The Town Hall Meeting; aka The Giant Straw Man Convention

From the Representative's website:

CONGRESSMAN BACHUS SAYS TOWN HALL WAS AMERICA AT ITS FINEST

WASHINGTON – Congressman Spencer Bachus (AL-6) today thanked citizens in the 6th District for their participation in his Town Hall on Health Care.
A crowd estimated at two-thousand people filled the Cahaba Grand Conference Center in Birmingham during the meeting on Monday.
Congressman Bachus made the following remarks.
"The Town Hall was American democracy at its finest and I hope the spirit of fairness displayed will serve as a model for the nation. People on both sides of the issue spoke with passion, but were treated with respect and civility by a large crowd. I am opposed to a government takeover of health care because it will lead to rationing, reduce quality, and raise costs. But the meeting raised areas where we can find common ground, including making private insurance more affordable and accessible, curbing fraud and waste, and making sure illegal immigrants don’t participate in any taxpayer-funded program. I want to personally thank the two-thousand people we estimate were in the room, as well as hundreds of others who wanted to attend. Your participation is vital and by speaking up you have already made a difference."

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Well, okay, there are some things about this press release that are true. There were indeed over 2000 people in attendance. It was an amazing turnout. We arrived 30 minutes before the doors opened to find the line already wrapped around the complex all the way to the back. The seats filled quickly and many, like me, sat cross-legged on the floor between the stage and the front row or between aisles while others stood wherever space could be found. As anyone who is familiar with central Alabama might guess, the crowd was maybe 95% white, comprised of mostly professionals (we saw many attorneys and doctors -- and I was thrilled to see my favorite history professor, now retired). While in line, it was interesting to listen in while groups of men in company polos and khakis conducted frat-boy type posturing, each in turn giving his generalized projection for the future state of affairs. Now and then a sign-bearer would slowly stroll by, saying nothing but hoping someone would read their message. Close behind would follow a card-bearer in flowing skirt and sport sandals or a bearded and braided man donning some t-shirt message about constitutional rights, passing out web addresses for their grassroots organization. It was the most civil demonstration I've ever witnessed.

And sure, the Town Hall Meeting is American democracy at its best. However, I wouldn't say that this town hall was democracy at its best. This was a rally, plain and simple. Still, it was comparatively civil. But, this is Alabama -- people don't get real fired up unless you insult their mama or their Jesus, or try to take away their gun rights. Well, and as we will see, the topic of illegal immigrants.

I do agree the main themes of the night were as he stated, "making private insurance more affordable and accessible, curbing fraud and waste, and making sure illegal immigrants don’t participate in any taxpayer-funded program." In fact, they seemed to be the only themes -- with emphasis on the last. And unfortunately, anyone that wished to introduce anything other than those three topics was quickly boo'ed. The problem with the three themes is that they all had to do with changing the system that's in place now, not about how these ideas would be addressed in the bill.

Now, I am not a Republican, but I can respect this man and was honestly impressed with Rep. Bachus's ability to diffuse anger. But mostly I was impressed by how craftily he developed a straw man in response to questions, particularly those made by proponents of this bill, so large and blatant you could just sense the fire danger. Quite impressive skill there, I must say. And although I know that comes across as sarcasm, I genuinely do admire good debate skills and he certainly does possess them.

And as the night went on, our flammable friend only got bigger. If the question had to do with the problems with the current insurance system, he'd throw up a chart representing how many of the uninsured are actually illegal aliens. In response to a multi-part question regarding how this bill will affect the elderly, the ballroom erupted in raucous applause when he shouted, "If you are here illegally, you don't get health benefits!" When someone asked whether this bill could be repealed in the case it is passed, he responded with more about illegal immigrants.

Ok. Can we burn this straw man down already? We get it: illegals bad. But it would seem Rep. Bachus would have us believe that if only we could change immigration law, we'd have a perfect health system. So, as in the case with other Town Halls across the country, it's clear this one didn't accomplished much of anything, other than to further underscore the divide between the two sides. Still, way to go District 6 for a relatively civil meeting rally.

Cellphone + microscope = Cellscope!

I don't always repost on the cool things I come across but this was worth it, even if KC and Harvey are the only ones that will really share my enthusiasm.

The folks at Fletcher Lab in Berkeley have fitted a light microscope to an ordinary cellphone. It can snap a photo of a specimen which can then be zipped off through the ethereal radio waves to a clinician for review. Great application for regions not served by hospitals or clinics.




"The CellScope project focuses on the development of a modular, high-magnification microscope attachment for cell phones. Due to its portability, affordability and functionality, the CellScope will enable health workers in remote areas to take high-resolution images of a patient's blood cells using the mobile phone's camera, and then transmit the photos to experts at medical centers. This device can reduce both the cost and time of performing critical disease diagnoses, as well as provide early warning of outbreaks in poverty-stricken regions in the world.

The CellScope team is developing a range of prototype lenses of varying lengths, giving either low or high magnification, depending on the lens and the application. The team envisions that the final product, after the optics are optimized, will be only a few inches long and weigh less than a pound. Already, they have successfully imaged malaria and tuberculosis (TB) using the CellScope system with image quality comparable to standard diagnostic microscopy. Their current focus is on developing applications to tuberculosis (TB) diagnosis and monitoring. Over the next year the team plans to carry out a pilot field study in collaboration with partner and begin the revision of the CellScope based on field test data."

Birthday Girl

Charlotte was suffering from unknown malady number three on her birthday:

But she was able to muster up some sunshine.

and even tend to babydoll's needs :)

And of course at the 2 year mark she has accomplished some significant milestones!

And of course, there's this kid, who has figured out how to make really cool photos.

Ok, so with a week gone by and Charlotte on the mend, we resume plans.

But Grandad needs to think a while...

Ok, thinking done and over with. On to better things.

(Righteous dudes.)

(Sorry everyone else, I either didn't get a photo of you or I promise you wouldn't want me posting the one I did get -- or I just got lazy)

Charlotte gets to play in water while we wait.

Madison says it's ready.

Happy Birthdays for Madeline and Charlotte

The Most Infectious Agent of All

Catch on fire with enthusiasm and people will come for miles to watch you burn. ~ John Wesley

One fine day in Microbiology lab the students lined up to get their agar plates dosed with various infectious agents such as Staphylococcus areus, E. coli, etc.

An inoculation station was set up at one side of the room across one long table -- one swabber for each of the four types of bacteria to be cultured. A student would approach, agar plate in hand, and said Swabber would dip into the bacterial-laden broth and rub a bit on the appointed sector. The student would then step over to the next bacteria station and get swabbed with that particular bacteria and so on until all had been visited. This was repeated for six plates for each of about ten groups. So, that's an awful lot of swabbing.

Perhaps not so noticeable during all this swab, swab, swabbing was that another contagion was being spread as well. It didn't come from a culture of dangerous, flesh eating or gut rotting bacteria. It wasn't being sneezed out as a virus or anything like that. This contagion was being spread via a very innocuous manner not likely to alert the hapless host to its super virulent nature. Very simply put, one of the swabbers was making little gram-positive smiley faces on the agars. Now this may seem like a thing of very little significance, but not for those who were being systematically polluted by this act of enthusiasm. Upon receiving his or her plate back, each person showed immediate signs of having been infected as they were soon struck with strange fits of... ack!... smiling. Yes, the simple and effortless application of a smiley says: "hey, this if fun, this is interesting! Microbiology rocks!"

(It was supposed to be a smiley anyway)

The most infectious agent, it turns out, is enthusiasm. It can strike suddenly and with a virulence unmatched by any bacteria or virus. Enthusiasm is what makes teachers extraordinary and students successful.

The Greeks used the term to describe someone intoxicated by the divine inspiration of the gods. (yes, I looked it up!) Art, poetry, philosophy, all these things were the result of this divine possession. Of course, today it just indicates a devotion to or fascination of a particular topic or ideal. But I prefer the former meaning that presumes the enthusiastic person is in possession of some sort of "essence" that can move between individuals, if allowed, and is ever replenishable.

Now, sadly, some people seem to display immunity. Indeed, in any particular population, there will be a certain percentage of people who are immune to the effects of enthusiasm. They can't even be asymptomatic carriers. Not. One. Bit. We all know someone we suspect of having this condition, right? It's really too bad they can't know the happiness within brought about by, say, holding a really large model of a heart.

(Enthusiasm. Get infected today.)

Now, it's true that some people with an abundance of enthusiasm often get mislabelled (to put it kindly). It's the risk one takes when revealing any part of their true self. And it's a risk that, in my opinion, is always worth it in the end. After all, as Ralph Waldo Emerson knows, "nothing great was ever achieved without enthusiasm."

How to not make friends with Carpenter Bees

I was perfectly set up at my kitchen table: The laptop was hooked to a larger external monitor so I could see my virtual cadavers on the big screen. All my books, notes and paper were spread before me in a semi-circle. I'd been studying well into the morning by now. Leaning back in the chair, stretching and yawning, I looked out the open doors to the back deck and nearly fell over. It was swarming with bees.

Well, on a sunshiny spring day such as this, this seemed a great thing. The plum and apple trees were in full glorious bloom with their limbs now above the level of the deck giving me a distinct feeling of being in the treetops. The honeysuckle growing up the fence was sending it's fragrance over on the morning breeze. It all seemed so... spring-full!

But then I noticed these were no ordinary bumblebees. Nay, these bees, friendly as they may have seemed, were of the carpenter variety. And they were moving in.

Now, you may ask "are you sure it's a carpenter?" Well, it's a good question. They may not, afterall, be carrying their union card. And you may not catch them with a mouthful of sawdust. So let me point out some distinctive features of these fine craftsbugs.

Carpenter bees do look just like bumblebees in size and shape. But carpenters have a smooth, black, glossy abdomen whereas bumblebees have black abdomens covered in yellow hairs.

Below is a Bumblebee. It is soft and cuddly looking, right? Fuzzy, striped.

And here you have its crafty cousin. This bee has a smooth, hairless rear, and, more importantly, it's sawing its way through my deck!!!

Look at this one hanging on -- come on, you know it's cool!

So, the good news is, the males don't have stingers at all. The bad news is, only the females dig these holes, so they're the only ones you'll likely ever have to deal with. But, the other good news is, they rarely use their stinger. In fact, you can handle these if you're careful and so inclined to do so.

However, as much as some of us would like to keep these around as pollinators (and heck, just for company) they have the unfortunate habit of chewing through wood. So I set out to discourage this -- and poison-free as well. I've read that you can simply plug up the hole with some wood putty. But I found this didn't deter them for a second. They just started chewing right back through it, possibly rather annoyed that they came back after lunch break to find their new sugarshack had just been stuffed with crap.

Still not wanting to coat the place with poison, I experimented with different glues (some of which were probably poisonous to something, yeah). Nope. They just regarded it as a minor setback and went back to work excavating. In the end, I went out there with a heated glue gun and filled the holes. I was surprised at how much I had to pump in before it started overflowing. I was also surprised to see this did not stop one very determined bee from getting itself half-stuck in glue.

(R.I.P, pretty Bee)

So I stood there a while, right arm across my waist, left arm bent up and making a fist upon which I could prop my befuddled head. And I thunk it over.

And here, folks, is the result of all that thinkerating:

I started sticking some spare pegs into the holes. They were a perfect fit! Wood screw hole covers would have worked just fine but this is what I had on hand.

So, a bit of glue, in went the peg and voila! They can't get in now! I placed eight of these in this way and watched to see what the little ladies would do about it. Sure enough, they could not get back in. Now, twice they started new holes and those got pegged as well. Finally, I was sure they had given up. Until I saw this:

Now, you've got to admire that tenacity! Not wanting to let all that hard work go to waste, she is attempting to gain entrance to her gallery from the side. She'd have done it, too, if I hadn't run her off. Sorry, sister.

So there you have it. A short visit from some friends that I unfortunately had to turn away. I closed up their properties and posted tiny little "Condemned" signs on them. But I suspect the were very soon happily chewing through someone else's deck.

Check back again soon as I'll be telling all about this beautiful lady and the conversation we had about our children:

Synesthesia

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Blended Senses

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December 2000

“I have a headache,” I tell her. She is walking away now and I’m trying to open my eyes. Why are we outside? The sun is in my eyes, damn it... drenching everything in red-orange blur. All I can make out are the silhouettes of people standing around me. Oh, here she comes. “No. Now. Something now” I say. I can’t wait for pills to work. The silhouettes start getting jittery. Some have their arms folded across their chests, others are gesturing wildly. One is coming closer.
“Do you know me?”
Of course I know him… the doctor with the red-orange hair. Wow, his sweater matches his hair. Nice, I try to say, makes you look heavenly...

_______________________

I am told I spent the next few days in ICU in a coma-like state. I finally woke up, still in pain. I had been transferred to the Red Room. The walls were a deep burgundy and the nurses wore head-to-toe maroon complete with matching face masks. I was confused. In Star Trek, they only don the reds for surgery. Had I been in surgery?

Actually, I was in quarantine until they figured out what sort of meningitis I had. All I remember is that everything was so red.

Months later, I was telling someone what I remembered from the Red Room.
“What red room?” he asked.
It was only after lots of arguing and phone calls that I finally conceded that room may not have been red after all. As it turned out, neither the first sunshiny room nor the doctor had been red-orange and the Red Room was actually white. So why did I see them in these colors? Had I gone crazy?

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I wasn’t really surprised. This was not the first time I’ve seen things differently than some people. Actually, one researcher says that as many as 1 in 23 people may have some form of synesthesia. Like me, these people may experience any variety of combined sensory perceptions. The most common form is colored letters and numbers in which a person involuntarily perceives letters and numbers (and other graphemes) to have color. For instance, where you see this letter "A" as being black, a color synesthete will see it overlaid with a different color. One synesthete might see it as orange, another might see it as blue. For synesthetes, this perception is very real to them, just as the black letters you are reading now are very real to you.

Other forms of synesthesia include having the perceptions of color (and/or shapes or texture) through hearing, touching or tasting. For example, when Sean Day, a colored-hearing synesthete, hears music he will perceive various colors in his visual field.

Another interesting form is lexical-gustatory*, a type of synesthesia in which words evoke taste in the mouth. Just like with most forms of synesthesia, people with this condition have in the past been dismissed as attention-seeking or hallucinating. As one of synesthesia's ambassadors to the world, James Wannerton has subjected himself to countless hours of research and brain scans (and film crews) to educate both academia and the general public. People don't "suffer" from synesthesia and it isn't a disorder. It is simply the way some people perceive the world.

There are about 5 common types but in all there have been reported about 61 subtypes of synesthesia. Here are a few examples from a list compiled by Sean Day:

• General Sounds --> Colors
• Phenomes --> Colors
• Tastes --> Colors
• Personalities --> Colors
• Grapheme Personification
• Object Personification
• Emotion --> Flavor
• Smells --> Sound
• Pain --> Sound
• Sound --> Flavor

When I was in pain and percieving everything around me to be drenched in color, I was experiencing "Pain --> Color" synesthesia. But it is not the only type I have.

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I first realized there was something different when I was about six years old. From the backseat of the family car, I was complaining about how it was difficult to keep up with days sometimes because once you got to Wednesday everything flipped around the other way. In my mind, Monday starts out with Tuesday to its right, and with Wednesday to its right. But once we're in Wednesday, the whole line flips around and now Wednesday presents with Thursday to its left, and Friday to its left, and so on. It's actually more complicated than that, but that's the easiest way to describe it.

(Above: Monday, dissipating, Tuesday and Wednesday follow)

My dad thought this was intriguing and asked me questions about how I thought of clock time. I remember him saying something like "wow, she has such a fascinating concept of time and space abstracts" which I remember to this day because it sounded so Carl Sagan-ey. (One of my favorite memories was sitting with Dad watching Cosmos on PBS)

My mom's response was equally memorable: "I think she may be retarded."

(Yes, that's the word she used. I mention that because, like so many others who have had their perceptions questioned, it embarrassed me -- I immediately shut up and never mentioned it to her again. )

But the difficulties I was describing were not limited to days of the week. I have this same trouble with numbers. 1 starts out with the rest of the line going off to its right, but occasionally when I get to a certain number, the view flips, turns, tilts, and so on. Many times, positive numbers continue off to the left, or straight up, or back to the right. As you might imagine, this complicates learning mathematics just a bit.

But the biggest problem I have with doing figures is that not all my numbers get along with each other. Almost all the numbers detest 2's bitchy disposition, while 9's Spock-like steadiness can mediate any situation. Certain numbers just don't like having to stand next to others, and will fidget just like first graders being asked to stand in line and wait -- eventually, they wander off.

This assignment of personality and gender to letters and numbers is called Ordinal Linguistic Personification, in which ordered sequences, such as ordinal numbers, days, months and letters are associated with personalities. Similarly, with object personification, everything that can be perceived gets involuntarily attached to it some sort of personification. It may be a gender and personality or it may get attached to it a color that represents that. Numbers, letters, months, grass, trees, furniture, clothes, books, even people. Even my own body parts have this sort of personification -- I recall as a small kid acting out "plays" in the bathtub with my fingers and toes, as each was (and still is) a different character.

My synesthesia actually isn't as pervasive as it might sound. I've always had it, so I don't know any other way. It does sometimes dictate my emotions and decisions however. I develop almost obsessive fondness for some people because I like their color -- I just want to be around them all the time! Conversely, I regret to say I may not like some individuals based purely on the same thing. Recently, I entered a room that had all orange (yuck!) desk chairs and I desperately wished I could turn around and run!

Most synesthetes have remarkable memories, as this gift functions as a natural mnemonic. Unfortunately in some cases this isn't so for me, especially when having to learn new concepts. If the thing or concept has no existing "relative" it takes me while to figure it all out. But typically, because of these strong emotional/personification and in particular the color associations, synesthetes have remarkable memory. I don't know why I don't -- maybe all those drugs I did in the 60s? (Relax, I wasn't actually alive in the 60's)

Which brings me to another point: synesthesia is not the result of psychedelic drug use. It is constant, involuntary, and has been a part of the individual since they can remember.

It also tends to run in families, so researchers across the globe are trying to tease out the gene responsible. Hopefully, through this type of research we will learn what gives some individuals these unique perceptions and, as with any research, learn more about the mysteries of the human brain as well.

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*Gustation involves activation of cranial nerves to process sensory input from the tongue in the form of sweet, salty, bitter, etc. But this only plays a small part in the perception of flavor. Flavor is the integration of gustation and olfaction and somatosensation.

Flavor synesthesia does not involve the same neural pathways. In other words, when James Wannerton hears the word "London," the mashed potato taste he experiences occurs in the absence of molecules that trigger olfaction, and without the activation of the sensory portions of the cranial nerves typically associated with gustation.

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More about synesthesia:

Sean Day and David Eagleman:

• David Eagleman's Synesthesia Battery

Richard Cytowic on Synesthesia:

Mother's Day and The Defenestration of Folk Music

(Mom... young, as I remember her)

The following are excerpts from something I wrote in 2005, seven months before Mom passed away. (These are only highlights, the whole thing was excruciatingly long)

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On rainy or boring days, or just anytime Mom got tired of me, she would send me to my room with an armful of her albums. Yes, I mean the round, black, vinyl kind, believe it or not. Carly Simon, Joni Mitchell, Phoebe Snow and others - they were my surrogate mothers.

...

When Mom was mad at Dad, or one of us kids, or just life, she would put on some Carly Simon (or the like) and ramp up the volume. For the next 4-5 minutes we were all her quiet, trembling captives while a husky female voice belted out despair and anguish on Mom’s behalf. This was her method for expressing all sorts of feelings and ideas. Yes, music was her medium.

...

When she loaded me up with an armful of albums she wasn’t just giving me something to do, she was giving me her toolbox, her art supplies you could say. I'd be alone for hours in my pale yellow room, lying on the floor with my feet propped up against the wall. I'd stare at the ceiling or into nothing at all while the smooth voices and mellow harmonies carried me far away from Mom's bi-polar hell. It was my favorite place to be, and a few years ago when I was instructed to find a "peaceful place" to ease birthing pains, I thought about lying there in my yellow room on my back with my hands behind my head and my feet in the air, keeping beat with my feet to Joni Mitchell's guitar strums.

...

My mom had moods that could shift faster than Alabama weather. And any trigger would do. And sometimes there seemed to be none at all, like the day I watched my record player sail out my second-story window, followed by Joni Mitchell, then Linda Ronstadt, then Phoebe Snow. After she left I looked out to see glass and plastic and machine parts all over the driveway. The defenestration of folk music. But if her fleeting intention was to take away the music, she was too late. It was mine. It was in me, woven around my heart like the very vessels that supply it life.

...

I only recently came to understand that all the insults I bore and all the projectiles I avoided and all the ear-bursting music and screaming really had nothing to do with me. She didn’t hate me. She hated her illness. I think she would rage until her energy was spent, only to discover she still had more blazing anger inside, with no way to let it out or to be consoled. And when Carly Simon or Joni Mitchell could neither say it for her, nor give her solace, her frustration turned into everyone's catastrophe.

…

When I sit alone in the quiet and think about those times, I don't see a mother expressing disdain for her child, but a woman who fiercely wished she could be more. And it is only then, that after 30 years of not really knowing this person as a mother, I can understand this person as a woman. To quote her beloved Joni Mitchell: “every picture has its shadows, and it has some source of light.” Without a good portion of each we have no depth.

...

It has not been perfect, and it has not been ideal, but it’s my life. It is made up of beautiful song writers, and beautiful song lovers. I know my mom loved me because she gave me music. And I can give it back to her when I sit by her bedside and sing to her. She stares at the ceiling or into nothing at all while my voice carries her far away from bedridden hell. Maybe deep down *she* is still in there, dancing and humming along and knowing that this tune is my way of saying, “thanks Mom, I love you too.”

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Charlotte's Heart

Some of you have asked about Charlotte's surgery.
She had open heart surgery when she was three months old to correct Tetralogy of Fallot. A slideshow of that is at the bottom of this blog. _________________

TOF happens to 5 out of every 10,000 babies. Heart defects of any sort are fairly common in individuals with Down syndrome, like Charlotte.

It is four (tetra means four) related defects:


1) Pulmonary artery stenosis: the artery taking blood to the lungs to go fetch more oxygen is narrow and thus...
2) Hypertrophy of the right ventricle: the right ventricle wall gets thicker because it has to work harder to get the blood through the narrowed pulmonary artery.
3) VSD- ventricular septal defect: a hole in the septum (the wall) between the two ventricles and thus...
4) Overriding aorta: because the ventral septum is faulty, the aorta kind of fumbles over it. All this allows oxygen-poor blood to leak through and get mixed with oxygenated blood. Leaning the mixture, so to speak.
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Charlotte was considered a "pink Tet" baby as opposed to a "blue Tet" because her defects were such that she still got enough oxygenated blood to keep her "pink." Even still, during one clinic visit, the cardiologist decided it was time to get her fixed up. So, about a week later we found ourselves at UAB awaiting the famous Dr. James Kirklin, son of the famous Dr. John Kirklin of Kirklin Clinic fame, to perform her surgery. I have to insert here that I have the greatest respect for this man and will forever be grateful for the kindness he showed me. He mended Charlotte beautifully and although she bears a scar, it is minimal compared to others I have seen.

It was also discovered during surgery that she had a PDA -- patent ductus arteriosus. The blood vessel between the aorta and the pulmonary artery usually closes shortly after birth... unless it doesn't and then it's called patent (open). About 3000 babies in the US are born each year with a PDA. It can close later on its own, or may require surgical repair. Charlotte's leaks so very little now that we're not going to worry anymore.


As a result of having to fiddle with such a small organ, Charlotte now has AV heart block. Her two sinus nodes that tell the heart when to do its pumping are not in agreement, so the result is a lower overall heart rate. I am told that this sort of iatrogenic heart block generally is not a huge concern (??), though she will eventually require a pacemaker, but that's down the road yet.





For now, she's happy and healthy and growing more beautiful each day.

CHARLOTTE'S TICKER

Charlotte and I braved the humid Alabama weather to get her periodic pump check.

First she got radiated and electrographerated.

Had some play time with her friend Kianna.

... and later, a familiar face showed up!

Doctor Colvin listened...

...and looked


...and then it was off to get hooked to the Holter.

And then she's done for another year!

(and you know this one can't miss a photo op)

The Holter monitor records heart activity while she's wearing it. After 24 hours, we take it off and send it in to be analyzed. To help the analyzer, we keep a log of her activities that could explain any unusual readings.
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Charlotte's log read something like this:

10:45 - start monitor

11:00-11:15 - nap

12ish-12:30 - lunch

1:20- 2:00 - climbing/falling/climbing/falling/climbing/falling...etc.

2:30 - heard beeping sound, found she had unpacked monitor and was pushing buttons, hope that doesn't matter

2:30 - accidentally scared the crap out of her when I discovered her doing this

2:45- napping bouncing on bed

2:50 - crying

2:55 - ticked off

3:00 - really pissed

3:10-4:10 nap

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Anyway, it was a good visit with nothing but good news. The PDA is all but closed and not something we're going to even think about anymore. She will not need pacing at all for the following year and maybe not even for two or three more. She's strong and healthy!