hospital
Insurance. Medicaid is a welfare program designed to
provide health care for the truly impoverished. Many
have tried to qualify for Medicaid by gifting or otherwise disposing of assets, a strategy known as the
“Medicaid spend down”. However, legislation such as
the Omnibus Budget Reconciliation Act of 1993 and
the Deficit Reduction Act of 2005 have imposed
restrictions that severely limit its use.
Senior Bulletin - AAP Section for Senior Members - Winter 2008
The remaining options for coverage of long-term care
costs include utilizing a reverse mortgage on a home,
using an “accelerated death benefit” within a life
insurance policy (if available), limited coverage
through private health insurance, or shifting the risk
to a private insurance company via the purchase of a
long-term care insurance policy. Long-term care
insurance is designed to pay for long-term care services at home or in an institution, either skilled or
unskilled, with benefits varying greatly among the
different major carriers.
The decision to purchase LTC insurance generally
must be made while you are still healthy. When shopping for a policy, be sure that you are familiar with the
common elements within most policies as well as the
differences of these provisions when comparing
policies and companies:
1. Amount of benefit: Most policies pay a fixed dollar amount for each day you are eligible for the
benefit, such as $200 per day.
2. Inflation protection: Since health care costs are
increasing, a policy without a provision for inflation
may be inadequate over the long term.
3. Guaranteed renewability: Similar to disability
insurance, almost all long-term care policies available in the insurance marketplace are guaranteed
renewable, meaning that the policy can not be canContinued on Page 16
15
Exploring Remedies for Long-Term Care Continued from Page 15
celed as long as you pay the premiums on time, and
as long as you were truthful when completing the
application. Keep in mind, however, that just
because a policy is guaranteed renewable does not
mean the premium cannot be increased. Most
insurers reserve the right to raise premiums for an
entire class or group of policyholders.
4. Place of care: It is important to know if the policy
requires that a nursing home be licensed or certified by the state to provide skilled or intermediate
nursing home care. Additionally, many long-term
care policies can provide coverage in the insured’s
home. If home health care is not covered in the
policy, it may be available as a rider, for an additional premium cost. The insurance company will
reimburse the cost of long-term care received at
home based on certain limitations.
5. Level of care: “Skilled care” refers to daily nursing
and rehabilitation care under the supervision of
skilled medical personnel. “Intermediate care” is
the same as skilled care, except that it requires only
intermittent or occasional nursing and rehabilitative care. “Custodial care” deals with assisting with
one’s daily activities, including eating, bathing,
dressing, toileting, etc. Typically persons assisting
the insured do not need to be medically skilled,
but the care is usually based upon the physician’s
certification that such care is needed.
These are just some of the many factors to consider
when implementing a long-term care insurance program. As is the case with other types of insurance,
policy features must be compared and weighed.
Typically, the more benefits included in the policy,
the higher the premium.
Mr. Blau welcomes readers’ questions. He can be
reached at 800-883-8555 or at [email protected]
Securities offered through Joel M. Blau, CFP, a registered representative of
Waterstone Financial Group, Member NASD/SIPC. Waterstone Financial Group and MEDIQUS Asset Advisors, Inc.
are independently owned and operated.
The opinions expressed in this report are those of the author(s) and are not necessarily those of Waterstone Financial Group.
The material has been prepared or distributed solely for information purposes and is not a solicitation or an offer to buy
any security. Investors in mutual funds should carefully consider the investment objectives, risks, charges and expenses.
This and other important information is contained in the prospectus, which can be obtained from your investment
professional and should be read carefully before investing. Investments are not FDIC-insured, nor are they deposits of or
guaranteed by a bank or any other entity. Diversification does not assure or guarantee better performance and cannot
eliminate the risk of investment losses.
Retirement “In Toto”
The End of a Professional Life
by Don Blossom, MD, FAAP
This is a very personal story. After
reading several articles in the AAP
Seniors Bulletin chronicling the
personal adjustments of retirement, yet clinging to “the profession” in various ways, I wanted to
share a different view. I started my
professional career as a medical
student in San Antonio and a
resident at the University of
Minnesota. I mark my entry into
the profession at medical school
because from that day forward I
considered myself “a professional”
and this attitude helped me negotiate the rigors of my education.
After residency, my wife (of 40 yrs)
16
and I headed off to private practice
and to raise a family. My professors at U of M were appalled that
I should squander my talents and
superior education on private
practice. Nevertheless, we journeyed to the mountains of northern New Mexico and joined 3
other pediatricians in a small
community of 20,000. We were
also serving a larger region of the
state. And, I wouldn’t change this
experience for anything. (Note: At
this point I must inform you of one
of my writing “quirks”, that is,
when I use “parenthesis” I am usually talking to myself or else I’m
hearing those little voices again.)
The “practice” was varied, challenging, and exciting. It consisted
of a diverse population that
included: four hundred proud
Hispanic families (who made their
children a priority) resident scientists from the breadth of the US
(whose priorities occasionally
were in question), and from
Europe, and other countries;
Hippies from the north (who had
few priorities) cowboys and Native
Americans from every direction
(with cultural challenges) and a
barrio Hispanic population in
poverty (and often into violence
or the drug culture). The patholContinued on Page 17
Senior Bulletin - AAP Section for Senior Members - Winter 2008
Retirement “In Toto” The End of a Professional Life Continued from Page 16
ogy was varied, daunting, and
unusual, as were the psychiatric
issues and the social issues. The
communities of Hispanics were
rich in family and tradition in contrast to the fragmented and displaced families of the scientists.
My professors in Minneapolis
could never have known the challenges of my early days of “private
practice”.
I was the first pediatrician in the
area that was trained in modern
Neonatal Medicine, and although
I was a generalist, nearly all of the
difficult neonatal cases came my
way, by default. The University of
New Mexico, then 100 miles away,
was just getting started in the tertiary care business and there were
lots of holes to fill in the system.
We were often on our own out in
the boondocks. It was also the
days before the specialization of
Emergency Room Physicians, and
we were further challenged by 24hour coverage of our ER’s pediatric
population. To facilitate covering
ER, NNU, and Pediatric Ward our
office was located in the hospital
where we rented space from the
hospital administration.
In addition, we covered several
outlying clinics in Northern New
Mexico, which had no pediatric
care at the time. I served as Public
Health Officer and the School
Physician. Our group established
relationships with the medical
schools of the University of Texas
and University of New Mexico to
proctor, mentor, and teach fourth
year Medical Students. My wife,
to her credit, postponed her
“higher education” to primarily
raise our three children in my
absence (with my intermittent
appearances and duties as a
father). I am pleased to report that
all of the children are now successful and happy adults, and they
appear to have suffered no significant pathology, so my absence
may have been to their benefit.
The hours were long and the problems challenging. We saw trauma
as well as illnesses, slapped plaster
on fractures and sutured wounds,
attended deliveries and C-sections
and then supported any gravely ill
neonates. We taught medical students and our nursing staff; we
started sex-education for our
schools and gave community lectures on pediatric health. Of
course there were epidemics of
infectious illnesses from Measles
to Chickenpox, Haemophilus
and Pneumococcal Meningitis,
Reyes Syndrome and Kawasaki’s
Disease, and an occasional case of
Bubonic Plague. We saw burns
and overdoses, abuse and neglect,
in addition to beans up the nose
and bugs in the ears. And there
were the complexities of chemotherapy for the unfortunate
children with malignancies, the
tightrope management of juvenile
diabetics, and the rehabilitation of
our developmentally handicapped. All of this existed while
promoting and administering to
preventative health and the
growth and development of our
well baby, child, and adolescent
community. It was all challenging,
rewarding, sometimes heartbreaking, but nearly always exhilarating. The pace and excitement
suited my Type A perfectionist
personality and, as best I can tell,
I was good at it. It was good for the
ego. It was good for the community. It was great fun. Sixty hour
plus weeks were a joy. My workaholic addiction was in full stride
and I was getting my “fix” on a
regular basis.
So . . . what happened to the focus
of this article “Retirement in Toto”?
Did I lapse into an old man’s musings? One more cup of coffee
please and I shall continue.
Without shame I will explain. But,
I needed to “set the table” and
Senior Bulletin - AAP Section for Senior Members - Winter 2008
establish the mood of accomplishment and satisfaction that we all
feel within a lifetime of an important profession. The exhilaration
and exhaustion of labors and
sleepless nights, the heartache of
the little ones who perished, the
warmth and joy of a child’s innocence and honesty (and their
broad grins and eyes shining with
admiration). (Note: Occasionally
their eyes showed the stark fear of
what was coming next.) Because,
when we retire, these are some of
the things that we give up and it’s
not an easy task. We give up more
- the community notoriety and
respect that fade in our absence.
We are no longer “The Doctor”, but
rather a private citizen lost in
anonymity, and many of the
things that massage our egos (and
we all know how big they are!) are
missing and gone forever in retirement. So we cling to our past,
uncertain of our future, and
unwilling to let go of this important personal history. And most of
us never do let go. I’ll tell you what
helped me let go. It may be helpful.
(Then again, it may not.)
First of all, there were all of the
changes in medicine that are
inevitable with time. There were
unsuccessful fights with the hospital administrators to save our
small community Pediatric Ward
(it was merged with the adult
ward). The encroachment of managed healthcare into the independent decision making of my
professional world, resulting in
important patient care decisions
being made by administrators and
those less qualified and experienced than myself. And finally,
there was the inevitable march of
sub specialization into my world,
relegating me to a “well baby” doctor. There were no longer the challenges of acute care medicine; the
drama of “saving lives”, the challenges of a difficult diagnosis, the
Continued on Page 18
17
Retirement “In Toto” The End of a Professional Life Continued from Page 17
uncertain horror of an emergency
room visit. All sick newborns were
rapidly whisked away to the tertiary care facilities (to their benefit
I might add). And there I was, left
to continually mutter to myself
and listening to myself tell mothers and families the same preventative instructions over and over
and over and over again in my new
role as a pediatric educator, but
hardly as a practitioner. The
bloom was off the rose. My job as
a “private practitioner” of this glorious profession of Pediatrics was
changed and gone forever. It was
now a business, not a calling. I was
now a social worker and source of
information, not a physician, not
a healer. My idealism had been
replaced by the reality of managed
care and all that goes with it. And
all of this made it easier to give up
“In Toto” my beloved profession.
Bury it with a tombstone of fond
memories. Move on to the unset-
tling uncertainty of a different life.
Hey, I’ve still got all my marbles.
Well, most of them anyway. The
shiny “steelies” have a little tarnish
and they don’t roll toward their
goal at the same pace but they still
hit the target!! I’ve got a lot left in
the tank. So why not tackle some
new areas of life. And, if I haven’t
lost you at this point I tell you all
about it in the next episode of “As
the Ex-Pediatrician Turns”.
Retirement “In Toto” Part 2
As the Ex-Pediatrician Turns
by Don Blossom, MD, FAAP
In earlier paragraphs I set forth the
foundation for my retirement.
Most of it was real. Some of it was
(most likely) my perception of
my professional circumstances.
Nevertheless, I became an unsatisfied practitioner. So where did I
take it? How did I go from being a
“big fish in a small pond” to “a fish
out of water”? It wasn’t easy and
there was a transition.
At first I grumbled a lot. I’m sure
my wife and my partners had to
endure a lot of nasty stuff.
However, I didn’t holler at my
patients or their mothers no matter how non-compliant they were.
I did most of my “holler’n”in my
early years (it takes some of us
more time to mature than others).
I resigned from my practice, bid
farewell to my partners and became a medical vagabond. It’s
called Locum Tenens practice. I
held licenses in several states and
“hired out” my services to those
who needed pediatric help. It
barely met expenses but my skills
in investing were beginning to pay
dividends. It reintroduced new
challenges into my career.
I worked in several towns in
Georgia (I tried to get to The
Masters - no luck), Montana &
18
Alaska (great fly fishing), all over
the state of New Mexico (helping
out old friends), and Massachusetts (God only knows why,
maybe for “da chowda”). I spent
three years working half time in
an indigent town in the Rio
Grande Valley that badly needed
pediatric help. And, I slipped
“down-under” to work in a mostly
Maori population on the North
Island of New Zealand for a full
year. (Their National Health Care
System is like a badly run HMO in
the USA . . . but lots of nice people.) I had no country, very little
identity, and I got tired of dirty
underwear and eating out. (My
wife did come with me to NZ.)
While in NZ our home in New
Mexico was totally destroyed in a
firestorm (Now this is Mother
Nature’s subtle way of getting your
attention and telling you to move
forward).
All were rewarding experiences
(except the fire) and I have no
regrets. I needed this mini medical sabbatical to transition into a
new life and come to accept
myself as I really was, a broken
down ol’ sawbones. Everybody
else did. As a retired physician I
was in very little demand. Many
of my efforts to volunteer my wis-
dom and experience were rejected. But I still had a lot of gas left
in the tank. Sounds sad, huh? But,
like T.O. says “getcha box o’
Kleenex ready” ‘cause there is
more. And, life and time does have
a price to pay but we can’t just sit
back and let our frontal lobes atrophy can we? I had a few other
experiments to try.
Now golf was always one of my
favorite things, so I lowered my
handicap. But man does not live
by golf alone so I perfected my flyfishing and journeyed to all parts
of the mountain west in search of
rising trout. The Big Horn in
Montana, the Arkansas and the
Frying Pan in Colorado, several
sojourns to Alaska, and a trip to El
Saltamontes in Chilean Patagonia.
I volunteered for several community projects and state organizations. I dabbled in writing a few
articles here and there (occasionally getting one published and this
was good for the ol’ ego). Of course
my wife, now with a masters in
Family Studies was ready to run
off to the Peace Corps to aid the
sick, the poor, and the destitute
masses of the world. She couldn’t
quite understand that my 30
years of practicing medicine in
Continued on Page 19
Senior Bulletin - AAP Section for Senior Members - Winter 2008
Retirement “In Toto” Part 2 As the Ex- Pediatrician Turns Continued from Page 18
Northern New Mexico qualifies as
a third world country (at least in
some areas). But she didn’t run off.
(I guess my frontal lobes were still
intact.)
Together we spend about three
months a year traveling to exotic
countries of the world. African
Safaris (running from belligerent
elephants in the Kalahari), the
Galapagos Islands (snorkeling in
the Humboldt current at the
Devils Crown), Machu Picchu
(climbing Huaynu Picchu) and the
Amazon Rain Forest (sweating &
slapping flies), and soon we will
travel to Egypt and Jordan (hopefully, we can avoid Osama and his
boys). Our list of countries and
adventures is longer than our life
expectancies. Our children are
scattered across the US so we
spend lots of time traveling in our
country also to see the grandchildren.
How do I pay for it all on a meager
“retired” pediatrician’s past earnings? It’s my new avocation -dabbling in the investment world.
While I was in private practice, I
ran our corporate profit sharing
plan and learned a lot about
investing with some degree of success. I now have plenty of time to
research my investment ideas and
I have done well. I stay at arm’s
length from all stockbrokers. I prefer making my own mistakes
rather than gnashing my teeth
over their bad advice (and I prefer
$7.99 a trade rather than a $300
commission). I have always loved
crunching numbers, learning new
technology, and dissecting businesses and these skills have served
me well. I actually enjoy reading
books by Ben Graham, “The
Intelligent Investor” or Warren
Buffet, or Jack Welsh, or pouring
through an end-of-the-year report. This new endeavor has many
challenges, much to learn, and I
find very little stress associated
with my efforts (though that is not
true for many investors).
Working out and staying in good
physical and mental condition is
important to me. I have a quality
gym where I spend 90 minutes a
day working up a sweat and minimizing the effects of age on
depreciating strength with weight
training. It’s good for the body and
soul. I like to top it all off by
rewarding myself with a hot steam
bath. I do some of my best thinking in that cloud forest.
And at this stage of my life I have
plenty of time to enjoy the many
perfect New Mexico days with
their turquoise skies and star filled
nights. I have time for a late breakfast on the Santa Fe plaza before
meandering through the galleries
with my wife. And, time to read all
of those great works that I never
had time for during my professional career (finally, a real education!). I do absolutely no pediatrics
at all. I’ve conquered the major
withdrawal symptoms of self-pity,
feeling underappreciated, my
quest to save the world, and boredom. And, I have time to write to
you, and if it’s right, to connect on
a subject with which we physicians do very poorly - cutting the
cord. But, retirement isn’t for
everyone. Am I happy? Mostly.
Could it be better? It can always
be better. So bring on the next
adventure. But the final question
still remains: Is my retirement plan
better than sex? (Next comes a
long pause while the writer tries
to remember sex.) “No, emphatically no.”
A woman called a local hospital . . .
“Hello! Could you connect me to the person who gives information about patients? I’d like to find out if a patient is getting
better, doing as expected, or getting worse.”
The voice on the other end said, “What is the patient’s name and room number?”
“Sarah Finkel, Room 302.”
“I’ll connect you with the nursing station . . . “
“3-A Nursing Station. How can I help you?”
“I’d like to know the condition of Sarah Finkel in Room 302.”
“Just a moment. Let me look at her records . . . Mrs. Finkel is doing very well. In fact, she’s had two full meals, her blood
pressure is fine, she is to be taken off the heart monitor in a couple of hours and, if she continues this improvement, Dr. Cohen
is going to send her home Tuesday at noon.”
The woman said, “What a relief! Oh, that’s fantastic . . . That’s wonderful news!”
The nurse said, “From your enthusiasm, I take it you are a close family member or a very close friend!”
“Neither, I AM Sarah Finkel in 302! Nobody here tells me a thing!
Senior Bulletin - AAP Section for Senior Members - Winter 2008
19
Parenting a Different Paradigm
by Susan DiPietro
My journey towards examining my beliefs and
assumptions about parenting began when my second
very independent child began school. This child did
not adhere to an unquestioning obedience to a rule of
authority. His reluctance to blindly follow a teacher’s
instructions forced me to look at my personal beliefs
and what I saw as social beliefs surrounding the roles
we expect children to fulfill. I began to look at characteristics that would most likely begin any parent’s
wish list for their child when they reach adulthood
items such as being independent, able to think and
make reasonable decisions for themselves, enjoy what
they do for a living and in general be content with
their lives. I then contrasted this with what not only
the school’s foster, but also what I often saw myself
and others doing as parents. Generally teachers wish
for students who stay quietly in their seats working on
a given assignment. The teacher will answer that creativity and questions are encouraged, but I can almost
100% assure you that there are strict boundaries
around the “allowed” questions. Just wait for the reaction when your child asks why an assignment is
important and then refuses to complete the assignment when the answer is inadequate. I began to wonder if we as a society expect children at the age of 18
to suddenly become independent thinkers capable of
making good decisions on their own, while paying
lip service to, but not really promoting these characteristics. I for one did not see independent thinking
fostered in school – unless it conformed to the
teacher’s concept of independent thinking. As a quick
check how often were you graded down on a paper
because your analysis did not coincide closely enough
with the instructors’ analysis?
This led me to question my own motivations for disciplining my children. Was I disciplining for my own
needs or truly for those of my child? Now this can get
a little tricky, but let’s take an example – a child throwing a tantrum in a store. Do I take the child out of the
store for one of the following reasons:
Children aren’t suppose to throw tantrums – a socially
correct view The child must learn to control himself
– or next time it will be worse – personal fears People
will stare at me and begin to offer ‘helpful hints’ –
embarrassment, or do I take the child out so that the
child can regroup and go back calmly into the store?
Now the out come looks the same – the child is
removed from the store, but the purpose behind each
scenario is quite different and the implication for how
we as adults approach children is profound. In the
first scenario the parents are acting on their own fears,
which may be well intentioned. Fears that the child
will not learn appropriate behaviors, will not fit in
socially or more personal fears that others may be
judging parental abilities. In the second scenario the
parent is not acting from fear or personal concerns,
20
but from an interest in helping the child gain mastery
over themselves. It is my contention that true selfcontrol comes from learning this internal mastery
rather than from controls imposed externally.
Improving parent skills lies in asking ourselves some
hard questions, and then making changes in underlying fundamental assumptions and belief systems.
The biggest question is are we acting out of our own
fears? In which case we are likely to be imposing external controls on the child rather than helping them
develop their own internal controls.
Do we view parenting as controlling the child or influencing the child?When have we ever had true control?
Even infants can refuse to eat and sleep. I prefer influence as children and teenagers require guidance,
but this implies the development of internal self regulation rather than externally enforced controls.
Do we have enough of our own internal self-regulation to help a child who is out of control regain their
own internal balance? The best guide is one who
knows the terrain. The ability to maintain our own
state of calmness and not confound the situation with
our own needs as parents is the first step in helping to
build an environment favorable for a child to develop
internal self-regulation. This state of calmness not
only translates directly to the child, but also allows
adults to react to situations with more flexibility and
creativeness. Creativeness and flexibility are highly
desirable as each child and each situation are different and may require a different approach. Prior to
reading another parenting book – if one approach
always worked there would only be one parenting
book - as parents and caregivers perhaps we need to
look within ourselves and do the ground work to
develop a parenting paradigm which will foster
growth and development leading to those characteristics which most of us would say we would like to see
in young (and older) adults.
Further reading and exploration:
Unconditional Parenting: Moving from Rewards and
Punishments to Love and Reason by Alfie Kohn.
Dr. B. Bryan Post
Post Institute For Family Centered Therapy
_ HYPERLINK “http://www.postinstitute.com”
__www.postinstitute.com_
Susan DiPietro my daughter works as a Family Partner
for EMG, which cares for severely emotionally, disturbed youth. She is in the Foster Family agency. Her
e-mail is: [email protected]
Joan Hodgman, MD, FAAP
Senior Bulletin - AAP Section for Senior Members - Winter 2008
TRIPLE BOOK REVIEW
THREE DIFFERENT BOOKS
AT LEAST ONE WILL INTEREST EVERY READER
by Avrum L. Katcher MD, FAAP
PONTOON
by Garrison Keillor
Viking, 2007
This is another one of the stories of Lake Wobegon, which Keillor has been memorializing for 30 plus years, in
television shows, books, short stories and a movie as well. Keillor’s gift is the ability to describe, write about
and explain about people for whom he has great affection, and who are so real that the reader says, “I know
you!” And you do. His output is immense, but the work he does attains heights comparable perhaps only to
Thornton Wilder in the play “Our Town.” One difference is that Our Town made me weep, just from a television production. Keiller’s work often leaves me laughing, chuckling and certainly nodding in comprehension.
Of a woman who left home, to leave a dissolute life and make a fortune, now returned to Lake Wobegon he
describes “She was original and creative and vibrant and independent and praised by one and all and then one
day she suddenly got very sick of herself and had to get away and she came back here [to Lake Wobegon]. It’s
peaceful here. You don’t have to be wonderful here. You can just be who you are.”
Or another woman, who describes herself in a letter to her daughter, “I’m an old lady and I need to tell my
stories to people who already know them and can tell me the parts I’ve left out. So, I’ll head home soon. Can’t
live with people, can’t live without them. That’s how it goes. Just one thing after another. Love, your mother.”
One could go on, but it is not necessary. This is a story about people, many people, written by a man who is
able to describe them in a fashion that you nod your head, “Yes, of course.” A pleasure to read about them. One
cautionary note. Since he writes about real people, there is a good deal of smut, but mostly happy smut however some may take offense. Just so you know. I loved it.
***
WHAT ON EARTH HAVE I DONE?
by Robert Fulghum
St. Martin’s Press, NY 2007
Fulghum has done best sellers; perhaps the best known is All I really need to know I learned in Kindergarten.
He is no Thornton Wilder or Garrison Keillor. Rather something of a cutie-pie who produces two to four page
mini-chapters about people and life, as he tells of his adventures around the world, seeking answers to the questions that mothers ask, generation after generation:
“WHAT ON EARTH HAVE YOU DONE?”
And, “WHAT IN THE NAME OF GOD ARE YOU DOING?”
And, “AND WHAT WILL YOU THINK OF NEXT?”
And, from fathers, ‘WHAT THE HELL…?”
Fulghum’s answers are cute, but sufficiently enjoyable to make mention of. He also likes the people he knows,
even when he does not agree with what they are doing. He quotes Epictetus, “If you can fish, fish. If you can
sing, sing. If you can fight, fight. Determine what you can do. And do that.” And also, “Why worry about being
a nobody when what matters is being a somebody in those areas of your life over which you have control, and
in which you can make a difference?” And he provides his own answers, “Not a self-defense or an apology. Just
a statement of position. The world and the universe go their inevitable way. Meanwhile…I know what I can do.
Meanwhile…I do it.”
***
Continued on Page 22
Senior Bulletin - AAP Section for Senior Members - Winter 2008
21
TRIPLE BOOK REVIEW . . . Continued from Page 21
And finally, in a more serious vein by far,
PLAIN SECRETS. AN OUTSIDER AMONG THE AMISH
by Joe Mackall
Beacon Press, Boston, 2007
Joe Mackall has lived in the midst of the Swartzentruber Amish community of Ashland County, Ohio, for over
sixteen years. They may be the most traditional and insular of all the Amish sects. They live without gas, electricity, or indoor plumbing, without lights on their buggies or cushioned chairs in their homes. Mackall has
become friendly with many, although he is not an anthropologist, psychologist or scientist, he does have a background in English and Journalism and is on faculty at the local University, and has published rather extensively
in his field. He could be a scientist, and he certainly is a writer. He writes in a familiar vein, which you will recognize if you have read the form of essays in The New Yorker and know who Joseph Mitchell was. Or Eudora
Welty. Beautiful descriptions in straightforward English of people, places, events and circumstances.
He expounds a way of life, a system of living, for a sect whose members are satisfied with what they are and
who they are, and see no reason to change. When a man has died, perhaps as the result of medical error—perhaps not—the family leader who is also a minister said, “Everybody who knew him needed him to be exactly the
way he was.” And Mackall realizes that after letting these words soak in, that he felt better. And he knew that
the speaker said what he did not to make him feel better, or to evangelize, which is not the way of this group,
but because “he believes what he said from the brim of his straw hat right down to the bottom of his rubber
boots.”
Mackall concludes, “I have learned a great deal from the…family and the lives they lead…some Amish families love with the same love I believe exists in my family and in the family that reared me. I’ve learned lessons
about the bounties and burdens of a close community. I’ve learned how seriously God’s will is trusted…I’ve
learned that I can drag my sorry heart and weak will to the farm in the middle of a day, and be consoled, completely and utterly, by beliefs I do not or cannot hold…I’ve learned that there are alternatives and values other
than those projected by the mass media and our consumer culture…I need not consume more than I need;
and that I should produce my fair share.”
And finally, “Despite how conflicted I am about aspects of the Swartzentruber Amish way of life, I can still recognize beauty and truth when I see it. And the beauty and truth of it is this: That to these plain people, in these
times and in all others, the values that reign supreme are community, acceptance, and faith, which can, with
prayer and a little luck, lead to peace.”
And I agree, from my own heart. And I hope you will take a look at each of these three relatively short books,
because each, in it’s own way, tells stories about people. All kinds of people. Not just Muslims, Catholics,
Protestants, African-Americans, Hispanics, the Puritans, Republicans, Democrats, doctors, the sick, the well.
All of us. The people who need us to be the way we are.
Promoting the Value of Pediatrics
The AAP Department of Communications, with help from the AAP
Private Payer Advocacy Advisory Committee, has created a new public awareness campaign, “Promoting the Value of Pediatrics,” designed
to increase appreciation of one of the greatest values in health care
today: pediatric care. Resources are provided for AAP members to
help them implement the campaign at the local level. For materials
and more information, go to the Promoting Pediatrics Web Site within
the AAP Member Center.
22
Senior Bulletin - AAP Section for Senior Members - Winter 2008
LUCIANISSIMO AND THE HIGH C
BY James L. Reynolds, MD, FAAP
Luciano Pavarotti (1935-2007)
died this September at age 71. He
made his U.S. debut in Miami in
1965 opposite Joan Sutherland. He
was known by various epithets
over the years: “Lucky,” “Lurch,”
“Deep Throat” and, most endearingly, “Lucianissimo. Most popularly, Pavarotti was known
worldwide as the “King of the High
C’s”. This distinction was won with
his brilliant rendition of nine perfect serial high C’s in the aria,
“Pour mon âme” from Donizetti’s
“Fille du Régiment”. He rendered
this feat at the Met’s 1972-1973
season where it earned him a
record 17 curtain calls and an invitation to appear on Johnny
Carson’s “The Tonight Show”. He
first performed this, however, at
Covent Garden in 1966.
Mr. Pavarotti once described his
emotion on singing a high C as
“excited and happy, but with a
strong undercurrent of fear. The
moment I actually hit the note, I
almost lose consciousness. A
physical, animal sensation seizes
me. Then I regain control.”
Pavarotti did not hold the record
for the very highest tenor notes.
The1980 Guinness Book of World
Records named Stefan Zucker,
‘’the world’s highest tenor’’, for
having hit an A above high C and
holding it for 3.8 seconds. That
occurred at Town Hall, New York,
on Sept. 12, 1972.
Notably also, Mr. Zucker sang the
role of Salvini in the world premiere of the fourth and final version (1829) of Bellini’s “delson e
Salvini” When His voice shot up
to a series of notes well above the
usual tenor top of high C the audience responded with shouts,
groans and hisses, and critics gave
him poor reviews. The critic Donal
Henahan wrote in The New York
Times that Zucker’s high notes
were like ‘’the scratching of a fin-
gernail on a blackboard’’, and
another critic called Zucker ‘’a
male Joan Sutherland’’. He had his
supporters: a woman in the audience hit a man next to her when he
wouldn’t stop booing during the
performance.
A tenor as popular as Enrico
Caruso did not have a high C.
Plácido Domingo, who started out
as a baritone and developed as a
tenor, has had trouble with high
C’s. Musicians have sometimes
referred to him as “Mingo”, omitting the Do in his surname. When
asked about omission of the “Do”,
the answer is: He has none—the
syllable “do” in the solfeggio scale
of course represents the note C.
Through the 18th C. high C’s were
sung by castrati, not by usual
tenors. Boys with good voices were
operated upon before puberty so
they could produce the note as
adults. The first prominent unaltered male operatic singer who
hit high C’s was a Frenchman,
Gilbert-Louis Duprez who sang
the notes with a chest voice rather
than falsetto in Rossini’s opera,
“Guillaume Tell,” in 1831. Pavarotti
was also noted for his William Tell.
The problem for male vocalists is
the strong tendency of their voice
to become falsetto when reaching
for high notes: Normally, the male
voice is pitched lower than that of
the female. For a man, singing in
the high range is much easier done
falsetto; a powerful male voice
singing high C is distinctly unusual.
There is a mystique about the high
C. It’s considered the acme of
operatic technique. More than
with any other vocalization a
singer has to have the training and
experience to know exactly what
he is doing in order to produce a
clear and sustained high C.
Apparently the sources of sound,
Senior Bulletin - AAP Section for Senior Members - Winter 2008
the chest voice, which is powerful,
and the head voice, containing the
resonant head cavities, must be
perfectly balanced, along with the
base of the tongue, the jaw, and
the larynx all being in perfect
alignment, free of tension, in order
for a talented man to produce a
ringing high C. Too much tension
in the throat and a raised larynx,
i.e., the jaw not dropped enough—
mouth not wide open enough—
are inimical to high C production.
The perfect high C moment in
opera is exciting, suspenseful,
emotional, and aesthetically joyous; audiences cheer. But cheers
turn to jeers if the note falters.
Adolphe Nourrit, the reigning
tenor in Paris until Duprez, mentioned above, attracted attention
with his testicular high C’s. Nourrit
struggled unsuccessfully to emulate his younger rival. This inability may have contributed to his
suicide: a case of death on the high
C’s, as one incorrigible punster
said.
Pavarotti’s voice was exceptional
not only for its vocal range—in his
earlier years he could actually
reach A above high C—but for his
vocal honey-toned quality, color,
control, and tessitura, i.e., vocal
timbre and volume: Operatic
tenors have an approximate range
from the C one octave below middle C to the A one octave above
middle C. Speculatively, the ability
to reach a high C may be a genetic
laryngeal trait: Pavarotti’s father, a
baker in Modena, was also an
amateur tenor.
Vocally, operatic tenors are classified into five types based not only
on range and tessitura, but also on
passaggio, transition vocal lift
points. The average passaggio
begins with a vocal lift around
middle C or C# and ends with a lift
at F or F# above middle C. The five
Continued on Page 24
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LUCIANISSIMO AND THE HIGH C Continued from Page 23
operatic tenor types are (from
highest to lowest) Leggiero, a very
light lyric tenor—e.g., Juan Diego
Flórez and Rockwell Blake—
Lyric—such as Pavarotti, Roberto
Alagna, and José Carreras—
Spinto, a lyric tenor with more
“push”—Enrico Caruso was one—
Dramatic, ringing, powerful, rich,
heroic—Franco Corelli and
Plácido Domingo are examples—
and Heldentenor, the German
equivalent of Dramatic, but with
more baritonal quality—Lauritz
Melchior was a Heldentenor.
(Sopranist and Countertenor [alto
or mezzo] are even higher pitched
voices than Tenor.) The word
“tenor” comes from the Latin,
tenere meaning to hold.
Pavarotti was the most widely
known tenor of his time both in
classical and popular-music cir-
cles. His theme song, Nessun
Dorma (None Shall Sleep), from
Turandot, became extraordinarily
popular 65 years after Giancomo
Puccini wrote it. Pavarotti used it
to introduce television coverage of
the 1990 (soccer) World Cup; then,
on the eve of the cup final in
Rome, he shared it with two other
tenors, Plácido Domingo and José
Carreras, in a “Three Tenors” concert on the eve of the cup final. The
CD became the world’s top-selling classical recording. As his voice
waned in the ‘90s, Pavarotti
became increasinglyand widely
popular, but understandably, less
successful in classical opera. He
was eventually booed at La Scala
for missing his high notes, but fortunately, his elaborately venerating funeral in Modena could not
have meen more lauditory.
A recent declaration by former
New York City mayor, Rudy
Giuliani, could eaasily and appositely have been said by Pavarotti:
“I’m trying to say this in the most
humble way possible: I’m very
good at doing the impossible.”
Such braggadocio must be an
Italian thing, and Italians seem to
mix effectively their politics and
opera. During the 19th C. Italian
u n i f i c a t i o n m ov e m e n t , t h e
Resorgimento, Italian opera goers
would shoutVERDI!,VERDI! which
the incognoscenti thought was an
evocation of the heroic operatic
composer of the movement, but
was primarily intended as an
acronym: Vittorio Emanuele, Re Di
Italia, i.e., Victor Emanuel, King of
Italy. He did become unified Italy’s
first king. Maybe bravura performance in politics and opera do mix.
Editors Note:
EugeneWynsen, MD, FAAP, has been a contributor to the Bulletin of seminal articles. The first to go through
my hands as editor was his article about withholding antibiotics for otitis media. I was not sure about this
article, but most of us use too many antibiotics, so I accepted it for publication. The next issue of the AAP
News had an article on the front page by a distinguished Earn Nose and Throat expert recommending withholding antibiotics for about 1/2 half of cases of otitis media. The next was an article about probiotics for
the Spring Bulletin. I knew about them so I had no problem with approving that one for publication.
Interestingly, the APP News came out in September with a front-page article on Probiotics. The last article that Dr. Wynsen has contributed is the one about Itsi Bitsi. I don’t have the journal in front of me, please
fill in the proper title. I have not seen any follow-up in the wider press but am expecting it daily. Perhaps
I don’t read the proper literature for follow-up on this subject. I have had no contribution from Dr.
Wynsen for Fall or Winter. I am writing this note in the hopes that it will convince him to share his avant
guard articles with us again. Joan Hodgman, MD, FAAP, editor
Title: Age of Reason
Author: Arthur Krystal
Published in NewYorker, 22 October 2007, pp 93-104. This is a short excerpt from a long profile of Jacques Barzun,
an incredible polymath, now just about at age 100. He has some difficulties said to be due to “aging and spinal
stenosis, which causes pain and numbness in the legs. He relies on a cane or a walker to get around, and, as
one might expect, he is alert to the irony of aging: when time is short, old age takes up a lot of time. There are
doctors’ visits, tests to be suffered, results to wait for, ailments and medications to be studied—all distractions
from the work. ‘Old age is like learning a new profession,’ he noted drily. ‘And not one of your own choosing.’”
What is most remarkable about this brilliant scholar is that despite all of this, he seems, according to the author,
a professional essayist, to continue to know everything. At one point in a long series of conversations, Krystal
was astonished at a reference that Barzun knew quite well, and exclaimed, “Why would you know that?”
[Barzun] replied, mildly, It’s my business to know such things.”
Avrum L. Katcher, MD, FAAP
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Senior Bulletin - AAP Section for Senior Members - Winter 2008