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REMDESIMIR-DEXAMETHASONE AND CONVALESCENT PLASMA FOR COVID-19 ILLNESS

September 3, 2020

Here is a story. A 72 year man with mild Parkinsons disease contracts COVID-19 virus and enters the hospital for admission. His main symptom was shortness of breath. Because of low oxygen levels in his blood, he was admitted to the ICU. There he received supportive care including nasal oxygen, IV fluidsand monitoring. He did not have to undergo intubation and mechanical breathing. He remained in the ICU for three weeks prior to receiving Remdesimir (antiviral antibiotic), dexamethasone, and later convalescent plasma. After these medications, his symptoms improved and he was transferred to the COVID ward and later discharged to his home.

Remdesimir is manufactured by one company (Gilead Corp.) so the supply may be limited for hospitals. It is still considered an experimental drug and is allowed to be used in hospitals for COVID19 patients with unstable vitals signs or when oxygen saturation is low. The cost for 5 days of this drug is $3,100.00.

Dexamethasone is a long term corticosteroid that is NOT an experimental drug, cheap, and has been used for a variety of illness for decades.

The New England Journal of Medicine revealed a 65% improvement rate of severely ill COVID-19 patients in a double blinded study when these medications were used. These patients did not receive plasma. I have talked to two nurses in my area (an ICU nurse and an ER nurse) who tell me that the decision to us these drugs “depends on the doctor” caring for their patient. There is no standard protocol. What is concerning to me is whether all patients at this level of illness are INFORMED about using these medications. Are the families informed? I suspect many COVID-19 patients die without these medicines. I also suspect that these drugs are used too late in the course. Even if the cost for these drugs are not covered by insurance companies, many able patients would likely pay this cost to save their lives.

Not enough studies are available regarding convalescent plasma  (plasma from people who have contracted COVID-19 and have survived)  It seems to be a drug of last resort and often times not available. Giving plasma is not that dangerous and has been used throughout the years for a variety of other illnesses.

THE TAKE HOME LESSON: If you know of anyone in the hospital fighting COVID-19, please be aware of these drugs and present them to the treating doctor. There use may save their life !!

Dr. D. 

THE CORONA-19 VACCINE….ON ITS WAY ??

August 7, 2020

I was pleasantly surprised when I heard Dr. Fauci speak at a congressional hearing last week when asked, “when do you think we will have a vaccine for use in the U.S? His response was that he was “reasonably confident” that we will have a vaccine for use in December. I expected him to say next Spring or early summer. He continued to say phase 3 double blinded trials have been underway with a very promising vaccine.

Keep in mind, there are many vaccine candidates: China, Oxford and France all have their prototypes.

In the U.S. Johnson and Johnson, Pfizer and Merck have their candidates. The medical group in Pittsburgh has a candidate. The NIH in conjunction with Mederna has their model.

I imagine once our initial vaccine is expanded for use, hospital workers, military, senior citizen homes and their residents, fire and police personnel will be the first recipients because of their high risks.  Afterwards, the vaccine will probably released to the general public above 18 years of age.

As safety data continues to accumulate over time, the vaccine will probably move down to the younger ages and eventually to all children.

There are concerns I have accumulated, however. In my practice I have been asking parents would they consent to getting the vaccine once it becomes available. Many have said NO out of fear of its safety.

Many have the belief that “the government is rushing this thing and it may not be safe.”

Other concerns turn to the financial issues. Is the vaccine going to be manufactured via private companies and if so, will they demand a profit? Will there be a cost? Will the vaccine go through insurance companies?   When polio vaccine was administered in the 1960’s everyone received the vaccine free of any charge; no insurance companies were involved. Will Corona-19 vaccine follow this model?

Either way, I feel that slow progress is being made to put this virus away for good.

….will talk later….

Dr. D.

CYTOKINE STORM AND COVID-19

May 21, 2020

Unless you study immunology you probably have never heard of “cytokine storm.” In fact, you probably never heard of “cytokine.” As we approach different methodologies for treating sick patients with Corona-19 virus, you will begin hearing this term in the media.

Here’s an analogy I present to patients; There is a burglary at the local bank. The sirens alarm the police and a quick response begins. The police arrive with multiple cars and perhaps armored vehicles. The police catch the criminal, takes him or her to jail and the case is closed.  That would be considered a normal response to an invasion.

Suppose the burglar sets off the bank alarm, the police come followed by SWAT, the CIA and FBI and soon armored tanks are surrounding the bank. Later, fighter jets launch laser guided missiles onto the bank destroying everything within 5 blocks. A massive fire erupts and many innocent people die. We would consider that excessive force associated with massive collateral damage.

The body’s immune system works very much like how society handles a burglary, a riot, or war. Very much like the Army, Navy, Air Force and Marine Corp and Coast Gard, the immune system has a variety of cells that carry out specific functions. If a splinter causes infection in our finger, there will be a defense response that is very limited. If we get pneumonia, however, a more massive defense system is launched to prevent death and to resolve the pneumonia. If we get a parasitic infection, other specific cells are involved to resolve the infection. Viral infections involve another subset of cells for defense. All of the various defense systems in our body are coordinated by chemicals called cytokines. Certain cytokines are produced to fight a minor infection whereas other cytokines are secreted by immune cells to fight major infections. Other cytokines are produced to fight cancer cells.

The commonality amongst the many types of cytokines is that they produce inflammation. Swelling, redness, itch, pain, pus development, mucous secretions and leakage from blood vessels or lung tissue all result from inflammation. Such inflammation is good since it is essential to destroy viruses, bacteria, parasites and cancer cells. However, inflammation is like a sharp cutting knife; it is essential in cutting your food but it can also cut YOU!

A cytokine storm is when there is an invasion (in this case, Corona-19 virus) and cytokines OVER REACT, causing a similar situation like I described with the massive unnecessary disruption of the bank robbery. When cytokines over react, there is massive swelling, pain, leakage and cell death. Since Corona-19 virus loves the lung tissue initially, much of the healthy lung tissue is destroyed in the process of fighting the virus. When healthy lung tissue dies, we can’t breathe.

Since our lungs are vital organs, when they are heavily destroyed, we die. If we survive long enough, other tissues are destroyed in the liver, kidney or blood vessels leading to strokes, kidney and/or liver death. The intense inflammation of blood vessels can cause clots anywhere in the body.

Most of the world’s research is now focused on how to block or slow down certain cytokines to decrease massive inflammation. In a sense, it is the body’s inflammation that kills us and not necessarily the virus. We already have an array of medications that are aimed at certain cytokines and hopefully, we will have a treatment plan that will decrease mortality and shorten morbidity. At that point, our fear of the virus will subside since, if stricken by the virus, we know our chances of dying would become very unlikely.

Hospitals now know how sneaky the virus is. It implants itself into the mouth and nose, travels down to the lung and very quietly “sets up camp.” This is when there is NO hint of us being sick; no fever, malaise or anything! Yet, there is an enemy in our lungs doing damage. After so much destruction has occurred and the immune systems recognizes the threat, the “cytokine storm” erupts. There is so much collateral damage during this war that death is a result of the massive destruction and not the virus.

My hope is that over the next 3 months the death rate from COVID-19 approximates that of influenza virus. Now that this illness is being treated early with cytokines inhibitors and/or antiviral drugs, I hope to see the number of ICU admissions (and hence death) decrease.

One very early detector of the disease being present before symptoms erupt is measuring the oxygen level in the blood. This is easily done by a pulse oximeter (approximately $35.00-$50.00 at the drug store) that is routinely done in the ER. We now realize the oxygen level drops to dangerous levels even before we have cough chest pain or fever. It is becoming the ideal screening tool and not temperature taking.

…will talk later…. Dr. D.

“BUILDING UP” YOUR IMMUNE SYSYTEM

April 16, 2020

As a physician, I get mildly irritated when I hear on talk radio people professing to give advice to “build up” your immune system. This becomes the latest talk in light of COVID-19. I heard from one participant that when a vaccine is available, he will NOT take it because of side effects and that “it just keeps the medical profession alive.” “The Tuskeegee experiments just prove that all these medicines and vaccines do more damage than good.”

It reminds me of those who say “my vote doesn’t count, so why should I vote?”

Tumaric, honey, bourbon, green tea, vitamin C, ginger were all offered as ways to boost the immune system. One person said his grandfather refused to give any of his children or grandchildren any medicine offered by a doctor and all his prodigy “turned out just fine.” Grandpa made his own concoctions. One person went so far as to say the way your cure COVID-19 infections is with lemon juice and aloe 3-4 times a day.

Let me say something here; there is a reason that science fair projects are offered and /or required in school. They teach you about what is called the scientific method. The scientific method requires inquiry, experimentation and most importantly, statistical analysis to prove or disprove a theory. It tries to establish fact. It throws away conjecture, personal opinion, and anecdotal stories that may have worked for an individual but not for the general public. Medicine is evidenced based. Studies are what we call “double blinded “ so as to not enter prejudice. Holistic medicine has its place and is helpful at times but holistic medicine is seldom checked by the scientific method. Often times, when tested, there is no statistical evidence that a product works. Remember to read the fine print on many commercial healthcare products that say “this product has not been tested by the FDA nor shown to be effective to cure or treat any disease.”

Anthony Fauci M.D. and many other scientists who have researched the human immune system would tell you, the field of immunology is still young. There is much more to learn how it works.

NO one knows EVERYTHING about our immune system. When I was a fellow in Allergy and Clinical immunology at Childrens Hospital in Washington, D.C.,(1981-1983) we knew about the structure and function of immunoglobulins, T-cell differentials, intercellular adhesion molecules, interferons, and other arachidonic pathway molecules. We knew about the role of complement cascade molecules. We learned how different aspects of the immune system played a role in allergic, autoimmune and hypersensitivity disorders. We connected clinical disorders with these scientific findings.

Today, we talk about the variety of interleukins, the huge variety of CD subsets, neuropeptides, tryptase and genetic makers for these product to further understand how this whole process works. What we do know is the immune system is divided into two main divisions; the innate and the adaptive systems. The innate system is the backbone of our protection against viruses, bacteria, parasites, and cells that have be mutated into cancerous cells. It has been part of our genetic blueprint since the beginning. Since micro-organisms have the ability to mutate and present to our bodies novel (never seen before) infections, the adaptive immune system has developed over time to deal with these newer infecting agents. The adaptive systems will always have to change to keep up with novelty. The more the body has battled with infecting agents, the more powerful the immune system becomes. This is why a toddler is going to get sick many times but the young adult seldom gets sick. Of course, being physically fit, adhering to a healthy diet and pushing away stress helps to fuel the immune system, but there is no evidence that these, in themselves , enhances the immune system.

Hence, we are relying on our adaptive immune system to fight COVID-19. Adaptive immunity many times fails, but over time it learns and finds new ways to conquer its enemy.

The planet has way more infectious agents than it has human cells. In fact our own body has more bacteria inside than we have human cells. WE ARE MORE BACTERIA THAN HUMAN !

In the end, microorganisms will long outlast humans. I must say, however, that our immune system has put up a good fight to keep us on the planet this long. We are David fighting Goliath.

Dr. “D”

…an update on COVID-19…..

April 9, 2020

There is more and more news about companies producing a Corona-19 vaccine. Johnson and Johnson company seems to be in the led but the researchers in Pittsburg seem to be just as progressive. I am sure other countries are working on a vaccine as we speak. Johnson and Johnson says they expect their first human trials by September 1. If their vaccine is approved, they are preparing to manufacture 1 billion doses over 4-6 weeks.

Here’s the question; when will it be available for use? Since this vaccine will be used worldwide, safety is of great concern. Overseers (CDC, FDA and WHO) will want to be absolutely sure that any vaccine will do no harm; that means that those brave volunteers who initially get the trial vaccine will have to be observed at least for 21 days if not longer. The vaccine will then be scrutinized to see if it is effective. This involves taking blood samples from such volunteers to see if they have developed specific antibodies to the virus and how effective those antibodies are at neutralizing the virus. Just as in HIV, we have to develop the technology to measure “viral loads” in the blood stream as well (i.e. the number of viral particles detected in the blood).

So, if everything goes well without problems, we may be able to see a global campaign of vaccinating everyone on earth by late Fall-December. That’s an extremely fast production time to produce a new vaccine since the normal span is 2-3 years.

In the meantime, I think it is time we ALL wear something to cover our mouth and nose when exposing ourselves to the public. The 6 foot rule should still apply.

If you are around no one else, masking is not required.

What about testing? I have talked with many parents whose child had a fever.

I have also had children come in the office because of fever. The details of the history such as the age, and duration of illness play a role in decision making.

Most non Corona-19 viral infections clear in 4-5 days, so if a child has had prolonged fever beyond that time timeframe, I become suspicious. I then tell everyone the child has been exposed to self-quarantine themselves for the next 10-14 days. If the child becomes clinically sicker over time and hospitalization is required, that is when testing is done. If the exposed adults who had contact with the child developed symptoms (fever, body aches, cough) then they should be seen in the hospital where testing will be done. The commercial labs still don’t have the quantity of tests kits to test everyone.

Psychologically (since this crisis will undoubtedly last through the summer months), it is important to prevent anxiety and depression since this crisis came down on us with speed and vengeance. Make sure you continue the pattern of your life before the virus started. Get up at the same time; make sure you know the difference between a week day and the weekend. Order pick-up food for the weekend as a treat. Sit out in the sun on a pretty day. Engage in hobbies that you put away because you never had time. Exercise on your own. Be sure to look at comedy on your TV or devices. Laughter combats the fall in serotonin levels that accompany chronic stress. Talk to friends and neighbors on the phone or computer.

THIS CRISIS WILL END !!! BE PATIENT – BE CREATIVE- BE LOVING

Someone “upstairs” is watching your moves actions and heart.

Dr. “D.”

 

…about Corona virus COVID-19…

March 16, 2020

As of March 12th we now know the spread of the virus in the USA has shown exponential growth (the spread of virus increases its velocity with time) That means that despite preventive measures of handwashing and social isolation the virus is expected to reach and infect the great majority of US citizens before summer. Once we can get testing done (for everyone free of charge) we will probably be amazed how many people who are healthy are also positive. They would be considered as carriers. We may find many carriers (especially children and young adults) may not get sick at all. I am waiting on data from China as to how many of their deaths were in children (presumably low if at all).

Preventative measures are not going to put this pandemic to rest; it serves simply to slow down the spread to allow for health facilities and the National Guard to prepare for massive hospital needed admissions, manufacture of test kits and durable medical supplies such as respirators. It also give the CDC some time to further study the epidemiology and characteristics of the virus. I am sure many antiviral drugs already used for HIV and other viral diseases are being tested against Corona-19.

If you have had known exposure to the virus within 3-6 feet for more than 5 minutes you status is considered moderate risk and you should isolate yourself for 14 days even if you feel well.

If you have the above exposure and feel ill with fever and cough, you should contact by telephone your major hospitals in the area as to where to show up- don’t just walk into the ER.

Likewise, urgent centers are referring this category to the hospital and will likely turn you away. Of course you should be wearing masks and gloves. When testing becomes available for all and you are positive without illness, then self isolation is recommended for 14 days.

Since the virus will probably infect you at sometime in the future, my suggestion is to support your immune system by

  1. Getting lots of sleep
  2. Avoid alcohol and recreational drugs
  3. Avoid mental and physical stress as best as you can
  4. Eat healthy meals
  5. Zinc lozengers seem to make viral attachment to mucous membranes difficult and defer infection (don’t know if this holds true for Corona-19)
  6. Take multivitamins

Since most of the entire Hunan Chinese population is probably infected it is valuable to note that their infectivity rate has stabilized. We will probably see the same in Italy.

When you find you are positive, DON’T PANIC; most infected individuals recover without the need for hospitalization.

Isolate yourself for 14 days and make sure you have all the foods and medicines you normally would need with any “flu-like” illness.

As we go along and find more information I will update this blog.

Peace to you and yours,

Michael Darden M.D.

USA HEALTHCARE – A REVISAL

July 5, 2019

So much is in disarray with healthcare in this country. Frustration from physicians, dentists, therapists and related technicians centers around the low and sometimes absent reimbursement for services that require great skill and knowledge. Patients complain about the high cost of medicines and the scanty amount of time the doctor spends with them. We talk about healthcare disparity.

Politicians and government administrators talk about how expensive healthcare hits their budget. As mental health issues continue to escalate, most private practicing psychiatrists do not take insurance because the low reimbursement rate for services would drive them out of business. An emergency room visit for a bad “cold” may cost taxpayers an excessive cost when that “cold” could have been managed outside the emergency room. All the above is true.

Meanwhile the entities that are smiling include the pharmaceutical and insurance companies. Not only do they bathe in financial luxury, but they make the rules of the business. Insurance company CEO’s often compete with each other regarding their ¼ to ½ billion dollar salaries. Yes it is expensive for pharmaceutical companies to get a drug approved for market, usually in the billion dollar range, but once approved, that investment usually turns a profit in the first year of sales. After that, the company goes through smooth sailing with astronomical profits for the remainder of the patent. That is enough incentive for these entities to invest in NOT making any change in the healthcare system. They are doing just fine.

We are now seeing the rise of urgent care centers; they realize this is big business and they want a piece of the pie. Being very convenient for patients, many are turning to urgent care for their primary provider. This hurts the doctor patient relationship since you are most likely not to see the same doctor upon return visits. Many doctor visits are managed by physician assistants or nurse practitioners. Though these specialties do a wonderful job with healthcare education and preventive care, logic tells us that their expertise in difficult diagnosis or managing complex chronic medical issues is second to physicians.

So, without completely socializing medicine, here is my solution:

  1. Increase the professions of nurse practitioners and physician assistants.to manage non-complex or non-urgent issues. Let them set up their private offices and received $72.00 then that is decent reimbursement for the nurse practitioner and a relief for the insurance company. Multiply this kind of incident millions of times throughout this country and you can see how our healthcare cost would go down. That comes to 90% reimbursement to the nurse practitioner (which is great) and a great reduction in cost for the insurance company. Both parties win. With a 90% reimbursement rate, (and allowing for a ceiling) the nurse practitioner could make a very decent living. Maybe not as much as the physician but there would be an understanding that these are very separate entities.
  2. Salaries would expected to be different.
  3. Much of this is already happening BUT the difference is that the billing for services is at a rate the PHYSICIAN would bill thus increasing the cost of medical care in this country. For example; a patient is seen in the emergency room for a bad nose bleed and a nurse practitioner manages the problem without a physician input. The ER may bill the insurance company $1,200.00 for the service since it was done in the ER and receive $850.00 as payment in full. If the same patient saw a nurse practitioner in his or her own office and billed the insurance company for $80.00
  4. like some states allow to do the above. Let midwives manage non complicated pregnancies and deliveries; these cases may not need the input of the physician. They do an excellent job of monitoring and maternal support. Obstetricians now get a flat fee (approx. $800.00) for nine months of non-complicated pregnancy. That’s a lot of time and responsibility to just get paid that amount. It discourages many to no longer deliver babies and resort to just GYN care.
  5. Have them do the job of routine physicals healthcare assessments, and managing minor medical problems. They can be in urgent care facilities and ancillary areas of emergency rooms
  6. The role of the primary care physicians would be different. Their role would be to treat and manage chronic, complex or difficult problems only. They would not have the role of preventive medicine, managing long questionnaires, or administering vaccines. These roles would be the responsibility of the nurse practitioners or PA’s. Physicians, however, would receive a far greater reimbursement for their services since they would be considered as experts in their field and not a “healthcare provider.”

So, if the doctor treats and manages an asthma attack in their office, his or her reimbursement from the insurance company would be very different. For example, today the doctor may bill the insurance company $200.00 for a 40 minute visit and receive $95.00 for the asthma management. In a new system the expertise of the M.D. would command a billing of $350.00 and the reimbursement would be $315.00. That would be great for the doctor since they would not have to see as many patients to stay in business and they could afford to spend more time with the patient. This benefits the patient. The insurance company still benefits since much of their outgoing cost for minor and preventative services are at a lower cost.

This system implies that the average salary for a PA or nurse practitioner would be significantly lower than the physician.

  1. PAY THE PSYCHIATRISTS!!! Many don’t realize that many psychiatrists do not accept insurance
  2. and for good reason. Psychiatrist get reimbursed by the insurance company at a rate that is dependent on the diagnosis. It may take many hours of psychiatric evaluation before a diagnosis is reached but the doctor may get paid “peanuts” if the diagnosis is not at all complex. Pay the psychiatrist for their time not the diagnosis. Pay them well for their expertise and many years of training since they are the ones who may prevent your loved one from suicide.
  3. Since most commercial insurance reimbursement amounts are tied to Medicare rates, increase Medicare rates for physicians. This would encourage more M.D.s to accept Medicare and Medicaid but Medicare and Medicaid would not have to pay out as much if much of the preventive and primary care is relegated to P.A.’s and nurse practitioners. Medicaid forces its M.D.s to comply with a plethora of rules in the area of preventive care. If this responsibility was shifted to P.A.’s and nurse practitioners (who do a better job) this frees the physician to do what he or she is trained to do.
  4. Have federal government coop with pharmaceutical companies as an option. The biggest hurdle
  5. for these companies is the initial cost to invent and get certified by the F.D.A new drugs and devices. If the federal government agrees to supply half the cost for research and development and the company adheres to a ceiling on the price of the drug at market then both entities win. The drug company may save 5 hundred million on getting the drug to market and the government saves from having to pay out ridiculous prices the companies may charge.
  6. PAY THE HOSPITALS THEIR WORTH!! They are life-saving institutions and are worthy of their efforts. Yes, an ICU stay for 2 weeks presents with an astronomical bill and a premature neonate stay in the NICU for a month may cost over a million dollars. Place an 80% cap on what insurance companies would have to pay and have the balance paid by government. With savings elsewhere in the system, government supplement should not break the bank.

In general, USA medical care is good, but we all are paying too much for it because of its structure, not necessarily management. In general, most medical care cost are for minor or non-complicated problems. It is just that the volume of these problems is high. Many of these problems are managed by intensive facilities such as emergency rooms and urgent care. If our structure connected people with a team of health care providers that are non-physicians then many visits can be managed via telephone communication, education and reassurance.

Case in point: a 3-year old child develops a fever at 2:00 am.-parents panic and take the child to the emergency room at a cost of $1,200.00. That same child’s parents could call on a pediatric nurse and be given advice to lower the fever and reassure the parents that the child can be seen the next day in the doctor’s office. The cost for that route could be approximately $150.00.

Patients get the idea that any ailment necessitates a trip to urgent care without contacting their primary care provider first. This process has to be stopped. During the days of HMO (health maintenance organizations) patients HAD to contact their primary care providers before any other service could be authorized. That was a good idea to save cost and it should be reinstituted.

Finally, education of chronic medical conditions to the public would be best served by free seminars sponsored by insurance companies and not drug companies. Education lowers health care utilization and costs; this would benefit the insurance companies.

Michael D. Darden, M.D.

THE DATING GAME

March 4, 2019

There seems to be a gap in the mechanics of dating from the current generation of teens and young adults and what dating was like “back in the day.”

Today the proverbial phone number is used for texting-not talking. So here we go:

  •  Person one: “ Whats up with you?”
  •  Person two: “just chillin…why?”
  •  Person one; “thought you might like to get some pizza or somethin”
  • Person two: : “I think Im goin ta just chill here- not tonight”
  • Person one: “ok but hit me up when you can”
  • Person two; “sure”

What happens then is that person one never gets any notice beyond that; no phone call, no text –  nothing. Person one rightfully feels that person number two is not interested in getting together.

End of story. End of a possible friendship or romance. Added to this crude mechanical communication seems to be a paranoia about starting a relationship. I am not so sure where this originates but fear of pregnancy, fear of HIV and other venereal diseases probably plays a big role. So the safe route would be for women to hang out with women and men to hang out with men. Unless there is a homosexual affinity, the issue of sex is removed from the equation and the getting together becomes safe.

A group of guys get together to play video games while altering their perception via alcohol or drugs and have a relaxed wonderful time. A group of girls or young women are at a party and seem to have great fun socializing, dancing and laughing amongst themselves. There is an element of comfort and familiarity among same sexes.

Maybe we are seeing the subconscious effects of the 1980-2000 media blitz putting fear into sexuality, especially because of the AIDs crisis. Sexuality in the 1970’s was fairly casual and almost conventional.

The biggest worry was pregnancy and gonorrhea. HIV was not a factor until after 1978. For those teens who participated in sex, it was a gradual continuum of “going further and further” over many weeks and months of “going together.” Sex was not initiated on the first or second date. It took time for comfortability to set in. Such is not the case today. Using today’s adults as models, dating implies the possibility of sexual activity. This obviously can be scary for a young lady to get together with a man one on one.

Add in the custom of texting and poor skills at talking face to face, this issue of sex and getting together often goes without understanding. Nothing gets resolved so the safest option is to not “hit the other person up.” It would sound ridiculous but relieving if person one above included in his text:

Person one: “thought you might like to get some pizza-my treat;  but look, this is not like I am trying to have sex with you.    It’s just a friend like thang.”

Without face to face dialog skills, relationships may ONLY be centered around sex for those who choose to participate. These are certainly bad models for those individuals who choose to marry and have children. I can’t imagine a married couple having a worthwhile and needed argument via texting.

It requires the skills of reading body language, refining the meaning of what the other person is saying and meaning. It requires the physical presence if an argument ends up with reconciliation, hugs and smiles that resolve difficult issues. Dating purely though text communication is disastrous when one matures and desires a long term companion.

So, for those of us who are members of “old school dating” we may have to better avail ourselves to sharing our stories as teens and young adults. Our young folks WILL listen. They are very interested in intimate relationships; in today’s fashion of social media and texting, they just don’t know how to go about it.

……..talk with you later,

Dr. D.

WHAT’S IN A NAME ?

December 11, 2018

It has been a while since my last blog, so here goes another……

I just returned from a short trip to Cincinnati, Ohio where I grew up and witnessed something that made me reflect some thoughts. While waiting in line for my airplane to board, I saw about 20 young men, all dressed uniformly in white shirts, black slacks, shoes and black sport coats with yarmulkes and the traditional black hats worn by orthodox Jewish men. Many carried their Torahs with them. These were not older men; most were older teens. They seemed to socialize in a cohesive unit of brotherhood. Even their cell phones were of uniform style.

So what is my point here? In the Christian tradition (as I suppose in all religions) the central theme is to love fellow man and women with all your heart, with all your soul and with all your mind. My personal goal is to simply achieve that theme. Now it does not say to love just certain people; I am of the understanding that it includes ALL of God’s people. To be honest, I felt a stranger to these young men; I was an outsider. I was even reluctant to strike a conversation as to the purpose of their trip.

I knew not all was in line with my goal. How could I love them if they seemed so strange and of very different genres than mind?

Now let me flip the script. Of all human beings, the sector that I feel most saddened about is the black male in America. I can’t say that so much about black females since, in many ways, they are thriving. My maternal grandmother said to my parents that when you have a family (there were 5 of us) you focus on the ones that are in need the most. Black males are in need the most. Yes, many of us are unemployed and just hang out on corners and strip malls. Yes many of us “bum” for money. Yes many young black males skip school just to hang out in similar places with not much to do except pace the side walk like a lion in its cage or talking on a cell phone. To show your underwear covered buttocks on a cold Winter day seems to imply that this mode of display is critical toward your acceptance. Yes, “nigga” and a variety of other foul words are expressed in every sentence. Yes, their coats and hoods are black to match their black skin and hair placing them on “the dark side” as Star Wars implies to be really deplorable.

Just as I felt a stranger to the Jewish fella’s, I can just imagine the alienation non-black people feel about the black American male. Most social groups of people have strong historical backgrounds that supports their esteem. Jewish people have a strong commitment to each other and many have their Hebrew language to cement their socialness. Many Hispanics have their own language, yet speak the King’s English as well. The Irish have their traditions, parades, Pubs and colors. Whites, who have not gotten over the fact that Robert E. Lee conceded losing to Mr. Grant in our civil war over slavery, have their own confederate flags, stock piles of guns, symbols and secret meetings.

American blacks have much of nothing historically to support esteem. With the consistent killing of young black males, society is telling all of us that this sector must be erased. So American black males are at the lowest rank on the pole. Social depression is like personal depression; it is a disease that is chronic and often difficult to improve. Unlike personal depression however, there is no pill available for social depression.

Being a pediatrician, I am trained toward preventive care. So what can be done to straighten up and uplift the American black male? This is not a simple answer but here is a suggestion that can begin to heal. When I see African patients who were born in the USA, parents usually give them a typical American name. They also have an African name that has meaning. The name ties them to a tribe that had historical unity and great esteem. When black American parents have their children and give them names, they are often based on family or biblical names or fine materialism or smooth sounds (Crystal, Porche, Little B, Snoop, Big Daddy to name a few). These names are like Jazz music. The quality of the sound being heard has to please the mind. Now, all of this is fine; it is a part of black culture in the USA. However, with the advent of DNA analysis, we can trace our ancestry back to African countries we know very little about. It would support upcoming children if they knew they had an American name yes, but also an African name derived from their ancestrial country. For example, much of my DNA comes from Mali West Africa. My name is Michael but I could also have a name like Amadou or Mamadou. I may never use it in the USA but just to know my parents gave me another name tying to my roots serves only to boost my self-esteem. I can then go back and learn about the proud people of my heritage before colonization and to connect with a history not just based on slavery. If slavery is the only background of my history then I am bound to be depressed with low self-esteem.

Get well black males !!   We are ALL supposed to love you too.

….will get back at yah in Spring…

Michael Darden M.D.

GUNS IN OUR SCHOOLS – THE WILD WILD WEST ?

March 2, 2018

Imagine if you will, that America’s “King” and his opportunistic henchmen in Congress pass a law that requires teachers to have personal weapons in their classroom. All students including the kindergarten student will be well aware that their lives are surrounded by adults who carry guns.

Now lets remember that children have an innate desire to emulate adults especially parents and people who occupy a great part of their lives- teachers. Teens want to drive, drink, smoke and engage in sex just like grown people. Kindergarten students want to grow up to be firemen. Elementary students want to be superheroes and older children aspire to become a famous athlete or rap star. Teens absolutely cannot live without their cell phones. So it would be natural for all students to want to be “strapped” as well with handguns.

They would somehow acquire them legally or illegally. To revise a line from one of Prince’s lyrics, “Mommy, why does everybody have a gun?”   No longer would there be fights after school or after a football game. The altercation would be over in a literal flash.  BANG! “you dead !”

So here is my answer to this whole gun thing:

  • Dear NRA: Look at history; we are no longer using dial up rotary phones- the telephone has evolved into miracle devices. So, come out with a new protection device, one that does not kill but still offers protection for anyone who feels they need it. The device may stun or immobilize a person but IT DOES NOT KILL. You have the money and the resources to come up with such a device. Your profits would soar since, like cell phones, most everyone would have one.  The conscience of your company (if you have one) would be better served to know that you are no longer getting rich by killing people, but by protecting people.

Michael Darden M.D.

…talk to you in the Spring….