Saturday, August 30, 2014

Finally, An Easy Screening Test

Finally... an easier way to screen for colon cancer has appeared. Finally... is a great word to express a breathy alternative to the dreaded notion of a colonoscopy. Other than a minority of people, most do not revel in the notion of a crampy salty purge followed by a tunnel tubing to a so called sweet spot... the cecum. For those lucky enough to get IV propofol, the "trip" has memorable value. A legal, controlled drug high is always a nice side benefit.

But for most people the idea of being screened for colon cancer is one of dread. But now, with the FDA approval of Cologuard, screening is as simple as submitting a stool sample for DNA analysis. Indeed! While no test, including colonoscopy is 100% of anything, Cologuard picked up about 92% of significant lesions.

The always distasteful issue of cost is a necessary consideration in health care. In the main, pricing in the medical arena is wild west, as has been exemplified by comparing the prices of the same procedure or operation in different markets. Cologuard's cost is not yet set since no insurers have dissected the role of this brand new modality. The manufacturer, Exact Sciences, suggests a price of between $500-600. As opposed to a colonoscopy, with its multiples fees including the gastroenterologist, the facility, the anesthesia, the prep and the pathologist (if biopsies are done), on average the relative difference is impressive.

Naturally the issue will in part be decided on who is the right candidate for Cologuard. Perhaps patients of average risk (no family history of colon cancer) will be targeted. Alternatively, an older population may be better suited for the non-invasive test. The risks of colonoscopy and anesthesia increase with age and the existence of other medical issues such as heart of lung disease. Currently Medicare is pondering the role (if any) of Cologuard.

One clear advantage of Cologuard is that screening will become more accepted. Only about half of Americans submit to screening for whatever reasons. It is reasonable to guess that a non-invasive, less costly and risky alternative will be more widely utilized. To extend that argument, more colon cancer deaths will be prevented with more screening. Consequently we will become a healthier community. Now, sadly, around 150,000 to 200,000 Americans die annually from this malignancy.

Will the number of colonosopies carried out decline? Surely that would be bad news for endoscopists, good news for patients and pocketbooks everywhere. That answer is unknown. At first blush, the simple answer is yes. With further consideration though, the need for colonosopy will rise with so many more patients undergoing screening. Every positive Cologuard test necessitates further investigation. But it matters little about the number of colonoscopies - what matters is health and its maintenance.

There is much left to learn. Who will be the target population for Cologuard? Will high risk patients be included, or those with previous polyps or colon cancers? In the spirit of competition, the notion that declining pricing points for colonoscopy is not out of hand.

No matter the small battles of ultimate implementation, Cologuard is about to change the screening landscape for colon cancer. It is a welcome addition to the progress of Medicine. The soon to be roll out should be interesting.


Sunday, August 24, 2014

Lost in Place

Away he went, whoosh, like that. People do it every day, go away, to here and there. Getaways had never been his style but what was once in disdain, now deigns primacy. Like eating vegetables, yeah vegetables. Too bad he had gotten so old. Once he read that when people are on death's slide they never say I should have worked more. Ta-da...

Oh yeah, he pushed through the crowds; won those tussles mostly, with a few ass kickings that are inevitable for most everyone. Smart mouthed back, he was, before life taught him humility. Even surgeons die. Fail, too, burying mistakes, most of which are inevitable. As the drone of the diesel sleeps him off he remembers that old woman, Clotilda Gray. Routine gall bladder extractions can go to hell in a hurry. Aberrant arteries be damned.

There in front of him was a couple, youngish, he 30, she 26ish. Acne she still had, youthful, he wished he would get a pimple. Not much acne, just at the jaw angles but her white teeth glared most everything else out. She full lipped, he thin ribboned. Perhaps that summarizes what he thought. No way could this milk drinker handle that, make it reach its full potential. Woman are endless; men, sadly - not except for those few who understood... Ta-da...

Slap, slap go those deep cobalt blue waves against the hull of this bucket of floating bolts. Vessels like this are one turn from salvage. Charm has its peculiarities. Hot, it's August. Men have their shirts off, most shouldn't. Of course he knows better, a white tufter is best left adorned. Some Asian kids are running back and forth on this top deck as the vertical mountains rise right out of the sea. Astounding really for a guy whose idea of a mountain is a pile of horse shit.

Nothing he had now, no inventory of people. The kids are playing out their idea of making it, three of them, boys. He could have told them that women would make them their slaves, but he didn't. Why bother, the power of la fica cannot be managed. Experience is a mean teacher. Once in awhile he hears a word... a raise, a grandchild, a car... bosh. Mildred, for her part, threw his sorry ass out... for cause, while keeping most everything. Her cause was named Penelope.

Maybe he will get lucky? Maybe he will get lucky! Some woman, somewhere, perhaps where he is going will show mercy. Could she not notice the stumbling infirmities, the creases and the sags and see something worth running with. The problem is and will always be that he doesn't want to belong to any club that wants him. Smart, he, not always. How ever could his favorite singers include a 17 year old named Birdy? Ta-da...

Startling to see this place, only a diety could have made it. People moving without sounds and shuffles. Had he become deaf? Pulling his tattered valise, he snaked to his hotel. Speaking in high school Italian, he managed to reach a front sea room with a lovely terrace. There he sat, looking as far as the water ran, until it met the sky. Tears streamed his cheeks, no reason. A balloon discharges its gas similarly. Reaching back he uncapped a side tabled complementary Fanta. Somehow its tasted exquisite. Just then a woman with strappy high sandals startled him as she looked up at him, camera in hand. "Come va..." said she. Ta-da....


Sunday, July 13, 2014

See Susan Fuck

Black-eyed Susans,
biennials, they
die after
2 years...

2 years, hmmm
if people knew
they would die
in 2 years...

or 20 or 40 or
be dead, definite, then

things could be 
readied, prepared,
with no expectation 
of more than allotted!

Life could be played,
be viewed so that
yellows and shapes
could morph... colors, shapes...

by choice
without fear,
since all time would
be accounted, 2 years

or 20, 40, 80 eee.
To think like a 
flower, like a smelly
lovely, attracting this and that!

Flowers are women,
not men. 
Attractants all, 

Nourishers, nectaters
never without a 
welcome to any and all

Made up so that
the circle of life
completes, replicates,
even fornicates, hmmm...

Why not??

Flowers, no Susans,
not even can
But they must or

there would be no more
after 2 years!
The circle would
cease. No!

Tonight, go out
at AM 2
with a flashlight
and flash-flash their beds!!

And you will see flowers

Sunday, June 8, 2014

Memories are Killers

A window, in and out, represents a pass through. It was there maybe fifty years, maybe more, surely it would have been called a picture window but for the fact that it was only a foot or two off of the ground. Perhaps a basement apartment, probably illegal, things like that were common here in this beat out shore town. A town, I might say, looking ready for a gay takeover. What with the nascent glitzy little shoppes and sushi restaurants amongst the decrepitude, look out lower socioecs! Tear downs on the way... Move out!

Breezy and 70, it was a nice day to push-pedal up and down the promenade. Filled now with expensive cars and white haired old men trying to act like their hard-ons were natural, not blue or yellow, l'estate era arrivata. Ha, fools they are, looking stupid driving German cars with so much refinement and power that their Buick reflexes would be overcome with ease in the event that they had the balls to drive like men. There is no pill for that derring-do.

Odder looking, that window now, for I saw it first in January when the thermometer recorded 1 degree F. F means fuck when the ambient temperature is one, at least that seems a fair equilibration. Indeed no pedal play that day, rather I cruised by in a toasty Jeep with heated seats. Some old men express their age discomfiture in other ways than in pointed projections. And so what?

Then, there was ice in the corners of that pane now slightly distorted with age. Glass is a liquid and in time gravity has its way. Without a double layer, windows allow condensation, heat loss and obfuscation by what in the old days was called fogging. Peering in I could smell that inefficient oil heater plying its mission, I sniffed that heavy odor pervasive without actually being in there. My long dead Aunt Jenny lived in such a similar place so long ago... No so long ago, not long enough to be forgotten. The sun shone brighter then. Memories are killers.

I wondered why the image of that winter flat flashed me now, now on a warm June day when there was no ice to be found anywhere but in a convenience store for sale at $4.59 a bag? Cozy I thought were they then, the two of them, renters, working casino jobs. I saw them once, together sleepy eyed in a nearby WaWa. It was six in the morning and the smell of their sex filled the air as I brushed by them as I stumbled to the coffee kiosk. Tousled, her hair, deeper black his beard...

She, lithe, hairless in all and smooth and he, dark and mysterious, respectively. White hair was a joke to them. Knowing about that partially dug out lair, imagination explained how they ate and played, diddled and ate and how those two had become one. Raw sex and deep passion, the evanescent addicting kinds were theirs then. When it's so cold what else is left? Heat always wins.

But today, bemusement forced me to halt the push-push. For no reason, I stopped to look into the window. Without any ice, any fog, the interior of the place appeared stark and off white, not well appointed and dogeared. Shore furniture and paint are easily humid frayed and unfortunately moldy to the core. Somehow that greasy oil heated air neutralizes that spore-ific whiff in winter, but today in June my nose curled mycotic as I peeped like a Tom. Passion, hmmm. Mold!

Empty, maybe they moved out, moved on. Were they still together? For one, I wanted them to be like mate-for-life birds, penguins? Woodpeckers? For two, though, no. Nothing lasts, not that kind of heat, not to be confused for love which is more of an acquired tolerance of mutual bullshit. Those guys in the Porsches, BMW's and Benzes, on the hunt with their pharmacologically supported pokers, they know, they hope. They of the last chance power drives want to feel lithe, hairless and smooth just one more time. Fools, dolts! Chumps...

Push-push, I moved on, thinking. Two weeks ago, the memory of her, Ashley? maybe, burdened me anew. Twenty-two maybe three; she, tender and wistful, looked at me in a way, inexplicable. She had a lonely sensuality as if she was unrequited, seeking... Surely I would have missed this signal, this invitation twenty years ago, but not now. Too bad, though, the evil masters of exhausted time and lost opportunities ruled that day and indeed this one too. Yet I could imagine her, side lit, midday, white sheets... Too slow and too soft to move then, a recent memory is no less draining than an old one. Curses! As it turns out... Memories are killers, more for the missed opportunities than the loss!

With the afternoon sun angled, I stopped at Stewart's and ate a hot dog slathered in yellow mustard. Bright yellow, that mustard, it glowed like it was high noon. Hope!


Wednesday, April 23, 2014

Tubo Catodico

"Hai già visto questo stupido film dieci volte. Perché lo vuoi guardare di nuovo? " Chiara era arrabbiata.

"Perché mi piace!" disse Fabrizio con la saliva agli angoli della bocca.

"Ti piace!" rispose lei. "Credo che ti piace guardare Belen Rodriguez e il suo culo, il suo culo grasso."

"E allora, quello che mi piace sono affari miei fatti".

Sospirando, "Dovresti guardare il mio culo con desiderio?  Perché lo fai più?

"Aw, Chiara, non ora. Tu sai che io sono depresso per il mio infortunio alla gamba. Un uomo che non può fare il suo lavoro è solo un mezzo uomo. Non sei tu, sono io. Sei ancora sexy. Inoltre mi fa impazzire come quasi svieni quando tu vedi Balotelli in TV.

"Ah - ah, Balotelli! No, io preferisco Stefano DiMartino. Ironico che lui è con quella puttana, tua puttana, Belen R-o-d-r-i-g-u-e-z. Odio Argentina!"

Infatti il rapporto tra Chiara e Fabi aveva colpito le rocce. Certo, per il momento due persone stanno guardando la TV insieme, il fuoco della passione si spegne. Tra due persone soltanto il calore è importante. Il resto è la jibber jabber di dentro e fuori della vita. Una televisione, in particolare, è una cattiva notizia. Il piccolo schermo è tossico, che tra l'altro è una buona ragione per non mettere uno in camera da letto.

Chiara Zilli aveva intenzione di rompere con il poverino, cercando le parole giuste. Purtroppo questi tipi di parole devono rabbia a loro carburante. Rosso di faccia, i capelli scuri quasi troppo rossi, sbottò , "Forse dovremmo affrontare la realtà, il nostro matrimonio è morto! "

Due aborti spontanei e senza figli agiscono sempre a discepito di un matrimonio. I bambini sono la colla. Appiccicosa, colla tenace che tiene un uomo e una donna insieme al di là della infatuazione che incitava la febbre. E' il desiderio caldo, la cosiddetta prima fase, che è ricambiato con la nascita di un figlio. Senza il bambino mette irrequietezza mette nella relazione, l' infatuazione svanisce come il blu, nei jeans lavati . E la TV non può risolvere quell’agitazione.

Ogni rapporto guastato  può essere definito dal punto di rottura. Spesso si tratta di un evento insignificante come una tosse durante il coito o un debole bacio labbra sottili. A volte può essere una bistecca bruciata o una camicia perduta. Ma per Chiara e Fabri si tratta di un argomento insipido della TV. Così triste. (: (:

Alcuni dicono che la TV è il soporifero delle masse. In breve, un istupidimento di percezione per alleviare di mezzo il dolore di vivere, il dolore della vita. Forse è così, con le immagini e i colori, i suoni e lo sfrigolio del "tubo catodico" è un ciuccio. Nessun pensiero necessario è il motto del mezzo.



"You already have seen this stupid movie ten times. Why do you want to watch it again?" Chiara was angry.

"Because I like it!" Said Fabrizio with spittle in the corners of his mouth.

"You like it!" she retorted. "I think you like to look at Belen Rodriguez and her ass, her fat ass."

"So what, what I like is my business."

Sighing, "You should look at my ass with such desire. Why don't you - anymore?

"Aw, Chiara, not now. You know I am depressed from my leg injury. A man who can't do his job is only half a man. It's not you, it's me. Besides it makes me crazy how you almost pass out when you see Balotelli on TV.

"Ha-ha, Balotelli!! No, I prefer DiStefano. Ironic that he is with that whore, Belen."

Indeed their relationship had hit the rocks. Certainly by the time two people are watching TV together, the fire of the passion is extinguished. Between two people only the heat is important. The rest is the jibber jabber of life's in and out. A television, in particular, is bad news. The little screen is toxic, which by the way is a good reason never to put one in the bedroom.

Chiara Zilli was planning on breaking off with the poverino, searching for the right words. Unfortunately these kinds of words need anger to fuel them.

Red faced, her dark hair almost red too, she blurted, "Maybe we should face the reality, our marriage is dead!"i

Two miscarriages and no children always act to the detriment of a marriage. Children are glue. Sticky, tenacious glue which holds a man and a woman together beyond the infatuation which incited the fever. It is the hot yearning, the so called first step, which is requited with the birth of a child. Without the baby, restlessness sets into a relationship as the infatuation fades like the blue in washed jeans. And TV cannot solve that agitation.

Every failed relationship can identify the breaking point. Often it is an insignificant event like a cough during coitus or a weak, thin lipped kiss. Sometimes it can be a burnt steak or a lost shirt. But for Chiara and Fabi it is an insipid argument about TV. So sad.

Some say TV is the soporific of the masses. In short, a dumbing down of perception to ease the pain of living, the ache of life. Maybe so, with the images and colors, the sounds and the sizzle the "boob tube" is a pacifier. No thinking needed is the motto of the medium.

Monday, April 21, 2014


Solo sole solo, lei! Sometimes he thinks in Italian although he is not fluent. Half baked, potato, mostly sums him up. Nobody knows him or so he thinks. Nobody knows everything about him. Odd, a bit, but isn't everyone a bit odd. Why else would he come here ogni giorno to the rock ledge overlooking a Sargasso Sea of weeds, hoping for salvation. A place where he has always come...

The small beach is rocky, but people here in Essington think of this as Amalfi. Across from PHL, the air resonates with turbulent burps and it smells a little, too. Jet fuel is aromatic, more so on bright days. Has it something to do with ozone? Magical is the sun, indeed!

Principessa, he would call that if he could. Oh, she reflects the light, making it beautiful for the privilege of kissing her. So stunning, she dries his mouth as if he put pure desiccant up his nose. Cocaine. Looking, a-stare, speechlessness leads to his bereftment. Today he looks older and haggard-er. Men, like ladies, have short half lives. When the decrepitude of age makes brutto a middle name... Hobbled and ... Yeex!

Once in another lifetime he came here, skin supple, he hard at will; then he prowled like a feral cat. Then he never felt pain, no discomfort. You might say his body fit him, but now, well, a fat suit better said. Memories flood him, looking at these people thinking they are Europeans. In fact, he once thought that as well. Tight and contorted, do they eat? He moves his foot, a few pebbles cascade towards Principessa two meters hell-ward, beached below him. Unnoticed little stones still pitter. Patter.

Once, a while ago, he had a telepathic thing with a skinny sylph, who went by the name, Lisa. Really her given was Doris, but people from sensual European countries are not Dorisses. Is Doris a Greek name, Dorian derived? Certo! No matter, only a person with a small heart could be a Doris. Between them, Lisa and him, no words needed. Too bad she had a flag in her umbilicus, planted by some guy from Llanerch. Who knows, words might have been tossed between them leading to... Whenever he reached out to her telepathically, he squeezed his ears together and he thought his pituitary was an antenna. He forced his energy up into his noodle by Valsalva reversal.

Looking at Principessa he decided to try his telepathy. Ears tight in, forehead furrowed like a cold scrote, he thought. Ti amo! TI AMO! TI AMOOOO!!!! A man his age shouldn't telepath so hard. Push! Oh no! Woozy, first his bad knee buckled, then his head went forward and like those pebbles he went... Off the wall, onto the beach, arms and legs akimbo. Pitter. Patter. A face plant is quite a thing to watch.

Bleary eyed, he awoke in the emergency room, whereupon some green doctor told him he was lucky, nothing broken, just scrapes and contusions. Mostly il medico wanted to know about a tetanus immunization.

"Yes, yes last year when I slip stepped a rusty nail, yes!"

"Principessa, is she alright? Hurt? Oh did I hurt ...." he trailed off.

"What? Princip, what?

"My love, did I hurt her?"

An old man, seemingly confused, can't recover. Deemed pazzo, credibility is lost and everyone pets you as if you are a dog. Nobody to call, no friends, he had to stay the night for observation. So to speak. As for Principessa, she left the beach shortly after la stella è caduta dal paradiso. She is a dancer, lithe and quick. She and her friends are contracted ballare nel video di musica. Professionals, yes. If the old man YouTubed he would find here there, moving so deftly, tears would wash his face.

Purtroppo, there is no happy ending for him. Should there be? No! Each person gets a chance, some more, some less, lucky or luckless. Oh well, it always comes down to the small things, some irrelevancy or another, upon which life is fulcrum-ed. Boh! Maybe he should have talked with Doris. Telepathy be damned. Would she seen have him differently, say in red, green and white? Imagine! At least she or one of their kids could have come to get him after his o-b-s-e-r-v-a-t-i-o-n ended. He should have married, eh? He should have planted una bandiera. Ovunque...