It’s a frustrating day here in the CatBox. I missed my cardiologist appointment appointment yesterday. TriMet Lift was was supposed to arrive between 8:53 and 9:27 to get me there for a 10:10 appointment. At 9:15 they gave me an ETA of 9:45. At 9:45 they gave me an ETA of 10:20. At that point I had to call to ask if Lisa could see me late. She could not, and I had to reschedule. I can’t see her now until January. I asked Providence Home Medical Equipment to give me a time to get the Oxygen Concentrator I ordered yesterday. They’ll let me know on Monday. I found the same make and model as the one I already have, so I’m already familiar with its operation and maintenance. Tomorrow is a holy day in the Church of the Ellipsoid Orb. My Broncos are meditating with the Bills. Because they stink, it won’t be televised here. May the divine Orb shine it’s blessed light on your team, unless they gamble with buffalo chips. Tomorrow, please expect no more than a Personal Update. It’s a busy WWWendy day, and she’ll be here an hour early, because she has an event at her bartending job. Irritated Hugs to all!
Jig Zone Puzzle:
Today’s took me 3:56 (average 5:01). To do it, click here. How did you do?
Cartoon:
Short Takes:
From The New Yorker: In what some observers called his most sarcastic opening statement of the impeachment inquiry, Representative Devin Nunes, on Thursday, accused witnesses of trying to mislead the American people with facts.
“From the beginning of these proceedings, the Democrats’ witnesses have offered facts, more facts, and nothing but facts,” Nunes said. “I, for one, have had enough of their factual games.”
Ramping up his attack, he accused the civil servants who have testified of having “an almost cult-like worship of verifiable information.”
“ ‘Step right up,’ these witnesses seem to be saying,” Nunes added. “ ‘The fact circus is in town.’ ”
Dang Andy! Isn’t that just like those Democrats? RESIST!!
From YouTube (MSNBC Channel): US Intel Briefed Senators That Ukraine Theory Is Russian Op: NYT
Senate Republicans knew this the whole time that they were pushing that conspiracy theory. Is Bought Bitch Moscow Mitch the only Russian agent in the Republican Caucus? It appears not. RESIST!!
From YouTube (a blast from the past): REFLECTIONS OF MY LIFE” THE MARMALADE ~ 1969 – original recording ~ HQ AUDIO
Experts in autocracies have pointed out that it is, unfortunately, easy to slip into normalizing the tyrant, hence it is important to hang on to outrage. These incidents which seem to call for the efforts of the Greek Furies (Erinyes) to come and deal with them will, I hope, help with that. As a reminder, though no one really knows how many there were supposed to be, the three names we have are Alecto, Megaera, and Tisiphone. These roughly translate as “unceasing,” “grudging,” and “vengeful destruction.”
Well, this is scary. I have known about Candida albicans for quite some time – 40-60% of us have some somewhere in our gut, but our immune systems generally keep it in check. In the mid-eighties, when DH and I both started allergy treatment, we were routinely tested for it; because of allergies tying up the immune system, it can get out of control if you have some, and especially food allergies. It was then treated with nystatin or some similar drugs,
I certainly never knew that, or why, it’s so hard to come up with antifungal drugs that aren’t as bad as the fungus itself. Candida albicans, the Candida which causes “thrush,” used to be considered annoying, but controllable. No one knew about these other strains of Candida Boy, have things changed! And rapidly!
In 2013 I took care of a gentleman who underwent surgery for what all his physicians, including me, thought was liver cancer. Surgery revealed that the disease was a rare but benign tumor, rather than cancer. As you might imagine, he and his family were overjoyed and relieved.
However, two weeks after this surgery, he developed a liver abscess – an encapsulated tissue infection. Surgeons operated to remove the abscess. Two days later, test results revealed that the abscess was caused by a fungus called Candida that was resistant to echinocandins, our most powerful drugs against this fungus.
The patient underwent multiple surgeries and received various antibiotics thereafter, but his abscess kept growing back. He died four weeks after the first surgery to remove the abscess. The cause of death was sepsis due to his echinocandin-resistant Candida infection, which, at the time, was uncommon in the U.S. This tragic case demonstrated to me firsthand the devastating impact of drug-resistant fungal infections.
In the years since, I have cared for over a dozen patients who have died due to antibiotic-resistant fungal infections. On Nov. 13, 2019, the Centers for Disease Control and Prevention released a report on antibiotic resistance threats in the U.S., warning that drug-resistant fungi have become major public health problems.
The new report revealed that 18 microorganisms cause almost 3 million antibiotic resistant infections and 35,000 deaths annually. For the first time, this report includes several antibiotic resistant fungi: Candida auris, other drug-resistant Candida (as in my patient above) and azole-resistant Aspergillus fumigatus. These resistant fungi are especially threatening because only three classes of antifungal medicines are currently available.
Antibiotic-resistant fungi?
We have heard a lot in recent years about the public health crisis of antibiotic-resistant bacteria, but less attention has been paid to antibiotic-resistant fungi. In part, this is because fungi became common causes of disease only over the past 30 years. During this time, the risk for serious fungal infections rose as more people suffered weakened immune systems stemming from increased bone marrow and organ transplantation, new drugs to treat cancer and other diseases, and complex surgeries. The widespread use of more potent antibiotics to treat resistant bacterial infections also has contributed by creating less competition for fungi to grow in human tissues.
Fungi include yeasts, which grow as spherical cells; and molds, which grow as elongated, tubular cells. Both yeasts and molds are more closely related genetically to humans than they are to bacteria. Therefore, it is hard to develop antibiotics that attack fungi without damaging human cells.
Candida are yeasts that commonly cause skin rashes, urinary tract infections and vaginal infections. However, they are also the third-leading cause of sepsis and other life-threatening infections in U.S. hospitals.
Candida auris was discovered in 2009, but it was almost never encountered in a medical setting until 2015, when numerous infections suddenly occurred on multiple continents. It is now one of CDC’s five most “urgent threats” for two principal reasons.
First, it demonstrates very high-level antifungal resistance. Ninety percent of strains are resistant to fluconazole, the frontline antifungal in many countries; 30% are resistant to two antifungal classes; and between 3% and 5% to all antifungals.
Another reason that the CDC is concerned about C. auris is that it has the unique ability to spread from person to person through contact with hands and clothes of health-care workers or contaminated medical devices. It also persists outside of humans in health-care environments, and causes large, long-standing infectious outbreaks. C. auris is a remarkably robust organism that can survive standard disinfection methods, high temperatures and salt solutions that kill other microbes.
Since the first U.S. case in 2016, C. auris has caused more than 800 infections in 13 states. CDC and local health departments currently are working to contain numerous health-care outbreaks. It is unclear why this fungus has arisen now, although climate and other environmental changes may have played a role. Likewise, it is unclear how widely C. auris will expand in the U.S. or globally.
Other drug-resistant fungi in the Candida family are also considered “serious threats” by CDC. These strains cause more than 34,000 infections annually, more than are caused by C. auris, but they are less likely to spread from person to person and cause outbreaks. Nevertheless, deeply invasive C. auris and other drug-resistant Candida infections are similar in severity, resulting in the death of 40% of patients.
Another dangerous fungus species the CDC singled out is Aspergillus fumigatus, which is a mold found in soil and vegetation that releases spores that most people inhale daily without problems. However, people with weakened immune systems – especially cancer patients or transplant recipients – can develop lung or other organ infections that kill between 50% and 75% of infected patients.
Azole antifungals are the only drugs that kill A. fumigatus without causing serious side effects. Azoles also are used widely in agriculture. Azole-resistant A. fumigatus infections are most common in Europe, where they have been linked to agricultural and patient use. Although these infections still are uncommon in the U.S., CDC has placed azole-resistant A. fumigatus on its “resistance watch list” because azole use is so widespread in this country and vulnerable patient populations are large.
Tackling antibiotic-resistant fungi requires many strategies
How is the U.S. fighting antibiotic-resistant fungi? CDC and health departments are leading the way in surveillance for resistance and, in the case of C. auris, outbreak containment and prevention. Containment involves rapid and accurate diagnosis of C. auris infections, and the use of hospital gowns, gloves, equipment and cleaning materials that reduce the likelihood of spreading the fungus.
Organizations that grade the quality of medical care for the public now require health-care facilities to have antibiotic stewardship programs that reduce inappropriate prescribing and development of resistance.
Efforts are underway also to control antibiotic use in agriculture and animals, since resistance cannot be tackled by only focusing on human medicine. CDC and other U.S. agencies are working closely with international partners, because antibiotic-resistant microbes do not recognize geographic borders. Finally, the crucial first step in tackling a problem is to recognize it, which is why the CDC report on antibiotic resistance threats is so important.
Alecto, Megaera, and Tisiphone, this is an area which demonstrates quite vividly why we need to fund medical research – despite the machinations of all those who would defund it completely.Please! Help!
It’s hard to know where to begin, because the past two weeks have been very bad for Trump – making them very good for America. So I hope you won’t mind that this post is a bit disjointed and not a smooth linear, chronological flow of events.
First, let’s address the medical concerns regarding tRump’s emergencyunscheduled“routine” visit to Walter Reed Hospital – with the White House doctor riding right next to him. But the White House staff and tRump himself assure us that he’s in perfect health. (Riiiggghhhttt)
In fact, “Team Trump” (part of his 2020 campaign) released an X-ray to prove it:
BREAKING: An X-Ray image has been released from President @realDonaldTrump’s visit to Walter Reed
Speaking of Speaker Pelosi, I think you’d agree there are folks who can throw shade very well – but there are few who can so expertly throw shade that it causes an eclipse. And Speaker Pelosi did just that this past week when she stopped in mid-sentence during a press conference – turned to the cameras and patiently explained to tRump what the word “EXCULPATORY” means:
I love it when Nancy Pelosi shades trump:
It's called an inquiry, and if the president has something exculpatory – Mr. President, that means you have anything that shows your innocence – then he should make that known."
That then begs the question: If Ukraine is as corrupt as you claim (and since Paul Manafort’s ties to Ukraine landed him in jail, that would seem accurate), why would tRump trust Ukraine to investigate two American citizens for … corruption?
But the two weeks of bad news didn’t stop tRump, despite being pummeled by witness after witness after witness, from trying to claim victory:
I can just hear the late-great Howard Cosell announcing the ringside action:
Trump is viciously landing punch after punch after punch …
Unfortunately, they’re all landing on his own face!
Another of my favorite moments (among many) was when Rep. “Bulldog” Ratcliffe (R-TX) made a humongous gaffe calling tRump a liar in closing with Ambassador Taylor, forcing him to “Yield back” while putting a knowing grin on the Ambassador’s face when Ratcliffe (reading from his own prepared script) mistakenly – but truthfully – said:
REP. RATCLIFFE: If they impeach President Trump for blackmail, or extortion, or making threats or demands they have to call President Trump a liar to do it. [BIG PAUSE] … I yield back.
The most heartwarming moment was when Ambassador Yovanovitch receives a much-deserved round of applause upon her departure:
And lighter moments, like “We Are All Congressman Krishnamoorthi” hashtag from his reaction after Rep. Elise “Screamer” Stefanik leaves him alone:
And of course Nunes great “Poker Tell” with a facial reaction that says it all right after the session when Ambassador Sondland admits there was, in fact, a “Quid Pro Quo”.
In closing, I think this pretty much sums up the past two weeks for tRump and republicans:
As much as I wanted to watch last night, by the time we finished with chores, it was just ending. However, I tried to find an unbiased article, and some video clips for you. I hope to do better in December.
Just 10 weeks out from when the first votes are cast in the Democratic primary, four candidates have separated from the rest of the field – Joe Biden, Elizabeth Warren, Bernie Sanders, and Pete Buttigieg. In the fifth Democratic debate last night, those four needed to shore up their strengths and address the weaknesses of their electoral coalitions. The remaining six needed to manufacture memorable moments that would help them make inroads against the leaders.
By this metric, Amy Klobuchar and Warren emerged from the pack. The first hour was Klobuchar’s best thus far, relying more on responses that showcased her witty, affable side that tends to resonate with voters more than detailed technocratic responses. This was in sharp contrast to the sharp-elbowed responses from Biden and Buttigieg – whose supporters Klobuchar needs – who were fending off attacks most of the night. Meanwhile, nearly all of Warren’s responses addressed racial disparities, a tack surely meant to appeal to black voters with whom she’s underperforming but desperately needs in order to have a shot at the nomination…
It’s a busy day here in the CatBox. I like the new keyboard, but the size and layout are unfamiliar, so it will take a few days to get used to it. Providence Home Medical Equipment just changed their policy. They say I need to take their huge oxygen backup tank in case of system failure, or they’ll take my oxygen concentrator. The problem is that there is no place in the CatBox to put it. So I think I’ll have to buy an oxygen concentrator for around $700 or more. ARGH! I want to finish as early as I can to get a partial nap in before Store to Door delivers groceries this afternoon. Please expect no more than a Personal Update tomorrow. I have an preventive appointment with my cardiologist. Hectic Hugs!
Jig Zone Puzzle:
Today’s took me 3:52 (average 5:20). To do it, click here. How did you do?
Cartoon:
Short Takes:
From The New Yorker: Moments after the decorated veteran testified to Congress on Tuesday, Donald Trump accused Lieutenant Colonel Alexander Vindman of becoming a war hero “just to make me look bad.”
In a vicious broadside on Twitter, Trump claimed that Vindman carried out an “evil plan, years in the making” to “load himself up with medals” that would give his future testimony against Trump greater credibility.
“Fifteen years ago, he went to fight in Iraq, thinking to himself, ‘Boy, this is going to help me when I try to attack Trump someday,’ ” Trump tweeted. “This is how the Never Trumpers roll.”
Dang Andy! How about that! Poor widdle Bone Spurs! RESIST!!
From Washington Post: A U.S. ambassador on Wednesday explicitly linked President Trump, Vice President Pence and other senior officials to what he came to believe was a campaign to pressure a foreign government to investigate Trump’s political rival in exchange for a coveted White House meeting and hundreds of millions of dollars in military aid.
The potentially historic, if hotly disputed, testimony from U.S. Ambassador to the European Union Gordon Sondland is the most damaging yet for Trump in Congress’s intensifying inquiry into whether the president should be impeached.
More forcefully than he has before, Sondland declared that the Trump administration would not give Ukraine’s newly elected president, Volodymyr Zelensky, a chance to visit the White House — unless Zelensky agreed to announce investigations that could help the president politically.
Drip… drip… drip… RESIST!!
From YouTube (a blast from the past):We Five- You Were On My Mind 1965
I am nowhere near as disabled as Ady Barkan. However, I am also a long term political activist, and my disabilities are also interfering with my activism. Therefore, I empathize with Ady’s perspective. In addition, I agree.
I have spent my entire career at the messy and vital intersection of movement-building, electoral politics, and governance. And for the past three years, I’ve done that work under the debilitating weight of ALS, a deadly neurological illness that’s robbed me of my ability to do almost all the things that most people take for granted: hug my son, go for a walk with my newborn daughter, or speak to my wife. I was diagnosed three weeks before the 2016 presidential election, and I vividly remember wondering, on that tragic November night, whether I was going to die under President Donald Trump.
Whom would I like to see replace him? Of the hundreds of elected officials, activists, and policy wonks I have worked with over the past two decades, Elizabeth Warren is the individual who I believe would make the best president. I believe that she, more than any other person in America, has the skills, the temperament, and the knowledge to lead us toward a more just and equitable future.
Please keep reading, especially if, like me, you’re an admirer of Bernie Sanders. Because I have no intention to diminish his incredible work building our progressive movement or the ways in which his historic campaigns for president have shifted American political discourse. This is, rather, a declaration of how I plan to vote in the California primary, and why I believe in Warren because during her whole career, she has fought to put economic and political power in the hands of working families. I’ve seen up close how she confronts a problem: She listens to the people most affected, does her homework, and then comes up with a plan. A brilliant, workable plan… [emphasis added]
I have shared only the introduction to this extensive article and urge you to click through and read it in his entirety. It also includes the best explanation of Medicare for All that I have seen. It shows how her plan is nothing like the Medicare at Gunpoint that some of her opponents either do not understand or are using to mislead.
It’s a busy day here in the CatBox. I’m trying to get my biopsy scheduled. It turns out they won’t let me go home unescorted, so we’ll need to do it at a time WWWendy can pick me up and take me home. Speaking of WWWendy, she’ll be here this evening, and a certain TomCat is VERY stinky. I’ll have my new keyboard this evening. The workaround for the damaged one is driving me nuts. Happy Hump Day to all.
Jig Zone Puzzle:
Today’s took me 3:34 (average 4:58). To do it, click here. How did you do?
Cartoon:
It’s time for a redux for the Republican Reich.
Short Takes:
From YouTube (MSNBC Channel): Trump Admin Was Cautioned That Ukraine Scheme Was Boon To Russia
I don’t think helping Putin was a mere side-effect of Trump’s election tampering by bribing and extorting Zelenskiy. It was a co-equal motivation for these High Crimes and Misdemeanors. RESIST!!
From YouTube (CNN Channel): Vindman’s answer draws applause at impeachment hearing
I don’t care where he was born. That is a true American hero. RESIST!!
From YouTube (a blast from the past): The Cowsils_ The Rain, The Park, & Other Things
