Scanned Objects, March 2011

Post Cards

Cape Ann, MA 1947

reverse: copyright 1947 Roy Lane, Rockport, Mass

Front Beach, Rockport, MA 

reverse: Front Beach and Observatory Point, Rockport, Mass

Carver's Pond, Bridgewater, MA 1913

reverse: "I'm a long way from home - Bridgewater. It reminds me of ? Hope all's well. You may remember I always do things well on Tuesdays.  Greetings, Abe"

Post Office, Lake City, FL

Red Barn Restaurant, Lake City, FL

reverse: Red Barn Restaurant, 2 miles South of Lake City on US 41 & 441. Amid good courts. Air Conditioned. "Just Good Food" on beautiful Lake Hiawatha.  Mr and Mrs Leo R Law, Managers.  Phone Lake City 9154

Whispering Pines Motel, Starke, FL

reverse: Whispering PInes. 4.5 acres of beautifully shaded grounds.  Modern Guest Cottages, each with private bath and auto shelter.  Panel Ray Heat, Electric fans. Dining room serving excellent food to our guests. Tel 450.  Mr and Mrs TR Connell, Owners.  On US 301 and Fla 200.  3.5 miles south of Starke, Florida

Lazy Lodge Motel, Lake City, FL

reverse: Lazy Lodge Motel. 13 miles South of Lake City.  US 41 and I 75

The Next Floridian Environmental Disaster

The abandoned Trinity Hospital in Jasper, Florida.  Like the new Governor, Trinity Hospital was making money by fraudulently over billing the federal government.

Last Summer, the Deep Water Horizon exploded, sank and subsequently pumped over 200 million gallons of oil into the Gulf of Mexico.  When they burned off the corralled oil we could smell the toxic stench in Lake City. We all endured the embarrassing 'junk shot,' the ineffective 'top kill,' and the 'lower marine riser' for several months to solve a preventable disaster.  There were known problems with the rig, there was lax regulation and blatant disregard for safety but, it was an accident.  We can be thankful that it was not planned.

The next great environmental disaster to strike Florida is Governor Rick Scott and this one is being meticulously planned.  The people of Florida (49% of the 42% that voted, which equals 20% of Floridians) voted for the Tea Party favorite, Gov. Scott.  The Tea Party thought "Oh let's endorse a guy who ran a company that committed the greatest Medicaid fraud in history because that is fiscally responsible, right?"  The irony doesn't stop there.

Rick Scott is worried about regulation, all kinds of regulation: no regulation, imaginary regulation and some of the most lax environmental regulation in the US.  To combat any regulation that would hamper any development, no matter how destructive or unneeded, he has proposed something that only an anti-science, anti-environment Tea Party radical would. He is going to merge the state's environmental, growth management and transportation departments and call it, drum roll please...The Department of Growth Leadership.  Is anyone feeling like an 8 year old yet?  This new agency will be mandated to equally weigh any environmental protections with job creation.  Since Florida already has some of the weakest environmental regulations this bodes poorly for our fragile ecosystems.

Other ominous signs from Gov.Scott include:

1. His selection of environmental department heads.  Instead of scientists or conservationists he appointed businessmen, a former executive of the St.Joe company (the second largest land owner in Florida) and a former executive of a shipyard in Jacksonville.  
2. He already has suspended all rule making and regulations pending his review.
3. He has proposed eliminating the State's regulatory power over major residential and commercial development.  This includes 'streamlining' the wetland permitting process that is already only 45 days long.  Wetland?  What wetland? Endangered species? No such thing!
4. I'll call his next proposal the Tea Party Delight and it demonstrates the infuriating magical thinking that he and his supporters engage in.  He wants to end concurrence.  What is concurrence you ask?  Concurrence requires that developers pay for infrastructure upgrades to accommodate increased population and usage (roads, sewer, etc).  By eliminating concurrence who pays?  That's right, you and me, because that is fiscally responsible...
5. He wants to end oversight of Developments of Regional Impact.  This has major implications for my community.  Florida is famous for enormous developments that often impact areas outside the local community by draining aquifers.  This oversight also protects less developed regions from being used as water supplies for poorly managed urban sprawl.  
6. He wants to stop local governments from enforcing more restrictive regulations than the state.  So much for 'We the People.'
7. He wants to prohibit counties from suing each other over water supplies or upstream pollution due to strip mining.  There have been proposals for water pipelines to South Florida in the past.  Gov. Scott who won these rural communities with his anti-government zeal now proposes to stop protecting our springs and rivers.  I wonder how the people of Columbia County will feel when they have no recourse if the Santa Fe and Suwanee Rivers become water supplies for the Tampa Bay area.

One would imagine with all this whining about regulation that Florida has been unable to develop for decades. Reality check Gov. Scott:  300,000 vacant homes in Florida.  I repeat: Three. Hundred. Thousand. Vacant. Homes.  Only in Florida...

ps: in case you were thinking he is a unique independent thinking libertarian type: he is also opposed to gay adoption; he is anti-choice; he favors a Arizona-style immigration policy; he is a climate change denialist; and he is apparently still up to his old tricks. Solantic health clinics (which Scott founded and is the primary share holder) is being investigated for Medicaid/Medicare fraud.  Oh the irony of a tea party wingnut making millions by over-billing the government...     

On more than one occasion I asked my patients to sign out of Trinity Hospital against medical advice and come to our clinic and I would  readmit them to a proper hospital if necessary.  I never had to admit anyone.  One patient had been hospitalized for three days with strep throat (and no, he did not have rheumatic fever.  He had strep throat.)  Gov. Scott might want to check out this property as a new Solantic clinic site.

Post Number 101

The Twelve Days of...Oh Hell, I Give Up.

On the first day of Christmas, Gio brought himself to Old Wire Road.  Additionally, he brought with him tales of the Peruvian rainforest, covetous bird scientists, masked gunmen, unsanitary rice and beans and all manner of ex-girlfriends.  We expected nothing less.

   

On day two, Moss needed a bath.  

Day Three...Giles' acute glaucoma resolved and that was exactly what we asked ol' St. Druid for.  Thanks to everyone that made a positive contribution to his well being, especially: Dr.WTF, Shands UF, science and all his well wishers.   

On the forth day of Christmas, Gio and I took a paddle down the Ichetucknee River.  Two limpkins, five river otters, ten kingfishers and an osprey in a cypress tree...

On day five, I gave up on the entire '12 Days of Christmas' motif.   Allison visited us from Portland and brought gifts from the civilized world.  Thanks for brightening our holiday.         

Gio courted various surgeons and rock climbers online.  Who could blame him after three months in the Amazon Basin eating E.coli infused beans with members of a Columbian drug cartel.  I expressed to him my concerns with women who start their online dating profile with the sentence, 'I love rock climbing.'  I have nothing against rock climbers (except their muscular bodies and funny shoes).  As an old friend of mine would say, "please don't say, "I love rock climbing."'

   

I promised Gio that I would get him some time with a wild manatee.  Instead, we visited a zoo.  I tried to promote the zoo by relating heartfelt stories of how the imprisoned beasts were all rescued from certain and painful deaths.  I almost convinced myself, but I feel Gio never bought in.  He did manage to shoot a nausea-inducing composition of a vapid Bald Eagle standing in front of Old Glory.  And yes, Cymande is feeding Giles in the reptile exhibit.

Air: 50 degrees.  Water: 73 degrees.  Steam.

We were again the only visitors to the park for several hours.  When we were pulling our kayaks out of the water we met an entomologist.  Somehow, we started talking about ascariasis or giant human roundworm and she explained how she found one, well, in her stool.  Which allows me to state for the millionth time: no one might actually read this blog, but I have the number one or two google image hit for ascariasis.  I had so much potential in this life...but here I am..giant human roundworm...I always had a thing for parasites.

After we visited the Florida Animal Prison we found the most amazing Italian Deli in Inverness, The Little Italy Deli.  The owner berated Gio for being an Italian vegetarian.  The food was unbelievably good, a rarity in Florida...I felt like I was back in Gloucester being scolded for ordering incorrectly at Cafe Sicilia.

   

Count them: 12 manatees, one for every day of Christmas.  Actually there were several others that were in the manatee hospital, but they don't count because: A. they were not wild and/or B. they were manatee specters. 

Elves!

The Mysterious Case of the Thanksgiving Hyphema

Working in pediatric primary care as a nurse practitioner, I am presented daily with both the best and worst that humanity has to offer.  There have been tragedies and joys that often defy description.  Ethically, I feel I can never mention these things here, nor have I been compelled to, but over this past month I had a case that was so interesting and educational (for both parents and clinicians alike) that I'm inspired to break my own self-imposed censorship.  It helps that the patient is my son.  While I'm not particularly thrilled with advertising Giles' medical history I know this will help someone.  So, here it is...

He is usually a neat eater, but he was obviously not feeling well.  Note the hyphema on the right lateral iris and the hyperemia.  

Past Medical History:  6 month old full term male.  Fraternal twin A.  Delivered C-section.  Breast fed and recently started on baby foods. Vaccines up to date.  Mild upper respiratory infection 2 weeks previous to current illness which resolved with supportive treatment.  Normal newborn screening labs. Taking vitamin D, no other medications.  

History of Present Illness: Giles was in beautiful Beaufort, SC visiting his Grandparents for Thanksgiving.  He was having a great time and for the first time ate a little mashed potatoes.  Nothing seemed amiss until the day after Thanksgiving when we noticed he had a pink right eye.  We assumed it was conjunctivitis and we assumed it was viral.  We were wrong.


We drove home on Saturday and noticed that Mr.Giles was not feeling like himself.  He was grumpy and his eye looked like "let's take him to our clinic and have a pediatrician check him out."  He felt it was likely conjunctivitis and likely a virus.  It wasn't, but we primary care people all think alike.  We were wrong.

The next day we went to see a local ophthalmologist, Dr.Nothing-is-Wrong, where he was diagnosed with a grade 1 hyphema (blood in the anterior chamber, where the iris is).  It was theorized that he hit himself or his twin hit him in the eye.  Dr.Nothing-is-Wrong felt that the odds of another cause would be very rare and he would have other symptoms.  He prescribed prednisone drops (for inflammation) and atropine drops (to keep the eye dilated).  No pressure of the eye was taken.


Giles wasn't feeling any better.  He continued to sleep either all morning or all afternoon and woke throughout the night.  His eye looked about the same.  He was acting weird.  We started to entertain all kinds of horrific scenarios and it was scaring us.

We followed up with Dr. Nothing-is-Wrong who stated that his eye was looking good, that he had a hyphema that was resolving and to continue the treatment plan.  He tested his pressure and it was normal but, as we now know, this was probably false.  We asked if his lethargy, somnolence, and irritability could be contributed to the hyphema and Dr.Nothing-is-Wrong said, "It is not his eye giving him those symptoms."  It is at this point that Cymande almost demanded we go straight to the ER, but I felt that if Dr. Nothing-is-Wrong said nothing was wrong then nothing was wrong.  He was wrong.

(Note:  We had read in several pediatric ophthalmology textbooks that somnolence is often associated with hyphema and that it often results in a rule-out sepsis work-ups (foreshadow).  This was mentioned to Dr.Nothing-is-Wrong and he seemed underwhelmed.)


Over the next 3 days Giles got worse.  He was more somnolent, more irritable and acting strange.  It was rare to get a smile out him.  Finally, he refused to wake up in the morning.  So, off to the University of Florida ER...

Upon arrival we were put in a private room where the ER resident, Dr. Something-is-Wrong, took the history and looked very worried.  First, she called for an ophthalmology consult and the resident adult ophthalmologist arrived and was soon followed by her attending.  They examined him and confirmed that he indeed had a hyphema, but they were unaware of it creating symptoms like his.  Then the ER attending arrived and said 'We are worried about him.'  Which made us even more worried.  The work up: Head CT: no brain tumor or eye tumor. Labs: no obvious bleeding disorder, no obvious infection, no obvious metabolic disorder.  Urine: clean.  Diagnosis: Hyphema and Suspected Afebrile Sepsis.

At 2pm and Giles was still sleeping and not really feeding well.  The ER work-up revealed no significant illness, but there was no lumbar puncture done.  The great unknowns remained: afebrile meninigitis vs afebrile encephalitis.  It was decided that he needed to be in the PICU. The PICU team sat us down and went through their thinking process.  We felt nervous, but safe.  They were thorough, thoughtful and they listened to the entire history. They called back the ophthalmologists and examined him under conscious sedation where his eye pressure was noted to be over 3 times the normal pressure.  They stopped any further workup and started him on pressure drops that miraculously brought him out of his stupor.  He laughed and squealed for the first time in a week.  We squealed with him.

The next day he was transfered to the general pediatric floor and a pediatric ophthalmologist, Dr. I'm-Going-to-Figure-Out-What-The-F%@#-Is-Wrong-With-Him (DR.WTF) examined him.  His pressure was coming down and we were discharged.  She later examined him under anesthesia and she ruled out all the bad stuff.  The working diagnosis is juvenile xanthogranuloma (JXG) of the iris, but we are not 100% on that.

So, the likely scenario is this: JXG caused a friable lesion of the iris to bleed creating a spontaneous hyphema.  The hyphema and cellular debris clogged the angle (drainage system of the eye) and caused uveitis (inflammation) which led to acute glaucoma (increased intraocular pressure).  This caused a severe headache which led to his somnolence, irritability and near toxic appearance.

Thanksgiving 2010 in Beaufort, South Carolina

The Day Before Thanksgiving 2010, One Day Late

Moss and Giles getting all Bass and Drum.

The boys are expressing themselves in new and surprising ways.  Moss is utterly amused by me singing 'doo doo doo, daa daa daa is all I want to say to you' and if I follow it up with  'squeak' then Giles squeaks his approval. 

The calm before Old Wire Road is widened and paved

Since our very first day on Old Wire Road we have been told that it was going to be paved 'next year'.  Next year has finally arrived and with astonishing efficiency they are widening Old Wire with all manner of large and exotic machinery.  To remind us that we live in a place where there are little rules or regulations, loggers driving tractors (that cut down a tree in 3 seconds) quickly took down over a mile of roadside trees with cars speeding by the entire time.  It was a frightening sight to behold. 

Moss is enthusiastic about his bouncy

The final days of Old Wire Road as a narrow dirt road

I've been trying to research the history of Old Wire Road but have found little information thus far.  From the information I collected I have pieced together the following:  The first telegraph line in Florida ended in the now defunct town of O'Leno and it followed old Route 47 which is parallel to Old Wire.  So, I believe that Old Wire Road is the old route of the telegraph line that ran to O'Leno (near High Springs).  There is suprisingly little history regarding this topic (as with many things related to Lake City.)  Over the years people have built their homes with respect to where the dirt road lies, but not with respect to where the actual property lines exist.  Some people are losing their entire front yards and several Live Oaks which were probably 200 years old were taken down for the newly alligned Old Wire Road.   

Giles investigates a pumpkin

One last look at the view North from our driveway.

Moss and Giles inspired us to be more festive.  I carved pumpkins while they watched.

  

The Great Idiotic Stump is now history, but the stupidity is alive and well. 

More on this topic to come...