Prankster at large

During my sophomore year in high school, I caught a ride to and from school with the juniors in my neighborhood. I wasn't old enough to have a driver's license, but they were. Four days a week they ran a carpool, one guy assigned to each weekday. On Fridays my mom drove us.

There was mischief, naturally.

Somebody came into possession of a condom. I don't remember who or how. The driver that morning —  let's call him Herb (not his real name, not even his first initial) —  had taken out his wallet for some reason and left it on the car seat while he drove. I distracted him and slipped the rubber into his wallet. My hope was, his parents would see it later and ask all kinds of embarrassing questions. Good fun, right?

It gets much better.

That afternoon on the way home, things got a little crazy in the car. Herb flew past an elementary school at a high rate of speed. The school zone limit of 15 mph was still in effect. Unfortunately for Herb, a State Trooper happened to be in the vicinity.

He chases us, pulls us over, and accuses Herb of going 62 in a 15. Catastrophe! Herb freaks out. The trooper sternly commands Herb to get out of the car and then demands his driver's license. Herb reaches into his back pocket, fumbles around nervously with the wallet… and the condom falls out onto the pavement.

I don't believe even Truman Capote could describe the look on Herb's face. The trooper breaks out laughing and lets Herb go with just a warning. I'm still laughing about it.

True story from 1970. Herb, wherever you are, you can't get mad at me because my practical joke saved your ass.

One of my favorite episodes of M*A*S*H was the revelation that placid B.J. Hunnicutt was the camp's secret practical joker, with a string of marvelous successes.

Yes, I still try to pull a good practical joke every few years. They require careful planning because I strive for quality, not quantity. Ask around, you'll hear. At work, ask Steve about the Frontline restaurant. At church, ask Becky about the fake newsletter. And watch out; you could be next.

Prince's Percocet

At this time it's difficult to tell what role Percocet played in the death of Prince, but there's an aspect of Percocet that is worth considering even if it wasn't a factor for Prince.

Percocet is a combination of oxycodone and acetaminophen. We hear a lot about the addictive dangers of oxycodone, an opioid. We don't hear so much about the dangers of acetaminophen, the over-the-counter drug used in Tylenol. The truth is, acetaminophen can be dangerous — or, as the FDA puts it, "Acetaminophen has a narrow safety margin".

Percocet tablets come in different strengths of oxycodone, from 2.5 to 10 mg per tablet. The prescribing physician selects the dosage of oxycodone based on how severe the pain is, how much risk of addiction there is, how large the patient is and what the patient's experience with opiods has been, and so forth. But every Percocet tablet, regardless of much oxycodone it has, also contains 325 mg of acetaminophen. The same is true of Vicodin, which uses hydrocodone instead of oxycodone.

Why does this matter? Because an overdose of acetaminophen can kill you by wrecking your liver. Acetaminophen overdose has replaced viral hepatitis as the #1 cause of acute liver failure in the U.S. About 50,000 Americans go to an emergency room each year because of acetaminophen overdose, and about 1% of them die. Even when they survive, it's a very unpleasant and expensive recovery that is only partial in many cases. It's an ugly way to go, and it's an ugly condition if it becomes chronic.

The FDA knows all about this problem, but it also recognizes the usefulness of acetaminophen when used in accordance with guidelines. The limit for acetaminophen consumption is 4000 mg a day for a healthy adult. (For someone whose liver is already compromised, it's lower.) Because of the prevalance of acetaminophen overdose, some have argued that the limit should be reduced to 3000 mg a day. Either way, if you stay within the guidelines for acetaminophen dosage, you will not exceed the limit:

• Two tablets of 325 mg each, four times a day, is 2600 mg per day.
• If you take two of the larger 500 mg tablets, three times a day, that's 3000 mg per day.

But people who exceed 4000 mg are putting themselves at grave risk. For that matter, even 2600 or 3000 mg per day every day over a long time could be troublesome. If you use that much acetaminophen, discuss it with your doctor who may recommend blood tests of liver enzymes.

Back to Prince. People who get Percocet tablets with low doses of oxycodone — the 2.5 or 5 mg doses that, some say, are easier to get a physician to prescribe — may be tempted to double up or triple up on their consumption of Percocet in order to get the amount of oxycodone that they crave. Problem is, in the process they unwittingly exceed the daily limit on acetaminophen. Did this happen to Prince? I don't know. But it has happened to other people.

By the way, acetaminophen is not the only over-the-counter pain relief medication with a narrow safety margin. Aspirin, ibuprofen (the active ingredient in Advil, Motrin, etc), and naproxen (the active ingredient in Aleve, Accord, etc) are in the same category. And combining the maximum daily dose of several of these NSAIDs can also be dangerous.

Aching Achilles?

A photograph of my right heel:

Maybe yours looks like this. My left heel looks basically the same. The bump in the blue oval is caused by a bone spur underneath the Achilles tendon, and it has the effect of stretching the tendon in a manner similar to the bridge of a violin:

Well, not so dramatically, but you get the idea. Problem is, Achilles tendons don't like to be stretched like that. Inflammation of the Achilles tendon, called Achilles tendinopathy, can be quite painful. And this is a problem that I've fought for seven years. I've learned a few things about the problem and how to manage it, so I'll offer these in case you might find something useful.

But first, the inevitable disclaimer: I am not a physician, and I do not practice medicine. My story may not be applicable to you. All your medical conditions should be evaluated by a physician or other qualified and licensed provider of medical care.

My initial reaction was to see an orthopedics MD, who x-rayed the ankle and diagnosed the condition. He said that surgery to remove the spur is a last resort because the rate of failure or complication is significant, recovery is lengthy and difficult, and the spur might grow back. He was reluctant to recommend an injection of steroids because of potential complications also. Instead he prescribed oral steroids, which helped immediately to reduce the inflammation. But long-term oral steroids are to be avoided whenever possible. Next he recommended physical therapy, which I tried for four months and consisted of two treatments: stretching exercises and additional steroids infused via iontophoresis. I found that the stretching exercises made things worse, and the iontophoresis was less powerful than the oral steroids. Besides, PT was expensive, time-consuming, and inconvenient.

During and after PT, I figured out a few things on my own:

• Shoes matter a lot. Thick-heeled shoes help because they elevate your heel and relieve tension in the Achilles tendon. Flat-soled shoes are your enemy. Don't bother to fix flat-soled shoes with inexpensive inserts that you can buy at a drug store; the fix won't work. Just get new shoes.
• When your tendinopathy is acute, minimize the amount of time you're on your feet for a few days. It's not the time to visit an art museum or walk on the beach. Postpone those until you're better.
• Don't go barefoot, even inside the house.
• Pain relief cremes are helpful. The one that works best for me, Movelat, is available only in Europe. But Aspercreme and its equivalents work too.

My next visit was to a podiatrist that my family has had very good experiences with. In hindsight, I should have gone to him first. He agreed with the diagnosis and said it's not uncommon for stretching exercises to be unproductive or even counterproductive. He agreed with my other observations and suggested two more measures. One, he provided custom inserts for my dress shoes to elevate my heel further. (I suppose I wear high-heeled shoes now.) Two, he prescribed splints to wear at night.

These look formidable, but I came to appreciate them. They stretched the Achilles tendon very gently while I slept. After six months of wearing splints, I found that I didn't need them anymore.

Obviously my condition has not been "cured" because the bone spur underneath the Achilles tendon is still present and possibly still growing. I can say, however, that for the time being these measures have reduced the condition from a substantial constraint on my activity to a mere annoyance. If you have Achilles tendinopathy, good luck and let me know what works and what doesn't for you.

Holiday no more

Last month I drove 400 miles on I-95 from North Carolina to the Georgia/Florida line. I lost count of the derelict or decrepit motels along the way.

By 1970 Holiday Inn alone had opened over 1,000 hotels, most of which were along the then-new Interstate highway system and many of which faced a Ramada, HoJo, Best Western, Travelodge, Econo Lodge, Days Inn, Super 8, Knight, Red Roof, or Motel 6. All these hotels were built to the same pattern: rooms opening to an outdoor walkway, thin walls, one or two floors, an onsite restaurant and an outdoor swimming pool — a regrettable combination of cookie-cutter architecture and inexpensive construction.

Almost nobody wants to stay in a roadside hotel like that anymore; our tastes have moved upward to Hamptons, LaQuintas, and Fairfields. Problem is, the pre-1980 properties that the modern brands replaced linger on. Some have been wiped clean to their slab foundations, never redeveloped. Weeds and even small trees grow through cracks in the asphalt and concrete, surrounded by rusting chain-link fences. Others are operated as deep-discount hotels catering to transients by the week, lovers by the hour, and operators of meth labs. The remainder simply sit there, eyesores that instantiate the recent TV show Life After People. Nationwide the number of empty hotels surely numbers in the thousands.

When a commercial building is erected, I'd like to see a requirement for the owners to place an amount of money on deposit with a trust fund and sign a covenant that if the property sits idle continuously for ten years, the trust fund can take over the property, demolish every building, replant it with natural vegetation, and deed the property to a nearby town. I doubt such a policy will ever be implemented, but instead more cities could act to acquire and remediate these properties.

Closed or open stacks, it doesn't matter

My alma mater, Georgia Tech, has announced a deal with Emory University that has the effect of moving Tech's library to Emory. As the two institutions noted, the existing collections of the two libraries have very little overlap because of the nature of the institutions. Suburban Emory has room to expand on its campus, but urban-core Tech does not. There will be economies of scale in operation after consolidated. The move will also allow Tech to reuse its two library buildings in the center of the campus. No doubt there is a feeding frenzy among professors and staff for that space. These are all good reasons to proceed with consolidation.

Not having any direct relationship with Tech since 1985, I find the move interesting because of what it says or implies about university libraries. Most technical journals in science, mathematics, and engineering have been digitized going back decades. Professors and students are now accustomed to browsing those journals online. The fact that the Tech collection of physical books and journals will move five miles away — not the easiest trip to make by MARTA, with parking constraints at Emory too — doesn't seem to be objectionable to anyone.

Many more technical journals are being published now than when I was a student at Tech (1972-76 and 1978-79). Conversely, fewer traditional books are being published. When I did research during grad school, I found that books from the 1950s and 1960s were a more efficient source material for me to use than journals. Why? Because a book typically had a full spectrum of information on a given topic, whereas journal articles were scattered across hundreds of feet of shelves. Online access makes that problem go away. Meanwhile the content of books that haven't been digitized becomes less relevant to scientists, mathematicians, and engineers each year.

Furthermore, between Google and Wikipedia, there is a lot of information readily available without having to go to a physical or virtual library. I know you're thinking that only a fool trusts Wikipedia completely. For many subjects, I agree. But on some specialized topics, Wikipedia can be quite good. An example is Wikipedia's article on Mellin transforms, a tool of mathematics that was central to my interest. This type of reliable information could take 30 minutes to find in a physical library under the best of circumstances, even with the help of a professional.

The irony, however, is that I became aware of Mellin transforms only because I browsed the stacks at the Tech library. That's how I ran across a book describing them. Emory's library is closed stacks, and the newly consolidated Tech-Emory library will be closed stacks too. I have read that NC State's new library is closed stacks. It's apparently an irresistible trend. Those of us who like to browse will have to be content with online access.

About HB 2

Usually I avoid politics in this blog, but I want to make a few points about North Carolina's House Bill 2:

• HB 2 follows Amendment One, which wrote into the North Carolina Constitution a definition of marriage as solely man-woman.
• 93 of North Carolina's 100 counties passed Amendment One, in some cases by over 80% of the voters in those counties. Statewide, Amendment One received 61% of the vote in an election that drew 35% of registered voters. The hideous but inescapable conclusion is that a majority of North Carolinians — not merely the legislators they elect, but We the People ourselves — are fully prepared to discriminate against LGBTs and to re-write laws to allow such discrimination.
• If you want change in North Carolina, start with people in those 93 counties and the voices they listen to.
• North Carolina is a key battleground state for the presidential election. Political operatives at the national level drove the introduction of HB 2 at the North Carolina General Assembly. It's a deliberate tactic to activate the conservative voter base in North Carolina in anticipation of November.
• I heard a journalist on WUNC say that Governor McCrory had "changed" (verbatim) HB 2 by means of Executive Order 93. That, of course, is nonsense. The Governor has no right to amend the law that the General Assembly adopted and he himself signed last month. The law remains on the books as-is.
• Into the 1960s and perhaps onward, a majority of voters in the South were likewise fully prepared to discriminate against African-Americans — and did. The role of the federal judiciary is to protect minorities and prevent such discrimination. Although federal judges don't always do the right thing, often they do. A federal judge in North Carolina struck down Amendment One. But opponents of HB 2 had better prevail in one of North Carolina's three federal court districts or before the U.S. Court of Appeals for the Fourth Circuit in Richmond, Va. The U.S. Supreme Court is likely to split 4-4, affirming whatever the lower courts decide. For the time being, judges whose names you probably don't know are very important people.

Hard to watch and hard not to

Sportswriter Scott Fowler of the Charlotte Observer aptly described Jordan Spieth's meltdown at the Masters yesterday: "It was hard to watch. It was hard not to watch."

Don't we often feel that way? I'm not referring to schadenfreude, the German word we so often read these days because the English language has no concise, direct equivalent for enjoying someone else's misfortune. Yesterday was not schadenfreude because hardly anyone derived pleasure from seeing Spieth's game collapse like that — not even his opponents in Augusta. Nor do I believe that those of us who have played golf on occasion and found it to be so much more difficult than it looks on TV had thoughts of vindication and equality when Spieth put two consecutive balls into Rae's Creek.

I'm sure that psychologists have researched why we find disasters, whether natural or personal, so riveting. We rubber-neck at highway accidents. We repeatedly watch TV replays of crashes at Daytona. The dénouement of the golf movie Tin Cup hung on a meltdown. Golf is a particularly strong trigger for this aspect of our psychology because golf is usually an individual sport with a slow pace. I am reminded of the intro to ABC's Wide World of Sports. We saw it countless times, a solitary ski jumper crashing in spectacular fashion. Not only did we never tire of it, we brought "the agony of defeat" into our culture as a catchphrase. (The intro was astutely scripted by the multitalented Stanley Ralph Ross.) Fortunately the athlete in that infamous clip suffered only a mild concussion and recovered completely.

Spieth was not physically injured yesterday. He has two or three decades of competitive golf ahead of him; perhaps he will play so well in future tournaments that he avoids the stigma of choking. Many people know that Greg Norman blew a big lead on the final day of the Masters twenty years ago — with bogeys on 10 and 11, and a multiple bogey on 12, almost exactly like Spieth. Norman was near the end of his best playing years, and plagued by injuries he could never dispel the public's recollection of the event. On the other hand, almost no one knows that Arnold Palmer blew the Masters in 1961. He won it in 1962 and again in 1964.

Will Spieth recover to enjoy the "thrill of victory"? We must wait and see. I hope so. Public humiliation is fit punishment for crime, not a desirable or necessary part of sport.