To See Dr Bunge

 

 

 To check into see Dr Bunge click HERE.

COVID-19 Treatments in Resource Poor Countries

 

 To download my Power Point from the lecture given to Karen doctors on Zoom Oct 2020, COVID-19 treatments in resource-poor countries, click HERE

https://app.box.com/s/bcdao0tmwfusm2m2m2tkxdsz63wrcft1

Marriage Principles 2, The Marriage Builder

 

From my talk on Sept 25 on Marriage, click HERE for the notes

I referenced The Marriage Builder by Larry Crabb quite a bit

https://app.box.com/s/m398stgfenvshj90uzzyar5y7em0ordv

Some Principles on Marriage

 A talk I shared with a fellowship group today click HERE

https://app.box.com/s/j9kpluznos5zwzqrozvpp6sfecbsul55

Thank You Spike Lee

Now I think I understand Spike Lee a little better. A man who can see things 30 years before others take them seriously is going to be an angry man. Watch “Do the Right Thing,” if you can stomach the profanity. Or at least see the clip that Lee has already noted is so similar to recent events (it's disturbing). You will see the complexity, the horror, the drama, the pain, the anger of today. The difference is, nobody marched for a strangled black man in 1989. The pain and the anger and the confusion of the violence and injustice around him, Lee carried by himself. Or carried it with a whole lot of other black men and women, most of whom did not have the focus or the understanding or the clarity or the charisma to make a movie to contain it. And so he was alone.

 

Thank you, Spike Lee. You were brave enough to focus that anger and that confusion into something real, disguised as something fictional. You were ahead of your time. But what you did perhaps planted a seed somewhere, so that when George Floyd breathed his last in real life, so much like your character Radio Raheem, people knew it was time to say something. Time to throw something. And so you woke the sleepers, made the blind see. Not enough to see clearly perhaps, to know the way forward. But enough to know there is light and a road.

General Colin Powell on Politics

Neither of the two major parties fits me comfortably in its present state. Granted, politics is the art of compromise, but for now I prefer not to compromise just so that I can say I belong to this or that party. I am troubled by the political passion of those on the extreme right who seem to claim divine wisdom on political as well as spiritual matters. God provides us with guidance and inspiration, not a legislative agenda. I am disturbed by the class and racial undertones beneath the surface of their rhetoric. On the other side of the spectrum, I am put off by patronizing liberals who claim to know what is best for society but devote little thought to who will eventually pay the bills. I question the priorities of those liberals who lavish so much attention on individual license and entitlements that little concern is left for the good of the community at large. I distrust rigid ideology from any direction, and I am discovering that many Americans feel just as I do. The time may be at hand for a third major party to emerge to represent this sensible center of the American political spectrum.

                                                                  -General Colin Powell, 1995

                                                                                                                                     

Corona Virus

Although there are many things we do not know about this virus, there are also many things we do know. The complete DNA has been discovered and published for example. Some other thing things we know at this point:

1.     A new virus hit the human race starting at the end of 2019. This is not surprising, as many viruses have jumped and recombine across species.

2.     As far as how deadly it is, this virus appears to be somewhere between influenza and SARS. The death rate of those infected appears much lower than SARS’ 10%, but higher than the typical yearly influenza which kills about 0.1% of those infected.[i] The 1918 outbreak likely killed around 20% of its victims.

3.     Starting with China, the countries of the world have taken very aggressive public health measures to try to slow and stop the spread of the virus. This hard work and sacrifice especially on the part of the Chinese (government, people, healthcare workers) has paid off as the rate of spread has been decreasing since the end of January.

4.     Despite these efforts, and their results, the virus has spread to some degree to several countries. These are still small numbers. It is too early to tell if they will be able to contain the virus, especially in some countries with less capable medical and public health systems.

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[i] https://en.wikipedia.org/wiki/Influenza

Following

It appears that a good church upbringing will do many marvelous

things for you, but one of the unfortunate things it also does is

convince you that Jesus is to be worshiped but not followed.

                                                                                                - Frost/Hirsch

friends

Facebook did not invent this problem but it does illustrate it quite well: having many friends can be a way of not having any friends.

Stateless Patients

A 30 y/o woman presented to a rural clinic for prenatal follow up: G2P1 at 25 weeks. As I used the ultrasound to check dates, look for anomalies, and measure amnionic fluid, I thought of the patient’s lack of sufficient identification in this country to allow her access to complex OB care. Instead, a volunteer internist was doing her ultrasound. The baby appeared healthy, but I later noted that she had not gained weight for several visits and that she was on prednisone. She had started having joint pains when she first got pregnant, was diagnosed with rheumatoid arthritis, started on steroids, and the labs that she could afford were sent off.

Through translators, the patient reported oral ulcers that were now healed, but no rash. Exam confirmed persistent pain and limited range of motion in the elbows, knees, wrists, MCP and PIP joints. Anemia down to a hemoglobin of 5 had improved to 8.5 with iron and steroids, but the WBC was still low at 2.7. She had negative rheumatoid factor, positive ANA and dsDNA, and negative anti-Smith. The creatinine was normal and urine protein was 3+. She met criteria for lupus.

I explained to the patient how a lupus diagnosis put her and her baby at risk, and the medications had risks as well. I increased the prednisone and asked her to come back in a week, hoping I could get some advice via email as to what to do. Thankfully, rheumatology friends overseas emailed back. We then developed a plan including medications that we could obtain and that were considered relatively safe during pregnancy, hoping to reduce the steroids at some point.

Three weeks after I first saw her, the patient had gained some weight and her joints were nearly normal, though she still had proteinuria. I outlined an ongoing plan for the staff as I left and prayed for her and the baby.

One wonders when helping people who are outside the “system” and its resources for whatever reason, at home or abroad: am I doing the right thing? Am I practicing beyond my scope if no one else will see them? How can I get better at doing this when medical progress seems to require more and more sub-specialization? And how can I protect these people’s privacy and security and still advocate for improved access to care?

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The Power of the News

The newspaper press is a great power, but just as an unchained torrent of water submerges whole countrysides and devastates crops, even so an uncontrolled pen serves but to destroy. If the control is from without, it proves more poisonous than want of control. It can be profitable only when exercised from within.
                                                         -Gandhi (autobiography Beacon, 1993 p. 287)
 

A Problem of Diagnosis

Efforts at cultural diagnosis are hampered if they are pursued from within the same framework of fundamental assumptions that brought into being the disorders they hope to cure.
                                                                                           -Ken Myers