The Case of Mushroom Soup and Medical Hoops

Through all the years of economic development that turned my tiny hometown from dairy country into an overdeveloped bedroom community at the far end of the T-line that feeds commuters into Boston, the woods behind my grandparents' house miraculously remains untouched. It's our own little Kampong Buangkok, where time stands still. Where unripe wild blueberries iridesce in the green light of the sugar maple canopy, lady slippers nod ladylike among fragmented breezes, and intoxicating vapors of moist decay rise from the forest floor. Intoxicating, indeed. For its seemingly enchanting surroundings, it's one of the deadliest places on earth if we're talking mushrooms.

My grandmother loved that the woods gave her easy access to mushroom picking, just like her mother did in Italy when she was a little girl. She fit the profile of the picker most likely to misidentify mushrooms: people from Europe or Asia who go after look-alikes from their homeland. Mercifully, she didn't cook amanitas phalloides, or Death Caps, into a soup and feed them to her grandchildren like the 72-year-old woman from Ithaca, NY, did right here in Marin County the day after Christmas last year. According to my mycology-buff neighbor Dave, amanitas, one of the deadliest of mushrooms for its unstoppable and swift sabotage of the body's organs, does not grow back East but looks like edible varieties that do. On the other hand, a quick tour of mycology blogs and websites after the recent incident revealed a common code of survival for anyone who picks mushrooms anywhere other than the produce section of the local Safeway: don't ingest from a source you haven't picked before without having the fungi tested. You might as well play Russian roulette or chase funnel clouds with low gas tanks. Precise identification is to mushroom picking what mesh hoods are to bee keepers and gloves are to snake venom extractors. The problem, I learned from the blogs-o-sphere, is the only experts to identify your mistakes all are employed at poison control centers --the folks who only enter the picture when it's too late.

We read these stories in the local papers at least once a year. The most recent headlines featured death caps picked in Santa Cruz and on Mount Tamalpais in Marin County. The families survived solely by luck and circumstance. And two small miracles: one at the FDA and one at the California Poison Control. The Santa Cruz Sentinal reported that a local doctor happened to attend a presentation at a European toxicology conference in Seville, Spain in which he learned about silybinin, a milk thistle extract. A German drug maker formulates silybinin into an intravenous preparation as a treatment for mushroom poisoning. After obtaining emergency FDA approval for a one-time use to save the Santa Cruz family in 2007, the doctor, Todd Mitchell, landed on the radar of the California Poison Control. This is an organization that stays on top of every development for every poison known to man and staffs a team to address hundreds of thousands of life-saving phone calls but, according to my friend, Patrick Finley, a psychopharmacologist at UCSF, has to appeal to the state for its funding every year. When the Ithaca grandmother and her grandchildren contacted Poison Control, it remembered Dr. Mitchell and called him to help contact the German company.

This is the part about jumping through medical hoops: It so happens that back in Seville, Mitchell met the toxicologist considered the worldwide authority on the medical implications of amatoxin poisoning -- who happened to live in Munich. They happened to email at least once in the past. So for case of the death cap soup, when Mitchell couldn't reach the German drug maker because it was closed for the holidays, and when he couldn't reach the Munich toxicologist, also likely on holiday, to help pave the way, that archived email just happened to contain the office phone number for a colleague who happened to be in his office after 6 p.m. in Munich during a time when all of Europe shuts down for two weeks. The colleague obtained the drug and arranged for Lufthansa to bump a wait-list passenger so that it could accommodate a courier delivering the silybinin. In the meantime, even though Mitchell could not use the same FDA emergency identification number for the Mt. Tamalpais case, the notoriously understaffed behemoth FDA managed nimbly to turn around a new number within an unprecedented few hours. The vials of silybinin arrived within 24 hours of Poison Control's first call to Mitchell, but fewer than expected. Because children have higher mortality rates to mushroom poisoning, Mitchell administered the proper doses to the children and what was left to the grandmother.

Historically in the U.S., only expensive and rare emergency liver transplants save the lives of people who mistake death caps for nostaligic fungii from other lands. Basically, unlikely survival. But the two families treated with silybinin made complete recoveries and went home with their own livers. It is a no-brainer, making such a drug easily available in the U.S., but according to the Santa Cruz Sentinal article, the FDA hasn't approved it because the costs -- for research and clinical trials -- is too high for the small market of mushroom poisoning here versus in Europe. A small market. Granted, it's all about funding and taxes and, eventually, the economy. But there's something about the "m" word that strikes a discordant note when it comes to simple plants that can save lives.

The Drying and Dying of Salmon Seeding

Facts are stubborn things; and whatever may be our wishes, our inclinations, or the dictates of our passions, they cannot alter the state of facts and evidence.
– John Quincy Adams

Above, recent facts and evidence of the human impact on the salmon population -- ten water specimens taken from various collection sites in the Lagunitas watershed -- await transportation to a lab that will test them for impurities from homes and businesses along the waterway. Results will offer a small slice of understanding in the drastic decline of coho salmon, a problem Californians claim they are passionate to resolve.

One hundred years ago, 6000 coho salmon spawned in the Lagunitas watershed on the northwest side of Mount Tamalpais. So many so that recreational fishers scooped them up like pennies from the wishing well. This year, so few were counted, fisheries biologists can't bring themselves to utter the number. But if in 2008 they counted only 20 egg nests, I fear the term "extinction" will come tumbling out if they open their mouths at all.

A series of dams built during the late 19th and early 20th centuries in the San Geronimo Valley, through which the Lagunitas waterway rambles, blocked about 50 percent of the coho population. Homes and roads built along the waterways damaged riparian habitat, creating further decline. That's a lot of disincentive for the female salmon that travel 33 miles from the Pacific Ocean though the San Geronomo Valley water system to lay their eggs in the same place they were born three years earlier. Add to that three years of drastically low rain levels, and you get a hostile ecosystem too dry and too dangerous for the fish to reach their spawning grounds.

In 2005, the coho were listed as an endangered species, and in that year, only 190 egg nests, or redds, were counted in the Lagunitas watershed. In 2007, 148 redds were counted. That doesn't look like a big drop unless you know that in 2006, 338 redds were created by the females born in 2003, when 383 redds were counted, but the 190 redds counted in 2007 came from a population of 496 redds. It doesn't take a math whiz to calculate the inevitable for the 20 redds counted this year. Whatever may be our wishes for the coho recovery -- and the recovery of salmon population throughout California -- the facts and evidence suggest recent low rain levels fail to balance the compromised flow of dammed waterways already hindered by stripped riparian habitats, and spawning will deteriorate to the point of no return if left to nature alone.

The Lagunitas watershed is considered the keystone watershed along the coast because A) it has supported the largest wild run of salmon left in the state, historically about 10 percent of California's coho population, and B) fisheries agencies look to Lagunitas to seed neighboring watersheds in their recovery efforts. But with so little rain the last three years, the number of redds in the watershed this year represents an alarming 89 percent drop in the number of returning offspring. The dams aren't going away and no amount of wishing will recalibrate the climate shifts that reduce rain levels and dry up what little water has collected in the watershed in the past four dry years. What's a watershed to do? For one thing, organizations like Salmon Protection and Watershed Network (SPAWN) and The Marin Municipal Water District rescue trapped juvenile salmon as waterways dry up. Since 1996, SPAWN (and more recently, MMWD) has been restoring habitat and monitoring the creeks. SPAWN also supports land acquisition, and educates the community.

As a result, the community support is overwhelming. During the first day of a six-week field study testing water quality in the watershed, neighbors around several of the specimen collection sites in town came out of their houses and shops to inquire, report, or worry about low or no fish sitings. Several offered to help in the effort, even if it was to show off their riparian repair efforts along the creeks running through their back yards or to direct us to fuller collection pools. In the more remote areas, people pulled over to the side of the road to come watch the collection and measurement efforts. And to inquire, report, or worry about low or no fish sitings. The study will measure the impact at the half-way point of a two-year county ordinance banning new construction inside the county's mandated Stream Conservation Area within the San Germonimo Valley, which seems to have enthusiastic community support. One of the collection volunteers who learned she could not build a ground base station for a solar-panel installation shrugged her tolerance.

As passionate as we seem to resolve the decline in the salmon population, its impact on the state's fishing industry, and the repercussions to human health, these efforts are a spit in the sea compared to the enormity of the problem statewide. Laudable and necessary, that goes without saying, especially given the dire need for human activism to reconcile its own impairments. With little hope of any significant reversal in global warming this year, however, we'll need something immediate on the order of a 40-days-and-40-nights miracle to restore hope for this spawning season. If you know any rain dances, send instructions soon.

A Surgeon General for the Masses

President-elect Barack Obama appointed Sanjay Gupta as surgeon general, and the pundit caterwaul has begun. Amusing and ironic, isn't it, that the voyernalists who've turned outcry into a form of news delivery are screeching over a fellow screecher's qualifications to communicate to the masses? The truth of the matter is that Gupta, like any other choice for this position, possesses some of the right qualifications and lacks others. But the surgeon general's job is to communicate best practices in health care to the American people. And if you've been paying attention, overwhelming evidence indicates that folks haven’t been inspired by past surgeons general: they are smoking more, drinking more, eating more, and risking more and varied drugs behaviors. CDC statistics bear this out, especially among 18 to 34 years olds. And people older than 34 are either increasing, staying the same, or decreasing minimially the risky behaviors that have turned the nation's health care delivery and insurance systems into medical and fiscal wrecking yards.

Let’s face it, we are, by and large (no pun intended), a digital nation that sources most of its health information from sensationalist television, followed closely by Internet search engines, blogs and headlines that twist context for entertainment value. Obama’s no idiot; he and his people are so good at reaching and convincing Americans, they can turn red into blue. It’s all well and good if you have appointees with gravitas, expertise, experience, and accolades; it does nothing if nobody listens. Gupta has all of the above plus he can inspire an entertainment hungry nation to action. Look at the guy: he's fit and trim, thinks fast on his feet, possesses the equinimity of a monk while juggling duties in several high-stress positions, and has great teeth. He could be riddled with all sorts of cancers, infections, and communicable diseases and nobody would really care because we like to eat dinner in front of the evening news. So, yeah, there are probably thousands of people more qualified to take the job, but if you want results, and especially if you need them fast, you have to get your audience 1) to listen and 2) behave. If a handsome, charming, erudite television surgeon gets our celebrity-obsessed nation to change its woeful ways, why complain?

(Even if takes sexy photos of well cut leaders emerging from exotic waters, if the subliminal messaging works, why mess with it?)

Hope for Learners Left Behind

As I was testing perfect salad firmness of avocados in the organic section of the market last weekend, an old friend drew up next to me to squeeze oranges for ripeness. By “old” friend, I mean one of those mothers who vectored off into other circles when the kids hit middle school and stopped depending on us for play dates. As members of the work-at-home crowd of parents who showed up for all the volunteer jobs at the elementary school, we saw each other almost every day serving hot lunch or arguing construction budgets at school committee meetings or organizing foundation fundraising events. After I declined to run for the school committee, she won the seat and did a much better job than I could have, having just started a new job and spending three hours a night helping our son navigate the labyrinth of mainstream homework with learning disabilities. Squeezing fruit and vegetables somehow created a safe bridge for my old friend to confess the same frustrations of public school for her youngest child’s learning disabilities. There we were, two public school champions, taking the first step in the 12-step process of defecting to private schools: admitting the public schools failed for our children. The guilt was as pungent as the bin of brown bananas nearby.

When it became clear that not only would our son meet his academic potential in a private school setting but that he could do it without the struggle that strangled his self-confidence and made, by his own account, “every day an embarrassment” for him, choosing private over public school was easy. But our public school comrades hummed agreement in that curt way that makes their disapproval obvious. This is Marin, after all, so of course it looked to many of our modestly-comfortable or not-obscenely-wealthy friends like the privileged motivation of the typical indulged Marin family. There’s no reasoning with privileged people who compete for reverse status, especially when their children sail through the best public schools in the state without a hitch. So the transition to a private school in San Francisco wasn’t difficult. Not a day goes by, though, when I don’t think about privilege. We could never have chosen private school without investing a good chunk of our retirement savings in the years of tuition ahead of us. Not a day goes by when I don’t think about all the kids who need something more suited to their learning styles than the assembly-line, learn-to-the test version of education but whose families don’t have the savings accounts to afford it: The fifty percent of “juvenile delinquents tested and found to have undetected learning disabilities” (National Center for State Courts and Educations Testing Services); the more than sixty percent of adolescents in treatment for substance abuse who were found to have learning disabilities. (Hazeldon Foundation, Minnesota 1992). Not only can’t these kids pay for the education they need, there's no way they can buy the testing that reveals they learn differently -- not combatively or lazily or stupidly. Or the chelation therapies that will drain the heavy metals from their blood and ease the stranglehold on their brains. Or the diet and nutrition guidance that discovers allergies that give them brain fog. Or the MRIs that determine the precise attention deficit disorder and corresponding precise medication and therapy. To name a scant few.

We began our journey to determine our son’s learning differences just before President Bush promised no child would be left behind. But like all the rest that came before him since the post-industrial institutionalization of public school education, he was thinking to fix a broken system by means of that broken system. Think about it: learning support, IEPs, 501Ks, teachers’ aides, to name a few of the fixes available to children for whom the typical classroom fails to teach are just that --fixes like patches on worn elbows or seams taken in or let out of an ill fitting shirt. Unfortunately, the shirt and the pants and the jacket are all part of the emperor’s wardrobe. Public school is a system designed to meet the needs of only about half the students (if that) it serves – kids who can sit still in straight lines for hours on end staring at the lines in a book or lines of words on a distant chalkboard, and listen while taking more lines of notes in perfect outline format. Kids who can hold the question until the end of the lecture, remember it, and use the answer to verify the assignment that he completed in the meantime anyway. Who can divert spit balls and bird calls and pins dropping and the genius jumping ahead to the next problem all at the same time without losing her train of thought. Who learn by reading the text and succeed by acing the test. The other half of the student population has to figure out how to compromise their untapped intelligence, drop out, or go someplace where the shoes and the shirt fit. (Or where if they don’t, you can get in without them.) All for the price of a private four-year college education, which hopefully comes next by the way.

In the next four to eight years, we are hoping for the change we need in the way our government doles out health care and insurance, rethinks unemployment support, and reengineers the financial, automotive and environmental industries. It’s going to take a stab at education too, but like those other programs, the new emperor mustn’t try to fit into the old emperor’s clothes. The system must be designed from the ground up to teach all learners, not just the smart and easy ones. In the words of one private school's mission to meet the needs of all learning styles, the right system will ask "not how smart is the child, but how is the child smart?"

My friend was all smiles as she told me with breathy relief about finally, after several years and countless doctors and specialists and educational alternatives, finding her son the right learning environment. Her story resonated both joyfully and painfully. Her boy, who has a mild autism disorder and visual and auditory disabilities, goes to a private school half the time and sees a tutor the other half. “The brutality is over,” she said, referring to his (and ultimately their) struggle to learn in public school. “But the financial bleeding has just begun.” He’s lucky, that one, to be among the few children who actually need the privilege and get it. Oftentimes in a privileged environment, the ones who least need it get most of it and do less with it. Here’s hoping for change that meets the needs of students with different learning styles who will show meaningful results with a little more advantage.