Male infertility: Varicocele embolization consultation, with CT scan

This is an ongoing series about my journey with infertility. I was diagnosed with a varicocele, which is likely responsible for poor sperm quality. It's something present in around 15% of all men, but in upwards of 40% of all infertility cases. Start here for the background and what we've done so far.

Varicoceles don't only affect fertility (and don't always lead to infertility). Apparently, they can be very painful; mine doesn't hurt at all. I have, over the past few weeks, noticed occasional soreness in my left testicle, but that's really only been since the urologist told me varicoceles are often painful, so it may be primarily in my head. Who knows how long I've had this issue, with no pain?

When a physician's assistant asked, "On a scale of 1-10 (10 being excruciating), what's the pain like?"

"Two to three," I said.

"What do you do when you feel the pain?"

"Nothing. When you get older your knee just hurts a little bit sometimes? It's kinda like that."


I had a consultation with the physician's assistant for an interventional radiologist who would perform a varicocele embolization.

This is a non-surgical, outpatient procedure. They're so confident in the procedure not producing issues that they don't even follow up with patients to see how they're doing a few days later.

I have a CT scan scheduled. This will show a map of my arteries and veins, give the doctor an idea of whether he'd go in through my neck or my leg (more in a minute) and whether for some reason I might not be a candidate for the procedure.

The alternative is a surgical fix, called a varicocelectomy, performed by a urologist, which comes with as much as six weeks of recovery time.

Now, some of this is recap from the first installment, but here's the skinny. We don't know why varicoceles occur (we know how they occur, but not the underlying cause). After being corrected, they can return. Once detected, we have no idea how long they've been there (we might assume mine's been there at least 19 months, since that's how long we've been trying to have a child). The urologist told me both the varicocelectomy and the embolization have a success rate of around 90% (that's success in eliminating the varicocele), and in case that the varicocele is eliminated for fertility purposes, about half of couples conceive naturally.

Sperm take about three to four months to develop; sperm I might ejaculate today started forming sometime between Thanksgiving and Christmas 2017. That means we won't find out if my sperm quality improves until four months or so after the procedure. We do that by a seed test, which is essentially me masturbating in a cup in someone else's bathroom (again, see the first installation for a deeper description).

Back to my consultation.

The procedure goes like this. You get an IV with an anesthetic (a name I wouldn't know) and a pain killer (fentanyl). In theory, just enough to keep you sedated, but a lot of people fall asleep. Then they take a catheter, put it into a vein in either your neck or your leg (you're facing away from the procedure, with a nurse monitoring vitals in your field of vision, if you're awake). Once the catheter is in, you get either some tiny metal balls or some tiny metal coils to break up the varicocele and hopefully prevent from happening again.

They pull the catheter out, remove the IV, monitor you for a couple of hours, put you in a car (preferably one driven by someone you know), and send you a bill at some point.

My next step is the CT scan. Results from that usually take about two days, so unless something comes up, that'll be the next installation.

Thought experiment: A 50-year rollback

I'm 41 years old. I can see 50 pretty clearly. I know lots of people who are older than 50. You probably do, too. I'm not sure exactly what put 50 in my head a couple weeks ago, but we're coming up on the 50th anniversary of the assassination of Dr. Martin Luther King Jr., so that's as good a place as anywhere to start, I guess.

My point in doing this thought experiment is for us to recognize three things:

(1) 50 years isn't very long in terms of human consciousness. Our brains and bodies take centuries — maybe millennia — to adapt biologically.

(2) So much happens in 50 years that it's amazing people who live 50 years don't short-circuit.

(3) Because of 1 and 2, have some patience with people who need a minute to wrap their heads around something newish.

Now: 2018

Since someone might read this in the future, let's take a look at where we are in 2018. The most recent estimated US census was 2016; the population is 323 million. The population of the world is estimated at 7.63 billion people. The market cap of the Disney Corp. is somewhere around $157 billion and its stock price is over $105; Amazon's market cap is around $750 billion and Apple is fast-approaching $1 trillion.

SpaceX recently launched a rocket into space then released a car on a trajectory toward Mars, just to see if they could do it. The launchers and the rocket both returned to Earth, landing on pads.

Most of the US has hand-sized computers/telephones/cameras/video cameras/music players/video machines in our pockets. About half the world has access to high-speed Internet.

A black man served as president of the United States for two full terms, with no known assassination attempts made public. Gay people can get married. Our current president is in talks to meet with the dictator of North Korea.

1x50: 1968

Now, let's roll back one set of fifty years. The US population was just under 201 million (less than 2/3 of what it is today). The population of the world was 3.53 billion (less than half what it is today). Disney stock was at 44 cents; adjusted for inflation, it was 30 cents a share. The guy who started Amazon, Jeff Bezos, was 4 years old. Apple wouldn't be launched for another eight years.

We hadn't yet gone to the moon.

Telephones were, by-and-large, on the wall. Some people did have mobile phones in their cars, but the handheld mobile phone wouldn't be introduced for five more years. Personal computers were still seven years off.

The Civil Rights movement was in transition from . Martin Luther King Jr. and Robert Kennedy were shot. Richard Nixon was elected president. "2001: A Space Odyssey" was the top grossing film. Arthur Hailey's Airport spent 30 weeks on top of the New York Times Bestseller list. There had been no openly gay people elected to any public office in the US.

2x50: 1918

The US population was 103 million, less than a third of what it is today. The population of the world was 1.8 billion, a billion of whom were incapacitated thanks to a flu epidemic that killed 20 million people.

The top five US companies the prior year were US Steel, American Telephone & Telegraph, Standard Oil of New Jersey, Bethlehem Steel and Armour & Co. US Steel is now #279 on the Fortune 500 list. American Telephone & Telegraph was broken up into the regional Bell Companies, and has since reformed as a more diverse communications company (AT&T). Standard Oil was broken up, also; the biggest remaining company is ExxonMobil. Bethlehem Steel stopped operating in 2003; Armour, a former meatpacking giant has been bought and sold a few times and is now a frozen foods brand.

World War I ended late in the year. The first scheduled passenger flight had only been four years prior, and the Post Office launched the first airmail service. Federal offices were racially segregated (and so were many businesses) and interracial marriage was illegal in many places. There were race riots. In 1916, the US Military introduced "blue discharges," which were neither honorable nor dishonorable and were often used to discharge homosexuals from the military.

3x50: 1868

We're only three sets of fifty years back now, and we're largely in the dark.

The 1870 Census put the US population at about 38 million people, only a little over a third of what it would be 50 years later. Estimates put the world population around 1.2 billion.

Tabasco first hit the market; MetLife and Pacific Life were both founded.

We didn't yet have a telephone or a light bulb.

Andrew Johnson became the first president to be impeached (like Bill Clinton, the only other president to be impeached to date, the Senate would acquit Johnson). We were very much rebuilding from the Civil War.

4x50: 1818

The US population, according to the 1820 Census, was a little over 9 million people. That's roughly the population of New York City today. The world population is estimated to have been between 950 million and a billion — less than the population of India or China today.

There were 20 US states, and the current design of the US Flag (though with 20 stars) was made the official flag of the nation. The steam engine hadn't quite made its way to the US from Britain.

We were still 11 years away from the first indoor plumbing.

The First Seminole War ended. Brooks Brothers, the men's clothier, opened its first store. Frankenstein was published.

5x50: 1768

Here we are, just five 50-year segments ago, we weren't the US yet. Estimates of the world population are around 800 million. The first modern circus is held in London. The Royal Academy is founded.

10x50: 1518

Just 10 50-year jumps ago, you might not recognize the world, which only had about 500 million people in it. Leonardo da Vinci was far and away the brightest technological mind, living in the Vatican during his waning years (he died the following year). Magellan went off to the Spice Islands. Thomas More's "Epigrammata" was published. Shakespeare wasn't yet born. There was actually a dancing plague — in Strasbourg, people just felt the urge to boogie, and many of them died of stroke, heart attack or exhaustion.

20x50: 1018

If you know someone who is 50 years old, and when they were a kid they knew someone 50 years old, you only have to go back 20 of those people to a world with fewer people than are in the US today. It would be another 48 years before the Normans would invade England, so the English language sounded very much like German.

There was no printing press. There was no Genghis Khan. We have a few written records about battles no one remembers.

50x50: 482 BCE

Socrates would be born in a dozen years. The earliest Kabbalists are starting to chase Ezekiel's vision of God on the chariot. The Buddha died the year before.

100x50: 2982 BCE

OK, here's the big one. Only 100 groups of 50 years, and we're basically on a different planet. The earth's population was nearing 100 million people. The Egyptian Empire is 100 years old and hasn't started building pyramids yet. The oldest city we've found in the Americas, Caral, isn't settled for another 300 years.

It's amazing how much happens in just 50 years. I don't even want to predict what our world is going to look like in 50 years, but hopefully I'm here to see it!

Male infertility: A journey begins

There don't seem to be many stories of male infertility online. If you want to know anything about any complications for women, there are lots of stories available. Some of those stories are self-authored, some are reported in magazines or newspapers, and some of them are from the husband's perspective.

That's not to say there's nothing out there. Most of the reader comments about male infertility here are from women, but here's a story from a guy who felt guilty about his infertility, but he and his wife got pregnant after a couple rounds of in vitro fertilization (IVF). Then there's a story from a man who didn't want to use a sperm donor for IVF, so his girlfriend broke up with him.

There's a book written by a woman about how there's just not that much out there on male infertility.

I did find one story detailing several types of male infertility.

There is a forum for male infertility, though a lot of posts in there are from women.

I decided to start writing about my journey for two reasons: (1) It's how I work through things, and (2) maybe it will help others share, or at least feel better.

Before we get going, you should be aware of a couple of things. Links (none of those above, but going forward) might have instructive images. By that, I mean pictures of penises and testicles. Also, I'm going to be me here, which means that I'll use both correct language and slang (read: I'll write both "scrotum" and "ball sack" and I might drop a cuss word or twelve). I'm not going to pull punches. I won't be gratuitously graphic, but if something's pertinent, it'll be here (if you're my mother or my sister, you might want to stop reading, since this might get uncomfortable for you). Finally, we're in a discovery phase at this writing, so this really will be an ongoing story, perhaps for months or a year or however long it takes.

For those of you who don't know me, I'm 41 years old, a few pounds overweight but a regular exerciser and distance runner. I live in Savannah, Georgia. My parents call me "Mr. Excitement" because it's typically difficult to read my emotions. I'm an introvert, which means not that I'm shy or afraid of sharing, it just means I charge my energy by being alone, which makes writing a great outlet for me.


I have what's called a varicocele. It's reasonably common; about 15 percent of men have them. They don't always lead to infertility, but in cases of infertility or subfertility (which I guess is what I have, technically), they appear in upwards of 40 percent of cases. It's probably hard to nail down a good number on who actually has them, since most people don't just go get tested for them.

Essentially, it's a varicose vein in a testicle. It's most common on the left side, which is where mine is.

The way my urologist explained it to me, we don't know why it happens, but we do know how. Veins have a flap that acts something like a railroad switch in them, which allowing blood to flow online in one direction. When that flap fails, blood pools and the veins become swollen, which means the veins leading to my left testicle are too big, and it's harming my sperm (more on that later).

Now, let's get into how we got here.

In August of 2016, my wife and I decided to start trying to have children. We started off "normally," just having sex as often as we were up to it. Over the ensuing months, that turned into an ovulation thermometer and ovulation strips. Her periods are slightly irregular, varying by a few days each month, so it was difficult to track any other way.

A year later, we decided it's been a year, let's get checked out. My wife is "mostly fine;" one of her tubes is blocked but that doesn't stop her from releasing an egg each month, and her ob/gyn says that's not going to impede pregnancy at all.

I scheduled my first seed test around the same time. Read: they test semen.

A seed test goes like this.

First, you're abstinent for a minimum of three days and a maximum of five. They want you rested, but not dusty.

I went to a an office in a local hospital's "professional building" and sat in a chair in a waiting room. It appears that most of the patients are couples; one woman was there with someone I assumed to be her mother.

Eventually, someone came to lead me out the door and down the hall. She handed me a piece of paper, a pen, and a cup, then told me to mark the time when I'm done, put everything in the carousel, spin it, ring the doorbell, and leave.

In other words, please don't check in again. We all know you're in here masturbating and we don't want to see you right after you finish.

The bathroom they sent me into was bizarre. There's a toilet, of course, and a sink. And a chair with one of those pads on it people leave on the floor and hope their dogs pee on. There's a TV/DVD player combo above the toilet and a pile of magazines hidden inside blue folders that probably haven't been updated since 1996.

There's a note to not use lube or soap or anything, since that can taint your sample.

I provided my sample, put the cover on the cup and put it in basically a bank safety deposit box, rang a doorbell and got out of there.

Since the order for the test had come through my wife's ob/gyn, they called her first with the results. "Low sperm count, low motility and little chance of pregnancy."

No details, no explanation of what that translated to, no next steps. So, we basically tried to figure out what we could do and how.

We knew some of the risk factors. Tight underwear. Bicycles. Saunas. Hot tubs. Alcohol. Caffeine. Being 40 years old. Being overweight.

I maintain that boxer briefs are fine. My wife wanted me to wear boxers. I refused, but as a compromise I mostly stopped wearing underwear except when I'm working out or running. I've stayed off my bike, out of the sauna and out of the hot tub. I cut back from 5-6 drinks a week to 3-4. I cut back from a pot and a half of coffee a day to a cup every couple of days, with a cup or two of tea every day replacing all the coffee. I couldn't do anything about my age (in fact, I had another birthday, making it worse), and I didn't manage to lose any weight — that's really difficult when you're cutting back on stimulants.

I asked my physician for an order to get another test. He gave me one, I went back in December to jerk off in a cup again, and waited. I got a call a couple of weeks later from my doctor's office with just the information that the test was abnormal, and I should go see a urologist (he sent over a referral). Again, no details.

So I went to the urologist, and he spelled everything out for me.

All sorts of things get tested, but he was looking for three things:

1. Sperm count: About 50 million per milliliter is average, but 20 million is considered a minimum threshold for normal.
2. Motility: About 35% is normal.
3. Appearance: Average is 14% of sperm in one ejaculation appearing "normal," with 4% being a minimum threshold for effective.

In my first test, my sperm count was 19 million/mL. He said that might as well be 20 million. My motility was 27%, which means they were generally lazy. A big fat goose egg on appearance, though. Zero percent appeared normal.

My second test — the one for which I tried to eliminate as many risk factors as I could — looked somewhat better. My sperm count was 74 million/mL (overachiever!). My motility was 67% (ditto!). The appearance, though, had only approved to 1% appearing normal (yeah, I know that's an increase of infinity, but it's still not good enough to give me a good shot at getting my wife pregnant).

Now that we had an idea of what the problem was, the next step was to figure out why.

He ordered some blood work and an ultrasound. The blood work was easy. I have good veins for needles. I don't have a fear of them and the sight of blood doesn't bother me.

The ultrasound, on the other hand, was pretty awkward. And yes, it's the same procedure used to show pregnant women their babies.

I sat down in the waiting room, and a woman came out to get me. We got to her room, which consisted of an exam table, a chair, a sink and a computer desk. She handed me a rolled-up washcloth and a hand towel folded in thirds.

"You're going to lie down on the table," she said. "You can leave your shirt and shoes on, but pull your pants and underwear down to your knees. Put the washcloth between your legs to prop your scrotum up, and use the other towel to cover yourself. I'll be back in a few minutes.

You know how you don't take a toddler's pants all the way off to change a diaper? Like you just let the pants keep the feet together well enough to move everything around as needed? I was in that position, but squeezing a washcloth between my thighs. Of course, a toddler can look up at you and all that. She wasn't in the room, so I was just staring at the HVAC.

Finally, after what seemed like 90 minutes but was probably more like four, she came in and asked if I was ready.

Uh, ready? Sure. I'm lying on an exam table doing kegels with a washcloth and wearing the shortest skirt a grown man should ever wear.

She sat down, put on some gloves, jellied up her sound-camera-thingy, and reached up my towel-skirt.

"I know this isn't your whole day," I said, "but what's the conversation like when you get home? How was your day, honey?"

She smiled politely and said she'd been at this for ten years and didn't even think about it anymore, it's just part of the job. "At least I'm not starting catheters," she said.

After 10 minutes of drawing abstract art on the computer screen with sound waves, she told me she was all done, when she left I could get dressed and head on out, and they'd call me when the lab came back with results.

This freed me up to start doing some research.

It turned out there were two likely culprits: hormone levels and varicoceles.

Hormone levels could be adjusted with Clomid, which we think of as a thing they give women.

Varicoceles, on the other hand...

I didn't want to Google image search varicoceles, because, frankly, I didn't want a pile of dick pics in my face. Turns out they're all illustrations anyway, since the varicocele is inside the scrotum.

"Want to know what the surgery's like?" my wife asked.

"That depends," I said. "Do they cut open my ball sack and fix something, then leave me stitched up and bruised?"

"Yeah, pretty much."

"I'll pass, thanks."

My hormone levels came back basically fine; he could find an excuse to give me Clomid if I wanted to, but really, the varicocele is most likely the problem.

It turns out there are two fixes for varicoceles. One is surgical, the other nonsurgical. They have roughly the same success rate (close to 90%), my urologist said, and successful correction typically leads to pregnancy about half the time, which is probably not that much different from "normal" couples.

In either case, there's a long waiting period to figure out if it worked. Sperm production takes about three months from genesis to ejaculation (so, sperm you ejaculate today started forming three months ago). They wait four months and then send me back for a seed test.

I've spoken to the urologist about the surgical version. He makes about a two-inch incision in the abdomen, goes in and drains the varicose veins, then fixes that little broken railroad switch. The recovery is 2-3 weeks of rest, then 2-3 weeks of light duty after that.

He also described the nonsurgical version, which is called an embolization, though I have an appointment set for next week with the interventional radiologist who would perform that, should I go that route. It involves going through my groin with a catheter, and putting a balloon up beyond the kidney (or something like that). The recovery is more like 2-3 days.

I'm assuming there's a cost difference, since that second one sounds more difficult, but the recovery time is so much better.

I've called the insurance company, and they'll cover both equally.

What's Next

I have an appointment with the radiologist next week, to learn a little more about the procedure, hopefully figure out costs, preparation and recovery, and work toward making a decision.

After that, it'll be recovering, waiting for that next seed test, and seeing what happens from there.

I'll check back in sometime next week.

Parsing Parkland: Practical thoughts on guns, mental health and movements

Note: We're going to talk about guns, gun rights and gun control; mental health, health care and privacy; and political movements and political parties. Before you get outraged, fucking read it. This is researched, thought-out and edited. I'm happy to listen to differing opinions based in fact — I might even change my mind (I've certainly evolved on some of the issues here) — but this is not a platform for your instant outrage. This is my website. I spew my own damn bullshit. If you want to spew yours, get your own damn website. If you need help doing so, get in touch and we'll talk.

In brief, what happened

Here is full coverage from the local paper, but in case you missed it, on Wednesday, Feb. 14, 2018, Nikolas Cruz (allegedly) walked into Marjorie Stoneman Douglas High School in Parkland, Florida, from which he had been previously expelled, pulled a fire alarm and fatally shot 17 people and injured a dozen others with an AR-15.

Cruz had been an outcast who had a history of police visits to his home. Children and Family Services paid him a visit after he cut himself on Snapchat and said he wanted to buy a gun. The FBI didn't act on a tip that he might be dangerous.

There were warnings, then, despite the fact that the couple he was living with following his mother's death said there were no warning signs he might do something like that. But we'll talk about privacy and such.

Some gun and gun law basics, and what we need to do

Let's start off with some definitions, particularly of the type of weapon used. We in the media have been terrible about this, so a brief explainer is definitely necessary for many of us. I'm gathering most of this information from this more in-depth summary and this look at automatic weapons laws.

You can also read this non-gun owners guide to guns.

First, the media often mention "assault weapons" or "assault-style weapons." We're not going to use that term here, since an assault weapon has the ability to switch between automatic and semiautomatic settings. The AR-15 used in Parkland and in other high-profile mass shootings does not have this feature.

If you're yelling about gun control — particularly if you're talking about banning certain weapons — you should also learn the difference between automatic and semiautomatic weapons. Very few people are licensed to own (never mind carry) automatic weapons. Lots of people are licensed to own and carry semiautomatic weapons.

An automatic weapon discharges multiple rounds (bullets) with a single trigger pull (so, you pull the trigger, the weapon starts to fire, and it stops when you release the trigger).

A semiautomatic weapon discharges one round with a single trigger pull, and then, assuming there is more ammunition available, chambers the next round. This covers most weapons on the market, from the AR-15 (allegedly) used by Cruz to an everyday pistol, the kind most of us not-gun-types typically see used on television.

Then there are manual weapons, which you have to either reload after each shot (think old-style rifles you see in Civil War movies), or you have to manually chamber the next round (think six-shooters you see in old Westerns).

There is hardware available to make some semiautomatic weapons behave like automatic weapons. It's either illegal or on its way there in most states. Stephen Paddock used what's commonly called a "bump stock" to do this when he managed to discharge over 1,100 rounds from his hotel room in Las Vegas, killing 58 people and wounding some 850 others.

If you want a breakdown of gun laws by state, Wikipedia has you covered.

Most states have separate rules for purchasing guns and carrying guns, and also have separate rules for long guns (like a hunting rifle) and handguns. You might not need a license to buy a weapon (though you might need to submit to a criminal background check and a waiting period), but you probably need a license to carry a weapon with you in public, and of course states differ widely on whether you need to demonstrate proficiency, take a safety course or register your individual weapons.

Some states also have "red flag laws," which allow some people — teachers or family members, for example — to report to authorities that maybe you're dangerous and you shouldn't be allowed to buy a weapon.

Florida does not have a red flag law, though one is currently hung up in the legislature.


What qualifies as a mass shooting varies by definition and can be really confusing if we don't pick a definition to agree upon.

If you saw the piece about a school shooting every 2.5 days this year, you were probably shocked. That's because it takes a very wide definition of school shootings, some which even the most slanted among us must admit are not school shootings — things like accidental discharge of a firearm in the parking lot of a school that had been closed for seven months.

Let's go forth with this explanation from Politifact, shall we? The current federal definition of a mass shooting is three or more shooting victims (excluding the shooter) in one or more locations in a single event. And can we agree that a school shooting is a shooting that takes place on or about school grounds when students and/or teachers are present? ["On or about" because if someone trying to escape crosses the property line and is then shot, it's still a school shooting.]


Now that we have some facts behind us, here's what I think.

First, stop whining. I don't want all your guns. By all means, if you are a demonstrably safe gun owner — i.e., you have no violent crime in your past, you take a safety course, you show some proficiency, you don't carry while intoxicated and you get your vision checked every time your carry permit renews (like a drivers license) — own weapons for protection and hunting.

If you have kids, I want you to be willing to submit to random home visits from Children & Family Services to make sure you're storing the weapons safely; we have way too many accidental shootings involving toddlers finding weapons.

You should also receive, during the permitting process, a psychological evaluation. It doesn't have to be invasive. If you're on medication (that you could go off of whenever you felt like it — or stopped being able to afford it) that's probably stopping you from killing yourself or someone else, sorry, you probably shouldn't have access to a firearm. It's not that you're definitely going to kill someone eventually, it's just that the probability is too high to risk.

Go read this piece by a veteran who enjoyed shooting an M-4 while in the Army and enjoys shooting an AR-15 as a civilian. She says, look, they're fun. But Formula One cars are fun to drive and you can't take those for a 150-mph joyride on the highway.

The AR-15 is modeled on military weapons that are designed to kill people. They have no other purpose. It's the weapon that legally obtained and used in Parkland and in Newtown at Sandy Hook Elementary and in Las Vegas (though the shooter modified his to fully automatic using a "bump stock" there).

If you are of the opinion that we need AR-15s and similar weapons for protection in case the government ever turns the US military loose on its people, we can keep them locked up in a civilian armory — hey, how about at private gun ranges? But let me point out that you can't go out and buy a working tank or a lot of other items the military has. Civilians are not equipped to fight against the US military. We never will be. And we never should be.

Some thoughts on school safety

People have offered up some ideas for keeping schools more secure; I have yet to hear one that won't detract further from education (and we could go on for long time how public education has been suffering from high-pressure standardized tests and fewer resources over the past couple of decades, but we won't).

More armed officers in schools. Parkland had an armed officer, but of course most schools have large enough campuses that if an officer is in one place and an active shooter is in another, it could be four or five minutes before an the officer can reach the same area. An AR-15 is limited in the number of rounds it can discharge by two factors: the number of rounds available and the ability of the shooter to pull the trigger. If you've ever performed a repetitive motion for several minutes, you know fatigue can set in, but let's assume a 19-year-old male with lots of adrenaline flowing can average somewhere around a shot per second for five minutes; that's around 300 shots fired if it takes an officer five minutes to get across campus.

So, what if there were more officers in the school? Well, now we're running into a resource problem, right? Teachers are already buying materials for their classes (and they're not paid for the time they put in outside of school hours, creating lesson plans, correcting papers, submitting grades, etc.), textbooks are outdated, some classrooms have upwards of 30 or more students, and budgets are dropping. Adding two more officers might mean cutting three or four more teachers. And how many officers can you station in a school before students feel like they're in a prison?

Arm teachers. It's hard enough to find good teachers. Are we going to make it a job requirement that teachers be proficient enough with a weapon to fire it accurately in a small room full of students with an active shooter? Or are we just going to give teachers basic firearms training and then ask them to act in a high-pressure situation with a high likelihood of accidentally shooting students who are not the shooter?

Neither of those sounds like a good idea to me. I don't have a great solution, but it seems taking care of this on the weapons side (see above) is the best way to go.

What we need to do on the health care and privacy side

Two personal stories about health care, to start. Congress and the president touted its tax reform as a big give-back to the middle class, and gutted funding for the Affordable Care Act (ACA), also known as Obamacare, also known as Romneycare (oh, you mean you forgot this is the same plan that Massachusetts' Republican governor instituted?). It's also the plan that Congress and the president have. When they largely gutted the program, they wrote themselves an exception. That tells you that Romneycare/Obamacare/ACA is so good the people who don't want to pay for it for us commoners want it for themselves.

I have insurance through my company; it covers my wife and I, and my employer pays most of it. I made a $14/month change to health care options this year, but my biweekly paycheck is down $74, which means almost $2,000 out of my pocket this year. If you're doing the math on my health care change, I paid $1,924 for $168 of increased benefits.

My sister is not so lucky. When she moved, she had to work a part-time job before finding a temp-to-hire job that. The company decided to buy her out early, which means she's a full-time employee after 2 months of temping instead of 3 months, but they still have a 90-day probationary period before they have to offer her health care. She has a two-year-old daughter, who, oddly enough, is not working full time.

In order to get her daughter health care, my sister joined the ACA exchange, which is partially funded by Medicaid. Funding for the exchanges has been gutted by the administration, and no one's required to take it.

So it seems very few do.

One day recently, my sister called me to say her daughter had a tick on her head and she needed to be picked up from preschool. I went to pick up my niece while my sister called the exchange to find out which urgent care facilities near me would take the insurance. She found one, and after I arrived and filled out paperwork, when the insurance card arrived via email, they said, "oh, we don't take the Medicaid version of this."

They referred us to another urgent care center 20 minutes away.

I'm no fool, so I called ahead. No, they didn't take it, but another center 30 minutes away did. I called them, and they also didn't take the Medicaid version of the exchange.

We're lucky enough that we could just come out of pocket for both insurance (which apparently doesn't cover much) and getting a tick removed from my niece's head. We're also lucky that we don't have a lot of Lyme disease here, so that's the end of it.

And yes, you can remove a tick at home by yourself. But good luck if your kid gets an infection on her scalp. At best you're talking about staying home for work for a while until they let her back at school. At worst you're talking about brain damage or death.

I've said it before and I'll say it again: health care may not be a right, but we're certainly better when as many people as possible can get help.

What does this have to do with what's going on?

The same way it's very difficult to find someone to take a tick out of my niece's head and check her out to see if she might need some antibiotics, even if she's covered by insurance, it's very difficult to find mental health care, affordable or not.

It's also hard for some who needs mental health care to recognize that they need mental health care, and it's even harder to compel them to get it — they have to be a proven risk to themselves or others. Even then, someone has to care enough to get them to help and check them in.

Nikolas Cruz had some mental health treatment a while back. He checked himself out, because he's allowed to.

Health care providers are not allowed to talk to anyone without a patient's permission. I have to sign forms if I want my doctor to be able to talk to my wife.

So when Cruz was investigated briefly after cutting himself and talking about guns on Snapchat, no one was allowed to tell law enforcement that he had undergone mental health treatment, so he wasn't on a list of people who couldn't have guns for mental health reasons.

That's why I want a basic mental health evaluation when you register for your permit. And your mental health history is absolutely relevant when purchasing a firearm.

Voices of Parkland

This is what students and faculty from the school are staying. Again, a plea against your outrage: Many of these voices are those of minors who have just lost 17 of their friends way before their time. If you're reading this, statistically speaking you're probably an adult who wasn't directly affected by the event. It's up to you, but if you're going on the attack, you're attacking teenagers. Pick your lane.

Movements, parties and American politics

Over the past several years, we've started to see more of what we'd call movements in the US.

The Civil Rights and antiwar movements of the 1960s were really the last time we had mass movements in this country. Growing up in the 1980s and '90s I saw the Million Man March, AIDS awareness, and the revival of the yellow ribbon campaign during the first Iraq War, but these were small in comparison.

Now we have Black Lives Matter, #MeToo, the Women's March, and now, as you'll see in the Twitter names of some of the students quoted above, we have #NeverAgain.

There is plenty of splintering within some of these movements. There is no overall organization, though some pockets are organizing and we may see national NGOs start to pop up.


Movements are not parties, but sometimes they become parties.

We have two main political parties in the US: Republicans and Democrats. Right now, they wear their respective jerseys and, by and large, follow other people with the same jersey. I'm not convinced the majority of jersey-wearers elected to national office are concerned with thinking for themselves. Each party agrees among its members upon some talking points, and members who don't stick to the party line are set aside as pariahs, unworthy of funding.

Every time we try to take money out of national politics, we write in loopholes, which are easily exploited because the people who need them wrote them in.

We're basically living in a Kurt Vonnegut novel. Or maybe Vonnegut wrote how he wrote because he had two eyes and a brain.

Ho hum, as it were.

Presidents have term limits, but senators and congressmen do not. It's time to set those. Five or six terms for members of Congress and two terms for senators — that will guarantee that anyone serving out the maximum number of terms works alongside at least two presidents.

What's next?

Here's where I hit you with a shocker: we wait six months, and we do this all again. Because our system doesn't want change; only those of us governed by the system do, and believe it or not, we don't have that kind of power.

Sometimes I think I should run for office, or volunteer for someone I agree with. Most of the time, though, I'm too cynical to think it matters.

Better Humanhood Podcast Episode 1: Being a mensch

We talk about Alice Cooper, Shep Gordon and the late Brian Palefsky.

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Better Humanhood Podcast Episode 0: Statement of Purpose

I know I said I'd be back in April, but I found a direction and purpose for the podcast. I'm not going to do extensive show notes this time around, but I hope you'll get a little more out of these.

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Taking a learning break…see you in the spring

Two of my favorite things to do are read and write.

While I've always found reading relaxing — thanks, primarily, to my parents, who, when I claimed boredom growing up, told me to go read a book instead of to go watch TV — I really love reading (and listening to) books for growth.

I write to make sense of things. To parse them in my mind. To explain difficult concepts to myself in a simpler form. Hopefully some of you have benefited from me doing that and sharing what I've learned.

I need a break to refresh that learning. The stuff I do here is what people often do on Sabbatical. So think of this as a reverse Sabbatical.

I also write to keep exercising my creativity muscle.

I have plenty of creativity to exercise scheduled in the next few months. I'm spending six months taking the Master Key Experience, which involves lots of reading and writing (and thinking). I want to pay more attention to the JKWD Podcast — it's really good and I think there's a lot of room for growth.

I have some thick books sitting on my shelf I want to get to, too, Antifragile and Tools of Titans (and I guess there's some new Tim Ferriss for me to track down, too).

I also want to learn some basic psychology. If you've got a recommendation, please pass it along.

And since New Year's is really an arbitrary date and you can start anything anytime, here is my annual posting of Doug MacLean's "Auld Lang Syne." Don't forget where you've been, but don't be afraid to leave it behind for where you're going.

Josh: The Podcast, Episode 79: Hiatus; see you in April

Hey, y'all. Thanks so much for being here the past 18 months! It's so awesome that you've stuck with me. Josh: The Podcast is getting a major overhaul. Listen to find out what you can expect and when you can expect it. Also...who knows? It might come with a new name...

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Creating from the middle

Some people claim they can only create when they hit a bottom.

Some people claim they can only create when they hit a top.

No doubt a lot of creativity can come from extremes. But what happens the rest of the time?

We can't all be Hunter S. Thompson, whose daily routine would kill most people on the first day.

But we can all be Stephen King, about whom I wrote recently. His advice is to show up, and keep showing up.

Steven Pressfield offers the same advice.

You can certainly do some things to make it easy to maintain some continuity in your creativity. Earnest Hemingway used to stop writing mid-sentence so that he'd have a starting point for the next day. Pablo Picasso, on the other hand, disagreed. He said you can stop if you're willing to leave the work as complete should you die before you get back to it.

Ritual is important to creating. So are habits. And routines.

Nothing's foolproof, of course. Even the greatest slip up sometimes.

But if you keep showing up, your chances of success get much better.

Josh: The Podcast, Episode 78: Vegas shooting, self-love and racquetball

Lesson from this week's podcast: Just don't be an asshole, eh? Yeah, we're talking about guns again, I feel like I'm kinda talking to myself on it, but at least I make for good company...

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