ppp 05-18-09

Quote of the day:

He who every morning plans the transaction of the day

and follows out that plan, carries a thread that will guide

him through the maze of the most busy life.

But where no plan is laid, where the disposal of time

is surrendered merely to the chance of incidence,

chaos will soon reign.

Victor Hugo (1802 - 1885)

My mother always emphasized the importance of planning, often repeating “Plan to work and work your plan”. She asked, “How are you going know if you ‘got there’ if you don’t spell out where you want to go in the first place?” Have you ever sat down and written out a budget? My first attempt at budgeting was when I first tied the knot about 35 years ago. I had accounted for EVERYTHING from groceries ($20/week) to rent ($95/month). Also included were transportation (1 bike and 1 car), birthday/Christmas presents for friends and family, insurance and savings. The whole totaled a whopping $400 per month which I could make as a part-time pharmacist/full-time Pharm D student. Anything that we brought in over the $400 was set aside for our house fund. We stuck to our budget no matter what. On one occasion I distinctly remember having popcorn for dinner even though I had enough money in the bank for a nice steak dinner.

When our landlord died, the new owner quickly doubled our rent. Seeing a lot more popcorn in my future my bride and I first took a night course on how to buy a house and proceeded to find and buy our first house in Roseville, MN. All the planning and savings resulted in a big down payment and relatively small mortgage. We had worked our plan and could measure our success. Budgeting after that purchase, however, became harder. (Did you ever see the movie The Money Pit with Tom Hanks?) In 1977 I began planning for retirement and slipped that into the budget as well. Cars were to be replaced after a 10 year lifespan but staggered so we always had at least 1 that was 5 years old or less. Each little addition to the family added some strains on the purse strings but “Pharmacy been berry, berry good to me” so income was able to keep pace. The budgeting process also has been “berry berry good to me” and allowed many freedoms not afforded to others.

The FDA and drug companies encountered a glitch in there plans recently: the H1N1 influenza virus by name. Five companies are now in the process of planning to ferment big batches of vaccines to curb the infection and prevent a deadly pandemic. Countries are planning for the worst by ordering there vaccinations early. If the US fails to order enough from the outset and the pandemic occurs then you can bet that supplies manufactured in the USA will be "nationalized".

It appears that our president knows where he wants to take us and has taken many steps to bring us there as quickly as possible. (Socialize everything that can't be nationalized?) Why would he want to rush things? Because we all might not want to go where he is taking us. With that in mind he had better do what he can before we all wake up. He now has the majority of Congress on his side and "in on the plan”. He knows that in less than 17 months we can change the direction of Congress so he has to work fast.

The last election was a little bit like the death of our old landlord… it was abrupt, inconvenient (for us as well as the dear old man). Pre-planning mitigated the pain but did not eliminate it. Plans have to be adjusted. All of the investments we made into life planning have paid off in the long run. As a family of 5 (plus a wonderful daughter-in-law) we can join together with other families in November of 2010 to turn things around. We may not have the power of those in office but they are only in office as long as the rest of us let them stay… and I’m betting there are more of “us” than of “them” come election time. So budget some time now, as an investment in the country’s future. Plan to be politically active before the next election but minimally plan to vote. Failing to plan is planning to fail.

ps. Best answer this week to the question "How are you?" was "Racing against the clock but the clock has more hands." (PT aide practically running down the hallway)

pps. Please note that some of the links may not be up for very long and that

New high blood pressure theory suggests that a viral infection may lead to hypertension by causing inflammation of the veins. Coupled with a high fat diet, veins become less pliant with resulting hypertension. Before you laugh… remember that H. Pylori theory for gastric ulcers was pooh poohed by many GI poobahs. The virus is CMV so you probably already have it in your system. Early work in mice but interesting all the same.

World-wide cases 8451, deaths 72. Sixty-six of the deaths were in Mexico. US officials are lifting travel restrictions to Mexico. This appears to have the same patterns of illness as whatever the “usual” strain that emerges each year. (Yes, the “regular” influenza kills too… about 500,000 globally each year.)

Glaxo already has orders for 150 million doses from just 4 countries. With purchase competition, don’t expect the prices to stay low. I will guess that a single self pay vaccination will top $30 each this fall (with costs about half of that). Just a guess… I could be wrong because there are 4 other companies trying to cash in as well. Ah…capitalism!

How is chronic pain in geriatric patients to be addressed? Some are calling for the elimination of NSAIDS and COX-2 inhibitors from the drug regimens of the elderly. The guidelines have physicians start patients on acetaminophen and add narcotics as needed for chronic pain. If ASA or NSAIDs are used then a PPI, so say “them”, should be added from the start. Gabapentin, some antidepressants, steroids and topical anesthetics are also entertained in the guidelines. Some MD blog entries at the end take major exception… I report…you decide.

We have known for more than 35 years that patients with epilepsy are more prone to suicidal thoughts. The FDA issued some guidance (and required warnings on the class) about a year ago on suicidal ideation and anticonvulsants. This site will take you to individual drugs and what the FDA has to say about each… this year.

Just about every website in existence could make that claim… we will see how they do. I wonder if there might be a government branch that will force the FDA to substantiate their claims about the site and give equal time to the things that could go wrong by visiting their site. (just wondering)

All you have to do is 1) lose your job 2) lose your health insurance and 3) have been on the drug for 3 months prior to job loss. Lipitor and other Pfizer drugs are included in this new drug offer. (just go to www.PfizerHelpfulAnswers.com for details)

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