Shout-out: Bug off, my spammy friend

It probably shouldn't bother me as much as it does, but it really irks me that somebody's trying to market health insurance policies to the six or seven people who drop by this blog by leaving bogus comments about how health insurance is a "major aspect of many people's lives." These comments are attributed to "Blue Cross of California," but link to an insurance agent's web site.

It's one thing if you're selling like P3N1S 3NLARG3M3NT or h/e/r/b/a/!++v0!0a0g0r0a, but I don't know why anyone would think this is an effective way to market
something like health insurance. I doubt this is a technique sanctioned by Blue Cross, and I doubt it generates more good will than ill. Maybe you get some hits by associating yourself with "health insurance" and "Blue Cross of California," but eventually some irate blogger who isn't as nice as I am will associate your name with "spam" or "jerk" or "fraud" or "California Insurance Commissioner complaint" or "serial masturbator."

Don't come around here no more.

Research: Badonkadonk interfering with IM injections

Doctors at a Dublin hospital report that fat tissue in the buttocks of patients, particularly obese women, may exceed the length of needles commonly used to deliver intramuscular injections:

Dr. [Victoria] Chan's research found 68% of the injections do not reach the muscles of the buttock. Dr Chan said her work suggested that patients were either not receiving the maximum benefit of a drug or receiving no benefit at all.

Professor Richard Guy, an expert in pharmaceutical sciences at Bath University, told the BBC News website the effectiveness of vaccines could be particularly compromised. They tend to be made up of large molecules that would only slowly diffuse out of fat tissue. He said: "Whether using longer needles is a practical solution, I'm not sure, as these are unlikely to be terribly popular."

Link to BBC News item.

Journal: Zero to miserable in less than 10 doses

I canned my second try with Cymbalta after about a week. Maybe I'd forgotten why I quit the first time around, but I think my second try was worse than the first. After a couple days, I was either getting up to pee or to put a dry pad on the bed three times a night. By last Wednesday, I was feeling sleep-deprived and achey, which was a bad thing because we were hosting a small crowd for Thanksgiving.

After a draining day of housecleaning, Thanksgiving dinner (and a generous dousing of white wine) left me feeling completely deflated, several helpings of turkey notwithstanding. On Friday, I stayed home and did nothing. Nothing at all. That morning, I quit taking Cymbalta. Again.

I've been sleeping better and better since then. I'm also trying to get back into swimming a couple of times a week. I'll be seeing the nurse practitioner at the pain clinic in a week or two, and I'm hoping she'll have a new angle for me.

technorati tag: multiple sclerosis

Current events: Vaccine controversy makes for daunting journalism

Daniel Schulman writes at the Columbia Journalism Review about coverage of the vaccine-autism controversy. Schulman's take is that the reporting on the subject has generally been too reluctant and generally too accepting of the CDC party line and too dismissive of contrary information. Schulman gives a helpful account of what some anti-vaccine folks see as evidence of a cover-up, and serves up a critique of a New York Times piece by Gardiner Harris and Anahad O’Connor that appeared on the paper's front page on June 25. Schulman notes that the issue is uniquely flammable:

Journalists agree that the thimerosal story is one of the most explosive they've ever encountered. In addition to the vitriolic response Anahad O'Connor drew from readers, he also said he received a number of e-mails praising him and Harris from fellow reporters who had been interested in covering the thimerosal controversy, but had "gotten scared away from really tackling the subject . . . they were afraid of getting hate mail."

Some reporters who have portrayed this as an ongoing scientific controversy have been discouraged by colleagues and their superiors from pursuing the story. A reporter for a major media outlet, who did not want to be identified for fear of retribution, told me that covering the thimerosal controversy had been nearly "career-ending" and described butting heads with superiors who believed that the reporter's coverage "in treating the issue as a two-sided debate" legitimized a crackpot theory and risked influencing parents to stop vaccinating their children or to seek out experimental treatments for their autistic sons and daughters.

The reporter has decided against pursuing stories on thimerosal, at least for the time being. "For some reason giving any sort of credence to the side that says there's a legitimate question here. I don't know how it becomes this untouchable story, I mean that's what we do, so I don't understand why this story is more touchy than any story I've ever done."

Link

Journal: Giving Cymbalta another try

A couple months after quitting in frustration, I've decided to give Cymbalta another try. The Zonegran I've been adding over the last couple months to my usual load of Neurontin hasn't seemed to do much for the burning neuropathic pain in my legs. And the shortened days have left me feeling impatient, frustrated, lonely. The bottom line, I guess, is that the pain relief and mood enhancement I got from Cymbalta may be worth waking up in my own pee a couple times a night.

It's just been a few days since I started the Cymbalta, but I think I've noticed a small decrease in the pain already: when I woke up this morning, I didn't feel the same dull ache that has made it so difficult to get out of bed. I haven't been sleeping well, though. I think last night I got up to pee like five times.

technorati tag: multiple sclerosis

MS and medical marijuana: "limited evidence" of longer-term effect on disability

Do results like these mean that more pot research is needed or that we should direct those resources to something else?

J Neurol Neurosurg Psychiatry. 2005 Dec;76(12):1664-1669.
Cannabinoids in multiple sclerosis (CAMS) study: safety and efficacy data for 12 months follow up.
Zajicek JP, Sanders HP, Wright DE, Vickery PJ, Ingram WM, Reilly SM, Nunn AJ, Teare LJ, Fox PJ, Thompson AJ.
Room N16, ITTC Building, Tamar Science Park, Plymouth, Devon PL6 8BX, UK. john.zajicek@phnt.swest.nhs.uk.

OBJECTIVE: To test the effectiveness and long term safety of cannabinoids in multiple sclerosis (MS), in a follow up to the main Cannabinoids in Multiple Sclerosis (CAMS) study. METHODS: In total, 630 patients with stable MS with muscle spasticity from 33 UK centres were randomised to receive oral Delta(9)-tetrahydrocannabinol (Delta(9)-THC), cannabis extract, or placebo in the main 15 week CAMS study. The primary outcome was change in the Ashworth spasticity scale. Secondary outcomes were the Rivermead Mobility Index, timed 10 metre walk, UK Neurological Disability Score, postal Barthel Index, General Health Questionnaire-30, and a series of nine category rating scales. Following the main study, patients were invited to continue medication, double blinded, for up to12 months in the follow up study reported here. RESULTS: Intention to treat analysis of data from the 80% of patients followed up for 12 months showed evidence of a small treatment effect on muscle spasticity as measured by change in Ashworth score from baseline to 12 months (Delta(9)-THC mean reduction 1.82 (n = 154, 95% confidence interval (CI) 0.53 to 3.12), cannabis extract 0.10 (n = 172, 95% CI -0.99 to 1.19), placebo -0.23 (n = 176, 95% CI -1.41 to 0.94); p = 0.04 unadjusted for ambulatory status and centre, p = 0.01 adjusted). There was suggestive evidence for treatment effects of Delta(9)-THC on some aspects of disability. There were no major safety concerns. Overall, patients felt that these drugs were helpful in treating their disease. CONCLUSIONS: These data provide limited evidence for a longer term treatment effect of cannabinoids. A long term placebo controlled study is now needed to establish whether cannabinoids may have a role beyond symptom amelioration in MS.

technorati tags: multiple sclerosis, medical marijuana

Research: Decaf coffee is bad for your heart (unless you're overweight)

Decaf coffee can raise your bad cholesterol. If you're overweight, though, decaf can raise your good cholesterol. "Only half a cup? Have you lost weight, Steve?"

From The Guardian:

Researchers funded by the National Institutes of Health, the prime public health bodies in the US, reported their 'very surprising' findings by poster at the American Heart Association's scientific meetings in Dallas. They compared levels of caffeine in the blood and indicators of general heart health before and after three months of steady coffee drinking or abstinence. The coffee drinkers, who had three to six cups of home-brewed black coffee a day, were in two groups, one on a caffeinated brand, the other on decaf.

The study found the decaf group experienced an average 18% rise in fat in the blood, the fuel that increases bad cholesterol, and had higher incidence of a protein called ApoB, which is associated with bad cholesterol. There was little overall difference generally in levels of a particular form of good cholesterol called HDL2, although within the decaf group there were significant differences depending on people's body fat.

Link

Driveway moment: Howard Dully and the 'ice-pick' lobotomy

On Jan. 17, 1946, a psychiatrist named Walter Freeman launched a radical new era in the treatment of mental illness in this country. On that day, he performed the first-ever transorbital or 'ice-pick' lobotomy in his Washington, D.C., office. Freeman believed that mental illness was related to overactive emotions, and that by cutting the brain he cut away these feelings.

Freeman, equal parts physician and showman, became a barnstorming crusader for the procedure. Before his death in 1972, he performed transorbital lobotomies on some 2,500 patients in 23 states.

One of Freeman's youngest patients is today a 56-year-old bus driver living in California. Over the past two years, Howard Dully has embarked on a quest to discover the story behind the procedure he received as a 12-year-old boy.

In researching his story, Dully visited Freeman's son; relatives of patients who underwent the procedure; the archive where Freeman's papers are stored; and Dully's own father, to whom he had never spoken about the lobotomy.

'If you saw me you'd never know I'd had a lobotomy,' Dully says. 'The only thing you'd notice is that I'm very tall and weigh about 350 pounds. But I've always felt different -- wondered if something's missing from my soul. I have no memory of the operation, and never had the courage to ask my family about it. So two years ago I set out on a journey to learn everything I could about my lobotomy.'

Link to NPR page with archived audio. Note the helpful "Lobotomy Resources" at the top right-hand corner.

Research: Can monks contribute to neuroscience?

An article at Slate.com by Daniel Engber notes the controversy over an appearance by the Dalai Lama at the annual meeting of the Society for Neuroscience. His Holiness believes that the Buddhist discipline of meditation can offer much to the study of consciousness, but more than 600 members signed a petition to keep the DL out of the Society's meeting. It's an interesting take on the science-vs.-religion thing:

The Buddhist scholar Carl Bielefeldt argued that Buddhist monks don't use the scientific method at all. A student who makes an unexpected discovery through introspection might be told by his master that he made a mistake. 'It looks like creation science,' he said. 'There are certain norms that cannot be questioned.'
The similarities between Buddhism and neuroscience that the Dalai Lama sees, however, extend beyond methodology. Practitioners of both disciplines-whether they're monks or psychiatrists-aim to replace sad feelings with happy ones. In this regard, he says, Buddhist inquiry has advanced far beyond Western mind science. Over a hundred generations, monks have used meditation as way of controlling their bad emotions. If neuroscientists really want to reduce suffering, they should study the effects of meditation on the brain and test it as a clinical tool.
A few presentations at the conference showed off the latest research in this area. A lab in Wisconsin used electrodes to measure brain activity in meditating monks and showed an increase in Gamma waves, which are associated with focused attention. A Harvard researcher suggested that regular meditation could thicken the cortex in certain parts of the brain. Another scientist found surprising perceptual abilities among Indian monks.

Link.

Research: Being cold increases the risk of catching a cold

In the winter, when I was a kid, my mom used to yell at me to wear at hat when I was outside. "You'll catch a cold!" Being a smarty-pants nerd, I thought, Yeah, right, mom- wearing that hand-me-down Minnesota Vikings stocking cap will magically ward off the virus that causes the common cold. Well, mom was right, sorta:

[I]n winter the cold weather outdoors causes the blood vessels in the lining of the nose to constrict, a reflex mechanism to save heat. This reduces the blood supply to the nasal lining where viruses can gain a foothold and become established. "The effect of the cold is that it reduces the flow of white blood cells, the body's immune response, cutting off the troops to fight the infection. The cold also slows the flow of mucus in the nose which is needed to trap the virus so you swallow it and destroy it in the stomach," Professor Eccles says.

Link to item in The Independent.

Steve McQueen and Laetrile

Steve McQueen died of cancer 25 years ago this month. A piece in the NYT focuses on how McQueen, who had mesothelioma, turned to alternative therapies, including Laetrile:

When his doctors told him they had run out of options, McQueen secretly met with Dr. William D. Kelley, a dentist and orthodontist who had devised a controversial treatment regimen he claimed had cured his own pancreatic cancer.
Dr. Kelley had been blacklisted by the American Cancer Society and had his license suspended in Texas. But McQueen was interested in the treatment, which was based on the notion that cancers arose and grew from a lack of enough pancreatic enzymes.
In July 1980, McQueen secretly traveled to Rosarita Beach, Mexico, to be treated by Mexican and American doctors using Dr. Kelley's regimen. He received not only pancreatic enzymes but 50 daily vitamins and minerals, massages, prayer sessions, psychotherapy, coffee enemas and injections of a cell preparation made from sheep and cattle fetuses. McQueen was also given laetrile, a controversial alternative treatment made from apricot pits.

Link (free reg req'd)

Research: Is This a Solution?

In the Washington Post, Robin Marantz Henig sees danger lurking in the new techniques for obtaining stem cells without destroying living embryos. To Henig, these techniques represent science that has been compromised to accommodate the moral and religious objections of those who control federal funding:

"There's a long history of using science to get around religious issues, otherwise we'd be sitting in the dark on the Sabbath," said Laurie Zoloth, a medical ethicist at Northwestern University, at the Genetics and Public Policy Center panel last week. "Whenever you have an absolute rule in a rule-based system," she said, whether in observant Judaism or in following the federal restrictions on embryonic stem cell research, people "figure out some way to stay within the confines of the rule" and still do what they want to do. These latest experiments, she said, were "something like tofu cheeseburgers," a compromise created for Jews following kosher laws that forbid mixing meat and dairy in the same meal.

And scientific good can come from adjusting to ethical concerns, as the example of animal experimentation shows. Not only were research results more reliable when the laboratory animals were subjected to less stress in response to activists' concerns, but when non-animal models were used instead, the experiments were often less costly and more easily reproduced.

Could a good outcome happen with stem cell research, too, as investigators begin designing experiments to satisfy their critics? Perhaps. But there's a greater danger here than there was with animal experimentation. The danger is that stem cell scientists will address what they believe to be their critics' major stumbling blocks in a way that both subverts the science and fails to respond to the critics -- the worst of both worlds. "How many hoops do you have to go through as a scientist," George Daley, a stem cell researcher at Harvard University, was quoted as saying when the Nature articles appeared, "when you don't think you are doing anything wrong?" It's in trying to parse out religious objections they don't always share or even understand that scientists can run into trouble.

Link

NYT: Big pharma's image problem hurting sales

The NYT reports that big drug companies, while still profitable, are feeling the effects of an "industrywide credibility crisis." Going back to vaccine refusniks and my sister-in-law, this must a factor in driving some people away from the scientific medical establishment:

Overall, prescriptions continue to rise slightly, but an increasing share of prescriptions are going to generic drugs. Also, consumers seem to be less responsive to aggressive drug marketing. 'A lot of the demand that the industry has created over the years has been through promotion, and for that promotion to be effective, there has to be trust,' said Richard Evans, an analyst covering drug stocks at Sanford C. Bernstein and Company. 'That trust has been lost.'

A poll last month showed that only 9 percent of Americans believed drug companies were generally honest, down from 14 percent in 2004. In contrast, 34 percent of people said they trusted banks, and 39 percent trusted supermarkets. "The incessant direct-to-consumer advertising on television I think has boomeranged," said Dr. Marcia Angell, a former editor-in-chief of The New England Journal of Medicine and a frequent industry critic. Dr. LaMattina and other executives say that perception unfairly disregards the billions of dollars that drug companies spend on research each year and the hundreds of important medicines they have discovered since World War II. Even the industry's staunchest defenders agree that it needs to explain risks better.

"We've created an impression with the American public that when a drug is approved, it's perfectly safe," said Billy Tauzin, president of the Pharmaceutical Research and Manufacturers of America, a lobbying organization for brand-name drug companies. "We have not done a good job about educating the patients of America that all drugs come with significant side effects."

Link (free reg req'd)

Research: Race-based medicine?

The NYT reports on the discovery of a gene that raises the risk of heart attacks in African-Americans by 250%. Six percent of African-Americans carry the gene, called leukotriene A4 hydrolase (catchy, isn't it?), which is involved in the synthesis of leukotrines, agents that maintain a state of inflammation. There's a drug currently in phase III trials that affects a different gene that is also involved in control of leukotrienes. Should a separate study of the drug with only African-American subjects be conducted?

Dr. Troy Duster of New York University, an adviser to the federal Human Genome Project and a past president of the American Sociological Association, said he saw no objection to a trial, provided it focused on African-Americans with the risk-associated variant of the gene and took into account that people with ancestry from different regions of Africa might show variations in risk. But Dr. Charles Rotimi, a genetic epidemiologist at Howard University, said a separate study of African-Americans would not be desirable. The variant gene may be overactive in African-Americans because of their greater exposure to deleterious environments, Dr. Rotimi said.

If that's what Dr. Rotimi said, does he mean that a drug shouldn't be studied because all we need to do to eliminate the increased risk for African-Americans with the leukotriene A4 hydrolase gene is to eliminate their "greater exposure to deleterious environments"? Yeah, forget the pill, we'll just ensure that African-Americans are no longer disproportionately exposed to deleterious environments. I'll just make a few phone calls...

Link (free reg req'd)

Drug ads: overselling the serotonin boost?

From nature.com:

Can depression be explained by a simple chemical imbalance in the brain? A pair of researchers has complained that the evidence for this is weak, and that drug companies should not be allowed to push this message in their advertisements.

After being bombarded by messages that depression is caused by the lack of a certain chemical in the brain, say the researchers, patients may be sceptical of other kinds of treatment, including other drugs and talking to a therapist. 'That message [in the advertisements] is at odds with what's in the scientific literature,' says Jonathan Leo of the Lake Erie College of Osteopathic Medicine in Bradenton, Florida, who co-authors an essay on the subject in PLoS Medicine this week. The duo would like the Food and Drug Administration (FDA), which regulates drug advertising in the United States, to take a look at antidepressant ads and issue warnings to any firm that does not comply with its rules.

Link (free reg req'd)

Current events: Federal appeals court upholds Maine law regulating pharmacy benefit managers

A federal appeals panel has upheld a Maine law that imposes disclosure and other duties on pharmacy benefit managers (PBMs). What's a PBM? Here's a summary largely drawn from the court's opinion:

PBMs act as middlemen between pharmaceutical manufacturers and pharmacies and health benefit providers (e.g., my HMO, your insurance company, etc.). PBMs use their market power to negotiate volume discounts and rebates with drug manufacturers. PBMs may also have "therapeutic interchange programs" that allow them to substitute a drug for the one your doctor actually prescribed.

What's good for a PBM, though, may not be good for your HMO. For example, in cases of "therapeutic interchange," a PBM may substitute a more expensive brand name drug for an equally effective and cheaper generic drug so that the PBM can collect a fee from the manufacturer for helping to increase the manufacturer's market share within a certain drug category. Or a PBM might get a discount from a manufacturer on a particular drug but not pass any of it on to your HMO, keeping the difference for itself.

Under the Maine law, PBMs must act as fiduciaries for their clients (i.e., HMOs, insurance companies, etc.): they must disclose conflicts of interest, disgorge profits from self-dealing, and disclose certain financial arrangements with third parties.

The Boston Globe describes the lawsuit this way:

The association had argued that Maine's Unfair Prescription Drug Practices Act was unconstitutional and could end up harming consumers because benefit managers use confidential information to get drug companies to compete with each other by lowering their prices. But supporters view the law as a means to promote transparency by giving health plan clients access to information about discounts, drug switching programs and any conflicts of interest involving benefit managers.

Link to Boston Globe story.

Current events: 5 cases of polio in Minnesota Amish group

From the NYT, in case you haven't seen it:

The 8-month-old Amish girl, whose name has been withheld by health officials, has an immune deficiency that makes her unable to rid her body of the [polio] virus. How she contracted the virus remains a mystery. She may have been infected in a hospital by another immune-deficient patient who nursed it for years. A doctor or nurse may have served as a go-between. Or there may have been a chain of carriers in the Amish community. The virus is spread from stool to mouth, a surprisingly efficient form of transmission.

Regardless, the girl is now a wellspring for polio, a modern-day Typhoid Mary who can pass it along to others. Anyone who has not been vaccinated is vulnerable. And though vaccination rates in the United States are at historic highs, an increasing number of parents are resisting inoculations for their children, fearing that they may cause disorders like autism, a connection scientists have almost universally discounted.

Link (free reg req'd)

Health policy: physician reaction to parents who refuse vaccination

The Washington Post reports on a study of pediatrician attitudes to vaccine refusal:

A team of pediatricians from three major Chicago medical centers surveyed more than 300 of their colleagues around the country about their attitudes toward vaccine refusal. Slightly more than half of pediatricians said that in the previous year they had encountered at least one family that refused all vaccines, while 85 percent said they'd had a parent turn down at least one shot.
More surprising to the authors were two findings: 39 percent of those surveyed said they would consider turning away a family that refused all shots -- researchers had expected the number to be about 20 percent -- while 28 percent said they'd think about severing a relationship with a family that refused some shots.

My sister-in-law has three little kids, the most beautiful, healthy-looking kids I know-- Gerber babies, all of them. None have been vaccinated. I don't know if they ever see an M.D. When they're sick, they visit a chiropractor/naturopath/kinesiologist. On a daily basis, they take an array of herbal and homeopathic preparations.

Shortly after she had her first kid, my sister-in-law had an illness that doctors were unsuccessful in helping her overcome. I'm not sure about the details, but the important bit is that a friend got her to try a wheat- and gluten-free diet, and it made her feel a lot better. She read books like "The Yeast Connection" and got connected, in part via the internet, to a network of people who were skeptical of the traditional medical establishment. She became a devotee of applied kinesiology, bought a Chi Machine, started using magnets.

It used to make me crazy. I couldn't believe that she'd dedicated her life to quackery, that she'd entrusted the health of her children to people who defied science. I was furious when she'd send emails and links to articles about how Nutrasweet causes MS or how supplement-and-diet-book peddler Dr. Mercola considers interferon drugs for MS "a waste of money." These days, though, I'm more or less over it. We do not live in an age of reason. For whatever reason, people distrust science and the authority it claims. A Gallup Poll in February of 2005 found that about half of all Americans think "God created human beings pretty much in their present form at one time within the last 10,000 years or so." This is apparently one of the things that my sister-in-law is teaching her kids.

Now, it's a free country and you're free to believe pretty much any kooky thing you want. But isn't there a public health problem lurking here? Don't we all have an interest in maximizing the number of people receive vaccinations? What about the dreaded bird flu pandemic? What if a significant number of people refuse to follow science-based advice? More generally, as a practical matter, in our health care system, don't we all run the risk of paying for the consequences of bad health advice?

Which takes me back to the article: apparently, if you're a parent who refuses vaccination, you run a significant risk of being "fired" by your doctor. What do these docs think are the likely consequences of terminating these people? I'll venture a guess that a refusnik parent who's been fired by her pediatrician is more likely to explore so-called complementary medicine, more likely to venture further and further from science. Is this desirable, from a public health perspective?

Link to WaPo article.

MS research: update on hematopoietic stem cell transplantation

Here's the abstract:

Acta Haematol. 2005;114(4):239-47. Related Articles, Links
Autologous hematopoietic stem cell transplantation for autoimmune diseases.
Tyndall A, Daikeler T.
Department of Rheumatology, University Hospital, Basel, Switzerland.

Ten years have passed since the first published consensus statement on the use of hematopoietic stem cell transplantation (HSCT) in the treatment of severe autoimmune disease (AD) appeared. During that time, around 700 patients suffering from severe AD have undergone HSCT in the frame of phase I/II clinical trials from over 20 countries including the US. The majority have received an autologous HSCT using one of a limited number of regimens, consistent with the original consensus statement. Long-term drug-free remissions, remission then relapse, no response and treatment-related mortality (TRM) were seen in all the subgroups of AD. An overall TRM of 7% was observed, with marked variation between ADs, i.e. 11% in systemic lupus erythematosus (SLE) and only 1 patient in rheumatoid arthritis (RA). Phase III prospective, comparative randomized trials are running or being planned in multiple sclerosis (MS), systemic sclerosis (SSc), SLE and RA. Basic science programs are also being undertaken to study the immunological mechanisms underlying the clinical events observed. Copyright (c) 2005 S. Karger AG, Basel.

Link.

Journal: I made the pot roast

Most of the day yesterday, my wife and my father-in-law were climbing about in our attic, putting in the wiring for some new lights for our kitchen. The day before, he had been up and down the step ladder, cutting holes in the ceiling while clumps of insulation and bits of drywall fell on his head. My in-laws were visiting for the weekend, ostensibly to attend a concert, but a day before they arrived, we asked my father-in-law if he'd be willing to help us put in a few recessed lights before the insulation people came by to add another foot and a half of fluff to the attic.

I thought that I might at least be of use in cutting the holes, or possibly in doing some wiring from below, even if I wasn't a great candidate for working in the attic (for a number of reasons). As it turned out, my father-in-law did pretty much the whole thing, with my wife assisting. I consulted as to location, and I handed a few things up to the attic, but mostly, I made dinner and manned the couch.

Around 7 or so last night, we sat down to dinner. With the kitchen a bit torn up, I'd fired up the crock pot for pot roast. From where I was sitting, I had a pretty good view of the TV. On Extreme Makeovers, the emotive Ty Pennington was unveiling the over-the-top remodeling job given to the home of what looked to be a gaggle of disabled kids and their adoptive mom. Suddenly, they all lived in a mansion with Kenmore appliances, a fountain-adorned pool out back, and a fabulous new Ford Fusion in the garage. That's a lot of pot roast.