Border Crisis: Fictions v. Facts (Part 2 of “Children from Central America”)

Despite extensive media coverage, there is probably much that you don’t know about the history of the border crisis—and what we can or should do in response. Too often the headlines are designed to stir passions, rather than inform.

At the end of next week, Congress will leave for its five-week August Recess. Between now and then legislators will be debating the issues, and no doubt many of your friends will be taking positions.

Here are the facts you need when weighing what you hear–whether on television or at a neighbor’s barbecue.

  •  Are you aware that since President Obama took office, it has become harder for illegal immigrants to cross our Southwestern border? This is something Fox News doesn’t usually mention.
  •  Did you know that even if we deport the tens of thousands of children who have come here since last October, many refugee experts agree they’ll try again—and that other children will follow them? In other words, they say, deportation will not serve as a deterrent. These kids are running for their lives.
  • Are you aware that in the past the U.S. has backed military coups and paramilitary death squads in Central America? As democratically-elected governments toppled, constitutional order collapsed, and the gangs took over the streets.  Does this mean that we are in part responsible for the exodus of kids fleeing violence at home? That is a difficult question, but definitely worth thinking about.
  • Did you know that the most powerful gangs originated in Los Angeles?  In the 1990s, we began deporting these thugs (via ConAir), and dumped them back in countries ill-equipped to police them.
  • Had you heard that the kids coming in today are not trying to avoid border patrols? They are rafting, swimming, and walking into the U.S. in broad daylight. So the problem is not that we don’t have enough border patrols to “secure the border. “ The new immigrants are eager to turn themselves over to border officials. Why? In 2008, former President George W. Bush signed the “William Wilberforce Trafficking Victims Protection Reauthorization Act.” This bipartisan measure mandates that the border patrols cannot simply send unaccompanied minors from Central America back to their home countries. The U.S. government must try to find responsible relatives in the U. S. and place the children with them (or in foster homes) while they await a hearing before an immigrant court judge.

Understanding this law–and why it passed so easily in 2008—is key to understanding the legal and moral quandary that President Obama and Congress now face.

  • Finally, how many Americans are aware that, despite high unemployment rates in the U.S., we face a labor shortage? We need more immigrants willing to pick crops, work construction, and provide long-term care for baby-boomers.

Canada’s population also is aging, and Canada  is welcoming them l –part of that  country’s embrace of multiculturalism. We are not. Are we missing something?

All in all, this crisis is far more complicated than most reports acknowledge.

Before you decide where you stand on the issue, you might want to consider the media myths vs. the facts below.

                                        On President Obama’s Role

Fiction:  President Obama’s lax immigration policies have encouraged children to stream into this country.

Fact: As marauding gangs have taken over cities in Honduras, El Salvador and Guatemala, children have been fleeing, not only to the U.S. , but to Nicaragua, Panama, Mexico, Cost Rica and Belize.

 From 2008 to 2013, the UN High Commission on Refugees (UNHCR) has documented a 712% increase in the number of Central Americans applying for asylum in those five countries.

Clearly President Obama’s policies on immigration did not drive their decision to seek safe haven in Panama or Costa Rica.

Fiction: Reports of violence in Central America have been greatly overblown. These children are coming to the U.S. in search of jobs, social services and better living conditions.

Fact: Street gangs in Honduras, Guatemala and El Salvador torture and execute young boys who refuse to join. As I explained in part 1 of this post gang members also pick out young girls who they want to be their “girl-friends”—which means they will be raped by one or more members of the gang. Neither their families nor the police can protect them. This is why they run.

According to the U.S. State Department, Guatemala now has one of the highest violent crime rates in Latin America. El Salvador reports the second-highest murder rate in Latin America, and Honduras ranks #1, world-wide.

There, child murders are up 77% from just a year ago.

Finally, note that Nicaragua, which is the poorest nation in mainland Latin America (and the second poorest in the Western Hemisphere, after Haiti)  has seen a 238% increase in asylum applications from Central Americans in the last year. This serves as strong evidence that desperate children and families are not seeking “economic opportunities.”

There are no opportunities in Nicaragua. They are fleeing the mayhem at home.

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Children from Central America Surge Across Our Border: Congress Must Now Decide Whether to Change the Immigration Law that George W. Bush Signed in 2008

If you think fertilized eggs are people but refugee kids aren’t, you’re going to have to stop pretending your concerns are religious– Syd’s SoapBox

News reports have been filled with conflicting theories explaining why tens of thousands of unaccompanied children from Honduras, El Salvador and Guatemala, have been streaming into the U.S.  Some observers say that their parents are sending them here, so that they can take advantage of the social services and free education available in the U.S. Others argue that they are not coming here willingly, but that they have been forced to flee gang violence in their home countries that ranges from murder to rape. Still others charge that President Obama’s lax immigration policy has drawn these migrants to the U.S.

Unfortunately many of the reports circulating in the media and the blogosphere are not backed up by evidence.  Even worse, the American Immigration Council  (AIC) says, “some are intentionally aimed at derailing the eventual overhaul of our broken immigration system. 

I have been fact-checking those reports for more than two weeks.  Below, a summary of you need to know as we debate this tangled story.

The AIC recently released a report, based on documented interviews with more than 350 children from El Salvador which states that  “crime, gang threats, or violence appear to be the strongest determinants for childrens’ decisions to emigrate.

Typically, the gangs try to recruit children. If they refuse, they and/or family members are shot. 

The United Nations High Commissioner for Refugees (UNHCR) offers charts showing how that in 2012, the murder rate in Honduras in was a whopping 30 percent higher than UN estimates of the civilian casualty rate at the height of the Iraq war. The charts  also reveal that, statistically speaking, Honduras, Guatemala and El Salvador are twice as dangerous for civilians as Iraq was.

Writing on Vox, Amanda Taub explains why minors are in special danger: “Children are uniquely vulnerable to gang violence. The street gangs known as “maras” — M-18 and Mara Salvatrucha, or MS-13 — target kids for forced recruitment, usually in their early teenage years, but sometimes as young as kindergarten. They also forcibly recruit girls as “girlfriends,” a euphemistic term for a non-consensual relationship that involves rape by one or more gang members.”  

This is what 15-year-old Maritza told the UNCHR when it interviewed hundreds of the fleeing children: “One member of the gang  “liked” me. Another gang member told my uncle that he should get me out of there because the guy who liked me was going to do me harm. In El Salvador they take young girls, rape them and throw them in plastic bags.”

Maritza’s uncle knew that neither he nor the police could protect her. “My uncle told me it wasn’t safe for me to stay there. They told him that on April 3, and I left on April 7.”
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Polarized Politics Led To Cantor’s Defeat– and Cochran’s Victory. Why the “Uncommitted Center” Is So Important (Cantor part 2)

Please scroll down for Part 1 of this post. 

When House Majority leader Eric Cantor lost his seat to ultra-conservative David Brat, the Washington Post’s Ruth Marcus summed up the majority view among political pundits: “The episode offers a disturbing commentary about the poisonous, polarized state of American politics.”  

I cannot agree. I don’t think “polarization” is toxic.  To the contrary, as the poet William Blake once wrote “Without Contraries, No Progress.”  Conflict can clarify issues, and help us move forward.  Indeed, the clash of opinions is a time-honored way of testing their validity.

Do you remember the 1990s, a decade when it became difficult to tell the difference between Democrats and Republicans? While Republicans headed toward the far right, Democrats moved right of center. During his second term, Bill Clinton started to sound all too much like Ronald Reagan, as he set out to “reform welfare,” forcing single mothers to go to work, even though we weren’t offering them affordable day care. After leaving the White House, Clinton reclaimed his position as a stand-up liberal, but at the time, the distinction between Democrats and Republicans was badly blurred.

Today, the difference between the two parties is clear.  I wouldn’t say that Democrats are ultra-liberal, but conservatives have moved so far to the right that Democrats had no choice but to take a stand on critical issues including: global warming, gun control, the need to raise the minimum wage, and universal access to health care.

By contrast, in the 1990s, Congressional Democrats were “lukewarm” on health care reform. As  Paul Starr reports in his newest book, Remedy and Reaction, Senate Finance Committee chairman, Daniel Patrick Moynihan, Democrat of New York, actually stood up to say, “We don’t have a health care crisis.”

But by  2010,  the crisis was obvious, and Democrats came together. Pelosi and Harry Reid marshaled the votes, and Congress passed legislation which, while far from perfect, is solidly progressive: Low-income and middle-income Americans receive the subsidies they need; insurers can no longer discriminate against people suffering from pre-existing conditions, and preventive care–including contraception–is free.There is much more work to be done, but at last, we have begun.

Since then, Congressional Democrats have not had the votes to pass much-needed legislation in other areas.

But at least President Obama is no longer the compulsive compromiser that he appeared to be during his first term in office. I see this as progress.  As I have argued in the past, on some issues compromise is not an option.  Too much is at stake. 

On the ground,voters are as divided as their elected representatives.  Politically active Democrats have begun to move  left of center while Republican voters have become more conservative. The Pew Research report that I discussed in the first part of this post reveals that a decade ago, only 10% of politically engaged Republicans took a conservative stance on almost all issues. Today, 33% express consistently conservative views. At the other end of the political spectrum, almost forty  percent of committed Democrats are consistent liberals, up from just 8% in 1994. The overall share of Americans who express consistently conservative or constantly liberal opinions has doubled over the past two decades from 10% to 21%. .

“As a result,” Pew reports, “ideological overlap between the two parties has diminished. “Today, 92% of Republicans are to the right of the median Democrat, and 94% of Democrats are to the left of the median Republican.”. 

“Republicans and Democrats are more divided along ideological lines – and partisan antipathy is deeper and more extensive – than at any point in the last two decades. And a new survey of 10,000 adults nationwide finds that these divisions are greatest among those who are the most engaged and active in the political process.”

                                 Is Polarization A Threat to the Nation?

Most pundits are appalled.
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Cantor’s Defeat—What It Does Not Mean– Part 1

Shocked by House Majority Leader Eric Cantor’s defeat in last week’s Virginia primary, many in the media have decided that this “earthquake” has re-shaped the political landscape.

Immigration reform is dead, they say, and tea party radicals are far stronger than many suspected.

Meanwhile, the alarmists warn, political polarization has divided the country, poisoning our democracy. On that last point they are half-right; Republican voters have moved to the far right, while politically active Democrats are beginning to shift toward the left.

But polarization is not necessarily a threat to the Republic.  Pointed debate can clarify the issues– and underline what is at stake, raising voter awareness. Conservatives are making it clear what they are willing to sacrifice for the sake of their ideology, and mainstream Americans are becoming alarmed. For example, David Brat, the far-right conservative who defeated Eric Cantor, says that he would like to slash social security by 2/3.  This is a statement that could bring out voters who normally would not vote in a mid-term election.

As I will argue in part 2 of this post, at this point, too many mainstream America are not paying attention to the issues. “I’m just not interested in politics,” they say. Or, “I’ve given up on politicians.” A democracy needs a passionate, engaged electorate. Indifference is what will poison the Republic.

Cantor’s Loss Does Not mean that “Immigration Reform is Dead”

The conventional wisdom says that, until recently, President Obama had been waiting for the House to act on immigration reform. Supposedly, Eric Cantor, the House Majority leader, was open to some sort of compromise on an overhaul of immigration law, and this is why he lost the primary.

Not so fast.

First, this is not all up to the House. Obama could use his executive authority to limit deportations.

Speaking at a fundraiser the day after the primary, President Obama said: “It’s interesting to listen to the pundits and the analysts and some of the conventional wisdom talks about how the politics of immigration reform seem impossible now. I fundamentally reject that.” 

An Army of Refugee Children Flood Our Borders–What Should We Do?

Even as the president spoke, thousands of children from Central America continued to surge across our border, seeking an escape from the violence and poverty of Central America.

Once minors get into the U.S., they typically turn to immigration agents for protection. Under a  law passed during the George W. Bush administration, children, unlike adults, cannot simply be deported.  They must be turned over to Health and Human Services, and protected while their case is decided. Some will go to court where Legal Aid lawyers will argue that they will be in danger if they return home. Others will be reunited with relatives in the U.S. Some will ultimately be deported–but this could take years.

On Fox Special Report with Bret Baier, political analyst Brit Hume paid tribute to these lone childrens” struggle and their courage: “The immigrant children illegally crossing American borders by the thousands have triggered a logistical, humanitarian and law enforcement crisis to which current US immigration policy has no satisfactory answer.

“It may be tempting to call for their deportation,” he added, “but that ignores an important consideration: what the minor children, most of them unaccompanied by adults, had to go through just to get here.

“Nearly all are from Guatamala, El Salvador and Honduras, three countries plagued by extraordinary levels of drug and gang violence. Honduras now has the highest per capita murder rate in the world.”

“I have seen some of these kids,” Hume told his audience. “A youth home where I serve on the board here in Virginia has taken in dozens of them.  They are remarkable kids from what I have seen of them.  They are well behaved. When meals are served some of them weep at the fact that they’re eating better than their families can back home.  They wait till all are served before they’ll eat. They turn up at prayer services.  . . .  They potentially could make an enormous contribution to this country if we can find a way to house them and care for them and let them stay”. (Hat-tip to Digby for calling attention to Hume’s impassioned speech.)

The flood of young refugees, crossing into this country daily– and overflowing holding centers—casts a spotlight on their plight, making it clear that illegal immigration is not a problem that we can ignore. We just don’t know what to do with these children.

One Boy’s Story

“‘Where I live, parents are obligated to give a son to the gangs,’” Carols, a 17-year-old from Honduras told Bloomberg, while fighting back tears. An uncle who tried to defy the criminals paid with his life.

Another child showed Bloomberg his right hand: before he fled Honduras, a gang had accosted him on the street and amputated the tips of two fingers

“If you want to live, you have to leave your family,” a third 16-year-old confided.

“Carlos’ journey of 1,700 miles (2,700 kilometers) took about a month by bus and foot,” Bloomberg reports. When he arrived in northern Mexico, just a quarter mile from the border, he  explained that he hasn’t decided whether he’ll try to reach an uncle in Houston clandestinely or voluntarily surrender to border agents.

“’If I do that, they could deport me,” Carlos explained

“That could be fatal,” the reporter observed.
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The “Cholesterol Con”–Eggs

In the past, I have written about the “cholesterol con” (part 1), the widespread  belief that high levels of “bad  (LDL)  cholesterol” can cause heart attacks. As I have explained (part 2), the myth has generated enormous profits for many commercial interests, including companies that peddle statins. (Please read both parts of the post.)   No surprise, manufacturers  have poured millions of dollars into perpetuating the myth, and  thus have succeed in convincing a great many Americans that they should avoid high-cholesterol foods–including eggs.

According to Harvard University’s Harvard Heart Letter, however, it is not the cholesterol in eggs or other food that’s a major culprit. It’s saturated and trans fats (which our bodies may convert to artery-clogging cholesterol).

Today, as my husband, son, daughter-in-law and I celebrated Father ‘s Day with a brunch that featured “perfect scrambled eggs” (here is the recipe), fresh fruit and mini-bagels, I regaled them what I had just learned by reading  “Heart Sisters.” (Okay, “regaled” is the wrong word. My son and husband are not quite as interested in healthcare topics as I am. But my daughter-in-law—who is from the South, has lovely manners, and a kind heart — is always extremely interested in what I have to say.)

On Heart Sisters, Carolyn Thomas (a Mayo-Clinic trained heart attack survivor) lays out what Harvard’s cardiologists tell us about the egg:

“Fact: Eggs are a good source of nutrients. One egg contains six grams of protein and some healthful unsaturated fats. Eggs are also a good source of choline, which has been linked with preserving memory, and lutein and zeaxanthin, which may protect against vision loss.

“Myth: Eating eggs is bad for your heart. The only large study to look at the impact on heart disease of eating up to six eggs per week (reported in the April 2008 issue of the American Journal of Clinical Nutrition) found no connection between the two. In people with diabetes, though, egg-a-day eaters were slightly more likely to have developed heart disease than diabetics who rarely ate eggs.  (Ed. note: Quelle surprise . . . this study was done on men only).

“Fact: Eggs do have a lot of cholesterol. The average large egg contains 212 milligrams of cholesterol. As foods go, that’s quite a bit, rivaled only by single servings of liver, shrimp, and duck meat. Your daily cholesterol maximum intake should be below 300 mg.

“Myth: All that cholesterol goes straight to your bloodstream and then into your arteries. Not so. For most people, only a small amount of the cholesterol in food passes into the blood. Saturated and trans fats have much bigger effects on blood cholesterol levels.

“So if you like eggs, the Harvard Heart Letter says that eating one a day should be okay, especially if you cut back on saturated and trans fats, plus dietary cholesterol from other sources such as red meat.

“Other ways to enjoy eggs without worrying about cholesterol include not eating the yolk, which contains all the egg’s cholesterol.” (Note: II personally like to have two eggs for breakfast poached, soft-boiled or fried in just a little butter two or three times a week. I eat mainly the whites just dipping them in the runny yolk. In this way, I consume just one yolk–MM.

Happy Father’s Day.

 

 

 

 

 

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Cantor’s Defeat–Wittiest One-Liners

Eric Cantor’s shellacking has drawn much attention–perhaps two much commentary. (After all, this was just a primary.  I don’t think that it “Changes Everything.”)

That  said, here are my favorite comments on this event::

– “‘Brat Upsets Cantor’ . . . The headline sounds like a failed Bar Mitzvah” — Delaware Dem

On Tuesday night, Ezra Klein wrote:“John Boehner must be having an emotionally complicated evening.”

 

 

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Longevity and Long-Term Care: The Medical Crisis of the 21st Century : Part 2

Throughout the 20th century, most Americans saw “longevity” as a goal. If we took care of our bodies, we reasoned, we could “live longer and better.”

But in the 21st century, I suspect that some of us will learn to fear “longevity” the way we now fear cancer.

This is the second in a series of posts that will explore the anguish that some experience when they live into their late eighties and nineties–and how we, as a society, can address the hardships of “old, old age.”

                                           Senile Dementia   

Thanks to better diets, exercise, and advances in medical knowledge, more and more of us are living to four score and seven. But the downside is that in too many cases, our bodies are out-living our minds. As I note in the post below, since 2011, 40% of the increase in Medicare’s outlays can be attributed to spending on Alzheimer’s patients.

Why is the incidence of Alzheimer’s (AHD) spiraling? Because we are less likely to die of heart disease or strokes, millions of Americans are living long enough to be diagnosed with senile dementia. One could say that longevity is the proximate cause of Alzheimer’s.

Because women live longer than men, they are more likely to fall victim to AHD, the most common form of dementia. If a woman lives into her 60s her risk of being diagnosed with Alzheimer’s at some point over the rest of her life is 1 in 6. By contrast, for breast cancer, her risk is 1 in 13.  By 2050, the number of people age 65 and older suffering from Alzheimer’s may well triple, rising from 5 million to as many as 16 million.

Why then don’t we hear more about this scourge? Because at this point there is little or nothing that doctors can do to stop it. The Mayo Clinic’ website explains: while some drugs can “temporarily improve symptoms of memory loss and problems with thinking and reasoning . . .  these treatments don’t stop the underlying decline and death of brain cells. As more cells die, Alzheimer’s continues to progress.”

Last month Consumer Reports warned that “the overall results” for Alzheimer’s drugs “are far less encouraging than the ads portray. Most people who take them don’t experience a meaningful benefit.

More than half experience side effects. And they’re expensive, costing anywhere from $140 to more than $656 monthly..

Even a small benefit or chance of improvement might be worth it if Alzheimer’s drugs were risk free,” Consumer Reports observed. “But they are not. They can cause side effects such as insomnia, nausea, muscle cramps, diarrhea, and reduced appetite, all of which can be troublesome for people with dementia.” Occasionally, the drugs may cause more serious side effects such as internal bleeding and a slowed heart rate that could be potentially dangerous.

Meanwhile, the average Alzheimer’s patient lives 8 years—and 40% of those years are spent enduring the most severe, late stages of that disease. Some patients linger for 20 years. This is what makes Alzheimer’s so expensive.

                                The Need for Long-Term Care

At this point, we cannot cure senile dementia, but we can reduce the suffering that patients and their families endure by creating the long-term palliative care system that millions of baby-boomers and many of their parents will need. First, this means figuring out how to fund such a system. Medicare pays for some treatments, but it does not cover long-term care.

Up until now relatives have provided much of that care at home, but increasingly, the burden is becoming too great for aging spouses. And even if their children live close to home, daughters as well as sons have jobs that they cannot leave.

Medicaid will pay for nursing home care, but only after the patient and spouse spend down nearly all of their resources. (New laws now make it very difficult families to transfer assets to heirs when they see Alzheimer’s coming.) And even when families exhaust their assets, nursing homes and hospices often do not provide the combination of palliative care and skilled nursing that patients require.

Finally, and most importantly, we need to think about how to ease the path to death. Here, I am not talking about euthanasia. (In a later post, I will address  ”aid in dying” –a.k.a. “physician-assisted suicide”–and explain why some palliative care specialists have had second thoughts about that solution.)

In this post, I am focusing on reducing the fear, the panic, the overtreatment, and the medical flailing about that makes what I have called “the American way of dying” so traumatic. Death always will involve loss and suffering, but it does not have to be impossibly cruel, and it does not have to wreck families.
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A Patient’s Story–How Much Can or Should– Your Doctor Tell You About Potential Risks?

Below a non-fiction story from Pulse: Voices from the Heart of Medicine, “an online magazine of personal experience in health.”  Pulse is both a magazine and an online community that provides a chance for patients, doctors, nurses, social workers to come together, and share their experiences.

The magazine’s founders write: “Despite the large numbers of health magazines and medical journals, few openly describe the emotional and practical realties of health care. We at Pulse believe that our stories and poems have the power to bring us together and promote compassionate health care. “   Pulse was launched by the Department of Family and Social Medicine at Albert Einstein College of Medicine/Montefiore Medical Center in the Bronx, New York, with help from colleagues and friends around the state and around the country (Subscriptions are free: You will find the home page here.

At the end of the story, see my note, asking HealthBeat readers: “What Do You Think: Should the patient have sued the doctor?” Would she even have a case?

                                                    Collateral Damage

By Brenda Scearcy

Dr. Robert’s office felt right to me, with a musical birdsong soundtrack, soft lighting and fresh green tea, and I had my best friend in tow: piece of cake. In this serene atmosphere, I was sure that I’d find out what to do next to finish treating my endometrial cancer.

It’s probably gone now, since my hysterectomy two weeks back, I thought. But let’s play it safe; he’s the gynecological-cancer guru.

Like a general gearing up for combat, Dr. Robert said, “We can beat this. We’ll do a second surgery to remove lymph nodes and omentum–robotically, of course, so your recovery time will be quick. Down the road we’ll definitely do radiation and chemo, and your odds of recurrence will go way down.”

That tone. So assured…

“What’s an omentum?” I asked hesitantly.

“A slab of belly fat deep in the abdomen that can trap cancer cells; we usually recommend its removal if the cancer nearby is aggressive.”

“Side effects?” I asked.

“Not much to speak of. In rare cases, you get a slightly draggy foot from nerve damage.”

My whole psyche was dragging its feet. Did I need this, just after coming through a highly successful surgery?

A month before, I’d sought treatment for a garden-variety fibroid. My primary ob/gyn, Dr. Ann, had offered to remove the fibroid laparoscopically. Beforehand, as part of her usual pre-surgical procedure, she sent a tiny chunk to the lab for a cancer check.

Bingo.

A cancerous fibroid is a whole different ballgame, so Dr. Ann and I went to Plan B–a full hysterectomy and ovary removal.

Immediately after the surgery, Dr. Ann cradled my head in her sweet-smelling arm and whispered affirmations to me, cheek to cheek. Although everything else is erased by anesthesia, I clearly remember the feel of her skin and how fervently she whispered, “You’ll even want to eat–salmon!”

I did heal like a champ, wowed by blissful, oxycodone-induced hallucinations and by seeing my teenage daughter mature as she stepped into her new role as pants-puller-upper.

Call me a flake, but I believed that Dr. Ann’s surgery had removed the cancer. During waking hours, I couldn’t drum up any sincere worry. (But I did have nightly “mares,” always the same: a terrifying man breaking into my house, and I a throttled screamer. On a subconscious level, my fears about cancer were in overdrive.)

My first post-op visit with Dr. Ann, a few days after the surgery, was tremendously reassuring. She showed me the lurid photos she’d taken of my cancerous uterine fibroid, backlit and glowing ruby-red, so I’d finally see my torturer. (I still have a wallet-size photo.) We laughed–hard, which I don’t recommend after abdominal surgery.

Then she went over the lab results with me. The cancer was grade one (not aggressive) and had been relatively contained, with just one other spot on one of the removed ovaries. Dr. Ann told me that this spot was a bit of misplaced endometrial tissue that had sprouted a tumor. It was not ovarian cancer, which is often more aggressive. Welcome news. She poured her heart into reassurances.

But still. “There are other treatments, like lymphectomy, chemo or radiation, that I want you to consider,” she said. A recent cancer survivor herself, she wanted to make sure that I stayed in touch with my inner warrior. She sent me to Dr. Robert.

And Dr. Robert insisted that lymphectomy/omentectomy was the least I should do. According to him, chemo and radiation were necessary insurance against the Big C.

He described the omentum as having little purpose and regaled me with stories of women who were vacuuming the house eighteen hours after their surgeries.

I’d studied ecology in grad school; its principles guide every part of my life. I know that everything is interrelated, and that when you do one thing, it can affect other things in surprising ways. But I wanted to believe that the cancer was behind me.

Also, I was foggy-headed, suffering from cold-turkey estrogen withdrawal after the hysterectomy. So my antennae weren’t up, and my energy for fact-checking Dr. Robert’s claims was nonexistent. And then there were those nightmares….

Ultimately, it came down to this: Dr. Ann recommended that I take Dr. Robert’s advice. He was the expert. Hoping that lymphectomy would seal the deal, I had the surgery.

The immediate after-effects:

(1) Excruciating shoulder pain, referred from my diaphragm, from gas injected during surgery.

(2) Lymphedema, a build-up of fluid caused by lymph-vessel blockage. Within two days, I looked like a sumo wrestler, with lymph pooling around my middle. No clothes fit.

(3) A walnut-sized pocket of lymph in my right belly. One night at supper, my shirt suddenly grew wet as lymph spurted out of one of the operation slits.

(4) Permanent nerve damage and numbness: Dr. Robert had accidentally cut nerves to my left quadriceps, groin and lower belly.

Dr. Robert had mentioned none of these possibilities.

During my hospital stay, I never saw him. Once home, I repeatedly phoned his office, begging for help, but he never called back. Two weeks later, during our only post-op visit, he said the nurse had never told him.

Having removed more than half of my abdominal lymph nodes, Dr. Robert found that they were all cancer-free. My post-op report stated that he’d removed them prophylactically; as I saw it, that was like removing a hip so I wouldn’t break it.

A year later, I found my legs and buttocks swelling up again. At first I thought I’d twisted my ankle, but eventually Dr. Ann enlightened me: I had chronic lymphedema.

She steered me to cancer rehab, where I learned I could improve the symptoms slightly with time-consuming exercises, careful skin care and $135-a-pair pantyhose that squeeze me girdle-tight.

Now I roll a tennis ball around my ankle to break apart the fibrosis caused by lymphedema. I research cheaper pantyhose. And to give myself time to exercise and heave my hips into those leg-hugging hose, I set my alarm forty-five minutes early each morning.

I’ve damaged my knee with the grunting maneuvers required to don the hose. Long walks are temporarily a thing of the past.

The last straw is that I must hand wash these tights nightly–an odious eight-step chore.

Looking back, what astounds me is Dr. Robert’s profound lack of curiosity about his interventions’ potential impact on my daily life. He could have anticipated some of the problems–what symptoms might I develop? How ugly would I feel as a human blimp?–and might at least have warned me about what to expect.

And if I’d known the risks beforehand, I could have asked myself which I would choose: uncertainty about a recurrence, or the tedious gamut of lymphedema care?
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The Next Plague: Alzheimer’s

In the 1970s and 1980s, a plague called AIDS swept through this country. Like a medieval scourge it was mysterious, incurable, and ruthless as it killed those who were far too young to die.

Now, baby-boomers have reason to fear a new scourge: It won’t cut them down in their youth, but if they dodge heart disease and beat cancer they may find themselves trapped in their bodies, watching their minds dissolve.

Did you know that a woman who is now 65 stands a 20% chance of dying of Alzheimer’s? (See Michael Kinsley’s essay in the New Yorker.)

On Bloomberg View Matthew C. Klein has put together a booklet of “visual data” titled: “How Americans Die.” These stunning interactive graphs will startle you. For instance, were you aware that suicide has recently become the leading cause of violent death in the U.S.?

But it is the pages devoted to Alzheimer’s here  and here that stopped me in my tracks.
I turns out that about 40% of the increase in Medicare spending since 2011 can be attributed to greater spending on Alzheimer’s treatment.(We don’t have reliable data on Alzheimer’s spending before that.) And that number is bound to climb.)

The Boomers will be the second generation to die of dementia, but the first to see it coming. 

These charts are terrifying but important. We need to begin thinking about how to cope with Alzheimer’s. Here, The Mayo Clinic outlines “What is On the Horizon for Alzheimer’s.

I’m not optimistic about a cure anytime in the foreseeable future. But we definitely need to think about how to care for the many who will be suffering from this dreadful disease.
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