Monthly Archives: September 2016

Bella: My Canine Silky Sullivan

My two Border collies, Buddy and Bella, love to race up the hill to our front yard. Buddy jumps out of the pickup and takes off at full stride while Bella instead lags far behind. Given Buddy is the alpha male, this behavior may spring from her respect for his dominance.

Bella on the left. Jack refuses to get out the pickup, instead demanding to ride up the hill.

Bella on the left. Jack, our so-called “Texas Brown Dog” on the right always refuses to get out the pickup. “Those silly Border collies, jumping out of a perfectly good pickup.”


About halfway to the finish line during this quarter mile sprint, in a fashion reminiscent of the thoroughbred racehorse, Silky Sullivan, Bella will lay back her ears, arch her back, hasten her pace, and rocket ahead like a low flying missile. At the last cattle guard that requires Buddy to tiptoe over it, young Bella will launch herself airborne, flying by or over a creeping Buddy. She then lands first at their seemingly agreed upon finish line, our front yard.

Many reading this post, may not recall Silky Sullivan- and for very good reason. He was a large red stallion whose racing feats occurred in the late 1950s. It will take someone from my generation or older to recall him. Silky Sullivan was known to have fallen behind as many as 41 lengths, only to come on like gangbusters and win by three lengths. His running style became synonymous with victory despite incredibly long odds.

Perhaps Silky Sullivan is best known for his appearance at the 1958 Santa Anita Derby where he fell behind over 30 lengths only to overtake the other horses and win the event. He became known as the “California Comet” and likely caused many instances of heartburn among the bettors.

Bella, our female Border collie, implements this unusual running style. She seems unwilling to race head-to-head with Buddy early in their races, but Bella dearly loves overtaking him and flying across the finish line first.

I suppose some people also eschew head-to-head competition but still harbor the never-to-be-denied desire to win. This Silky Sullivan approach to life may not be limited to racehorses and dogs, but  may  include humans as well. Of course this behavior in humans may be more nuanced than it is in animals. Instead of an overt competitive edge, the desire to get ahead may be more subtle. What do you think? Do you know anyone who may demonstrate this “Silky Sullivan” approach to life? Do you ever show this type of behavior? Food for thought.

Tree Story

As I trundle around my ranch, my gaze is often drawn to unusually shaped trees. For example, the tree below while fully developed, is missing its middle portion. It looks strange. The main branch likely broke off many years ago in a wind storm or lightning strike but has compensated by growing from its outer branches. Such adversity, such perseverance from this Live Oak tree. This tree has managed to overcome and become an attractive, if unusually appearing, tree once again.

The strong Texas winds during storms have blown down a number of other trees around the ranch. Most died soon after being toppled but surprisingly some have survived. The  trees downed by wind had shallow roots with the root ball surfacing completely or partially. Several trees with some remaining root structure have survived. They eventually redirected some of their limbs skyward and, if not exactly thriving, at least continue to live.These trees are all Live Oaks, the name coming from always having leaves. As compared to the usual deciduous trees that lose their leaves in the winter, the Live Oak always appears to be alive and pushes off its old leaves in the Spring to make room for new ones. The strong life force of the Live Oak conjures up for me the verb “to live” as much as it does the adjective “live.”

Oddly shaped tree that likely lost its main trunk to wind or lightning many years ago

Oddly shaped tree that likely lost its main trunk to wind or lightning many years ago

A blown down tree that has survived.

A toppled tree that has survived.

This felled tree not only has its trunk bent toward the sky but also has vertical shoots springing from near its base.

This felled tree not only has its trunk bent toward the sky but also has vertical shoots springing from near its base.

Looking at these challenged trees causes me to lean in and listen closely for their stories. It seems to me their botanical grit has frustrated the destructive forces of nature and offers a a metaphor for our human condition.

All of us are faced by life’s challenges. Fortunately most of our challenges are not serious but some are. A few of us have endured great challenges including death of a loved one, divorce, or loss of a job. Like the tree story, some people, despite such huge losses following their necessary grieving response, are able to re-establish their emotional grounding and get on with their lives. Others faced with similar or even lesser stresses sometimes just don’t bounce back as well. In my professional life as a neurologist, I was always surprised by how different people responded to bad news about their health. These responses varied widely. (if interested many examples are shared in my recently published book, Carrying The Black Bag: A Neurologist’s Bedside Tales) Which factors lead to these differences?

To continue the metaphor further, while external forces such as windstorms and lightning damage trees, an even greater menace to our oak studded ranch results from a tree disease known as Oak Wilt. This fungal disease spreads via a beetle through wounds to the tree or via its root system. It chokes off the channels that take up vital, life sustaining nutrition and hydration. In very short order, an affected tree loses its leaves and dies. A Red Oak tree will die within a day or two. Live Oaks take longer to die and  despite being very ill, some will survive.

A tree killed by Oak wilt

A tree killed by Oak wilt

The kill rate for oaks is 80-90%, yet some Live Oaks will maintain leaves on a limb or two and fight valiantly to survive.

A tree severely affected by Oak wild but one that will likely survive in altered shape

An Oak tree severely affected by Oak wilt but will likely survive with a drastically altered shape

Without hopefully torturing the metaphor too greatly, It seems to me several points can be made. First, this serious tree fungal disease can be overcome by a few determined Live Oak trees. While damaged, the surviving trees, given enough time, will live and may even eventually become handsome trees once again. This is, i believe, an example of the strong life force of the Live Oak trees along with some good luck.

A second point relates to the higher death rate of those trees affected by the internal disease, Oak Wilt, as compared to the trees that sustain major damage by external forces. The internal forces of Oak wilt are more often fatal to the tree than are the external forces.

Might this also be true for people? We often face external adversity with greater determination especially if our own spirits are not sapped. Self-doubt, discouragement, depression, and hopelessness diminish the quality of our survival more so than do grievous external forces such as job loss, financial reversals, loss of a limb, or geographic relocations.

Oak trees are not humans. I get that. Yet, the apparent desire of Live Oak trees to persevere despite injury or illness provides a ready comparison for the human condition. Given that all of us will likely face a serious loss or illness, perhaps it is worth pausing to contemplate how we might nurture our fortitude and prepare ourselves for the inevitable.

Perhaps the tree story will help to nourish the hope that maintains our human existence during turbulent times.

Does Hillary Clinton Really Have Parkinson’s Disease?

I usually avoid writing about political matters. In recent days though, I’ve been asked by multiple friends, both lay people and physicians alike, to share my views on a video put out by Dr. Ted Noel, suggesting Hillary Clinton suffers from Parkinson’s disease (PD).

The implications of a potential President of the United States having a progressive neurological disease tends to focus our attention and require careful consideration. For that reason, I’ve decided to share my thoughts on Dr. Noel’s assertions that Hillary Clinton has PD.

My  professional background is that of a practicing clinical and research neurologist. I  treated patients with PD for decades and also directed a Parkinson’s Disease Center of Excellence for the National Parkinson’s Disease Foundation. My background qualifies me to comment on the assertions made by Dr. Noel. He trained as an anesthesiologist and admits to strong political views on his video blog. As for me, I am neither a registered Democrat nor Republican and possess the strong belief that medical and scientific facts must not be viewed through a convenient political lens. Politically driven science leads to bad science.

I have a great interest in the impact of medical disorders on the decision-making of public figures. Toward this end I’ve appeared on History and National Geographic channels discussing the likelihood that Adolf Hitler suffered from PD. I’ve also written on the topic; most extensively in my recently published book entitled, Carrying The Black Bag: A Neurologist’s Bedside Tales. I refer those interested to Chapter 13 and my argument that Adolf Hitler, in addition to his other medical disorders, also suffered from PD and this disorder affected, not only his movements, but also his memory and cognitive function. Hitler’s PD may have impacted his conduct during the latter phases of World War II and influenced the outcome of the war.  The evidence that Adolf Hitler had PD is in my view  substantially stronger than that purported by Dr. Noel for Hillary Clinton.

I support Dr. Noel’s contention that, in the absence of a hands on examination, observing videos of someone with Parkinson’s disease can lead to a strong conclusion that the person had PD. This is possible because the disorder demonstrates easily recognizable tremor, slowness of movement, stooped posture, lack of arm swing, gait abnormalities, and blank facial expression. The neurological examination allows the examiner to feel the particular type of muscular rigidity in PD (so-called cogwheel rigidity) which cannot be observed from a video.

Sketch of a man with PD with the typical features

Sketch of a man with PD with the typical features

What is missing from Dr. Noel’s “facts” is a discussion of how PD develops over time and its typical order of presentation. The medical field refers to this as the natural history of the disease. It is here that Dr. Noel makes several errors, no doubt because his training and experience are in Anesthesiology, not Neurology, nor does he likely have extensive experience in the diagnosis and treatment of people with Parkinson’s disease.

For example, he claims the onset of Hillary Clinton’s alleged PD dates to a fall she suffered eleven years ago, the fall resulting from her PD-related loss of balance. While loss of balance (referred to as loss of postural righting reflexes) is a well known feature of PD, this is NOT an early feature, nor it is a first sign of the disease. Rather balance problems are a late finding in the natural history of the disorder and follow the onset of the more major features, such as tremor, rigidity, slow movements, blank facial expression, and lack of arm swing while walking.

Hand tremor (not head tremor) is the most common presenting sign of PD. This is a slow rhythmic tremor of the fingers, a so-called “pill rolling tremor” named after the apothecaries of old. parkinsonsTo my knowledge, Clinton has never shown this type of tremor. As Dr. Noel points out, the hand tremor can be suppressed by holding the hand against the body or by manipulating an object. Nevertheless, the hand tremor returns periodically, especially when under emotional pressure, and is the most obvious feature of the disorder. Given the many public appearances of Hillary Clinton, this type of tremor, if it existed, should already have been observed many, many times.

Dr. Noel instead refers to the head-bobbing Clinton demonstrates in several videos as her purported tremor. While some people with PD have head tremor, this is unusual and not seen in my experience without tremor elsewhere in the arms or legs. In addition, the tremor of PD is rhythmic and of a certain, predictable rate. Her head bobbing is non-rhythmic and does not appear at all typical in rate or form for the head tremor of PD.

Slow movements, so-called bradykinesia, are another major sign of PD. I have not viewed any video that shows Hillary Clinton demonstrating slow movements beyond what would be expected of a 68-year old person. While treatment can mask the signs of PD, they can still be detected by experienced examiners, at least after the so-called “levodopa holiday” passes which typically lasts no more than a year or two.

Stooped posture, lack of arm swing and leading with the back of the hands while walking (simian posture) with forearms flexed, along with shuffling feet with short steps are convincing features for PD. Again, I am unaware of Clinton demonstrating any of these diagnostic features.

What Dr. Noel points to is a “bug-eyed” facial expression occurred only when Clinton was startled or overwhelmed by reporters shouting questions at her. A person with PD typically has wide-eyes, blank facial expression, and reduced frequency of blinking which Clinton does not demonstrate. A person with PD demonstrates these facial features all of the time, not episodically.

The blank staring facial expression of PD in Muhammad Ali

The blank staring facial expression of PD-  Muhammad Ali


Likewise his contention that her recently diagnosed pneumonia resulted from a swallowing abnormality associated with PD fails to be adequately supported. While swallowing problems exist in many persons with advanced PD and may lead to aspiration and pneumonia, they are present in association with the cardinal features of PD, such as tremor, slow movements, and muscular rigidity. The swallowing abnormalities do not occur in the absence of the cardinal features of PD.

We have no evidence these cardinal features of PD exist in the video, nor do we see the minor signs of PD, such as a blank facial expression, lack of arm swing, stooped posture, shuffling gait, soft and muffled voice, simian posturing of the hands, oily skin, dandruff and acne. Clinton’s speech patterns are readily available to anyone who follows the campaign. She does not demonstrate soft and muffled speech as is seen with more advanced PD.

In summary, the evidence presented by Dr. Noel is far from convincing that Hillary Clinton has PD. Dr. Noel has cherry picked various signs without fitting them into a logical context or natural history of PD. I do not believe Hillary Clinton suffers from PD based on current evidence.

Whether she has another neurological disorder cannot be discerned from the limited medical information available. Medical records and examinations are needed.

Dr. Lisa R. Bardack, Hillary Clinton’s Internal Medicine physician, has released limited information on Hillary Clinton. Clinton has treated hypothyroidism, seasonal allergies, and we know of her recently diagnosed bout of pneumonia for which she was placed on antibiotics.

More concerning was the episode of closed head injury that took her a full five months from which to recover. She apparently developed a blood clot within her head in 2012 believed to have been a transverse sinus thrombosis- a very serious  brain disorder. Almost certainly Clinton would have  been attended by a neurologist or a neurosurgeon or both; however no neurological records have been released of this major medical event. We do not know whether she suffered any permanent brain damage or other complications from this episode.

She also has suffered episodes in 1998 and 2009 of deep vein thrombosis (DVTs) in her legs and takes an anticoagulant, Coumadin for prevention of future blood clots.

As an aside, Hillary Clinton’s falls or risk for falls while on Coumadin, demands caution, especially when climbing stairs or at risk for falls or cuts.

Very little medical information has been released for either Hillary Clinton or Donald Trump despite the rhetoric streaming from their campaigns claiming the opposite. As compared to the medical records released by John McCain and George W. Bush when running for President, the currently released medical information is meager by comparison. This is, in my opinion, very unfortunate.

Whether a candidate is healthy enough to become president and perform the duties of the office should be a condition for running. The people who vote would benefit from health information just as they  benefit from policy statements and fiscal plans. Since both major candidates, Clinton and Trump,  respectively are 68 and 70-years of age, the need for this information takes on even greater importance.

The candidates in my opinion should release their full health records and not just politically sanitized versions or the results of their most recent physical examinations. A list of their medications should also be released and would likely be revealing. Lacking a willingness by the candidates for full medical disclosures, a non-partisan panel of medical experts should review all available medical records and attest to the candidate’s health status and their ability health-wise to meet the demands of the office of President of the United States. Such a course of action would be in the best interest of the American people.


Sometimes It Is Just Better To Go Along With The Herd

Several days ago I spotted a parade of animals in the Texas Hill Country that caused me a classic double-take. I was so shocked I stopped the pickup and took a picture. The parade of animals consisted of a lead Llama and a long string of Boer goats (some of which are seen in the picture). Marching along in the line and among the goats was also a large gray goose. A goose?  Look closely at the picture and you will see a Llama leading Boer goats. In between the goats just to the right of the small tree waddles a  gray goose. I wish I could have gotten closer picture but look closely, it is really there.


I am at a loss to explain why this lone goose decided to join the goat herd. Was it displaced from its own flock and suffering extreme loneliness? Did the goose have problems with its own identity? Or perhaps since the Llama protects the goats from coyotes and other predators, did the goose simply feel more secure in this goat herd than off on its own.

Animals never fail to surprise me. Would love to hear your speculations for this strange, mixed herd. Perhaps at times it is simply better to just go with the flow and join the herd, any herd.


The Urge To Blog

Why are some compelled to write blogs? My own desire grew after assuming a new  identity in retirement, that of a newly minted rancher. The novelty of it intrigued me. Being a “city boy,” nearly everything including raising livestock, operating ranch equipment, mending fences, and building barns held a strong fascination.cropped-header-option-1.jpg

The thought occurred if I enjoyed learning about and living a rural and retired lifestyle, then perhaps others would like to read about it too. This interest eventually led me to begin blogging about my writing process and finally to aspects of my book. Admittedly, I also needed to decompress from my busy former career as a clinical and research neurologist and thought others might enjoy reading tidbits resulting from my inevitable backward glance at my life.

While still a young blog, I consider Views From Medicine Spirit Ranch  to have been successful. Its  popularity supports my original premise that others might enjoy reading about this subject matter. I very much appreciate receiving comments from readers and learning from them. The only experience better  is having friends and family visit the ranch, especially those who “get it.”

Two Longhorn cows and calf

Two Longhorn cows and calf

Certainly not everyone who visits our ranch leaves with an appreciation for the land and for the animals in a way like Trudy and I do. That’s okay. Some would rather sit on the back porch and work their smart phones than absorb the tranquility and develop new ranch experiences.

Nevertheless, some who visit throw themselves into ranch life. A recent visit to the ranch by good friends LaNelle Etheridge and Madeline Douglas were two cases in point. Incidentally, both La Nelle and Madeline have been beta readers for many of my writing efforts and have fully supported my efforts to market my book, Carrying The Black Bag.

La Nelle and Madeline herding 'em up

La Nelle and Madeline herding ’em up

La Nelle, Madeline, Trudy, and I recently worked calves. This consisted of vaccinating for blackleg and ear tagging them. Both visiting ladies threw themselves into the effort, helping and enjoying the novel experience.  Both also managed to avoid being stepped on or pooped on. This was an accomplishment. Between swims in the pool they also tended the vegetable garden and hiked the steep green hills of our ranch. Both ladies are extremely intelligent and mindful such that our conversations on the back porch were for me especially pleasing.

Vaccinating and Ear Tagging with La Nelle, Madeline, and Luke

Vaccinating and Ear Tagging with La Nelle, Madeline, and Luke, the neighbor’s grandson

I could see excitement in their eyes as they became engrossed in their experiences that were so different from their usual lives in Lubbock. They sensed the tranquility of a Texas sunset from atop a hill while sipping a glass of chilled wine. These “Sundowners” have become a regular feature of our ranch life.

The dogs and I enjoying a "Sundowner"

The dogs and I enjoying a “Sundowner”

Years ago at my retirement party my brother-in-law presented a large number of T-shirts on which was written “Tom’s Ranch Hand.” Paul Plunket in his humorous way predicted I would put friends and family to work on the ranch and possibly even avoid the need to hire any help. In this he was correct only to a degree.

T-shirt read Tom's Ranch Hands

Madeline on left and La Nelle on right with their T-shirts that read Tom’s Ranch Hands- Hutton Ranch

I had two T-shirts left over from my retirement party. At the conclusion of La Nelle and Madeline’s  visit, I presented a T-shirt to each. Both appreciated the gift, small tokens though they were. This further convinced me of the wonderment that exists at Medicine Spirit Ranch set in these green hills of central Texas. It is a wonderment for at least some. Perhaps that is the way it always is. Different experiences resonate for different folks. I hope for future visitors to our ranch and to describe in writing the experiences for those unable to experience it directly.

A Texas sunset

A Texas sunset