Showing posts with label medicine. Show all posts
Showing posts with label medicine. Show all posts

Tuesday, May 17, 2022

Visions

Retinal hemorrhage, that was the diagnosis
If you ask me, I was on my way to psychosis
I just wanted to scratch my eye out to remove this damn floater
And to be rid of the piercing pain, it was akin to an electric motor
Spinning out of control, and tearing right through that eye socket
Without regard for all those plans and things I had on my docket
It was all I could do to not scream, "This is killing me, cease and desist"
I'm quite used to ellipses but this blind spot was rather an eclipse

The soul was duly darkened even as my vision was threatened
The pain was altogether unbearable and no relief beckoned
I must say, I couldn't suffer fools during that interlude, I was rather uptight
It's quite hard to keep it light when you literally can no longer see the light
I was curt and incredibly frank
   during those six months of blinding regress
When the obviously-misnamed, eye-opening affliction
   was my daily business
But there was no comfort to be had, I'd been told, just apply eye drops
Take frequent breaks, rest, the body will heal and, in time, it will stop

"You have an incredible tolerance for pain,
   why didn't you call me earlier?"
Now you tell me, I mentioned that I was in pain,
   and you ignored me, Doctor
I've been religiously applying those drops
   that you said I could buy over the counter
Do you really mean to tell me now
   that I might have gotten some relief much earlier?
"Well yes, there are any number of interventions
   that I could have prescribed.
Well, all is good now, you've made a lot of progress, that can't be denied.
We'll just take a look at things, keep using those eye drops on demand."
He quickly bade me goodbye, and I left his retinal consultancy stunned

Dear friends and family, it is a matter of some regret
That I belatedly explain why my conduct was so circumspect
True, during that time I was in considerable pain and rather upset
And, as I've explained, an unwitting victim of a doctor's neglect
It's cold comfort, however, and understanding will never quite offset
The feelings hurt and perhaps the frayed tempers
   that came with the mindset
But look, it was the loss of my sight, after all, what do you expect?

my scream for edward munch

Visions, a playlist


By definition a Visions playlist should simply be Stevie Wonder's incomparable album, Innervisions, first on my desert island list. However I'm trying to broaden my perspective so I offer this musical look at things (spotify version) See previous sensory processes ...

Timing is everything
Observers are worried

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Writing log: April 14, 2021

Saturday, July 11, 2020

Top Public Health Interventions

A list of the top public health interventions in history...

  • Sewer pipes (Mesopotamia 4000 BC)
  • Soap (for washing hands circa 2800 BC)
  • Emperor Shennong of China mandating drinking boiled tea (2737 BC)
  • Mosquito nets (from Cleopatra's time through present)
  • Vaccination (Jenner 1796, Pasteur 1880)
  • Pasteurization (Pasteur 1864)
  • Antibiotics (pace Fleming's penicillin 1928 onward)
  • Existence of unions (1827 onward)
  • Child labor laws (starting with the Cotton Factories Regulation Act of 1819 in England to present)
  • Birth control pills (Djerassi 1951, and Pincus and Rock producing Enovid, the first birth control pill approved in 1957)
  • Tobacco control (1952 to present, from the 1964 US Surgeon General report through the Tobacco Control Act of 2009)
  • Seat belts (1955 to present, the crucial milestone was 1966 with the National Traffic and Motor Vehicle Safety Act in the USA)
  • Occupational safety regulations (kicked into high gear in the US with Occupational Safety and Health Act of 1970)
  • Water fluoridation (widespread after 1945)
  • Iodized salt (1924 onward)
  • Ban on use of lead in gasoline (regulation starting 1973 - banned in US with Clean Air act in 1996)
  • Antiretrovirals, especially in African countries to manage HIV (1996 onward)
  • Board certification for doctors (1917 onward)
  • FDA approval for food and medicine (onset with Food and Drug Act in USA 1906, effective after 1938's Food, Drug, and Cosmetic Act )
  • Helmets (although a 1600 BC invention, their public health application came in sports after 1896 for American football and transportation circa 1914 with the motorcycle helmet)
  • Gun control (in most countries almost immediately after its invention circa 1000 AD with Yemen and the USA as modern day outliers)
  • Alcohol control (an ongoing and uneasy spectrum of regulations even to the extent of prohibition with religion even weighing in)
  • Oral rehydration therapy (1940s, popularized with ORS sachets especially after the refugees successfully treated during cholera epidemic of cholera after the Bangladeshi Liberation War)
  • Facial masks and shields (briefly after the influenza pandemic of 1918, in East Asia after the SARS pandemic of 2003, in China, Taiwan, South Korea, Vietnam, Mongolia, Japan and the Czech Republic memorably immediately after the start of the novel coronavirus SARS-CoV-2 pandemic January-April 2020, and the rest of the world circa March - June 2020, with notable American exceptionalism - in most enlightened states in the US. The N95 respiratory mask, conceived in 1992, remains a milestone although cloth masks have long had their uses. Whither my Texas neighbors you may ask? The neighbor who was overheard just a month ago, after The Grand Reopening of Texas, shouting "There is no virus" remains under the relentless grip of the Positivity of The Governors even after their July 2020 pivot. My best guess is that it will take 9 months, or perhaps personal experience, for the aversion to evidence and public health to penetrate consciousness. On the other hand, norms can change quickly, as evidenced in other countries, but I won't hold out hope for the year 2020 in the USA at large, I think it's a Vision 2021 project despite the rising body count)

This became a collaborative list with crucial additions from friends and The Wife, whose pointed comment about the birth control pill prompted me to add It's a Man's Man's Man's World by James Brown to the playlist I was conjuring for this list. Indeed oral contraceptives have probably positively affected the greatest numbers of humans lives outside of soap and sewers.

A twitter follower also challenged me that it was Emperor Shennong's courtiers, not the Emperor himself, who mandated boiling tea - that the Emperor just preferred his tea boiled. This again speaks to the Princpal-Agent relationship, and posits that there is a difference between the wishes of the Emperor and those surrounding him. The suggestion is that "Who will boil me this tea?" is the antecedent to "Who will rid me of this meddlesome priest?". I dodged the question as is my wont because, in any case, it was fortuitous that boiling water, with its side effect of killing germs and other beastly organisms, became an integral part of humanity's public health arsenal.

There was some controversy about my inclusion of child labor and the existence of unions, enough that I was even moved to play Devil's advocate

Think about it, would we have Dickens without child labour? What paradise have we lost when the youth of Bangladesh, or Ghana are no longer doing shifts in the textile factory, or planting yams and pineapples in the hills of Aburi? Our modern day Oliver Twists and Little Annie's no longer have the hard knock life, coddled as they are with this modernity, they have school not farms, and they are constantly demanding fondleslabs of mobile entertainment.

Of course, it was facetious to posit a world without Dickens, there was more than enough outrage in 19th century England and the world for Charles Dickens to get novelistic material. The little street urchins and cannon fodder for the worst excesses of capitalism might make the headlines but the the vast majority of capitalism's operation is a mundane grind, a rigged shell game on a tilted playing field - pick your metaphor. Call them the underlying conditions and risk factors that favour capital over labour. The notion of "the weekend", far from being divinely prescribed as days of rest, was in actuality a hard fought victory of labor and trade unions, as were occupational safety regulations. Social welfare and the advances in communal living have had considerable impact beyond the economic sphere and have public health effects.

Looking over the list, the human species has gotten away with much faulty biology and superstition. I suppose that belief in unseen things is what makes the Gospel of Germs such a hard sell that it requires constant marketing and reinforcement. Hilaire Belloc would satirize late 19th century popular conceptions of The Microbe in The Bad Child's Book of Beasts and More Beasts (For Worse Children). Things are not much changed in 2020 than in 1897.

The Microbe by Hilaire Belloc

The Microbe is so very small
You cannot make him out at all,
But many sanguine people hope
To see him through a microscope.
His jointed tongue that lies beneath
A hundred curious rows of teeth;
His seven tufted tails with lots
Of lovely pink and purple spots
.
The Microbe by Hilaire Belloc 2

On each of which a pattern stands,
Composed of forty separate bands;
His eyebrows of a tender green;
All these have never yet been seen -
But Scientist, who ought to know,
Assure us that they must be so...
Oh! let us never, never doubt
What nobody is sure about.

It is interesting that the tiny clumps of viral RNA that are driving our current covidious predicament fit much the same description.

the novel coronavirus SARS-CoV-2

The inverse list is also interesting, and we have a great candidate in Thomas Midgley for the most catastrophic intervention. Midgley invented both leaded petrol, and the CFCs (chlorinated fluorocarbon) used in refrigerators. The collateral damage, and body count, of these two inventions are world historic. Still, knowledge about their effects on the environment was not well known in his lifetime, unlike the inventors of gunpowder or the nuclear bomb. Midgley didn't have an Alfred Nobel come-to-Jesus moment and continued tinkering until his death.

I think we have real time candidates for the negative list either with neglect or by wilful policy decision making. It's slightly morbid to follow the implications of that thought because it gets to valuing abstraction over of flesh and blood. What is the value of a human life? And who gets to coldly decide that on the golf course or hastily fortified bunker?

Back to Basics


Covid-19 is a funny disease as my doctor uncles and aunts put it. It's forcing humanity to go back to basics and causing us all to change our way of life. If you take a look at the coronavirus superspreading timeline, you quickly get a sense of the activities that are now to be avoided, they involve crowds, and places with poor ventilation and sanitation, and where we sing or chant. We basically shouldn't touch or breathe on each other. And these are hard lessons to teach and follow, as I've found even after months of self isolation. The 7 and 9 year olds in my household are not the only ones that need constant reminders about the best practices for survival, frequently washing hands is not obvious despite our best efforts to make it a habit. It's hard to be a good neighbor when you can't do small talk and even conversations over the fence are fraught and wary episodes.

All communal gatherings have the potential for risky distribution of disease even as they might give comfort and social and economic utility. Paradoxically, we need to draw on social living for comfort and resilience, yet in our present, it is social distancing and enforced absence and the foregoing of our rituals and traditions that is our best chance of survival.

We are all in this together and it pays to learn the lessons of The Mosquito Principle, for these clumps of viral RNA, like our close and longstanding companions, mosquitos, don't discriminate. While we wait for a vaccine or effective treatment for Covid-19, our mantra has got to be: stay home if at all possible, maintain social distancing, and wash hands with soap frequently, wear masks when outside and perhaps even indoors when there is poor ventilation or if in the company of others beyond one's core living unit.

Optional: pray.

For faith healing is always an option; epidemiologists will forever be fighting a rearguard action against the placebo effect of faith. The other alternative is the very human hope that you will be saved, a deus ex machina is always a possibility - vaccines do get developed. Indeed this wishful thinking is firmly embedded in American mythology and culture.

And yesterday was the day of our cinema heroes
Riding to the rescue at the last possible moment
The day of the man in the white hat or the man on the white horse
Or, the man who always came to save America at the last moment

Someone always came to save America at the last moment
Especially in B-movies

B-movie by Gil Scott-Heron

In lieu of herd immunity, researchers at the Center for Disease Control (CDC), or perhaps the Surgeon General, would do well to issue the following public warning:

Nostalgia can be a fatal disease.

Observers are worried

chief zaachi physical and spiritual center

A Public Health Playlist


As always, a soundtrack for this note. (spotify version)

Suffice to say that I prefer public health interventions to faith healing, as always there is the fine print: your mileage may vary

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Friday, July 27, 2007

Anatomy Lessons

As part of an occasional series, a few items briefly noted, this time an anatomy lesson of sorts.

I. The Emperor's Teeth


Last year I pointed to an article that had brought me much comfort, the account of a wonderful taxicab conversation with the cab driver who — well, you should read all of it in his voice (it's a few paragraphs down the linked page).
"Funniest trip I ever had to make," said the taxi driver. "Now, you'll like this one..."

"So I gets a call on me wireless," he continued, "an' 'e says; 'Ere, I've got one for you.'

"I says, 'Oh, yeah,' and 'e says, 'Yeah, you're gonna like this one, I want you to go to this address, in Kensington, pick up Napoleon's tooth and take it to Swindon for auction.'

"I says, 'You what ?' 'E says, 'You 'eard. Napoleon's tooth. An' I 'ope you're insured 'cos it's worth 8,000 nicker.' ...
The humour gave me much comfort and I filed away the idea of eventually writing something of substance on said tooth, said transporter or whoever it was that had collected or bid for it.

Serendipity struck when I noted a related story last week; the headline: Napoleon's Toothbrush Finally Has a Home
The Wellcome Collection, as the new museum is called, includes early anatomical models, surgical instruments, prosthetic limbs and other examples of medical progress, as well as eye-catching objects ranging from Peruvian mummies and Chinese torture chairs to Greco-Roman phallic amulets to Japanese sex aids.

It also presents what can only be called celebrity curiosities, like Napoleon's toothbrush, Charles Darwin's walking stick, Benjamin Disraeli's death mask, Horatio Nelson's razor, Florence Nightingale's moccasins (worn during the Crimean War) and some locks of George III's hair.
I immediately wondered whether Henry Wellcome was the collector who had been the successful bidder for Napoleon's tooth and whether it was also part of his collection. And if not, the obvious question needed to be raised: was someone somewhere considering reuniting Napoleon's tooth with Napoleon's toothbrush? Inquiring minds want to know.

These are strange days and perhaps the cabdriver's eventual punchline bears repeating
"Well yeah, still, I'll tell you somefin'. You gotta 'and it to his dentist, 'aven't you? 'E shoves that tooth to one side, an' e says, 'I'll 'ave that and I'll keep 'old of it till someone invents eBay.'"
lion king


I wonder when Napoleon's tooth was excised. Was it before or after he crowned himself emperor? Would the course of world history have been different if he used a chewing stick instead of a toothbrush?

Some poetry is in order:

The Emperor's Teeth


The Emperor has no teeth
His toothbrush plain disappeared
But after much blood, sweat and tears,
Teeth and toothbrush were reunited after two hundred years.

II. The Bible and the Ganglion


I once had a recalcitrant ganglion — don't you love that word ganglion? It just sounds gangly, like an uncoordinated teenager in the throes of a growth spurt. Perusing dictionaries you'll read this definition: "rich fluid enclosed within fibrous tissue and usually attached to a tendon sheath in the hand, wrist, or foot". Well talking of growth spurts, one of the hundreds of ganglions in my body suddenly started swelling one day on my wrist. It was mostly benign, a little bump that I paid no attention to for a month or so, after which time, however, the enlarged fluid sack began to pinch a nerve on my wrist. That drew my attention because the pain was as most pain associated with the nervous system is, sharp and debilitating. The ganglion turned from recalcitrant to excruciating.

The American health care system may be a little sick these days but the university doctors that I consulted back then did their best to provide relief - a little syringe plunge to drain the fluid. I was a little curiosity for the trainee doctors. After a few months of weekly treatment "It will go away soon, just let us know if it gets too painful", and with their patient increasingly bewildered by the seeming randomness of the sharp pangs of pain, the surgeons were called in, and well, they did what surgeons do, they exercised their scalpels, dove in and snipped. They called the procedure a ganglionectomy - that word also sounds delicious and loopy and rolls off the tongue quite felicitously; I like the "nectomy" part especially, like the verb to dissect, it is onomatopoeic perfection. Incidentally the pill-swallowing post surgery was, how to put it, interesting, but that was another story.

In any case, my doctor uncle later on told me how he would have treated my case had he been consulted. What he had been taught at medical schools in England, Ghana and Nigeria was that the time-tested treatment for recalcitrant ganglions is the forceful impact of a heavy object.
"Sometimes a good whack cures this kind of thing."
Indeed his English resident had suggested holding the patient's wrist on the table and using a heavy book like the Bible to hit the bump. He was surprised that my American doctors hadn't done the deed, perhaps they were being too careful — afraid of the insurance companies and all that...

Every so often, as my eyes pass over the little scar tissue, my memento of that episode, I think to that incongruous image of a heavy bible dropping with vicious, but medical, intent onto my supine wrist.

I still wonder, did I really need to subject the Harvard endowment to $9,000 dollars worth of surgery when a twack with a King James bible would have done the efficacious deed? For that matter, did it matter what version of the Bible was used? Would a Revised Standard Edition have worked? Indeed did it have to be a bible? Would a telephone book have worked its numeric charm? Was there clinical significance in the choice of a holy book or was the religious designation simply a placebo effect of sorts? Was it a mere article of faith? Would a Koran, Torah or some other Holy Book have done the deed? I have visions of a rural hospital somewhere, say Libya, with a villager complaining of ganglionic discomfort. What would the Bulgarian nurse practitioner prescribe? What cultural sensitivity does the Hippocratic oath entail?

New Oxford Annotated Bible


I have a quite hefty New Oxford Annotated Bible (with the Apocrypha) on the bookshelf and it always give me pause when I read it because of the literal connection I've outlined between body and soul — sidenote: do the Apocrypha have relevance here? I'll note without comment that, serendipitously, said bible is nestled between Kwame Gyekye's Tradition and Modernity and Hans Christian Andersen's Fairy Tales, a delightfully-illustrated version. Would any of those tomes have provided faster relief?

Would The Riverside Shakespeare fit the bill, the Bard's comedies and tragedies have been known to work wonders elsewhere? Or does the weighty object need to be a softcover book? How did doctors come to learn about this remedy? Is it an old wives' tale that doctors spin to impressionable young trainees? What about Karl Marx's Capital Volume III - surely a Penguin classic, let alone a critique of political economy, might do, or would I need the later and slightly heftier volumes on the theory of utility and surplus value? Or, since I'm discoursing on matters dyspeptic and poetic, would Anthony Burgess's The Complete Enderby have worked? Or would a lighweight tome like Anthony Winkler's The Lunatic do the deed (a new edition came out last month)? There I was reading it last year.

Sidenote: I have a Nigerian friend who used to tell of how he and his siblings would be punished as children. They would be forced to walk up to their father holding up a bible to receive a few well-chosen whacks of the cane - at such times, dropping the bible was a definite no-no and it heightened the dread. I couldn't help but be reminded of that curious ritual (was the punishment corporal or psychic I wonder?) when I read Chimamanda Ngozi Adichie's Purple Hibiscus a few years back - the mystery of the African father and Serious Religion.

And to digress further on matters of the soul, I've heard that one of the reasons people in Northern Ghana vote the way they do is that the political bosses go around before election day accompanied by clerics, and make recalcitrant villagers pledge to vote the right way on the handy Koran. I've always thought that this was a stereotype of pork-barrel politics (or perhaps beef in this case) adapted for the supposedly religious, backward and illiterate northerners - even as said northerners are often far more worldly and cosmopolitan than the rest of Ghana. And surely our electorates were more sophisticated these days? But political scientists don't really know why voters do the things they do in the comfort of a voting booth. What has been happening in the USA recently after all? Perhaps the choice of book does matter.

But to return to matters ganglionic, this being the web, perhaps someone somewhere could eventually resolve these open issues, namely:
  • Has a doctor ever whacked your ganglion?
  • And if so, what book or implement did he or she use?
And Dear Toli Readers, what books would you suggest for a homebrewed ganglionectomy?

III. Faux Boils


Apropos ganglions:
"I'm tired of hearing about your faux boils"
That was what someone very dear to me exclaimed a couple of weeks ago in mock exasperation at one of my discursive tales. I believe she meant "foibles" although the notion of fake boils, beside being hilarious, also seemed to work. A sociolinguistic friend branded the malapropism as folk etymology rather than eggcorn. Still, I like the coinage and it seems relevant since I've been dealing with a plagiarized something-or-other these past few weeks. Ghana must go as they say.

IV. The President's Polyps



The novelist and gothic satirist Will Self is no stranger to anatomy and on it he tends to veer towards the grotesque. Last year he riffed on Haydn's Nasal Polyp:
I've been toying with a short story of this title for years, ever since hearing – or thinking I heard – a Radio 3 announcer say, with predictably risible stuffiness: 'During the winter of 1772, Haydn, then resident in London, found himself unable to compose, so troubled was he by a nasal polyp..'. There was something about the notion of Haydn's nasal polyp – rather like Flaubert's parrot, or Lenin's brain, or Churchill's black dog – that seemed almost purpose-built for a story title. Not that I really wanted to write anything serious about Haydn: this was going to be more a piss-take of that particular strain in contemporary letters, perhaps exemplified by the titles above, that seeks out profundity by yoking a mundane, or curious, thing – parrot, brain, polyp – to a great name.
He then went on to note a case of literary serendipity shared with Ian Rankin apropos the conductor's nasal nostrum.

Flaubert Parrot


Now you can probably guess why I was drawn to that piece and its confluence of small things and cultural observations let alone the fact I'm a big fan of Flaubert's Parrot - Julian Barnes' novel that is.

Well yes, it was the polyp. What the hell was a polyp, I wondered? The word sounds polymorphous, polyandrous, poly-something-or-other. When you pronounce polyp, you feel as if you're missing something, it seems curt, abbreviated even. It stands to reason that it designates a tuft of tissue, a small growth or tumor.

This came to mind when it was announced that George W. Bush had five polyps removed in a routine colonoscopy last Saturday. There was a pleasing symmetry of the image of the keys to nuclear missiles being handed over to Mr Cheney just before the surgeon's scapels was applied to that area.

Now presumably nasal polyps have a different impact than polyps from you-know-where but it seemed that some dots needed to be connected. The President's polyps have now displaced the conductor's polyps in the panopticon, or rather the pantheon, of polyps. Hadyn must surely be turning in his grave. I wondered whether Haydn's music was the kind of thing Mr Bush listened to on the iPod his daughters gave him for his birthday.

I do hope that Will Self writes his piece and, further, that he manages to tie in the five presidential polyps to give the requisite historical sweep that this story deserves. If not I'll file that tidbit around and perhaps get around to writing something of substance with it, perhaps linking things to Napoleon's tooth — Emperor to conductor to Decider. In parting one has further questions:
  • Where will the five polyps live once the doctors are done with them?
  • Will they be preserved as a whole or separately to be studied by future generations?
  • Will the 43rd President of the United States change his stripes now that they have been excised?
  • Will the course of the American Empire later be judged to have turned on said polyps?
  • Furthermore, will future curators of the Wellcome musueum seek to gain access to them rather than the undoubted presidential museum that is being planned somewhere in Texas?
Needless to say: observers are worried.

V. Body: A Playlist


I was recently reading Mingering Mike: The Amazing Career of an Imaginary Soul Superstar and in the spirit of that chance discovery I've been thinking that if I ever decided to be the svengali of a boy band that I might well call them The Five Polyps. Their demo for their first album, Napoleon's Tooth, might be the breakout ballad, The Recalcitrant Ganglion. The b-side would be the funk track Faux Boils.

As usual, a short playlist founded in reality seems appropriate.
  • Raphael Saadiq - Body Parts
    An instant vintage affair from one of Oakland's sons of soul
  • The Jacksons - Body
    The Victory album doesn't get as much love as it should. I believe Jermaine and Tito orchestrated this dance track reminiscent of the earlier Shake Your Body Down To The Ground from the Destiny album
  • Sonny Rollins - The Serpent's Tooth
    On an album with Miles Davis, a young Sonny stretched out.
  • Ohio Players - Body Vibes
    The funk was on fire with these brothers
  • Bootsy Collins - Body Slam
    It's about the Pinocchio Theory as Bootsy would sing as he competed in those funky seventies. Did he deal with Haydn's nasal polyp one wonders? Wasn't he Parliament/Funkadelic's Sir Nose or is my attribution sloppy?
  • James Brown - Bodyheat
    The godfather of soul brought the motherlode of funk. He is sorely missed.
  • Nas - Don't Body Ya'self
    The dark prince of hip-hop goes pidgin on everyone and body parts start flying at the lyrical onslaught. 50 Cent got downgraded by a quarter.
  • Johnny Gill - Wrap My Body Tight
    Johnny Gill provides the counter and seeks comfort
  • R Kelly - Your Body's Callin'
    Hmmm. He is obsessed with bodily functions isn't he? No comment.
  • Me'Shell Ndegéocello - Body
    Me'Shell was seeking a comfort woman a few years ago. One hopes her search was conclusive.
  • Coleman Hawkins - Body And Soul
    Perhaps the greatest solo in jazz history, this 1939 excursion still delights with its emotion.
  • Dwele - Flapjacks
    I'll end with Dwele who was so great, exuberant and soulful in last night's concert in Oakland. There were many moments of musical genius but the most sublime was when he orchestrated an expedient audience choir on top of the laidback groove. The ladies in the audience would hum "la la la la la / da da da da da / paaaa daa daaaa" And the men would punctuate in harmony:
    "I'm digging your flapjacks"
    As The Wife and I sang and shook our behinds in soulful harmony we were sated by the celebratory vibe. We had paid our soul insurance and our bodies and soul could receive treatment from Doctor Soul himself. Amen. Hallelujah.

    Dwele Some Kinda


    Note: since this is a family blog I'll add the obligatory disclaimer. There is no need to elaborate on what body parts flapjacks refers to. It's a metaphor for the soul, not the body.

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