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Say What? | November 10, 2014
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It’s All in Your Mind | July 9, 2014
Dr. Barry
Sure I read the big journals to keep up…JAMA, New England Journal of Medicine, Table Hopping, etc…I want to be reasonably up to date with the “scientific” literature but I also try to keep an open mind (albeit attached to a somewhat skeptical eye) about the out of box subjects like energy fields, coherent rhythms, intuitive information systems, field versus particle psychics…as Einstein is said to have put it the particle is wholly responsive to the field. Are we really “particles” dependent on the energy fields around us? What about the energy fields each of our bodies generate. Can you have an effect on these fields…does it make a difference to your health?
There is a lot of talk…scientific and otherwise on this subject right now. University level talk. This isn’t about psychic fairs and palm readings anymore. This is using the concept of physics and metamorphosis to try and explain the universe around us we can’t see but know exists. I have been reading a lot about this recently…from a variety of sources. Maybe it’s just because I want to believe that with the power of your mind you can change things. Maybe you can’t bend a spoon but can you break a habit? I have always said attitude is everything…will it turn out the Power of Positive Thinking can affect your health? Well, I sure believe the opposite. That you can will yourself into poor health. That you can let stress really affect your health. That depressed people are generally sicker people than those who aren’t depressed. There are a lot of people who think that you can affect your health positively with just your mind. Either these people are the paradigm shift ahead of the rest of us or they are kooks…however well intentioned…but kooks nonetheless. I am hoping for and betting on the paradigm shift but that doesn’t mean I won’t “hedge my bets” by looking for the real science behind this stuff as it becomes available. There are people out there who think they can affect your energy fields with their energy fields as well…giving you a psychic energy manipulation to fix your fields. In this area we have some “real” science to guide us…referring to the practice of reiki now…there have been two reviews published in the International Journal of Clinical Practice and the Journal of Alternative and Complementary Medicine that conclude that reiki “is not an effective treatment to any illness.” Astonishing as it may seem a nine-year-old student named Emily Rosi published in the Journal of the American Medical Association study where she showed that “Therapeutic Touch”, which is reiki by another name, could not be shown to exist. The practitioners specifically trained to feel and manipulate energy fields could not do so when under controlled circumstances. Don’t get me wrong…I know the body puts out electrical fields…what I don’t know is whether you can externally manipulate these fields – especially not with the power of your mind. But I certainly do feel you can manipulate your own energy fields! I do think the power of your mind cannot be underestimated. Obviously a lot of coaches, trainers, etc. would agree with me.
I found out about Quantum Jumping when I responded to an email from Mind Valley Academy. There were many courses on self-growth, personal improvement physically, mentally and spiritually. Obviously I haven’t taken all the courses but I am in the midst of several series including the one on Quantum Jumping…Burt Goldman formulated the technique he labeled Quantum Jumping using a meditative and visualization technique to “jump” within your mind to an alternative universe where you meet a better you…you know the better you if I just went to the gym more, I just kept my weight down more, if I only reached out to my friends more…THAT better you…in your mind you now hang out in that alternative universe with your best self….you spend some time with him or her…if follow what they do…how they act…it’s you after all so the stuff they are doing is what you could be doing yourself…now jump back to this world and try to follow the same techniques and habits here. Bring the habits and patterns of your perfect self into this world. This is obviously only my poor paraphrasing of only one aspect of his technique but it could be really positive stuff if you let it and are open to it. Aren’t all the great athletes supposed to use visualization techniques to improve performance? Absolutely no reason you can’t either. And the great thing is that all it takes is your mind. No expensive equipment. No special uniform. No special time or schedule you have to keep. No need for a partner or group.
It’s about Mindfulness…living your life examined not going through the motions. I know the term Mindfulness is a little “soft”…a little psychobabble sounding but regardless of the baggage I do think it refers to a life examined….living 50 years not one year 50 times. I like that concept and it’s no better represented than in the movie Groundhog Day…this poor guy lives the same day over and over until he “gets it right” and can move forward. It’s one of my favorite movies because it’s both funny and thought provoking (at least to me) without being preachy.
In the same vein I also enjoyed the movie About Time. It’s about a guy with the ability to go back in time and fix mistakes. He doesn’t kiss the girl at midnight on New Year’s Eve the first time around so, if he wants to he can go back and relive it and kiss her this time. His father from whom he inherited the ability tells him his personal little secret is to relive each and every day. Didn’t make the right move on the date? Didn’t stand up to the bully? Mindfully he would monitor what he did/what he said/how he acted each day so he could improve it on the “repeat” day. In a great twist the son improves on his father’s technique by living so alertly and mindfully that when he encounters whatever situation he would want to possible do-over, he was alert and mindful enough to do it “right” the first time.
You want to feel better? Try going on YouTube and watching one of the over 100,000 motivational videos…they are usually pretty short and super positive. Best to do this early in the day so you can use the positive energy that same day. Better than any pill from a bottle.
Let me finish with a little humor. Adam is in the Garden of Eden but he is a little lonely. He petitions the Lord for a mate…the Lord tells him he can make a perfect mate in every way…a great partner in bed, in life, perfect match in every way…Adam says, “Sounds great! What will this cost me?” The Lord responds, “The perfect mate will cost you an arm and a leg.” Adam then responds, “Well, what can I get for a rib?!”
What Change May Come | Jan 7, 2014
Dr. Barry
Obamacare…surely you know I have thoughts on this. It directly impacts my business in both ways…getting insurance for my employees and figuring out how it affects my patients. There is much I know. There is much I do not know. I do know it’s a mess. A big mess and it’s going to get messier from the sounds of it.
Okay, let’s start with the obvious. Before I go criticizing the President and his plan what’s my alternative? I used to think the problem was too big to solve…that unless I devoted hours and hours to the plan I would never get it right or understand the nuances. I thought I would have to spend countless hours listening to the economists and the “thought leaders.” Luckily, as it turns out, it came to me out of the clear blue…of course I think that’s really the fulfillment of the subconscious ramblings and ruminations of my mind until it surfaces in my conscious but call it clear blue if you will. I’ll take it from wherever it may come.
So, my plan is simple…just extend Medicare or Medicade to whomever wants to buy it…don’t make it mandatory. If you have low income you can buy into Medicade. If you have more money, have a job etc., you can buy into Medicare. You have to pay something. You can’t get coverage for free. I don’t have the exact number but roughly 20 cents of every dollar you pay to Blue Cross Blue Shield goes to the paperwork and the processing and the advertising, etc. All those $200,000+ salaries which seem quite nice for a not for profit organization have to come from somewhere (I’m only bitching because I don’t have one of those aforementioned jobs!). Medicare on the other hand charges more like 5 cents per dollar. That’s a huge difference when you are talking about the number of dollars in the system. You don’t need a new tax code or more IRS agents. You don’t need a super expensive website that still doesn’t work more than a month after it’s supposed to be working. You need only expand systems that are already working but need significant reform…not replacement or reinvention.
Libertarians should love my plan because it preserves choice. Republicans should love my plan because it doesn’t set up a new huge government bureaucracy. Democrats should love it because it offers an option for everyone to get insurance. Insurance companies would love it because it still leaves them in the game because part of Medicare…most of Medicare for that matter…involves people choosing between Medicare plans that that are supplemented by the private insurance companies, like Excellus, Atena, AARP, etc. So it’s winner winner chicken dinner but that ship has probably sailed already.
So, even though we don’t really know all the details on Obamacare, we do know a few things:
1. The plan is supposed to provide insurance to everyone
2. The plan is dependent on getting young, healthy people to sign up in order to cover the cost of older people
3. There is no penalty or surcharge for “pre-existing” conditions
4. Part of the plan calls for doctors and hospitals to form groups to “manage patients.” Translation = manage costs
It’s this manage patients part that interests me and should interest you. It’s basically the return of a previously tried and abandoned form of reimbursement called captivation…this was a plan put forth by insurance companies years ago that gives the doctor and/or hospital a set amount of money to care for a set amount of patients. So let’s say that I am given $100,000 to take care of a set of patients for a year…if, because I have a lot of young people who don’t need much doctoring, there is money left at the end of the year I would get some of that as a reward for giving frugal care. If, because I have more patients go to the hospital, or have more difficult to treat diabetics or do more tests, and there is no money left at the end of the year I would be penalized. The name of my practice is PREVENTIVE medicine associates…so I do think it makes sense to order lots of mammograms and colonoscopies and check your labs frequently when you are on blood pressure meds or hypertension meds or diabetic meds. I would rather be safe than sorry.
Also, the part where preexisting illness isn’t penalized is crazy! You don’t pay the same for insurance for a Ford as a Ferrari. Why should a diabetic smoker pay the same rate as a healthy person? Now things like Multiple Sclerosis…that you don’t have much control over contracting would be treated differently. Actions have consequences…so do inactions and I would have an appropriate sliding scale. So Obamacare is going to give medical access to the chronically ill who couldn’t previously afford it…how is this going to cut costs?
Sure, there is lots wrong with the current system. Prices are crazy. More of these expensive tests keep suggesting other even more expensive tests without even giving you a firm diagnosis. Deductibles are out of sight. Non-generic meds cost an arm and a leg. There can be long waits to see the specialist and communication between doctors is still last century. I don’t see how Obamacare can fix these issues. They say they want to focus on primary care and encourage more doctors to go into primary care but for the last decade we have faced a potential 30% cut in Medicare pay each January 1st unless the President signs each year a bill overruling this law. Hard to recruit people to go into a profession that has faced this potential 30% cut in pay annually for the last decade or so. A big distinctive to go into primary care is that specialists make twice the income the primary care doctors make…would even a 10% increase make a difference? Don’t you see a lot of young doctors going into primary care? Not in Upstate New York you don’t.
My profession is under siege. Between lower reimbursements and much more paperwork and pre-authorizations and rising expenses and dealing with the electronic medical records and the daily dreaded risk of malpractice…morale has never been lower. Doctors have been de-selected by insurance companies without warning or obvious cause and with no real recourse. Luckily I am an optimist (of the Lafayette branch) so I have promised myself to always look on the bright side. Just because most can’t see a bright side doesn’t mean there isn’t one. This will be a challenging next few years for doctors and patients alike. Don’t have a thrombo over things you can’t affect. Try and find the humor.
In the meantime, don’t rely on insurance companies or the government or your momma or supplements…take care of yourselves with the old tried and true…diet and exercise. Exercise and diet. Excelsior!
Join a Club! | September 12, 2013
Dr. Barry
A few months ago I urged you to take a hike…my advice this month is to join a club. This article is not for you folks with small kids. You are plenty busy with homework, housework, the soccer league, bunko night, etc. Your world is probably busy and varied. You focus on the kid and that’s god and important…but at the risk of your current scorn (you know who you are) I again urge the ladies to not forget about the big baby. Oh I can almost see you sneer as I write this. There goes mister misogynist, mister sexist, mister me me me. Compare and contrast that sneer against your expression as you sign the divorce papers. Is that too harsh?
Plan some time with your spouse that doesn’t involve the kinder if you value that relationship. It was just the two of you in the beginning; hopefully it will still be the two of you together when and increasingly if the kids move out. That doesn’t happen on autopilot. Maybe it did for your parents’ generation but not anymore. This is the family we are talking about, your family…isn’t a little investment in energy and time appropriate? I’m talking about date night. You can go with other couples or a group or other people just not with the kids. You know it’s different when the kids are around. So, you young professionals with kids YPWK’s (follow them on Twitter…hashtag WTF). You people should skip the rest of this column and maybe read the exercise ladies column or the guy who writes about the corruption of our government both locally and nationally. There’s nothing more for you to read here…move along. Thank you very much.
Now, I guess I am writing this column for you widows and retirees. Most of you have one thing in common. Your world is shrinking people! You are hurtling up! Are you making new friends or losing friends? People keel over…interests change…all kinds of shenanigans…but most of us I think could use a bigger support group. It’s really very easy to get socially isolated. It’s also very easy to fix….Join a club. Wine tasting…club for that. Giving toasts? Club for that. Book club? Plenty of those. Poker club? Sure thing. Royal Order of Whateverthehell. The Ladies That Knit on Their Knees. Shriners. Optimists. Odd fellows. Church groups. Sewing groups. Canning clubs. They all share the commonalty of getting you out of the house for new experiences, and a chance to meet new people and to do new things, and to possibly make a difference in the world. The retired population has such a huge amount of collective experience and wisdom and it’s going to waste when you just sit at home watching NCIS for the 50th time. Social isolation is a real problem with real medical implications. I’m not going to quote any medical journal here because I don’t have to. Real life examples abound. Look at your Momma (not my momma, mind you!). Or your mother in law. Are they doing the same things now they did 10 years ago? Is their social circle getting bigger or smaller? I think most people don’t stop to realize just how limited their activities have become…most of us are up for a challenge, ie. invited to dinner or a movie but most of us are not great at challenging ourselves ie. spontaneously deciding to take a class or join a club.
As I write this I got the Cazenovia College extended learning catalog in the mail. OCC I’m sure has equally diverse offerings. You can take all sorts of classes…Hypertufa Garden Sculpture for you artists…Understanding the Mind of a Dog for you animal lovers…Photography, Soup Making, Whittling, Jewelry Making…quite the smorgasbord of offerings. Why, you could probably teach a class but I am happy to get you back in the classroom on the either side of that little desk. Most of these classes are one to three sessions long so we are not talking about a major commitment here. But we are talking about a commitment to yourself. Frankly, I’m not sure you are up for it. I mean look at you…when was the last time you really and truly tried something different. You don’t even try different restaurants anymore…you go to the same place and order the same thing all the time. It’s not sad but it’s not joyful either. You don’t have to turtle up…you don’t have to close window after window in the house that is your life. The view can’t be all that good once you close that last window…perhaps its similar to the view from inside the casket! You don’t have to rehearse for it…the hearse will come in on its own good time.
“I don’t fly anymore.” “I won’t drive downtown.” “I have stopped visiting the family that lives out of the area.” All these statements tell me you have a problem. Sometimes it’s a medical issue…many times it’s not. I view that as an integral part in my role as Doctor/Life Coach. It’s not all about sore throats and rectal exams…maybe I can help you with the social issues as well. It doesn’t cost extra and I have had a lot of people that are going through the same thing you are. I see what the successful ones do and I see what the failures don’t do…any chance you want to really explore the issue? Or, just continue to live in a smaller and smaller universe. You can expand that universe immensely with a club, group, organization, etc. You will find people who are different from you and people who are not. You will really enjoy some people’s company and will grow to dislike that one or two people in any group that tweaks you.
It’s good for you physically, it’s good for you mentally, I think it can be good for you spiritually, tell me again what’s stopping you? Yes I know about inertia. I don’t live in inertia, I live in Lafayette…I am a member of the Optimist Club there so you know I’m walking the walk…repeat after me: “Every day I wake up and I can improve something in some way…maybe improve myself in some way, maybe improve my surroundings…any little thing but going forward in some way, or I can get older, weaker, poorer of spirit, etc.” It’s a choice you make every morning you get up. Choose to get involved! Join a club!
Try Something New…Yes, Yoga! | May 9, 2013
Dr. Barry
This article will hopefully be short…short, sweet and to the point. How’s that for a change? I know how well you listen when I lecture about diet and exercise…so if you don’t follow my simple recommendations about the basics of your health, how likely are you to try something new? Well, hope springs eternal so I thought I would write about something that I know can benefit anyone. Yoga. That’s right…yoga.
You should do yoga. Not try yoga…do yoga. You should do it if you are injured or sick. You should do it if you are well. You really have no good excuse…oh you have plenty of excuses but each and every one can be overcome if you really want to. Instead, when I mention yoga you draw back like I was swinging a rattlesnake in your direction. I really can’t understand why you are reluctant. Yoga can be done very cheaply. No special uniform is necessary. You can practice it at all skill levels in the same setting. Young or old. Male or female. You don’t need a partner. You can do it alone to a tape or take a weekend retreat. You know my mantra…diet and exercise…exercise and diet. But if I were to amend my mantra it would be diet, exercise and yoga.
I often get a funny look when I recommend yoga. People are willing to risk getting hooked on pain pills or having ulcers with the nonsteroidal drugs rather than consider yoga. People seem willing to have surgery or have needles stuck in their backs, risk infections or go for rounds of and rounds of physical therapy but are not willing to try some prolonged gentle stretching program. I’m not saying you shouldn’t do physical therapy…I’m saying you should do both. It’s a good fit with both cardio programs and strength building programs. So what’s stopping you. There are yoga classes all over the place…the fitness center…the church recreational center…the firebarn…but you can look for a dedicated studio if you want to class it up a little. I take my classes at a dojo in Liverpool. If you are reluctant to do yoga with others or are somehow worried about embarrassing yourself in front of others you can get a DVD from the store, the Internet, the library, and try it at home. Taking a class with others works better for me for some reason but I do tend to keep my eyes closed most of the time or maybe it’s that I’m so focused on me I don’t notice much else. Please hold the cracks about me focusing on me all the time, anyways.
So yes, I recommend yoga. This isn’t about religion. This isn’t Jesus versus the Buddha…this is a set of exercises that stretch and realign your spine and body and seek at the same time to relax you and get you in touch with the basics…like breathing and physical self-awareness. By that I mean listening to what your body is trying to tell you. What hurts and why and how you can possibly make it better with stretching and better balance and posture. How is that not a good thing? What keeps you from trying? No, you may not break a sweat during yoga…you might but it’s not guaranteed. You put as much into it as you like and of course I think the results reflect how much you put into it. Yoga tests not specifically a cardiovascular exercise…it’s not aerobic and it is not weight training but that doesn’t mean it shouldn’t be in your exercise program. If you really have an exercise PROGRAM hopefully that doesn’t mean just doing the same exercise every day. Of course consistency is important but more in terms of frequency…there should be some variety in your exercise and yoga should be just one part of your pattern…
Of course there are multiple types of yoga but I’m referring to the slow set of repetitive stretches that challenge your range of motion and balance. Opens up your spine and lifts your spirit. Sure it’s uncomfortable at times but that’s what the slow stretch is all about…you get all up in that discomfort…you own that discomfort…you map that territory…you’re not paying taxes on that discomfort but it’s just a matter of time…that’s your personal discomfort…then…as you learn to let go of the tension…the position becomes comfortable and you decide if you want to challenge yourself further.
I have never left a yoga class not feeling relaxed and somehow more centered and peaceful. I know that sounds a little “soft” but you can’t understand the feeling if you haven’t done the class.
I’m not the only one recommending yoga. The PX90 program has a yoga component. All the high-end spas and workout places have yoga available. I have never left a yoga class not feeling relaxed and somehow more centered and peaceful. I know that sounds a little “soft” but you can’t understand the feeling if you haven’t done the class. How long that peaceful sense lasts depends mostly on me…sometimes it’s hours afterwards before my innate pessimism returns…sometimes it’s minutes…why oh why are you pulling out coupons in the seven items lane at my beloved Weggies. I overlook your having 20 items in the 7 items lane because I’m feeling good after yoga but when you pull out the coupons suddenly the old Joey is back. Still, my point is that yoga makes me feel better both physically and mentally and I know it will help you too if you would only give it a try. It’s May 2013 and it’s just the right time of year that you tried something new…or you could keep coming to my office for the drugs that give partial relief, see the chiropractor, go through physical therapy again, another round of MRIs, injections or surgeries. If that’s working for you, great. But I see many people who are not getting better or feeling well despite the above. Yoga is an essential tool you should have in your personal health tool box. The instructor where I take my class usually ends with an expression that goes something like “thank you for taking this opportunity to quiet our chattering monkey minds.” You know how that resonates with my prior writings about how the day to day grind dulls us and obscures what’s important…we focus on the minutiae and forget about the big picture. Yoga will help you stretch thoroughly and relax for at least a time. It’s up to you to and me to make that time last longer. It’s up to you to make the time to give yoga a try. Until then…get well…stay well.
Get Your Healthy App On | April 8, 2013
Dr. Barry
I write this month about apps for the smartphone. If you don’t own one now the experts say you will soon, the next time you upgrade your phone for instance. In roughly two years’ time therefore, the only person on the planet without a smartphone will be me. Now I had a smartphone but gave it to my daughter and got a militarized flip phone so I can get it wet and not hurt it. I didn’t use the barcode reader and the night sky reader or the Angry Birds game whatever that is. I didn’t need all the fancy bells and whistles. I couldn’t read my email without glasses so it’s back to the primitive phone that only makes and receives phone calls. Can you imagine my primitive state? Smart phones do so much these days, from GPS to capturing photos of what you ate last night. How did I ever get by not getting a photo of your sushi plate emailed to me while I’m trying to read. The ugly downside to the smartphone is so obvious to everyone over 20. They intrude on real life. How many times do you see someone at the dinner table checking their email while a conversation with real live people occurs around them? I was in the Caribbean recently with my wife and I marveled at the obviously American family sitting next to me in the outdoor dining spot…the gentle warm breeze…the sights, the sounds and smells. The family of four was all sitting there each one immersed in their own device. It looked like two iPads and two iPhones from the dim glow but really…you travel thousands of miles to “get away” and still can’t bear to really separate yourselves from your tech? don’t you know how ridiculous it looks for you to be frantically thumbing these little pads constantly?! Listening for the furtive tweet honk or other personalized sound that notifies you that someone or something has something for you? Just as you laugh at me for being a tech dinosaur, future generations will laugh at you for this frantic fingering. How panicked you get when you can’t get a signal and check your Facebook constantly. You look like a heroin addict who can’t get his fix. Heaven forbid you have to endure a little silence or perhaps get involved in the conversation.
There is no way to turn back the techno clock nor would I want to. We live in a world of constant change and miniaturization and I foresee that we will all be wearing glasses in the future that projects a data street or multiple streams based on what we are looking at or doing. Don’t have to look down at your watch or hold anything at all to make a phone call. For that matter the data streams will project onto your contact lenses. We probably already have the little watches that can work as a phone as well. We will do more with our voices and less with the keyboard; at least not a physical keyboard. No, peripheral brains are here to stay and as we seem to be getting dumber all the time it’s a good thing. Don’t think we are getting any dumber? Look to Washington…any sign of intelligent life there?
So let me help you put something in that peripheral brain that can make a difference with your health. And by doing so make a difference in your life. Maybe some free app from the internet can motivate and educate you in some way that has escaped us during your office call. How many of those little icons on your phones are links to something actually useful?
Of course these apps will only work if you actually use them. You must put them front and center in your phone like a photo of your fat self front and center on the fridge. Get in the habit of using them daily…anything less won’t work. There are literally thousands of apps available, some free, some not, and I’m not saying the list below is best but it’s a start. These are from the list I give my patients and I will add it to any apps that people suggest (after I’ve checked them out of course).
So the big areas that a little peripheral brain can help you include quitting smoking, diet and exercise as well as hypertension and diabetes management. You can take great care of yourself without these apps but if they are available why wouldn’t you at least give them a try. One of the hallmarks of people that are improving themselves, one of the reoccurring suggestions from the gurus of self-improvement, one of the recommendations from all the experts in the health industry is to track the data. Using these little phones you can follow your blood pressure, your blood sugar, your exercise frequency, etc. the more you know the better decisions you can make. The very act of keeping track and reflecting on the activity can reinforce good behavior, patterns and lifestyles. More of my patients are keeping their copies of their medical records on their phone but I still don’t know the best app for this.
Most importantly is quitting smoking and there are multiple free apps, but the one with the most umph is My Quit Coach (available at the Apple Store or Droid download sites as are all others). This one has a livestrong association which I don’t know how I feel about but the app is good and the issue of quitting smoking so important. You can chose to quit it at once or slowly and the app tracks differently.
For diabetics I recommend WellDoc or Glucose buddy. Both not only track data but interact with you to attempt to change behavior, results.
To remind you to take your meds, try RemindMe. Most experts think the average patient screws up their meds all the time and the more the meds the more the screw ups. What’s wrong with having that little device that’s next to you remind you to take a pill? Might just be the thing to keep your college age daughter on her birth control pills, or grandma might need help remembering the third batch of pills each day which your old hand me down phone could help her with.
When was your last tetanus shot? No questions about what shot or when with the VaxTrak app. Do you know how many pages of old records I have to comb through to try to figure out when your last pneumonia shot was? Keep track of your own vaccine info.
If you want to stay healthy you have to take care of your blood pressure. If it’s high you have to treat it. If you treat it you should track it and besides knowing more about your own health it proves to your doctor that you are an involved participant in your care. The app for you is IBP blood pressure.
Although I have more to say on this in a future column, if you have trouble sleeping try Pzizz, it’s $10 at press time but worth a try.
For those working on diet…and you should all be, I offer you four choices: LoseIt, MyNetDiary, Mindful Eating and Mindful Bite. I like the first two apps more than the second two, but it’s a style thing, not a content thing.
For those working on fitness and that’s you: MyFitnessPal, C25k, iFit and Daily Cardio Workout. Many also have calorie counters and diet information. C25k stands for couch to 5k, meaning they will go from being a couch potato to fit enough to run a 5k. Pretty neat.
Finally for relaxation…for those of you too stubborn to follow my advice and try yoga, try Breath2Relax or Buddhify. I really like the latter program as you can customize it for commute, exercise, etc.
Lastly for brain training, consider Luminosity Brain Trainer or Memory Trainer Pro. The former is a more thorough program and the latter is something you do while you are waiting for your lunch to arrive. I don’t know if either program will help you remember your girlfriend’s favorite song. These apps can’t help your marriage or help you figure out what’s really wrong with that kid or grandkid of yours, at least not yet. Give them time. I’m working on an article about an exciting new Internet-based treatment program for insomnia. No gimmicks, no fancy machines, no medications of any kind. Nothing to lose or break or have to send back. You can get to the bottom of the problem or you can just cover it up. This new program offers a real, long-term solution that does not require input from you or some kind of work on your part. And of course that means 90% of you can’t be bothered and will ask for a sleeping pill. I know, believe me, how important a good night’s sleep is but I can’t believe taking some medication that powerfully affects your brain night after night is good for you either. What do you know…neither do the experts as recent news stories detail. “Use less, use lower doses” was the recent update from the FDA. Of course, they also recommend not using drugs for more than two weeks at a time, but try to tell that to someone asking to stay on this medicine for all time.
But there is hope, speaking of hope…if you were trapped in the calendar, how would you survive? Yes, this is a mental challenge. Until next month…get well, stay well!
One of the Last Chapters in the Big Book of Life | March 8, 2013
Dr. Barry
I am so going to surprise you by actually writing about something I have some experience with. I want to talk about something that’s going to depress you. No, not the economy, it’s not about the future of health care, although both subjects have left me morose. It’s March so it’s a dark, wet, cold time anyway…perfect weather to let a bad mood fester. Of course that’s why I always take and recommend a vacation down south this time of year for some much needed warmth and sunshine on the old pineal gland. No, the depressing issue I want to write about is Nursing Homes. Not the care in nursing homes…but your unrealistic expectation of life therein. I have worked in two nursing homes and was a medical director of a third. I still have a floor at a local home that I have worked at for over 20 years so that’s my bone fides. Last year my mother died in a nursing home so I also have the perspective of a family member.
I don’t write these columns to make friends…sometimes I write to get stuff off my chest or to show a different side to a story, but today I write to because sometimes there’s stuff you really need to hear and you are not going to hear it from anyone else…not in writing, anyways. Everyone who works in any aspect of the nursing home environment…the nurses, the diet staff, the therapists…they all will nod in agreement with what you are going to hear. I’m not going to sugar coat this topic…it’s too important.
Let’s start with the basics. No matter how nice you try to make it…paint the walls in cheerful colors and dress up the dining service and have memory hour during activities…it doesn’t change the basic facts. For the vast majority of residents, the nursing home is the place to go to die. It may be in 3 days or 33 years but most people don’t get out alive. It’s the last train to Clarksville, people. It’s the end of the end of the line. No body but nobody says “I am looking forward to spending my last days in the nursing home. Get me there on the double.” Not everyone wants to spend their waning days in their own home…however unrealistic that may be without a buttload of help. Not everyone has the resources for this help and so we shuttle you off to the nursing home.
So the nursing home is unfortunately all too often the last chapter of your life. It’s usually not a very pleasant chapter. Can you see the comparison with a book? If the last chapter of your life is going to be unpleasant…why would you prolong it? Is it better to die within a month of entering the nursing home or would you rather linger usually in great diminished capacity until some illness finally claims you? You go into the nursing home because of a broken hip or because you are too old or weak or had a stroke…most nowadays go in with dementia. Even the demented patients…maybe especially the demented patients, know they are in the “wrong place” and can literally beg anyone that comes by to take them home or ask over and over again “Why am I here?”
These poor retches are taken care of by people who can never get paid enough for the care they give. Their families have completely unrealistic expectations of how much time and effort can be put into any one patient’s care. The costs of care…or at least the charges seem outrageous. You could live abroad a cruise ship and get more care, better service and better food for a cheaper price. It’s the next most regulated industry short of nuclear plants. Probably has surpassed nuclear plants by now. Whole staffs have been hired…countless hours of completely ridiculous paperwork to try to explain away and justify the events that inevitably have to happen in the nursing home. Here’s a partial list of what inevitably happens.
Your loved one WILL FALL. Unless we strap them down they will want to get up for any number of reasons no matter how confused and weak they are…and they will fall. Honestly you know, I blame many of these falls on too many medications. Staff and families alike want a medicine for each problem…there must be a pill for the agitation…sure there is but it comes with a black box warning that says its use results in more deaths than in patients who don’t take the meds. But meds or no meds your loved one will fall…the last fall will result in some serious injury and they will pass away…will you make them struggle in some ICU or will you let them pass quietly away with family nearby?
Your loved one WILL get dehydrated, have a urinary tract infection and get pneumonia. You can’t easily or reliably prevent any of these things from happening. If you give them food they can’t recognize they will choke. Personally I would rather choke on a nice sausage sandwich and die rather than have all my food pureed so it’s just globs of different colored mud on the plate…the pale yellow puree…the brown glop and the green glop…I know the therapists that made that suggestion and the dietary staff that is arranging it are doing their best but that doesn’t mean you have to go along with it. A knowing and eminent doctor long ago said that “Pneumonia is a friend of the elderly and in firmed alike”. He said that over 100 years ago and that means that a quick death from pneumonia is preferable to a slow lingering death.
So let’s get down to serious suggestions. Maybe you won’t understand my suggestions until you have someone you love go through this. Just because it’s the last chapter of your life and just because you don’t want to prolong this certainly difficult tome doesn’t mean you don’t have a helluva lot of control over it still.
Make you loved on a DNR. Of course you don’t want your mother to die. Sorry, gonna happen anyway but you can help her with a DNR. When the end comes they can die peacefully with meds to keep them comfortable or they can die surrounded by tubes and wires and some poor nurse or doctor crushes their chest in an order to keep them alive a few days longer…and those won’t be good days.
Let them eat whatever they want. If Uncle Johnny wants ice cream for breakfast, lunch and dinner…why the heck now. Who cares if they were on a low-salt diet on the outside. Who really cares about their diabetes now. It’s about quality of life now…not quantity. Unless the resident can sign the papers themselves don’t put a feeding tube in. this isn’t saving their lives…it is prolonging their suffering. When you can’t reliably swallow any more it’s game over…
Stop most of the pills. Why are you letting them give your loved one a pill for cholesterol? Don’t you realize a stroke or quick heart attack would be a blessing for most of them. Likewise it’s long past time to worry about high blood pressure…the side effects from the pills are likely worse than any possible benefit from the meds. Your own doctor will likely admit it if you press him. If the pill directly makes them feel better…Tylenol, pain pills, etc., use it. Otherwise, you are just not thinking about the end game, a painless gently passing into the next life.
Aggressively treat pain. I hate codeine for chronic pain on the outside but in the nursing home because again it’s the last stop on the train to endsville I open up the cabinet and will try to help keep your pain to a minimum. No one ever said to me “My mother was too comfortable when she passed”, but they have said the opposite. Don’t be frightened of morphine at the end. We are not committing euthanasia, we are making the patient pain free as far as we can tell. It’s one of the few things we do have control of.
I try to treat all my nursing home patients with three guiding principles. Would I do this to or for my momma? Would the patient themselves want this treatment if they could wake up and speak to us for just a moment? How do we help the families realize there is only one eventual outcome and to focus on that understanding rather than the day to day stuff that drives them crazy? I am not saying in any way that the families’ concerns aren’t real or valid. It’s just not focusing on the big picture. This makes decisions easier for me. I hope my suggestions make things a little easier for you.
GIVE ME ALL YOUR LOVING | Feb 11, 2013
It’s February and one’s thoughts should turn to love…Valentine’s Day and all that. My thoughts turn to sandy beaches and bikinis but I have been married a long time…a very long time…at least it seems like a very long time. Hey, whose idea was it to suggest people should be in monogamous relationships that last until someone dies. Is that a reward or a punishment. Let me get back to you on that one. I will ask my wife. She knows the answer to everything or so I am told over and over. Do I sound testy? My wife says I get testy at times. If she really knew me, she would know why and how to prevent it, namely, more sex, more sex, while I’m still young enough to enjoy it! I don’t know how you 70 year old people do it. Between the wrinkles and the arthritis and worrying about the grandchildren, it’s hard to imagine what that must be like. Frankly, I don’t want to imagine it. The very thought makes the back of my eyeballs ache. I love my wife and she keeps herself in great shape and you can bounce a quarter off many parts of her body. Not that she’s given me the change but I have a good imagination. At 70 however, I’m going to need beer giggles, several tongue depressors and no doubt drugs still in development. Of course, it’s highly unlikely I will survive to 70 once someone reads this article to her. Don’t you be that one. I know you are dying to get me in trouble but it’s bad karma for you. Everyone who knows my wife knows that is the center of my universe but I wouldn’t mind orbiting around her a little more often. If you get my drift and I think you do sir!
In years past I have written at this time of year about how most women seem to lose their sex drive a decade after the wedding cake and men are forced to deal with their sex drives until the testosterone wears off, usually decades later. I would gladly give men advice on how to keep pleasing their women but I got nothing. Flowers, candies, doing the dishes… all old bromides for a bygone age. I’ve tried them all…the cards and candy left for her to find on her steering wheel, the romantic text messages, the spontaneous flowers. Good the first 10 times but them it’s ho-hum. I would stand naked in the doorway covered only in peanut butter and a few well-placed bits of dark chocolate but I wouldn’t be able to keep the dogs from licking me and that’s gross even for me and, with my luck, the door would be opened by one of my kids. So, clearly, I am drawing a complete blank in the pleasing the modern woman department. Go read Cosmo or something for that advice. On the other hand it’s easy to give women advice on men. On that subject I can speak with some degree of certainty. It’s easy. It’s simple. It’s inexpensive. It’s much more important than you know.
Keep the loving coming and maybe mix it up a little. That’s it. That’s all. Notice I said loving to try to fru fru it up for you but you know I mean sex. If you put as much effort into trying a little something new or different in the bedroom as you do in worrying about your next haircut, we men would be ecstatic, if you could put a little effort into your bedroom wardrobe like you do your work wardrobe, you would have my gratitude and the gratitude of the nation. It’s fine to fuss over a new casserole recipe but I have a little bedroom recipe I would like to work on with you. When I heard about these 50 shades of gray books, I thought that might light a little fire in the right places for my wife but all I got was a green shade of disgust when I brought it up. But then again can you blame her? Look at what she has to work with. Still this little ring on my finger means I am cut off from all other avenues of intimate pleasure. I am happy to be faithful but how about a little wow once in a while. Still, it’s not just me. Most of the women’s magazines in the checkout line have an article about how to spice up the love life… locations, outfits, time of day, toys, etc. Cary it up a little bit. Is that too much to ask for a man facing a life sentence? But may I suggest skip the sexting? I don’t see how that can be anything but trouble.
By mentioning adding a little variety, frequency and intensity to your intimacy I am covering ground covered previously and by others but good advice bears repeating. I know the women are all thinking what a sexist pig and the men are all thinking how do I leave this article around so she will read it, commend on what a chauvinist I am, and he can make her feel good by agreeing with her but then segue into “say whatever did happen to that fuzzy outfit I bought you last year?”
Leaving covered ground let’s switch it up with a little Valentines trivia to provoke conversation at the restaurant, the bar, the kitchen table.
Who was cupid? Who was Valentine?
Who is credited with selling the first mass produced Valentine’s day card?
Approximately how many marriages are performed each day in the USA?
Name two states that have towns/cities with the name Valentine?
Son of Venus goddess of love and beauty.
Roman clergyman executed for performing marriages in defiance of Emperor Claudius II who thought that marriage was bad for his soldiers… weakening their righting resolve.
Ester Howard of Massachusetts.
6,000
Texas and Nebraska
I understand laughter is the best medicine so let me close with a few bon motes.
Did you hear that having sex burns as much calories as running 8 miles? What I want to know is who can run 8 miles in 45 seconds!!
I liked these two from Playboy.
A woman and her boyfriend were having an argument. The woman shouted at him, “Leave! Get out of his house.” Resigned, the boyfriend headed for the door. But the woman continued. “I hope you die a slow and painful death!” she yelled. He turned around and asked “So, now you want me to stay?”
And, finally, a man was unhappy with his wife’s emotional swings, so he bought her a mood ring to gauge her temperament. He found that when she was in a good mood, the ring glowed green and when she was in a bad mood it left a big red mark in the middle of his forehead!
I would close by saying next month we will deal with some real and serious medical topics but wait a minute, not just myself but experts have opined that sexual health is part of physical health and can be one gauge of a relationship. I’m sure Dr. Oz and Dr. Phil are both on record saying the exact same thing, perhaps not in the same way I do, but I’m sure they are doing their best.
WHAT EXACTLY IS A PSA AND WHAT IS THIS BLOOD TEST I’M GETTING | Jan 24, 2013
PSA = Prostate Specific Antigen. This is a protein that is made in the prostate that normally circulates in minute amounts in the blood stream. Women don’t have a prostate and, therefore, they will not have any measurable amount of this protein that is specific for the prostate, hence, the term “Prostate SPECIFIC Antigen”. Young people have small prostates and low levels of this protein circulating. Old people have bigger prostates and higher levels of PSA. We don’t really know why but the prostate is one of the few glands/organs that grows as we get older. Your height shrinks, your kidneys shrink, etc. etc.
The PSA test is just a measurement of this protein in your circulation.
It slowly goes up as you age. The normal range is 0-4. Some experts say you should age normalize the results and use a bigger range as you get older. So, up to 4.0 is okay if you are younger than 60 but over that age maybe a top score of 6 is still normal. The actual number is less important than how it changes over time and it’s easy to measure. When the level is elevated or jumps a lot from the last test, there is a reason. There is always a reason but only sometimes is it cancer. Sometimes the level is elevated and it’s just the prostate getting bigger over time. Sometimes it’s an infection and more of this protein leaks out due to the inflammation/infection. But, sometimes, elevation of the PSA is associated with cancer.
There is no perfect test. I have had patients with PSAs under 4 who had cancer and patients with PSAs over 30 who did not have cancer. Cancer can only be determined by a biopsy. Prostate cancer is treated differently depending on the stage, your age, the aggressiveness of the cancer itself. But if you don’t find it when it’s still small, it greatly limits your choices and the PSA offers the only hope of finding the cancer before it has spread from the gland.
So an elevated PSA doesn’t necessarily mean you have cancer BUT a big jump in the PSA (over 1.5 increase) and every number over the current cutoff of 4 should get checked out. This means either having the test repeated within 6 months or talking about a trial of antibiotics or possible prostate biopsy. What do I do with my results. Your results will be sent to me by the method you selected at the time of the blood draw. This will be done by Dr. Barry directly for each and every sample. It will be Dr. Barry who sends you the email, mails the result or calls you…your preference. You should be notified whether the results are normal or abnormal. You should be notified within 10 days or you should call 559-9936 and let me know. You should share your results with your doctor. Tell him you had a free screening done and the results are xyz. It should be a number hopefully less than 4. If it’s over 4, it doesn’t mean you have cancer, but it does mean you should get it checked out.
There is some controversy over the PSA test. Although I don’t know a doctor seeing men who doesn’t order the test, there is one specific government panel that suggests that people shouldn’t be tested. This makes no sense to me. Little the government does lately makes any sense to me including but not limited to the health care field. Just drop dead already will you. Dropping dead is cheap, chemotherapy is not. The PSA is just like the mammogram…not every abnormal mammo is cancer…not every high PSA is cancer. But, the PSA has still revolutionized prostate cancer because before this test was available prostate cancer was usually diagnosed after it had widely spread to the bones. You could do things to slow the cancer down but this was usually a death sentence and prostate cancer was a top 5 cancer for men. Now with the PSA the cancer is found when it’s still inside the prostate and you have options…watchful waiting if you’re 85 but robot surgery or radiation therapy etc. if you are younger. The technical meaning of younger being having a 10 year life expectancy.
I set up this screening because I am an optimist. I’m not looking for new business. Like Scrooge learned… “Mankind is my business.”
Here Piggy Piggy Piggy… | Sep 25, 2012
That’s right…I’m talking about the State Fair…..A chance to get up close and personal with livestock of all shapes and sizes and breeds. By the time you are reading this the Fair has been open for at least a week already. Hopefully you have checked it out. If not, there’s still time to get out there and I will give you plenty of reasons why you should. I love the Fair! The sights. The sounds. The smells! I have a strange soft spot in my heart for the multicolored chicks in the bird house. Who thought that up? Why? Having personally raised pigs and sheep (don’t ask!) I do like to check out the squeaking and squealing piglets and watch the sheep shearing. To watch the cascading waves of wool come off the lamb at the hands of a good clipper is almost magical. In the end you a pretty big pile of wool and a lamb ready to enlist. How’s that for sustainable energy!
Speaking of sustainable energy, you have to have one of those lemonades made from fresh squeezed in front of you lemons and a quarter bucket of puro cane sugar. (I have watched a few too many crime shows, I can’t say pure, it has to be “puro”, the Mexican way, like you are talking about blue crystal meth), at least it’s not the dreaded high fructose corn syrup. The pucker factor mixed in with the ice cold sweet jolt is a real pick me up. I, of course, always bring my cup from last year because you get a discount, I keep it in my day pack on my back, having taken kids to the fair for years you a have to have something to hold all the small junk and you should have a stroller/wagon for all the really small kids, say under 15. Most kids these days are weaklings. Yes that’s right, I have a day pack, at least it’s not my fanny pack, but that’s another article. Yes, you can pick up some type of freebie bag from Nimo or Keybank to carry your junk, but I prefer the small backpack because I like to keep my hands free. I must be unencumbered if I am to save that baby falling off the tilt o whirl. I only hope it’s a toddler or smaller or I’ll get crushed! Oh what’s that? Not this time? Ok, just saying I am ready is all. Should a horse get away from its handlers I am prepared to wave it away from the twins in the stroller, that right, because my hands are free. And you know there are plenty of opportunities for the Heimlich maneuver to come up, there are too any sausage selling places to have an EMT crew stand by at all of them , but that’s where the action is. I don’t think anyone is choking on the walk away Sunday, and I do like to end my fair visit with one, where they start with the brick ice cream on a cone and then dip it in chocolate and then thrust it, still dripping of excess chocolate into the nuts and end with a cherry on top! Here my health related suggestion, enjoy the ice cream etc., but ditch the cone, you have had carbs aplenty already. I go to the one near the taffy store where you see the taffy get pulled and pulled in the machine, so, of course, I recommend getting a box of that salt water taffy to go. Sure it’s a stress test for your fillings, and you can enjoy them for weeks after the Fair. An edible memento. A Fairmento.
The Fair is expansive enough (that’s right, expansive, not expensive; you can do the Fair on the cheap if you have to). It’s expansive enough to wear out the kinder, the teens and the elders alike, it’s an agricultural, entertainment, and gustatorial triathlon. Between the rides and the exhibits and the stands selling almost everything, but bath salts, the fair can be a draining and exhausting day. That’s why I love it and encourage all my patients to go. Precisely because it is a challenge, it is absolutely a different experience each time you go, if you do it right. Can we be honest here? I think most of you don’t have the strength for a full day at the fair. Admit it. It’s too much walking. Too much exposure to the outside at one time. There are bathroom issues. The crowds. The parking. I hear it every day. Along with all the excuses about why you can’t exercise. That’s a defeatist, I hear. That’s a negative attitude and I can’t tell you how bad that is for your health. No! Rally, I say! Do not go gently into that dark night!
Ok, you can’t take a full day. So what, do a couple of hours. Take one of those buses from the nearest mall, etc. Are you worried about eating unhealthy? I worry about your unhealthy eating the rest of the year. If you are eating right a few indulgences at the fair are meaningless. That’s ok. You know you are going to overindulge in something. Blooming onion? Mystery meat on a stick? Don’t delude yourself, own that pizza fritz, but own the work it’s going to take to get that junk out of your system. Maybe now that I think of it, you shouldn’t own the fritz, rent it, or nibble one fritz between the bunch of you. You do go to the fair as a group, don’t you? That’s a part of the fun. Who will break down first? Will it be Grannie’s knees or Dad’s temper? I like to go with a group of 8 people and play those water games where you squirt the target. If you have 8 people you can own the whole row of seats and someone from your group is guaranteed to win. It’s a blast to go with a little kid this way because all the other adults and older kids can blast away all around the target, but not hit it and the little kid thinks he beat everyone. It’s good to build up the spirits of the little kids before life’s brutal realities grind them down. Of course one of the other kids will be jealous, how come he gets to win because he is the smallest, you never let me win like that, then they have to reveal the secret to the now quivering tot and all the others have to nay say it and there’s the part with Dad’s temper.
So why go to the Fair?
Point 1. It’s Exercise. That’s right, capital E Exercise. Plain and simple, even if you skip the Indian village you have to walk a ton to take in the whole Fair. Don’t skip the Indian village. It’s probably the lone space at the Fair that is quiet and peaceful and less crowded. You go from the hustle and bustle of the midway to this tree trimmed area that seems both cooler and slower, you know how often I say that to feel good, o get your mind and body right you should spend time outdoors in nature, this is a natural oasis amidst the ice cream of the future and the carnie that will guess your weight or zodiac sign. Sure I pick on the carnies, they are easy targets and they probably can’t or don’t read so I don’t fear reprisals. Now listen, just because they are illiterate doesn’t mean they can’t safely and responsibly put those vomitoriums together, never mind that reference to babies flying off rides earlier.
Why do you let me go off on tangents? Let’s get back to the Indian Village…You have a moment away from the din. Enjoy the natural oasis and then once more into the breach as you thread your way back into the midway in search of a candied apple and a henna tattoo. So just coming to the Fair can be a bit of a physical challenge, the heat, the humidity, the crowds, etc. This is a good thing. You know I think you should challenge yourself. Grow or grow old, my father has said many a time. Or did I read that in a fortune cookie.
Point 2. Try something new. You know that’s also one of my mantras, not motto, I am sensitive because I have been accused by my closest friends and allies of exceeding my motto allowance, who know!! So my mantra has been to challenge yourself, try a new ride or new game, some new food, actually sit and watch a show being put on by talent from all over the state. Ok, every act may not be worthy of America’s Got Talent, but just the experience of seeing someone perform live? That does something good for you.
Point 3. Support the local businesses. Ok, the guy selling the Sham Wow isn’t local, but many local merchants make their presence known at the Fair. Jobs going overseas. Local plants closing or downsizing. Here is a chance to make a difference. How often can you say that? How often can you actually do that? You go, you meet up with someone. You spend a little money, you keep people working, and that’s got to be a good thing in the long run.
Point 4. Sheer entertainment and education. I’m not talking about just the sheep, with so many venues and activities the only way you can be bored at the Fair is if you are a teenager with a dead smart phone, Ewuh, what’s that smell? Where are we? Why is the Center of Progress building selling sham wows? I know you wouldn’t willingly and knowingly do to it, but if you actually give it a chance there are many interesting shows each and every day. How can you not enjoy watching the Frisbee catching dogs, the high divers, the guy that uses a chain saw to sculpt logs, the livestock judging, the exhibits, the shows from the grandstand to all the little venues? I am not much for the grandstand shows or the free court shows, but they also have multiple smaller venues and I have seen great talent there for free and in the shade. I’m talking about local greats, Nancy Kelly and Joe Whitting, to name just a few.
Point 5. People watching. I don’t care what a wreck you have made of your life or your physique there is bound to be someone at the fair that makes you feel better about yourself. You could be a 400 pound, bath salts loving, no underwear wearing, bad tattooed, unemployed drunk and still find someone to look down on at the Fair. I’m not saying that looking down on others is a good thing, but we all compare ourselves to our surroundings don’t we? Is it only me? Ok, so I have hair only in places I don’t want it and my mug would fit right in on a most wanted poster and I could lose a few pounds and dress nicer, etc., at least I have more teeth that that guy! Is that shirt two or three sizes too small. Ok, I admit it; I can’t tell if that person is a man or a woman. (Those people frighten me) I’m just saying!
People trot out that old shibboleth, I have been to the Fair ten times, nothing changes, and it’s always the same. I used to go when the kids were in the house, but why go now? I can’t get around that well, that should set off a red flag, unless you are 80 years old and beyond, and speaking of Seniors, did you catch my Mother’s dance group performance? How many of you can say your parents are still alive in their 80’s? How many are dancing at the Fair? Way to go Momma! Or would you rather stay home and watch reruns of Little House on the Prairie and wonder about the butter sculpture.
So, nothing changes at the Fair? Well obviously some things are the same, we call those traditions, like Christmas and Easter, and no one says, I did Christmas for 10 years, nothing’s different. I would say there is always something different to a person that really takes a look, to a person that is still growing, to a person that still has some life left in them. So, get to the Fair and have your own experience.