What is Dr. Lanny Up To?

What am I up to?

“Not always this laid back”
“Not always this laid back”

Thank you for asking. I am asked this question so often. This phase may just be a salutation, but I have learned many have a curiosity about my various endeavors. A blog seemed like the best way to answer this question on a regular basis. In addition, this blog provides a means for me to keep track in an organized fashion of what I am up to.

The purpose is to record and relate what I am up to these days. The information will be in one place for recording memoirs and historical events. It will be a place to document the present and consider the future.
I expect to regularly make entries concerning various categories: physician/surgeon; medical research and development; the golf adventures and Life. You may see a recent post or follow the topic that might interest you.

Let me know what you think as this blog will becomes my “Lectronic Legacy” in what ever time remains.

Answering the frequently asked question (FAQ) of what am I up to now?

A BLOG seemed the best and most efficient means of answering the FAQs on a regular basis.  It might be said that I wear multiple hats or have many interests.  Discovery in medicine will always be the main topic.  However there are other categories; Golf Adventures, Inventions, and some Christian writings.  Hopefully the BLOG will be a format to tell what I am up to in each of these main endeavors.  It seems almost daily there are interesting events; at least to me. Perhaps the events may be of interest to others.

I want to make it clear, I am not retired.  Retirement it is bad for one’s health.  I concluded my clinical practice in 1995, but work regularly in these various endeavors.  I do not see anywhere in the Bible where retirement is to be desired or realized.  I have told my daughters that I will not be speaking at my retirement party.

From time to time I will answer publicly herein those questions that recently surfaced and may be of general interest.  I will not be recording what I had on my hot dog at a ball game, let alone focus on mundane events.

I trust I will accomplish the intended goal of answering “What am I up to?”

Michigan Governor’s Folly Continues

5/21/2020: Michigan governor’s response to the Midland flood is that she will sue the responsible party.

Guess who? The State of Michigan who has oversight and determined the structure was sound.

The following responsible party information from: https://en.wikipedia.org/wiki/Edenville_Dam

“Following the federal government’s 2018 license revocation, the Michigan Department of Environment, Great Lakes, and Energy (EGLE) took oversight of the dam, which involved temporarily lowering the lake by 7 feet.[11] EGLE determined that the dam was structurally sound.[12]”

“[12] Erin Ailworth; John D. Stoll (May 20, 2020). “Failed Michigan Dam Lost License in 2018”. The Wall Street Journal. Retrieved May 21, 2020. After its license was revoked by FERC, regulation of the Edenville dam was taken over by the Michigan Department of Environment, Great Lakes and Energy in 2018. Spokesman Nick Assendelft said the agency inspected the dam in October 2018 and found it structurally sound.”

Incomplete data analysis on Coronavirus Incidence

5/20/2020: The incidence of coronavirus cases are increasing because the frequency of testing is increasing. That should not be surprising nor unexpected. The magnitude of the condition is not reported; asymptomatic or symptomatic patient, just positive or negative test.

The incidence of coronavirus cases with hospital admissions are high perhaps for this contributing reason.

Reimbursement has always been the name of the game in medical economics. Now there is bonus money for coding as COVID-19 for billing purposes. Medicare will pay hospitals a 20% “add-on” to the regular DRG payment for a billing coding of a patient with the new government COVID-19 billing codes.

Medicare has determined that a hospital gets paid $13,000 more if a COVID-19 patient on Medicare is admitted and $39,000 more if the patient goes on a ventilator with the coronavirus diagnosis.

https://www.statesman.com/news/20200422/fact-check-do-hospitals-get-paid-more-to-list-patients-as-having-coronavirus

This is in addition to the base reimbursement. What you incentivize you will get more of. Ever wonder why the high incidence of COVID-19 patients?

The real numbers may never be known.

Malaria drug evaluation: some facts

5/8/2020: There are many factors to be considered in evaluation of a drug. The first issue is safety. Hydroxychloroquine has met that standard for 50 years in treatment of malaria, lupus and rheumatoid arthritis. The main potential side effect is adverse effect on the heart and that is infrequent.

A prescription for any treatment selects the intended patient based upon certain criteria. Is the patient without the disease? In this case the treatment is called preventative or prophylactic.

The treatment should be disease specific and in this case the physicians considering the use of hydroxychlorquine for the coronavirus symptoms is called “off label (not FDA approved for this use). It is not being proposed as virilcidal for SARS CoV 2. There is no such certified drug at present. It is being prescribed to affect the symptoms of a specific patient.

The next consideration for a use of a drug is for those presently affected by the disease is the disease stage at time of onset. Did it just start or is the disease progressive?

The magnitude of the disease in the patient is the next factor.

So why all the controversy concerning reports of hydroxychloroquine? So far the answer appears simple and logical. There is a difference in severity of the condition and the amount of the drug given.

The success reports have a patient population that are at the early stage of the disease and treated with low dose.

The failure reports are the use of those advanced to hospitalization and/or very high doses known to be toxic.

The complication in the negative reports are related to the amount of the dose. Those taking 200 mg twice day are not as sick and have fewer complications than those taking greater amounts. There also is the caveat that those getting the higher dose are those most severely effected and with other conditions.

For emphasis, the patients not likely to get a benefit are those in the hospitalized group. They are those (recent New England Journal Medicine) who are the sickest and those with most comorbidity (other disease conditions) and on the highest doses. This is not unexpected adverse result.

The two opposing views, may be agenda driven, but both have credible logical medical rationale. However, but each is based upon different patient selection and treatment parameters.

Bottom Line: It is legal for a patient and their doctor to decide on the individual’s treatment and/or prescription. You may decide with the advice of your physician.

Spiritual Warfare at New Heights

5/5/2020: The evidence of spiritual warfare is a new heights. The evidence is recognition of the standard daily operating procedure of lies, deceit, deception, and less than half truths. The Bible stated that where ever jealousy and envy exist so does every other sin. (James 3:16) This should give us some insight to the characters and character of those in the present day public debate; certain news media and politicians.

As a result, I personally want to make a connection with truth. Truth is not just a concept but a person; Jesus. (John 14:6) The concept that Jesus is synonymous with truth may be hard to grasp. The difficulty is overcome as one experiences by relationship and practice they are one and the same.

Who would have thought possible?

4/30/2020:A book written by a futurist more than 2000 years ago predicted that there would be a time when a day’s wages would be required to buy a loaf of bread. Reference upon request.

Who would have thought this was possible, until today when the prediction was exceeded.

Venezuela sets new price controls, with eggs costing more than a month’s wages.

https://www.reuters.com/article/us-venezuela-economy/venezuela-sets-new-price-controls-with-eggs-costing-more-than-a-months-wages-idUSKBN22D41S