kicking my oil addiction

my car smells like french fries -- badly burnt french fries

Exciting stuff, friends. My little baby "Yelley Elley", my sunny yellow new-old diesel 240D Mercedes Benz, has made the leap off the grid. Just last week I started filling up with biodiesel. Straight out the pump, can you believe it?

What is biodiesel, exactly? Well, in this case, it's B99.9 - 99.9% walnut and soy oil, 0.1% diesel fuel. So while I'm not 100% off the grid, I'll take 99.9% any day. I'm paying a bit more ($3.30/gallon) but that's $3.30 not going to Big Oil. Plus, my car smells like burnt french fries out the tailpipe (better than than smoky mess that spews from a semi-truck), helps the environment, and runs smo-o-o-oth.

There is at least one other of us at Harbor using biodiesel. Another uses compressed natural gas (and she wants just 5 mo' minutes of sleep - hint hint). Several - I count 5 - use hybrid gas/electric engines including Su's ever-recognizable Prius. So I KNOW at least a few of us are taking action on our wasteful use of the Earth's precious resources, and I'm CERTAIN that we all are at least somewhat concerned. So, below I've posted a upcoming conference in LA on biofuels.

And check back here on my blog for more updates on my life driving the fried flyer.

FIRST LOS ANGELES BIODIESEL COMMUNITY CONFERENCE TO BE HELD AUGUST 1ST

Press Contacts:Rob Reed: 310-399-3659 - rob@conservfuel.comGretchen
Gray: 310-880-3892 – gretchen.gray@sbcglobal.net

The first Biodiesel Community Conference will he held August 1, 2007 from 7pm to 10pm at Mt. Olive Church,1343 Ocean Park Blvd., Santa Monica, CA 90405. Los Angeles, CA – (July 16,2007) The Los Angeles Biodiesel Community Conference is open to the general public and will offer action-based discussions on Biodiesel Basics, Legislation, Local Distribution, School Bus and Other Fleet Usage, Biodiesel Education, and more.

The event is being sponsored by Southern California Disposal and Recycling, and will be hosted by The Los Angeles Biodiesel Working Group, the LA Biodiesel Co-op, Socalbug (the Southern California Biodiesel Users Group), and Josh Tickell, author of “From the Fryer to the Fuel Tank” and “Biodiesel America.”

The purpose of the conference is to empower and educate the public, local businesses and community leaders in their efforts to make biodiesel a viable fuel option for Southern California. Collectively we will establish a groundbreaking action plan that will provide the steps to expand biodiesel distribution in Southern California and establish new legislation that promotes sustainable fuel options.We, as a community, can make biodiesel an affordable and available fuel option. It is time for us to unite and take action today!

For more information, visit www.socalbug.org.Please contact Rob Reed or Gretchen Gray to schedule an interview with the following individuals to discuss the Biodiesel Community Conference agenda and action plan before or at the event: Josh Tickell – Author/Filmmaker; Kent Bullard - Chairman of Socalbug, a 501c3 non-profit organization, and Kris Moller – Owner/Operator of Conserv Fuel (www.conservfuel.com).

If you would like to attend the Biodiesel Community Conference please R.S.V.P. to: http://www.evite.com/pages/invite/viewInvite.jsp?event=RPOJJMHHFRVGPATDMHFR&unknownUser=true
-- Kent BullardCFO (Chief Founder & Operator)Southern California Biodiesel
Users Group, Inc.kent@socalbug.org
805-218-6945

from the desk of the Resident Clinic Director - improving patient care and diabetes

Hi all. No, not another anti-Pharm diatribe from me. This one is a clinical diabetes case from the Harbor-UCLA family medicine clinic:

You all know that a few of us family med residents have been involved in the diabetes chronic care collaborative with Drs. Snyder and Cheng. We've been trying to provide intensive and attentive care (including testing, treatment, education, and self-management) to our most out-of-control (OOC) diabetic patients. Heres an example from today's RCD experience that shows what were up to.

* Please talk to one of us if you're interested in participating in the collaborative!*

Mahdi alerted me to a nursing visit BS OOC - 269 fasting. (This is something you have to address in the few spare minutes you have while RCD between triage, med refills and the occassional fire that erupts in the waiting room. It's fun, actually.) This 66yo Latina lady with her daughter at her side explained that shes NEVER been in control of her diabetes in the 15 yrs shes had it. Her last A1c in 1/07 was 9.8. Her home BG is 200-400. She's been seen only a couple of times here, but already her meds are maxed out: metformin 1000/500/1000 (max), pioglitazone [Actos] 30, glipizide 20 bid (max). So, fair doctor, what do you do?!

Obviously her oral meds arent doing it. Your choices are: increase the actos to 45 (max dose)? Start a 4th agent - acarbose, Januvia? All of the above? Start insulin? Take a second - based on what you know about this lady's diabetic control, how can you best help her?

Well, a little bit more of the story helps. First, she and her daughter are asking for insulin. That doesn't happen too often (many patients fear that insulin causes blindness, amputation, etc - educate patients, people!), but when someone has a chronic, debilitating condition that isn't helped with maxed oral meds, she knows that only insulin can help her. Smart lady. Fortunately she's been given insulin in the past so knows the routine. I start her on NPH 10 units (she's thin, so 10 is a good start. If shes obese, I might start 16 units) before bed and counsel her on increasing the dose every 3 days by 2 units if her AM fasting BGs are >130. Both she and her daughter understand, but adjusting insulin like this is tough for newbies; she might need more counseling in the future.

What else do I do? She's already on 3 orals hypoglycemics. What else? carvedilol, lasix, losartan, simvastatin, warfarin - the ingredients of a cardiac patient. Turns out she has CHF and a prosthetic mitral valve. Question: Should she continue Actos? For one, it's not helping and increasing it to 45mg probably wont help either. Second, many speculate that the heart failure dangers of rosiglitazone [Avandia] may be a class effect, so right now we cant be sure that pioglitazone [Actos] wont lead to failure also. Especially in this patient who a) isn't helped with Actos and b) has a history of CHF, we may be doing MORE harm than good giving her Actos even IF she had had A1c improvement. So, I D/C it.

How about the glipizide? She is on a hefty dose of this sulfonylurea which, on its own and especially when given with insulin, can induce hypoglycemia. So I D/C that too.

I keep her on the metformin at the same dose to continue her peripheral insulin sensitization and inhibit gluconeogenesis, but not after checking her creatinine first to make sure it's <1.5 and she's not at risk for lactic acidosis.

Why this email and why this case? Many of our patients are languishing with OOC diabetes on the same stale regimen they've been on for months or even years. Don't be afraid to start ramping up therapy more rapidly. We are working on clinic infrastructure improvements to make doing this easier. Secondly, I, for one, will start discussing insulin therapy with all of my diabetics, even those on less-than-max oral therapy. Bringing up insulin early and in the context of physiology (insulin therapy is, after all, just hormone supplementation) may help patients understand their disease as well as dispell some of the myths and fears around insulin use. SubQ injections are, after all, a lot less scary than foot ulcers, amputations and blindness. Finally, don't forget to be a family doctor and see the patient as a whole. What is her understanding of her disease? What does she want from her visit? What other comorbidities does she have that would change therapy or clinical course? Protocols are tremendously helpful, but they aren't for everyone. Treat the person, not the disease.

Fortunately she has follow-up here at clinic with her primary doc on July 24, less than a week away, and I'm curious to see how well her sugars are controlled but moreso to see how well she and her family take to her new treatment regimen. I think they and I will be happy with the outcome.

~Casey

cross-posted at:
the Life of KirkHart
Harbor-UCLA Family Medicine blog
Cure This!

Wicked is Wild

April and I were finally able to appropriately celebrate our 5th! wedding anniversary last night. April had arranged for us to see Wicked at the Pantages in Hollywood.

What an incredible show. The music is unique and fun. The performances are out of this world, and if you are any bit a Wizard of Oz fan, then the official untold backstory to Wizard of Oz that is Wicked will get you going. Highly recommended.