The Runs for the Roses? The other race to Derby Day

catchyWeek 1, Sept. 3-9, 2017:
One case of hepatitis A

Rui Zhao hunkers behind his twin computer monitors. Most visitors to the epidemiologist’s uncomfortably cramped office talk to his brow and the short black hair on the top of his head. They may glimpse his eyes when he looks up from his screens. On the wall to his left are small stuffed toys of irregular shapes, each a cuddly version of some nasty germ. From this third-floor office at the Louisville Metro Department of Public Health and Wellness, Zhao watches other germs work their way across Louisville. In the 90-degree days of early September, it’s a bit too soon to think about influenza, which will sweep through nursing homes in cold weather, taking lives as it does most every year. More of interest now: the chronic liver diseases hepatitis B and C. In fact, cases of hepatitis B are dancing upward in the metro area. Hepatitis C is already considered an epidemic, although the number of new cases is tiny.

Of hepatitis A, there’s a single case. And there’s no case the following week. It’s meaningless noise in the ebb and flow of the 25 or so infectious diseases surveilled by the state. Each year, one or two people in the city — and, rarely, as many as five — will contract the hepatitis A virus. They travel to a country where it’s common, endemic. They bring it home from mission trips or as a souvenir from an exotic vacation. More frequently, travelers never know they have it. About 30 percent of adults with hepatitis A produce no symptoms.

But for the unlucky, it can be brutal, bringing low-grade fever, headache, weakness and exhaustion, diarrhea, sudden nausea and vomiting, and abdominal pain, especially under the ribs on the right side, where the liver sits. Stools turn pale and urine dark. There may be intense itching. The white of the eye and skin often yellow, another sign that the virus is in the liver. And that’s the end of it, usually. Unlike hepatitis B and C, hepatitis A doesn’t settle in for a lifetime, grinding away at the liver. Uncomfortable? Absolutely. Miserable? Often. Life-threatening? Only in people older than 50 and those with other health problems. And it’s self-resolving, with no cure but time. It’s also highly contagious, most likely to spread while its host feels tip-top, before discomfort sets in. Any virus shed during infection lingers on surfaces for months. It is frequently transmitted by food, and while it succumbs to soap and water, or near-boiling temperatures, gel sanitizers can’t touch it.

Hepatitis B and C, on the other hand, infect via body fluids like blood, semen or vaginal secretions — the same pathways taken by the virus that causes AIDS. Since February 2017, a combined hepatitis A-B vaccine has been offered to visitors at the syringe-exchange sites operated by Metro Health and Wellness. There is no vaccine against the relatively new virus hepatitis C, which was discovered in 1989 and originally called non-A, non-B hepatitis. The syringe-exchange clinic is one sure way for the health department to reach a group of people normally driven into the shadows, a population vulnerable to a variety of diseases.

The importance of such contact is about to increase. The question is, will it be enough? By April, few will think so.


Weeks 2-5, Sept. 10-Oct. 7:
Three new cases of hepatitis A. Total: 4

The Courier Journal is full of the troubles facing the University of Louisville basketball program as October rolls in with 70- and 80-degree days and enough sunshine to convince anyone that summer will stretch on forever. Zhao notes that hepatitis A cases are now double the number seen in a normal year. But whether those four cases are significant isn’t clear. There’s also an unusual surge in false-positive hep A tests. He always sees a few. Every year, three or four people will test positive, yet their illness makes no sense. Usually, these cases of mistaken viral identity involve women 60 and older who have symptoms that would fit any number of diseases, including hepatitis A. It’s essentially a bad joke played by an aging immune system. Immune defenses lose precision with each passing year; our bodies are more prone to interpret any number of ailments as an attack on the liver and ramp up antibody production to fight a phantom infection.

For the rest of these story, go to

Travels With Mitch

Stalking Mitch McConnell through coal country, one thing is clear: When I say Mitch, Mitch says nothing. 

Mitch McConnell, John Cornyn

Story From Louisville Magazine

It’s 9:35 in the morning on Aug. 7, and I am late. There isn’t a soul in the office at Whayne Supply. Desks empty, papers abandoned in mid-scrawl, phones silent. It’s as though the Rapture has sucked heavenward all the good people of Corbin, Kentucky, about 40 miles from the Tennessee border. Nobody mans the front desk. That alone feels like an invitation, so I wander in. As I advance, I see two men to my left. I expect them to yell, “Get out of here!” They don’t. They don’t seem to care. I push through a door and into a warehouse. And now I hear voices. The farther I walk, the louder the voices. The farther I walk, the brighter the light. Finally, I reach a large room at the end of the warehouse.

I am entering the presence of Senator Mitch McConnell.

Maybe 100 people, mostly men, stand around a chunk of coal the size of a pygmy hippo. It catches the light and glitters seductively, displaying a dazzle every bit as beguiling as that other carbon product, although this one is not quite ready for an engagement ring setting.

A young woman yells (young women, I’ll come to learn, are always yelling), “When I say team, you say Mitch.





“When I say Kentucky, you say coal. Kentucky!”




That night, when I bed down in an overpriced Holiday Inn Express in Hazard, the chant will ring through my dreams. I will have heard it 100 times or more. Maybe 1,000, with occasional variations:

“When I say Mitch, you say coal!”





No chants are unprompted. No enthusiasm is unaided by the ample voice of some young female campaign worker.

I ponder starting my own chants.

“When I say ketchup, you say tomato!”




But I don’t. There are more serious matters at hand.

READ THE REST: fullmitch

Risque Business: Hail to the Queens


Terri Vanessa Coleman at the Connection. PHOTO BY JOEY HARRISON

No time to write a proper intro this morning. Here’s my latest story, in the June issue of  Louisville Magazine, about the drag queens of the Connection nightclub and the businessmen behind this growing entertainment — well, maybe not an empire, but at least a sub-empire. You can also read it here. Joey Harrison shot the above photo, but photos in the story are by Mickie Winters.

It’s midnight, Saturday, April 5, at the Connection nightclub on South Floyd Street downtown, and Terri Vanessa Coleman is singing. Her muffled voice comes through the walls from her dressing room. It means she is in some kind of a bother, a ferment that’s been building since the first show at 10:30 p.m.Another performer says Terri Vanessa bumped her out of the way during the opening production number, leaving her to flounce onstage unescorted. Then Terri Vanessa had angry words about who-knows-what with the guy who cues the music, and now he’s upset. And she’s been singing ever since. That’s never a good sign.

She doesn’t want to talk about it. “Not now!” she says, poking her head from her dressing room door and waving a long pink fingernail. “This is just not a good time, honey. Maybe Thursday.”

In a dressing room at the other end of the narrow blue hall, Mokha Montrese shivers, a small white towel draped over her shoulders. Apart from a G-string and tape over her nipples, she wears only jewel-red lipstick, her No. 301 false eyelashes and gold jewelry. Her wig is off, her own hair crushed into a tight cap. She cannot get warm, but she does not get dressed. Next door, Cezanne Blincoe is nearly ready for the next set, her makeup perfect, her dress picked out. She moves like a woman with all the time in the world.

Mokha shouts to Cezanne through the wall. “Cezanne, I really need to go home.”

Cezanne walks in, taking in the scene.

“I’m feeling worse as it goes on,” Mokha gasps. “I really need to go. I feel so weak. And I’m so f–cking cold.”

“Put some clothes on,” Cezanne offers. Instead, Mokha puts her head down and closes her eyes, each breath coming with a tiny catch.

At the other end of the hall, Hurricane Summers and Franco de la Rosa can still hear Terri Vanessa’s indistinct warble through the wall. They look at each other, and Franco, aka the  Puerto Rican Papi, goes back to sizing up his physique. He’s the male lead in the drag show, LaBoy LeFemme, escorting the girls through production numbers. They tower over him in their impossible heels. … READ THE REST OF THE STORY

Fixing Broken Hearts: Louisville Magazine 8.2011

Louisville researchers are using stem cells found in the heart to treat devastating heart failure.  While patients improve after stem cell transplant, no one really knows why. I wrote this story for the August 2011 edition of Louisville Magazine.

No alarm sounds but Dr. Roberto Bolli is awake. Again.

He’d slept fitfully, waking often to fret about the coming day, the thousand things that could go wrong, every possible misstep. Now, at 6 a.m., there was no point staying in bed. By 8, the cardiologist is in the bone marrow transplant laboratory at the James Graham Brown Cancer Center watching the research team prepare precious stem cells. The cells, coddled and multiplied for four months, will now, with a bit of luck, save a life.

Across the street in Jewish Hospital, doctors prepare Mike Jones to receive those cells. Jones, 66, a painting and remodeling contractor, will be awake during the procedure.

It’s good to be awake when you’re making history.

Read the rest of the story.

The Incredible Lavon Williams

If you haven’t been down to the Cressman Center  at 100 East Main St., get there soon. We swung by today noticed they’re still showing the amazing work of Lavon Williams.

These hand-carved pieces brim with life.  Williams, a fifth-generation woodcarver, creates rent parties jammed with lively dancers, women in colorful, sexy garb, and revivals alive with the spirit. Each piece conveys a sense of story, perhaps  none more clearly than “Luke and the Preacher,” a relief carving of a pair of men making their way down a moon-lit avenue, a church in the distance, and the city’s buildings bending to engulf them.  Other times the story is just a suggestion, such as a carving of a girl in a golden-yellow dress, skipping rope.

Williams  depictions are full of pent-up energy.  He uses warm colors, as well as the tone of the wood, to highlight the sculptures. And he makes powerful use of exaggerated proportions — the woman mourner in “Oh Mary Don’t You Weep” raises a gigantic hand to the heavens, large enough to shelter the mourners beneath.

Hands are often larger than faces, such as the hands of the bass player Mr. Johnson. And sometimes feet are gigantic, as in the woman dancing in The Gambling House.  Faces are part suggestion and part detail, but the emotions on them are always plain, whether poignant, joyous or raucous.

“You want to try to be as expressive as possible and as explosive as possible,” Williams told Kentucky Educational Television for a story a few years ago. “You’re looking for a fantastic movement or a fantastic shape that comes in the piece.”

I first saw Williams’ work at the Kentucky Folk Art Center at Morehead State University.  We acted like giddy kids when we ran into him in the museum parking lot. I didn’t have the presence of mind to take notes. He was really charming and down-to-earth. He’s a big guy. I didn’t know it at the time, but in basketball-mad Kentucky, he’s probably more famous for his role in the 1978 University of Kentucky national basketball championship.

Cressman Gallery Hours are Wednesday through Friday, 11 a.m . to 6 p.m; Saturday 11 a.m. to 3 p.m.; the first Friday of the month, 11:00 am-9:00 p.m.

Food Police Or Criminal Fat

The Louisville Metro Board of Health recommended a ban on trans fats at its Feb. 3 meeting.

So now they want to tell us what we can eat? Oh please!

Is this the case of over-zealous know-it-alls telling us what to do, or is there any evidence that the food police are heading to the scene of an actual crime. I thought I’d take a look at the evidence, dust for fingerprints, scan for stray DNA, extend a metaphor beyond the bounds of the law.

Trans fats are used to extend food shelf life. Although there’s a little bit of naturally occurring trans fats in meat, there is some question this fat behaves the same as the artificial trans fat that appears in many commercial baked goods and commercial fried foods.

I looked at some recent research about trans fat. Most of this data is from a systematic review of studies involving about 140,000 patients. The review was published last year in the Journal of AOAC International. Two of its authors, Dariush Mozaffarian and Walter Willett, have published a great deal about trans fats, including a comprehensive 2006 study in the New England Journal of Medicine. Here’s what the research shows:

  • Trans fats are associated with an increased risk of heart disease.
  • It only takes a little trans fat to do a lot of damage. In one study, each 2 percent increase in trans fat consumption associated with a 23 percent increase in heart disease.
  • Trans fat seems to stimulate more weight gain than other fats, especially around the belly. This is the most dangerous weight gain, linked to a higher risk of heart disease.
  • In recent years, researchers have shown that inflammation — as measured by certain markers in the blood stream — increases your risk of heart disease. That’s why more doctors now recommend you have something called a CRP test in tandem with your cholesterol testing. CRP is the test for C-reactive protein, a marker for inflammation. If it’s high, your risk of a heart attack is high. Trans fat consumption associates with a rise in CRP and other inflammatory markers, including interleukin-6, and tumor necrosis factor.
  • Some studies suggest that increased trans fat consumption could increase insulin resistance, leading to a higher risk of diabetes.
  • One study showed higher infertility rates in women with increased trans fat consumption. Note that it will take more than a single study to confirm this connection.
  • Another single study showed an increased risk of gall stones in men with increased trans fat consumption. Again, no single study is definitive, and more research must test this conclusion.
  • Finally, a study showed an  increased risk of Alzheimer’s disease in the elderly with increased trans fat consumption.

You might conclude the food police have a good line on a killer.  Trans fats are more dangerous than even the saturated fats health experts have been warning us about for years.

Frank Repka, an associate emeritus professor from the University of Toledo Medical Center, explained this to me a few years ago. Repka is a Ph.D. nutritionist. He says trans fats actually reduce the number of cholesterol disposal sites in your liver.

You have special ports or receptors in your liver that capture and remove bad cholesterol — you know, low-density lipoprotein.   Saturated fats inhibit the number of the receptors you make, Repka said. But trans fats shut down those receptors six or seven times more efficiently than saturated fats.

If you take a cholesterol-lowering drug, it increases the number of those LDL receptors in your liver. If you eat trans fats, you’re working against that goal big time.

If trans fats make up as little as 1 percent to 3 percent of your daily diet, they make trouble.  The American Heart Association recommends that trans fats make up no more than 1 percent of your diet. That’s not much: 2 grams a day in a 2,000 calorie diet. Carefully examine food labels.  Even if the label doesn’t include trans fats in its nutrient profile, look at the ingredients. If they include partially hydrogenated oil of any type, you’re consuming trans fats.

There’s probably little chance that Louisville will adopt the trans fat ban. Maybe citizens can establish a neighborhood watch.  Note the suspicious activity down at the Bob Evans restaurant and their servings of Stacked & Stuffed Hotcakes. There is nothing sexy about these, despite the double entendre of the name. Each serving packs 6 to 7 grams of trans fats. Remember that statistic about each 2 percent increase in trans fat increasing heart attack risk by 23 percent?

Happy dining.

Some links to more info:

Here’s our mayor talking to LEO. Scroll down to the question about trans fat. The mayor says people need to be educated to discuss the issue with their representative. Looks like the education needs to start with the mayor. OK, well, the guy can’t know everything.

The new kid in food town

I love grocery stores. So it’s been an absolute nail-biter watching the new Fresh Market go up at the end of my street.

I tour grocery stores on vacation. When I visit my sister Ellen in Dayton, I always squeeze in a visit to the fabulous Dorothy Lane Market near her home. A few years ago I found a wonderful grocery store near my Aunt Ruth’s house in California. I think of it often. Why didn’t I take pictures? But I am no shopping snob. I love my neighborhood Kroger and Paul’s Fruit Market as much as I do the high-end places only suited for special occasion grocery binges. About the only thing I like better than grocery stores is the big open food market in Barcelona where we bought bread, wine, and cheese every afternoon of our visit. We ate eat these for dinner in our little apartment: a different cheese every day, Spain’s fabulous wines, and baguettes that inspire poetry.

So when The Fresh Market on Brownsboro Road near I-264 opened for the first time today, I was there 16 minutes later.

For me, part of the shopping experience is aesthetic, and Fresh Market is among the best on this score. You walk into their large floral department, and flow into the rainbow of fruits and vegetables. Very enticing. The lighting here is better than the usual fluorescent grocery store buzz. (But don’t be fooled by the giant windows on the outside of the building. Those are fake. This is electric light, not natural. This is a big-box store and we saw the block walls go up before they were covered with fake windows.)

The vegetable and fruit selection was impressive. I was delighted to see beautiful green beans – they tend to look like hell in a lot of places this time of year. The mushroom selection wasn’t bad, but there were a lot more dried varieties than fresh. Mushroom prices, of course, were astronomical, but some of the other produce was on par with Kroger. There were many out-of-season fruits in knockout colors, all for very high prices.

The meats and seafood selections were more than complete and almost as lovely as the produce. I actually stood open-mouthed staring at the Maryland crab cakes, two for $5, until interrupted by a cheerful employee. All the employees were very chatty, warm, and informative. I’ll be interested to see if that vibe continues, and how deep it actually runs. It was very exciting to see not only flank steak – tough to find around here for some reason – and short ribs. Recipes danced in my head.

The prices – no surprise – were almost uniformly high. Boneless skinless chicken breast was on sale for $2.99 a pound. I’d love to try them, but I can get them at Kroger or Meijer for a buck or so cheaper.

Traffic flow in this store was exceptionally good. I’m a perimeter shopper, rarely bothering the prepared foods in the center aisles, and this store was ideal for me, while still seducing me through the bakery and freshly prepared foods. I didn’t buy the pot stickers they had on sale, though I was sorely tempted. This will be an experiment for another day. Whole Foods, which has a similar fresh prepared-food section, wins the Bland & Beautiful prize for theirs. I hope The Fresh Market cooks have a spice rack and a salt shaker and know how to use them.

Of course for my introductory Fresh Market jaunt I explored the center aisles where a mixture of organic, natural boxed and canned goods was not so overwhelming that they left out the Cheerios — the fifth food group in my life.

The bakery was pretty, with the fussy petit fours and tortes and cakes, but all made at some mysterious central processing factory. The guy at the counter didn’t know where that was. They do make some of the breads and rolls at the store. There was a generous selection of breads. I did not miss the scary blue and yellow cakes one sees at Kroger. Do people really eat those things?

I bought bagels, made elsewhere. A BIG disappointment. They were the typical grocery store bagel – that is, bread formed into a doughnut shape. Worse, they had that near crumbly texture that reminds me of stale bread. Grocery store bagels are so rarely any good, I don’t know why I thought these would be different. Alas, Louisville seems to be without a good bagel. (And a good pizza, although a fellow shopper recommended a new place, Spinelli’s, on Goose Creek.)

Fun and useless was a large candy section near the front of the store. I loved the colors, and even thought about buying my favorite chocolate bar, Green & Black Dark Chocolate, but that was clearly Satan talking. I only find Satan cute when we’re in the wine section. Kentucky grocery stores can’t have wine sections, so Satan’s pull was inconsequential and I saved the $3.95.

Besides the bagels, I brought home those Maryland crab cakes. I’ll have them for lunch and let you know.