Ghostbusters

Everyone knows it goes on. Big Pharma either solicits or creates scholarly review articles that paint its drug in a favorable light, attributing the writing entirely to a prominent thought leader in the field.

But this article in today’s New York Times exposes the process in a way none has before, following the production of a review article from it’s first inception in a Wyeth stratgey meeting to the hiring of a ghost writer and the correspondance with the attributed author, its rejection by a peer review journal and final publication in a throw away.

Most of us docs know that the articles in throw aways are slanted towards Big Pharma’s agenda, and if we read them, do so with that in mind. But some of these ghost-written articles make their way into peer-review journals. One could argue that the peer-review process should weed out the artciles that are not medically correct. But what if the peer reviewers have conflicts similar to those of the supposed author?

Oh, what a tangled web we weave…

Thank you, Bruce

For the past few days, my brain has been stuck in high gear. Nothing particularly is wrong. Everything is fine, actually. But I’ve been unable to relax. You know what I mean – Shoulders and neck are like a board, songs are running through your head and you can’t get them out, food sticks in your throat on the way down and you just cannot relax. Deep breathing only works for a few seconds. Sleeping just makes your neck hurt even more, and when you wake up, that same damned song is still stuck in your head. (I love that song, really, but enough already…)

Then, this morning, while walking to work, I slipped on my IPOD headphones and clicked on Bruce Springsteen’s Thunder Road.

Within 30 seconds, I could feel my shoulders relax in a way they had not done in weeks. My step lightened. My breathing deepened. My head cleared. And that damned song became nothing but a memory.

I sighed.

Four hours later, I was still feeling great.

It wasn’t the first time Bruce had come through for me

When I was in labor with my first child, I came very close to having a C-section. The baby’s head was up at -1 station and I had been pushing for almost two hours but getting nowhere. At that point, we turned down the epidural so I could feel what I was doing. And I put on my Walkman with a tape for Born to Run blasting at almost full volume. Within 3 pushes, Emily was born.

What is it about music that can literally transport us to another place? And what is it about Bruce?

I don’t think it’s just me. When I was in grad school, my roommate, who was always neat but never cleaned our apartment, cleaned it one day because a friend who was visiting happened to put on my Born to Run album. “You always play that album when you clean”, she later explained. “As soon as that song started, it was like I couldn’t help myself. I grabbed the vacuum and off I went.” She had never cleaned before, and was never to again. But that day, Bruce put her into a place where nothing was more important to her than making that place shine like there was no tomorrow.

I don’t know if I’ll ever understand it

But I’m sure as heck going to remember it. And in the future, if I ever find myself stuck in a place and can’t get out, I won’t wait so long to call on my man Bruce.

What music does it for you?

Take Your Bladder Back from Pfizer

For years now, Big Pharma’s approach to drug marketing has been to first promote disease awareness and then sell you their drug for the disease you never knew you had until they told you about it. HPV testing and vaccination are textbook examples of an extremely successful use of this marketing approach. (With a little mandatory vaccine regulation thrown in for insurance.)

But what if we could combine disease awareness with brand name recognition by actually renaming the disease with your drug’s brand name? Better still, forget disease recognition altogether. Cast an even wider net and tie your brand name to the symptoms of the disorder. Who cares if other diseases might have the same symptoms? You’re going to own that symptom, and then, like a rancher with a roped calf, brand it.

That, in essence, is what Pfizer is doing with their Detrol Ad campaign.

The Detrol Ad Campaign

Detrol is a drug that is FDA-approved for treatment of overactive bladder (we docs like to call it detrusor instability). The hallmark symptoms of overactive bladder are urinary frequency and urgency. Pfizer calls these symptoms “that gotta’ go feeling”.

In their ads, Pfizer barely mentions the term overactive bladder. They just show images of woman rushing to the bathroom, and then tell us about Detrol. Their icon is the little woman on the bathroom door, so that every time a woman heads to a public rest room, she will think of their drug. (See a typical ad on Ad Pharm Blog)

Of course, no good drug marketing campaign these days is complete without a website. With theirs, Pfizer is using every play from Big Pharma’s market-to-women playbook. First, female empowerment – “Get the help you deserve”. Next, the worry card – images that compare your overactive bladder to a healthy bladder (message – your overactive bladder is un-healthy), telling you overactive bladder “is never normal”, warning you that your symptoms “may lead to an accident” and telling you that “the less you gotta’ go, the less you gotta’ worry”. If you weren’t worried before, you sure are now. And will be every time you pee. Finally, the training – How to talk to your doctor about your bladder symptoms, or having The Detrol Discussion.

Leave it to Big Pharma to take a universal bodily function, turn it into something to worry about and sell you a drug for it.

It’s brilliant marketing.

And of course, I don’t like it.

Why not? For one, we all have to go to the bathroom. But since most of us women these days are also crazy busy, we often put off the deed as long as we can. Until we can’t anymore. Hence, that gotta’ go feeling. We don’t need a drug – we need to slow down our lives so we have time to go to the bathroom.

Not to mention the fact that the symptoms of urinary urgency and frequency are also symptoms of urinary tract infections, diabetes, uterine fibroids, early ovarian cancer and pregnancy. None of which are treated with Detrol last time I checked. Overactive bladder is a diagnosis of exclusion, only to be made after ruling out these and other underlying disorders.

But let’s suppose you’ve been cleared from all these and other conditions that can cause you to run to the bathroom. Taking a drug is the last thing you want to do.

Because there are so many other simple, inexpensive and healthier ways to address the problem. Detrol’s webpage lists these as things to do “in addition” to taking your medication. I say do them “instead” of taking medication.

Treating the problem without medication
  • Make time to pee. The first and most important thing to do is to take the time to go to the bathroom before it’s an emergency.
  • Get real about your fluid intake – what goes in must come out. How many of you have a big plastic bottle of H2O on your desk at work? Getting your recommended 8 glasses of water a day, and even more if you’re dieting? If you’re going to drink that much water, you’re going to be in the bathroom. That’s just the way it is. You don’t need a drug. Just some common sense. If you’re going to guzzle water on a long car ride, you’re going to need to take bathroom stops. If you’re ordering the liter diet coke with popcorn at the movie, don’t be surprised if you miss the good part because you’re in the ladies’ room.
  • If nighttime frequency is a problem, cut back on evening fluids. You can’t drink tea while watching Letterman and expect to make it through the night.
  • Drink enough water. While a lot of us are water guzzlers, some of you out there actually may not be drinking enough water. Your urine is concentrated, and that can be irritating to the bladder as well, especially if you’re also post-menopausal. So for you, the trick may be to increase your fluid intake a bit.
  • Cut back on the Starbuck’s Latte’s and Diet Cokes. Both caffeine and carbonated beverages can be bladder irritants, and caffeine is a diuretic. Put caffeine or diet coke habit together with an 8 cup a day water intake and you might as well just put your office in the ladies’ room, because you’ll be there more than you’re at your desk. Trust me on this. And it can be just as bad if you don’t drink enough water – now you’ve combined concentrated urine with a bladder irritant. You’ll go smaller amounts when you hit the stalls than the water drinkers, but you’ll still be there more often than you need to be.
  • See if other foods are bothering your bladder. Other foods that can irritate the bladder are chocolate, tomatoes and citrus fruits and juices. Maybe not for everyone, but maybe for you. If this is the case, simply eliminating or limiting these foods may be all you need to do to control your symptoms.
  • Try bladder training. Some of us have gotten ourselves into some bad habits when it comes to our bladders – running to the bathroom the minute we notice we have a bladder, jumping up out of bed 5 times before we fall off to sleep. But you can retrain it to hold out longer. It really is mind over body on this one.

What if these steps fail?

So let’s say you’ve tried everything up there and you’re still rushing to the bathroom. Maybe you’re even having occasional accidents. Your doctor has ruled out infection and other causes, and diagnosed you with irritable or overactive bladder. What can you do?

If you are post-menopausal, I usually first recommend a trial of low dose vaginal estrogen. (It’s an off-label use with some support in the literature.) For some women, this is all they need. If you don’t want to take vaginal estrogen or are not postmenopausal, then Detrol (or its generic) is definitely a treatment option, and it’s often quite effective.

Bottom Line

Urinary urgency and frequency are common symptoms in women. It’s important to see your doctor to rule out urinary tract infection (a very common problem in my practice) and other underlying causes. Once these things are ruled out, most symptoms can be controlled with simple changes in diet and fluid intake, along with some bladder training for more resistant cases, and if you are menopausal, a trial of vaginal estrogen. If these things fail, there are medications that can control symptoms, one of which is Detrol or its generic.

And as they always say, talk to your doctor.

Ginger Gold Apple

This is the perfect apple. Juicy, flavorful, light and crisp. Just listen to how it sounds when you bite into it, the juice running down the side of your mouth …

Remember the apple you ate as a kid? What an apple should be?

This is that apple.

Cubby Sitting

There is a wonderful editorial in this week’s JAMA by Laura M Prager, MD a child psychiatrist who worked part-time during her children’s early years. Years in which she completed her fellowship on an extended schedule, then worked only four hours a week – just enough to keep her skills honed and her foot in the door – until she re-entered the full time work force some years later when her children did not need her at home.

This work schedule gave Prader the time to be the mom she wanted to be – in her case, the mom who was able to sit outside her anxious preschooler’s classroom every day for the three weeks it took her child to adjust to the world away from her –

Drawing from my years of training in child psychiatry, I offered to be a transitional object for her or, in her vernacular, a “cubby toy.” …Each morning I walked her into the class and then retreated to the hallway outside the room, where I sat in a wooden cubby with a magazine and waited. The first week she came out to check on me quite regularly. By the second week, she waved to me when she came out to get her jacket on the way to the playground. By the third week, she was done with me. I asked her if she wanted to bring anything else with her to take my place, and she shook her head no: her shiny pink backpack full of the precious toys of the moment that we’d packed with care the night before was enough.

In addition to having what sounds like an amazingly supportive boss, Dr Prader also had a role model for her unique career path – her mom, a doc who had a successful part-time child psychiatry practice for many years. A woman who showed her that achieving work-family balance is possible with some inginuity (and some creative financing).

I have to be honest and say that I rarely ever considered working part time, and working just four hours a week would have been completely impossible financially. I was lucky enough, though, to have the world’s most amazing baby sitter, who in fact handled my youngest daughter’s preschool transition in much the same way Prader did. (I said she was amazing, didn’t I?)

And while I was not able to do the cubby sitting for my kids myself, what I did do was to carve out my own little area of medicine that made it work for me and my family – office gynecology. I first gave up OB and then surgery, giving me regular hours and some semblance of a managable home life.

At the time I chose to limit my practice to the office, no one else in my field that I knew was doing it. A few women were giving up OB, but usually at the end of their careers, when children were usually grown and out of the house. It took a lot of persuasion to convince my boss that an office-based practice was financially viable (it is), and a little more time than that to convince myself that I wasn’t less of a doc than my colleagues still putting in the grueling hours in the OR and on the labor floor (I’m not).

Now, a decade later, I regularly have residents and students asking me “How do I get to do what you do?” I’ve now become the role model for a new generation of doctors, showing them a path they might not have considered when they first became attracted to this field of medicine.

The carrying costs for a doc (malpractice, licensing, support staff, call coverage) may be too high for many practices specialties to allow them to retain an employee who only works 4 hours a week, as Prader did. And it’s hard to envision a workplace that can support more than an occasional employee working part time. Or a fellowship program that can sustain that kind of flexibility for more than one fellow at a time.

But the opportunities are expanding. They have to, with 50% or more of medical student graduates being female. At our institution alone we have one obstetrician who works regular hours as a hospitalist (we call them “laborists”) and another doing what I do, only half time. And several other women working regular hours on the teaching service, with limited on call duties and predictable hours (for the most part).

I don’t know that any of us will be doing much cubby sitting any time soon, but it’s a start.
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Tempeh, over at Mothers in Medicine, tells you how to get a part-time job in medicine.

Cream of Mushroom Soup

Central Park, late Autumn 2008

As the days shorten, we turn to the light of the hearth to replace what has been lost from the sun, firing up the stove to make foods whose warmth fills our stomachs and our hearts with rich, pungent flavors that linger on our tongues and in our bosom long after the last spoonful has been eaten.

Food like mushroom soup – for me the perfect antidote to the cold that permeated my bones hours after I had ridden the Central Park Bike Loop this morning with Linda and Paula. Makes me feel good enough to want to do it again next week.

Well, maybe not that good…

Cream of Mushroom Soup

For this soup, I married elements of two recipes from a pair of my fave chefs – Jamie Oliver and Ina Garten. You can make this soup as light or as heavy as you like by varying the fat content of your milk. (I used a mix of half-and-half and skim milk.)

1 lb assorted fresh mushrooms (I used cremini and shiitake), sliced.
a few ounces dried mushrooms (I used chantarelles; Porcini are more readily available.)
1 cup boiling hot water
2 tbsp olive oil
2 tbsp butter
2 large shallots, minced
2 cloves garlic
3 tbsp fresh thyme leaves, un-chopped
1/4 cup white wine (Sherry is also nice)
1 liter chicken broth
Sat and pepper to taste (be generous with both)
Milk, cream or half and half to total 2 cups
1/4 cup finely chopped parsley

Place the dried mushrooms in a 2 cup Pyrex bowl and pour over boiling hot water to cover. Let steep for 20-30 mins. Take out and rinse the mushrooms to remove the grit, the roughly chop them and set aside. Strain the broth using a coffee filter and set aside.

Heat up olive oil and butter in a soup pot over moderately high heat. Add the cremini, shiitake and reserved hydrated chantarelles, stir for a moment or so then add shallots, garlic and thyme along with some salt and pepper. Saute over moderately high heat till the mushrooms have given up most of their liquid. Add the wine or sherry and cook off for a few minutes. Add the chicken and mushroom broths, turn down heat and gently simmer for 30 mins. Cool slightly.

Remove half the soup from the pot and puree in a food processor or blender till smooth. Add back to the remaining soup in the pot. Stir in milk/cream and 2 tbsp parsley, heat through and serve garnished with remaining parsley. Serve with fresh warmed bread or crostini and a cool glass of white wine.

Medicine 2.0

My friend Linda diagnosed and successfully treated herself for Benign Paroxysmal Positional Vertigo using the Internet.

It’s a new world, folks.

Why You Weigh Less in the Morning

In my last post, I posed the question “Why is my morning weight lower than my bedtime weight?” It’s true, you know. Your lowest weight is always in the morning.

Let’s see if I can explain it.

Basically, overnight weight loss is a combo of (1) water lost via the skin and respiration, (2) basal metabolic caloric expenditure and (3) urine loss in the morning. Water loss, excluding urine and feces, accounts for over 80% of the weight lost while sleeping.

Overnight weight loss may vary depending on how much time one spends in Slow Wave Sleep (SWS) vs REM sleep, with longer duration of SWS correlating with higher sleep weight loss. Slow wave sleep has been called the restorative phase of sleep, and increased exercise during the day leads to an increase in time spent in SWS during the night.

Energy expenditure during sleep varies with varies with circadian rhythms as well as sleep cycle. So one could hypothesize that disruption of these rhythms night lead to aberrations in weight.

The sleeping metabolic rate in non-obese individuals appears to be higher than that of their obese counterparts. Meaning that thin folks may stay that way, not just because of what they do while they are awake (namely, eat less and exercise more), but also because they burn more calories while they are sleeping. (I know. Totally unfair.)

Sleep deprivation has been found to be associated with obesity in adults, and appears to be a possible cause for the rise in childhood obesity. In this regard, I will tell you that I used to stay up till the wee hours blogging. But I don’t do that much anymore, and am definitely getting more sleep. I wonder how much that has contributed to my weight loss success?

Bottom Line

While most of your overnight weight loss is water loss, don’t discount the loss that comes from the energy you burn while you are sleeping. It may not be a lot on a given night, but multiply it by 365 nights a year and it adds up.

The amount of energy you burn while sleeping seems to depend on how well and how long you sleep, so make sure you get enough shut-eye.

And while you’re awake, get some exercise. Exercise improves the quality of your sleep, and that may lead to more weight loss.

Now if you’ll excuse me, it’s way past my bedtime.

The Vagaries of the Scale

I’ve been dieting since July 15, and while things have slowed down a bit, they are still moving in the right direction. I am down 29 pounds, and am very happy about that.
That’s 29 pounds when I weight myself naked and after my morning shower, which is how I always weigh myself. That’s because I know it’s the lowest number I can get. (Except, of course, if I were to weigh myself after a good sweating work out, in which case it would be another pound or so lighter. But I consider that cheating.)

My morning post-shower weight is always a pound less than the weight I am when I wake up. And 3-4 pounds lighter than the weight I am right before I go to bed.

Why is that?

Not to get graphic, but let me just say that although I know that what goes in must eventually come out, nothing much is happening on that front between the time I go to bed and the time I wake up, other than emptying my bladder once in the morning. And, me not being George Castanza, nothing is happening on that front during my shower. (Seinfeld fans will get this one, it’s too embarrassing to try to explain it to the rest of you…)

So here is my question – what is causing the weight loss between going to bed and my morning weigh-in? I know that I am digesting my dinner and burning a few calories, but 2 and a half pounds? Is it really all water? I’d have to weigh my morning urine to be sure, and am hoping not to have to do that to answer this question. But I know that if I empty my bladder during the day, I don’t see a drop in weight, so I don’t think that is it.

And what is it about a shower that causes one to lose a pound? Evaporative water loss?

When you are tracking your weight loss, you need to be consistent about when you weight yourself, because there are rather significant differences as you can see, depending upon the circumstances. Clearly the weight I am tracking is my morning post shower naked weight. I’d be nuts to do anything else.

But the little part of scientist in me is intrigued by the variability in weight over such a short time.

Other similarly-intrigued dieters and non-dieters are encouraged to comment.

Family members reading this post will most certainly feel the need to comment on how I am my father’s daughter. And they will, of course, be right.
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I decided to answer my own question – See my post entitled: Why you weigh less in the morning

Biking the Old Croton Aqueduct Trail

The pleasantly warm fall weather has extended both the biking and the softball season. So on this gorgeous November Sunday, I left Mr TBTAM at the ballpark in Hastings-on-Hudson with the Usual Suspects, and joined my friend Paula, whose husband was also in the game, for a 10 mile ride along the Old Croton Aqueduct Park Trail.

The 26 mile trail runs along top the Old Croton Aqueduct, an engineering marvel built in the 1842 to supply water from the Croton Reservior to New York City. The aqueduct is dry now, having long ago been replaced with a more modern water system with higher capacity. What remains is a wonderful trail that runs from Croton Reservoir to Van Cortland Park, easily accessible to New York City by car or rail.

The OQA Park Trail is really designed for walkers, but bikes are absolutely allowed. The way is unpaved, and there are not infrequent roots or rocks, so leave your thin-tired racer at home. I had no problems with my touring bike, but those with mountain bikes would do even better.

The trail is not a straight shot, and crosses more than a few streets unevenly in the Southern part, so make sure you bring directions, a trail map or like me, a friend who knows the trail. I’d also recommend leaving smaller children home, since the path is raised rather high in some narrow spots and has no guardrails. We were fortunate in this regard that there were few to no muddy spots and the leaves had dried from the prior day’s rains.

Our journey took us through the Hudson River towns of Hastings, Dobbs Ferry, Irvington and Tarrytown, affording backyard and town views with occasional glimpses of the Hudson. (I made a google map of our ride to measure it)

Paula, who knows more about nature that Eull Gibbons, pointed out to me various unusual tree leaves, ginkgo pods and these large black walnuts, almost as big as oranges, on the trailbed.

Did you know they can be used for dye? Here, I’ll let Paula tell you all about it…

Paula also told me that Laura’s Ingall’s father in The Little House on the Prairie used to hunt squirrels in the fall just to get at the black walnuts in their stomachs. As she puts it “A squirrel’s full belly’s worth of nuts, washed and dried in the sun, would be just about right for a tasty walnut pie, so they say. Have you ever wanted a walnut pie that bad?” Can’t say I have, Paula…But let’s get back to the ride.

We stopped in Tarrytown for sustenance and to visit the historic Lyndhurst Estate, built in the 1830’s for NYC mayor William Paulding and later home to robber baron Jay Gould. Although we did not take a tour inside the mansion, we did enjoy rambling around the grounds

and gazing at the Hudson (that’s the Tappan Zee Bridge).

After Tarrytown, we rejoined the trail, heading north towards the Rockefeller Preserve. Here, the atmosphere becomes much more bucolic, although civilization is never very far.

A few miles into the Preserve, the boys called us and announced that their games were over, so we left the trail and met them along Rte 9. Too bad – I would have loved to continue up to the Croton Reservoir. Oh well, there’s always next season.

Thanks, Paula, for the wonderful company, great conversation and the fascinating tidbits of nature. And while I don’t think I’ll be making black walnut pie any time soon, I am keeping you to your promise to teach me how to make Lebanese stuffed grape leaves…

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More About The Old Croton Aqueduct Trail

The Ovarian Teratoma that Caused a Coma

Aunt Voula had a teratoma too – Guess they didn’t get it out soon enough…

There’s an absolutely fascinating medical story in today’s New York Times Magazine, a case that reads like something straight out of an episode of House.

It’s the story of a young woman rendered rapidly comatose with encephalitis caused by an immune response to a benign teratoma in her ovary. Teratomas are funky tumors that can contain elements of skin, hair, nails, bone, thyroid and neural tissue. An unusual immune response to the teratoma in this woman led to development of antibodies to her own neural tissue, which then began to attack her brain and led to her coma. When the teratoma was removed, the immune response waned and comatose woman woke up and went on to an almost full recovery.

Astute readers will recognize this story from a recent case report in the New England Journal of Medicine. In that article, we learn that what happened to this woman is a rare condition called called Inflammatory Limbic Encephalitis, and it is not unique to teratomas but can occur in response to other tumors, both benign and malignant.

In the Times article, the medical resident who diagnosed the patient actually comes across another case the following year and worries that there may be more young women out there similarly afflicted yet undiagnosed. (Expect a rash of pelvic sonograms, CT’s and MRI’s for everything from schizophrenia to depression looking for teratomas…) I can reassure her that in my two decades or more of practicing medicine I’ve never heard or read of even one case until now.

I did, though, allow myself about 5 minutes of wondering if perhaps my migraines were not an auto-immune reponse to some microscopic, never diagnosed teratoma hidden deep within my ovaries, too small to be seen on the imaging studies I have had over the years for various reasons. Until I reminded myself that surgical removal of the ovaries actually tends to worsen migraine in more women than it helps them. Oh well, nothing is simple…

And that’s the problem with modern medicine – it’s not simple. Case reports like these, while fascinating, can be misleading. They’re the Made-for-TV medical stories that makes curing disease seem like such a simple exercise – the cause of your problem is visible, measurable and even better, removable! (Now you understand why surgeons love what they do. Their motto is – “To cut is to cure.” If it can’t be cut out, it’s someone else’s problem. Next case!…)

Unfortunately, most of the diseases that cause morbidity and mortality in our country are chronic diseases with multi-factoral etiologies whose cures are as varied as their causes, aren’t as much fun and don’t make for exciting spreads in the Times. Disease like diabetes, hypertension and heart disease. Would that there were a tiny tumor somewhere causing all those problems.

I wouldn’t count on it.

Obama, Don’t Get a Puppy

Those carpets look expensive…

Trust me on this.

You’re about to start a new job and move your family across the country to a place they’ve never lived before. Then, as soon as you get there, if not before, you have to solve America’s financial crisis, get us out of Iraq, find Bin Laden, and fix health care. You’re going to be a very busy man, and Michelle is going to have her hands full getting the family moved and settled in, not to mention doing whatever it is First Ladies do (though I would suggest she carve out something as far away from healthcare as she can – that backfired for poor Hillary).

This is not the time to get a new puppy.

Having a new puppy is like having a new baby. You and Michelle are going to need your sleep – listening to a puppy whining at night won’t be helpful in this regard. Not to mention the accidents. You don’t need to be coming home after a long day as Leader of the Free World only to step into doggy poo on the living room carpet.

Of course, you could hire a personal dog trainer. But that would make you look elitist and you don’t want to start out your tenure making that kind of impression.

No, a puppy is definitely not the way to go.

What you need is a dog that looks like a puppy, is cute like a puppy, and acts like a puppy but is already house-trained.

What you need is my dog, Lucy.

Look at her! Isn’t she adorable? She’s 3 years old, she’s well-behaved, she’s smart, and she’s hypo-allergenic. Your girls would love her, and she would love them.

Oh, don’t get me wrong, Obama. We love Lucy dearly. We do.

But the truth is, we’re all out all day long and poor little Lucy is home alone except for an hour when my friend Lori walks her. She would have a much better life there in the White House with the White House staff to keep her company when you’re all out.

Of course, like any dog, Lucy is not perfect. She does bark at strangers, but that would be a good thing what with your need for security and all. And she has never bitten anyone, so she won’t cause an international incident if you have, say, the Israeli and Palestinians over for dinner together.

You’ve said we all need to make sacrifices for our nation, and this is ours. We’re willing to give you our dog so you can focus your energies on the nation’s problems rather than wondering where to step. And save the US taxpayer dollars from being used to clean the White House carpets.

It’s the least we can do.

Obama’s Hiring

It’s been less than a week since he was elected, and already Obama’s got a transition website up and running, including an online job application form for those interested in working with his administration. Positions that are open include everything from high level cabinet appointees to short and long term committee and commission members. 

Let’s go, guys and gals. You know who you are. Time to stop talking and do something. Send in your application. Your government needs you. 

I’ll Have What She Had

Estelle Reiner, Wife of Carl and mother of Rob, died this week at the age of 94. You know Estelle – she’s the woman who, at the end of Meg Ryan’s fake orgasm at Katz’s Deli in When Harry Met Sally, turns to her waiter and says – “I’ll have what she’s having”.

Well, Estelle, I think I’ll have what you had. Teen radio singer, submarine draftsman in WW II, artist, wife, mother, anti-war activist and actor. She took up jazz singing at age 65 and recorded 7 albums! A life well-loved and well-lived.

We should all be so blessed. And so bold. Rest in peace, Estelle.