Janine Ripper has way too much time on her hands now.  So, she decided that the 6 degrees of separation could lead to a discussion of 7 links.   A retrospective of my blog to discuss 7 posts, 7 links you may find useful.  My issue is that I not only write this blog, but I prepare reports for clients, and send notes to my clients almost every day.  So, between those reports, notes, and blogs, there are more than 2000 pieces for the last calendar year alone!  But, I will limit this to my blog-  but you are welcome to disagree with my choices.  Let me know what you think I should have chosen…

My Most Beautiful Blog:  Beautiful to me are the feelings invoked as I write the post.  And, I described a business principle that was made obvious (to me, at least) when I was sharing a baseball game with my son, daughter, son-in-law, and grandson (about ½ my immediate family).  The topic was vision, mission, and goals- and time management.   We need to remember- each and every day- that our family is a vital part of the equation.

My Most Popular Post: The problem with this choice is that the newer posts don’t get equal weight.  The question is not the most popular post the day or week you posted it- but the most popular post by number of clicks.  And, I am assuming the word “My” belongs to my blog, not to me.  So, the winner is:  Do You Know This Key to Building Team Trust.  A guest post from Mohammed Fahtelbab.   He had sent it around to clients and friends and I asked him to republish it on my blog- a request to which he acceded.  Thanks, Mo!  If you want a post I personally wrote (this comes in second by 3 views), then it’s  Well Deserved Kudos- and a lesson for us all!, when I thanked people who made a difference in my life.  (I thank them every day- this was just a public acknowledgement.)

My Most Controversial Post:   Most of my controversial discussions are NOT to be found on this blog. I try to keep my politics out of the blog.  (Actually, everything we do is politics; I am talking about Partisan Politics; and my party does not exist within the Commonwealth of Virginia…)  The winner of this category was a technical/medical series, where I disagreed vehemently with the facile conclusions presented by ProPublica in the Atlantic:  Reactions to The Atlantic (ProPublica) Dialysis Article.

My Most Helpful Post:    This is the hardest to discern, since I consider ALL my posts helpful :-).  And, there is no scientific way to determine this fact, so it’s all my personal bias… I discussed resolutions and changes we need to institute in our (business, personal, professional)  lives last September (my new year), which I do discuss from time to time.  But, this list was the most complete.

A Post Whose Success Surprises Me:  This is going to be a bust.  I expect (demand?) that everything I do be a success.  As such, how could a post’s success surprise me?  I could say that Mo’s guest post could be construed as surprising, since I didn’t write it.  But, I knew it was a winner from the second I first saw it.

A Post I Feel Did Not Get The Attention It Deserves:  All of them?  Ok, I’ll pick one.  A topic that is a real problem when traveling on the Internet.  The fact that any Tom, Dick, Harry, or Sally can print something and the rest of the world assumes it is factual.  The post was “Truth or Internet?  Why Are They Often Mutually Exclusive?”  How often do you get eMail or see something on the web and pass it along.  Do you ever check to make sure it’s true?  That’s how the Big Lie works.  One person invents a fact, someone else believes it (because it resonates with their beliefs) and sends it, and a geometric progression of publicity begins.

The Post I Am Most Proud Of (sic):  This is easy.  I am proud of every post I have ever published.  But, my first post, Opening Gambit, was the hardest one to publish.  It meant I made a promise to you- the reader- to post the very best information I can, each business day of the year.  I’m keeping my promise—and I thank you for reading them.

So, what are your choices for these categories?  Write me and let me know…

Oh, wait… I’m supposed to pass the buck… This is a hard choice (so I wrote down everyone and pulled lots for the four “lucky” choices…

  • Tor Constantino- The Daily ReTort
  • Janet Callaway- The Natural Networker
  • Leanne Chesser- WAHM Solution
  • Veronica Campos-Hallstrom- Club Creative Art….

Come on down, the pot’s boiling, so the coffee will be ready shortly….



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The new site is ready…

Cerebrations can now be found at:


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Not a real post- but an announcement


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No, I have not run out of things to say or discuss. I really have tons that I would like to post at once.  But, over the past few days, I have been working to move my site- to our own domain.

Too many people found it hard to find my blog.  So, I think we’ve solved the problem.

You can find my blog here:

From now on, all my posts will be on that site.  We are awaiting the ICANN to approve (propogate) new subdomains-,, and  We will post updates as soon as these are available.

Thanks for reading my blog.  I hope you will drop in on the new site- soon and often.

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ESRD Needs Different Blood Pressure Management (from normal patients)

Plugged into dialysis

We love to come up with health care prescriptions that work for everyone.  But, that rarely happens.  It’s how drugs get abused- we know the drug solves this problem in one cohort, so we apply it to another cohort.  The problem is the second cohort has other associated maladies that interact negatively with the drug.

It seems the same principle applies when we try to proscribe blood pressure management for dialysis patients.  We have long known that mortality for ESRD (end stage renal disease) patients is high;  cardiovascular disease the primary cause of death (many patients have what could be termed uncontrolled hypertension).   Yet, we have set the targets for blood pressure based upon our knowledge of the general population, and not directly for or from ESRD issues.  This is true because ESRD patients have never been included in studies concerned with blood pressure management.

It seems that the relationship between blood pressure and mortality among ESRD patients may be U-shaped:  one group has higher mortality at low blood pressure, while another has problems at high blood pressure (but moderate pressures [140/90 mm Hg] are probably good for everyone).   These results were discussed in a study funded by DCI (Dialysis Clinics, Inc.) led by Dr. Philip Zager (joint appointment with DCI and University of New Mexico Health Sciences), to be published shortly in the Journal of the American Society of Nephrology (advance copy posted).  This six-year study examined 16,283 patients (6250 died during the course of the research), all of whom survived at least 150 days from first outpatient dialysis treatment (to ensure that the dialysis treatment was successful). One key fact resulted from this study: Systolic blood pressure correlated better with mortality than did diastolic pressures.  The other significant finding was that ESRD patients with diabetes had higher mortality risks with lower systolic pressures.

Low systolic pressure was linked with elevated mortality, but this correlation was even more pronounced with the elderly or those patients also suffering from diabetes.  For patients 50 y of age or older, systolic pressures below 140 mm Hg were detrimental; pressures exceeding 160 were not associated with elevated mortality.  On the other hand,  for the younger patients, systolic BP of 160 mm Hg or higher were a problem, while the 140 mm Hg or lower were not a problem (diabetes and race did not affect these results).

ESRD patients manifest different relationships from the normal population.  ESRD patients in their 30’s had similar relationships with “normal” between systolic blood pressure and mortality.  For each decade increase in age, mortality related to low systole increased and that for high systole decreased for ESRD patients (but not for the general population).   This may be related to the fact that organ perfusion is affected (higher systole would tend to augment blood flow to the various organs of the body) when the patients have non-compliant blood vessels and other arterial diseases.  [It should be noted that cardiac disease was not monitored as part of the study (and one would expect it to manifest increased incidence with age).]

In an accompanying editorial by Drs. Crews and Powe, it was suggested that,  with the purported desire of Congress (American Recovery and Reinvestment Act of 2009) to have the Institute of Medicine define national priorities for effectiveness research,  “determining which treatment works best, for whom, and under what circumstances”, a new study be funded.  The aim should be to determine the desired approaches for the treatment of cardiovascular disease and ESRD; one that would more clearly define the desired intervention in the case of blood pressure management.

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Still not walking? Your brain wants you to cover 6 miles every week!

We already discussed the need to exercise to preclude disease (Parkinson’s, cancer, autoimmune).  Now, there’s more reasons to get walking.  Dr. Kirk Erickson (University of Pittsburgh) and associates just published results in Neurology from  a follow-up from the Cardiovascular Health Cognition Study.  They reported that walking six miles weekly not only protects the grey matter of the brain- but it also helped retain memories.

The study involved 299 dementia free patients (mean age 78), who tracked how many weeks they walked over the nine-year period.  At the end of the nine-year period, these participants had undergone MRI scans.  These participants were then re-examined and studied four years later (the subject of this publication). The study participants walked from 0 to 300 blocks weekly (mean distance: 56.3).  The researchers found that walking 72 blocks (6 miles) was a critical threshold.  While some 40% of the participants did develop dementia, walking the 6 miles did preserve the grey matter and reduced the risk for cognitive impairment by at least 2 orders of magnitude. (73 of the 299

parahippocampal gyrus.

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(24%) walked the threshold distance or beyond.)  Interestingly, the researchers broke the participants into smaller subsets to see if longer walks improved the results; however, they found no significant cognitive improvement among those walking longer distances.  Moreover, the grey matter volume in the hippocampus, frontal gyrus, or parahippocampal gyrus did not correlate with any change in cognitive impairment. (Please note that ONLY cognitive impairment and brain matter were studied here; there could- and should- be cardiovascular improvements from the longer duration walks, since a 6 mile walk does not equate to the recommended weekly 150 minutes of physical activity to achieve good health.)


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Hypobaric Treatments Proposed for Cardiac Patients (patent pending)

The illustration shows the major signs and sym...

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You heard that the Tour de France athletes have tried sleeping in sealed tents that simulate high altitudes (where the oxygen levels are lower); the goal was to improve their performance at normal elevations.  As the body acclimatized to the hypoxic conditions, their mass of red blood cell increased. This was further augmented by ventilator changes, as manifested by increased tidal volume.   Now, some cardiac specialists at the Montefiore Hospital (Bronx, NY)  are trying that same technique to improve the performance of their patients.

With heart failure, the cardiac muscle is weakened; it can no longer pump blood effectively, which leads to shortness of breath in the patient.  So, why would we try to have them in hypobaric environments?  Dr. Simon Maybaum (who is patenting just such a chamber for cardiac patients, United States Patent Application 20090025726) believes it is just the poor blood flow, not the lack of oxygen, that affects the patient’s well being.

Dr. Maybaum is now leading a small study (15 patients) to determine if this approach works as well as he hopes.  The study has chosen medicated patients with pacemakers who have limited activity (these are termed stable heart failure patients); they will be subjected to simulated altitudes of 1500 to 2700 meters.  The treatment duration will start at about 1 hour and extend to three (3) hours over the course of the study.

It is hoped that the red blood cell levels will be increased (this is what happens with the athletes on this program), so the patients’ ability to transport oxygen will be augmented. Peak oxygen consumption levels will also be monitored; the normal patient level is under 15 ml/kg/min versus that of a bicyclist of some 45+ ml/kg/min. If the test works, the patients will use the tents at home (instead of the controlled hospital environment).

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Augmented Peripheral Vision in the Deaf Uses the Auditory Complex

(B) Lateral view of the human brain, with the ...

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We have discussed several aspects of the brain- and its ability to compensate for injury and disease.  This is the mechanism by which stroke victims can relearn things that were lost- by using different parts of the brain.

The auditory complex in deaf people has not been receiving inputs for significant time periods. It has long been thought (some data) that those who are deaf from birth develop larger visual fields than hearing folks.  The question was whether this region has been developed to amplify vision for the deaf.

Now a study published in Nature Neuroscience has shown that peripheral vision amplification does employ that portion of the brain (in deaf cats) that normally deals with peripheral hearing. Dr. Stephen Lomber of the University of Western Ontario along with Dr. Meredith of MCV (Virginia Commonwealth University) and Dr. Kraj of the Medical University of Hannover determined the peripheral vision of deaf cats by flashing lights at the periphery of their vision.  If the researchers cooled the auditory cortex (which rendered its capabilities moot), the extra-ordinary peripheral vision capability  was lost.  It made little significant difference if they cooled the left side, the right side, or both sides.

The same process is being studied to determine what happens when the deaf receive cochlear implants. .  The question to be answered: Once the cochlear implant is inserted, does the brain rewire itself or just continue using pathways long gone?

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