Work(s) in Progress

10+ years of ALS research

I am looking backwards today. I moved to Colorado with my first husband in 1995. I've been thinking of him recently. It was his birthday on Saturday (Happy Birthday rb).  A friend of mine is making a video for his son's wedding and I recommended that he use a song from when I married this former husband of mine, Chet Atkins & Suzy Bogguss, "you bring out the best in me." (you can play it here.) And no, this song is NOT jinxed or unlucky. My ex sent me a note today that reminded me that even though we've been divorced now for almost 10 years, he continues to inspire me to be the best I can be. His email is a post for another day. Today I have ALS (amyotrophic lateral sclerosis; Lou Gehrig's disease) on my mind.

When I've taught students about ALS, I generally have had them read a few posts from BrainHell - a wonderful first person account of experiencing ALS from diagnosis until death. I'm often asked why Stephen Hawking is still alive if he has ALS. Um, not exactly ALS, more likely a variant motor neuron disease know as spinal muscular atrophy type IV.

I started working on ALS in 1995. Soon after I established my own laboratory a few years later, or perhaps before, I met Ian Pearson who had recently been diagnosed with ALS. Unlike the majority of people with this diagnosis Ian has lived with this disease for many years. Tonight I received a number of emails from Ian about his current plight and changes to the Colorado Health Care system that may cut his life short. For this reason, I am going to copy his various emails into this post in their entirety. Please contact me if you would like Ian's contact information (it's the only thing I'm going to redact).

One of Ian's emails ended with this post script "The preceding text has been written using Ez-keys by Words plus, a communication program for people with physical disabilities. I use switch scanning and a piezoelectric sensor switch, mounted on a headband and activated with my eyebrow muscles. This document took roughly 40 hours to write. "

In my mind, the most horrible thing about ALS is the LACK of cognitive loss. Imagine, your brain is working perfectly; you cannot talk; you cannot move; if you are lucky, you might be able to blink or move an eyebrow that manages a cursor on a computer screen. Imagine now a decade of this. As you are thinking of these things, I ask you now to read Ian's letters.

Thank you.

May 12, 2009

Dear friends, family and other worthy souls,

For those of you who didn't already know, on Monday April 27, one of the local TV news stations ran a short piece about a change in Colorado Medicaid reimbursement policy that has effectively ended the program under which the facility where I live operates. If I have to go out to a hospital for an extended stay, I won't be allowed to return to where I have lived for more than the last five years and my only option for health care to stay alive. If the policy isn't reversed the entire program will end on July 1, 2010 and I will have to find a new place to live, possibly outside Colorado.

Here is a link to the story written out with the video on the top right corner: http://cbs4denver.com/health/medicaid.problems.patients.2.995937.html  

Below is my reply to the reporter who did the story. As you can read, I was very disappointed and frustrated with all that wasn't said and the missed opportunities of the piece. I've also attached the letter that I wrote back in March to the policy makers and affected parties. It explains the problem and gives my perspective on the situation. On March 10, a patients' father here, Doug Paris (in the video), held a meeting that he organized, to call attention to this critically important issue. He invited representatives from the state Medicaid board, hospitals, nursing homes, the media, local politicians and family members. That is how the TV news got involved. My letter was distributed at that meeting, the initial interviews were conducted (including with Kate), and Kate recommended that the reporter interview me. Unfortunately the reporter showed up without notice so I didn't have time to prepare anything to say (it takes a long time to write anything using my eyebrow).

I have a lot of things going on right now but I wanted to get the word out about this. I may follow this with information how you can help. I just got word today that the HCPF board is reviewing the financial statements from the two HBU facilities in Colorado. I am drafting a letter to the HCPF board to emphasize the key points against this flawed policy and may solicit your help to write your own versions of request that they reverse their Medicaid reimbursement policy for the HBU program. Please stay tuned for more information. Thank you for your interest, support and possible activism.

Thankful for all I've got and not letting it go without a fight,

Ian

April 30, 2009 (letter to the reporter Rick Sallinger)

Dear Mr. Sallinger,

Thank you for your efforts. However, for all of the time elapsed and information that was provided and available to you, I was very disappointed in your finished product. Perhaps your piece is just reflective of the sad devolution of television news into its current state of info-tainment. Both local and national coverage is light on useful information and heavy on sensationalism and triviality. In that vein, I thought that your piece was pretty thin on providing useful information; just a sympathy story with no sense of outrage. In general it's true that there is less substantive material to fill a local broadcast than national coverage but in this case, a paucity of substantive information wasn't the problem. This Medicaid reimbursement issue is somewhat complex and multi-dimensional but you missed providing the most critical information. Given that there is such limited material to fill the daily broadcast, the viewers' attention spans are brief and individual stories don't exceed 4 or 5 minutes; I think that you could have developed this story into a multi part series. Each episode could have examined one specific aspect; the historic context and nature of the issue (what was the motivation and justification for the State's policy change?), the personal impacts (as your piece focused) and the actions and consequences of the new State policy and the future implications.

The State HCPF is acting irresponsibly. The bottom line is that the State prematurely made an unnecessary policy change that is ethically, logistically and fiscally unsound. Colorado is effectively trying to save money by exporting and pawning off this patient population on other states. ALL of the affected parties including hospitals, nursing homes, the two existing hospital back up facilities and families/patients are unanimously opposed to it.

If you're going to condense the rather involved and complex issue down to a three minute piece, you have to chose a specific focus. Quite predictably, you chose the "Look at those poor people" track. Unfortunately this approach left out the most important points to communicate;

1) it didn't accurately describe the problem,

2) it didn't state that HCPF has changed the policy to save money without first reviewing with prospective new care providers (there aren't any) to determine whether the new plan was logistically possible (it isn't achievable, and a small pilot program would have revealed that) and,

3) no evaluation of the actual financial consequences was planned or conducted.

It didn't explain that people will be forced to go out of state BECAUSE the only two facilities in Colorado now with the remaining patients won't and can't afford to operate under the fixed rate schedule. The State's proposed alternative is to send us to nursing homes (none of which accept vented patients). The consequences are already being seen as patients who would normally go into the hospital back up program are stacking up in area hospitals, in some cases in ICUs (because their only vents and qualified staff are there), and racking up much greater expenses and consuming critical care staffing and resources unnecessarily. Someone has to be paying for these greater expenses. How are the hospitals passing through these costs? Don't they have enough of a financial stake to lead this fight with a PR blitz, if not with a legal suit?

This was the whole reason why the Hospital Back Up (HBU) program was established; to provide specialized care units for long term patients on ventilators with minimized costs and maximized efficiency. Only full service hospitals are capable of providing the same level of required care but at much greater cost. The two facilities in Colorado with HBU units operate on very thin financial margins. The imposition of a fixed rate reimbursement schedule (rather than being reimbursed for per patient operational expenses with all of the statutory Medicaid restrictions) is shutting down the HBU program without providing an alternative. The fixed rate reimbursement schedule was developed for Medicaid patients in nursing homes and doesn't take into account the additional expense of long term full time respiratory care of ventilator dependent patients.

Another dirty little secret about the HBU program is the demand for HBU beds exceeds the capacity of the two Colorado HBU facilities. Both facilities had waiting lists under cost basis reimbursement. The fact that there were no other HBU facilities operating prior to the State's policy change demonstrates that even cost basis Medicaid reimbursement isn't profitable. The two programs were established when governmental compensation more closely coincided with operational expenses and remain as vestiges of that time. It's shameful enough that Colorado has left it to market forces and a grossly inadequate state managed Medicaid program to care for a small vulnerable patient population with no other alternative for medical care. In a 2007 study by Public Citizen that evaluated Medicaid as administered by each state, Colorado was ranked 43rd overall. The individual ranks of the four parameters: eligibility, scope of services, quality of care and reimbursement were 41st, 40th, 42nd and 21st, respectively (p. 58, Unsettling Scores: A Ranking of State Medicaid Programs (2007), http://www2.citizen.org/hrg/medicaid/assets/reports/2007UnsettlingScores.pdf). The summary noted that the low Quality of Care score was attributable to very low quality nursing home care and very low rates of childhood immunization. The relatively moderate Reimbursement score was calculated from all providers under Medicaid (of which, the HBU program is too insignificant to affect an overall reimbursement score). It's worth noting that this assessment was done before the current economic crisis and state budgetary limitations. The effective elimination of the HBU program defies belief on the basis of ethics, responsible governance, viable logistics and intelligent fiscal management.

I will use the video of your piece with substantial supplementary information in an e-mail PR campaign to my personal and professional contacts to barrage the HCPF representatives with calls and e-mails until they see their wayward ways. I only wish that your reporting had more substance, carried a sense of outrage for bad governance and a message and vehicle for social activism to a much larger audience. I suppose that was too much to expect but for a man in my position, eternal optimism is standard operating procedure and, ultimately, I've learned to be my own best advocate.

Most sincerely,

Ian Pearson

March 8, 2009 (ironically my Birthday)

To all concerned,

Background I have been a Hospital Back Up (HBU) patient of the Skilled Nursing Facility (SNF) Unit at North Valley Hospital (recently renamed with the oxymoronic pleonasm, Vista View Care Center) since April 2004. Prior to coming here, I was resident at three other hospital facilities during the preceding eleven months. Over the last nearly six years I have come to a clear understanding of what is required to keep me (and others who require a comparable level of medical care) alive with an acceptable quality of life. I am writing this letter so that those who are making changes to the Medicaid reimbursement policy for facilities like this one better understand those medical requirements and the inevitable impacts of those policy changes. I am also writing to all other interested parties who may be able to influence and affect change to reverse this policy decision.

The Reimbursement Issue

The Colorado Department of Health Care Policy and Financing (HCPF) reduced reimbursement for new HBU patients, effective October 1, 2008. Existing patients were granted an exemption to the reimbursement change until July 1, 2010. The essence of the change is that reimbursement will now be made according to a fixed rate fee schedule rather than the existing restricted cost basis.

Historic Context and Existing Conditions

In order to understand the impacts of a reduced reimbursement one must understand the historic and current conditions under the cost basis reimbursement status.

For years, the SNF Unit here had been operated at a financial loss because of restrictions of Medicaid reimbursement, even under a cost basis, didn’t fully cover operational expenses. The hospital had other facilities that had a sufficient profit so that the extra cost of the SNF Unit was offset enough to be deemed acceptable. This mode of operation provided higher staffing levels, more auxiliary patient services (full time psychologist on staff, a comprehensive speech therapy department with an assistive technology program, a comprehensive and personalized physical therapy program and facilities, etc.), more frequent restorative therapy and showers and a more extensive recreation program than exist now.

After Vibra Healthcare purchased the hospital they fired many employees and closed or greatly reduced entire departments and facilities. Under this mode of operation the financially losing SNF Unit became a greater financial liability. In 2007 Vibra managers announced that they intended to close the SNF Unit, citing the financial burden. They later reversed their decision to close the SNF Unit and implemented a cost cutting strategic operation. Because the auxiliary patient services were already gone, cost savings were realized by increasing patient to staff ratios with reductions in Certified Nursing Assistants (CNAs), nurses and Respiratory Therapists (RTs) on all shifts. In addition, efforts were made to keep the patient population at capacity to minimize marginal costs and maintain more profitable economies of scale.

With fewer staff caring for more patients, stresses upon staff and patients increased and safely margins were reduced. Nurses were routinely required to care for 8 or 9 patients (many with complex, transient and extensive medical needs), CNAs, responsible for 10 to 12 and RTs, for12 to 14. Safe and reasonable patient to staff ratios should be roughly half these numbers for patients who require this level of care (and were under the previous management). Staff turnover required a greater reliance upon temporary agency staff, who individually vary considerably in competency and efficiency, and added to safety concerns.

After the announcement of the HCPF policy change, the Vista View management announced that they would no longer accept any new HBU patients under the new reimbursement protocol. In order to keep the SNF Unit filled to capacity, they began admitting patients with funding sources other than Medicaid. These patients have a wide variety of medical needs, often more complex and extensive than HBU patients and some have dementia, are belligerent or violent, or have other psychiatric issues. These conditions further tax the capabilities and resources of the already overworked staff and take them away from their regular responsibilities. There have been several instances when many, and sometimes all, staff on the unit have had to restrain one patient; on occasion, for up to an hour. During these times, the floor is left severely compromised, if not completely unattended. In addition, these patients have a high rate of turnover, adding a greater burden for nurses with frequent admissions and discharges.

Implications of Reduced Reimbursement

Even before the admission of non-HBU patients to the SNF Unit began, the staffing levels were marginally adequate. I can’t envision any scenario in which a facility could provide safe and adequate medical care to ventilator dependent HBU patients with less funding than under restricted cost basis reimbursement. There are no excesses to reduce or eliminate. If an established facility like Vista View, with well trained and experienced staff, isn’t willing or able to provide care to HBU patients with reduced reimbursement, what facility can? Nursing homes aren’t capable and regular hospitals don’t want us.

A handful of patients who have been discharged from here to facilities not oriented toward caring for HBU patients provide a vision of the future under the reduced reimbursement. All of these patients DIED within three months of leaving here. Lower staffing levels, less experienced and knowledgeable staff and the lack of full time RTs all contributed to the deaths.

Even if HBU patients don’t die within months of being transferred to a different facility under reduced reimbursement, our life expectancies and quality of life will definitely be diminished. What will be cut or reduced from existing programs like at Vista View? The only other facilities that are equipped to provide a comparable level of care are fully staffed/equipped regular hospitals. Operational expenses are much higher at hospitals and they aren’t set up for long term residency. That is why and how HBU units like at Vista View were established.

Personal Profile and Conclusions

I was diagnosed with amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig’s disease, at age 34. My wife and I were basking in the joy of the arrival of our second child,, born just five months before. I was steadily progressing in my career as a hydrogeologist at a small engineering and consulting firm in Denver. I had worked as a carpenter before attending graduate school and earning my Master’s degree. I was an endurance athlete and had always been very physically and intellectually active and had boundless energy and stamina.

I worked for another two years until the progression of physical disability forced me to retire. My illness put a tremendous physical and emotional burden on my wife and family as my wife cared for me at home.

In May 2003 a bad chest cold sent me to the emergency room where I conveniently went into respiratory distress with a blocked airway (if it had happened anywhere else, I would have suffocated). The next day I was given the choice of having a tracheostomy and going on a ventilator or doing nothing and likely dying within a week. I chose to stay alive.

In order to qualify for Medicaid and pay for my care, we sold our home, property and material assets, liquidated our savings and investments and my wife and children moved in with her parents. I am now almost completely paralyzed, confined to bed and am on a ventilator full time. The transformation to my current condition has been extremely difficult and I know that few people would be capable of following a similar path. I accept the life that I have now and maintain a positive attitude. I continue writing my life story and thoughts and beliefs that I want to convey to my children. I want to watch them grow up and leave them an enduring legacy of love and strength. I remain confident in my resolve to live for as long as I can keep having a positive impact in the lives of others.

I have fought too long and hard and my family has sacrificed too much for me to let a bureaucratic policy change lead to my final demise. I know what is required for my care. This reduction of Medicaid reimbursement can only lead to a reduction in the quality of care which has already been cut to marginally adequate levels here and now.

ALS is a relatively rare disease with no known cause, treatment or cure. The likelihood that anyone will get, much less, survive as long as I have with, a rare debilitating disease and would require the level of medical care that I receive, is very low. However, there are many things that can happen to anyone that would put them in a similar situation; paralyzed and on a ventilator, if they wanted to continue living. Just consider that YOU are one bad lane change, one infected wound, one mosquito bite (i.e. West Nile virus), or any variety of accidents, diagnoses or infections away from living like me. What will become of other Coloradoans who meet such a fate? Will the State subject them to a de facto death sentence by committing them to an inadequate health care facility? If not that severe, what quality of life will those people have?

I understand the motivations of the state Medicaid administrators to find all reasonable ways to reduce costs during these difficult economic times. I can’t understand how anyone could impose a policy change, regardless of motivation, without a clear understanding of the full financial, logistical and social ramifications. Furthermore, if, in this case, the policy change is made with knowledge of those impacts, I believe that its time to examine the ethical and moral standards that allow a small vulnerable population to be dangerously compromised for the sake of relatively modest cost savings.

Most sincerely,

Ian Pearson

The preceding text has been written using Ez-keys by Words plus, a communication program for people with physical disabilities. I use switch scanning and a piezoelectric sensor switch, mounted on a headband and activated with my eyebrow muscles. This document took roughly 40 hours to write.

Songs of Hope & Glory

A few years ago, I tried to maintain a separate blog, Songs of Hope & Glory, where I gathered all of the good I found in the news, in stories, and in my life. I haven't posted there in a year,  not for lack of inspiration, but simply for lack of time. I've just imported all of those older posts here. I will be going back to tag each of those older posts as a Song of Hope & Glory. Look for more news of the good soon.

Awed by surveillance technology

I am awed by surveillance technology. A friend sent me an email, one of those that had been forwarded a few dozen times.

It said:

"This is a photo from the 2009 Inauguration, In which you can see IN FOCUS the face of each individual in the crowd !!! You can scan, double click and zoom to any section of the crowd. . . wait a few seconds. . . and the focus adjusts. The picture was taken with a robotic camera at 1,474 megapixel. (295 times the standard 5 megapixel camera)"

Link here,  or copy and paste the following html code:

http://gigapan.org/viewGigapanFullscreen.php?auth=033ef14483ee899496648c2b4b06233c

I used to read Robert Heinlein extensively. I think privacy is well and truly a thing of the past.

Digging out

My University finally closed yesterday at noon. By that time the main road between where I live and Denver had closed. I'm very glad I chose to work from home and was able to skip the commute. People I spoke with yesterday who were down town made it sound like they were not getting hit quite as hard as my neighborhood.

It looked like this from my front door for most of the day yesterday. This was taken at about 11AM yesterday - so about 4 hours into the snow storm.

 I dug out my driveway yesterday at about 2 PM. We probably got another 3 inches of snow between then and this morning. I'm glad I did. The snow was wet and heavy with about an inch of slush at the bottom. I'd estimate that we got about 12 inches of snow total. It difficult to be certain. We had very high winds so some areas had several feet and others just a few inches. My roof still has lots of snow while my neighbor's has none.

The sun is starting to come out. I love this about Colorado. By Monday I suspect there will be few signs of this storm, perhaps some very green grass.

Snow Day

Yesterday was sunny and in the 50's. Today the snow is coming. No one seems to know for certain how much snow we will get. Some areas are predicted to get 2 feet of snow in the next 24 hours. Others, like downtown Denver, should get 8 to 16 inches. I rescheduled all of my appointments for today and tomorrow before I left the office yesterday evening. My car can manage 8 inches of snow, maybe, but not 16.

I woke up to an automated emergency message from the University of Denver at 6 AM this morning. I still work at the University of Denver on the weekends so I am still in their alert system. It had not yet started snowing where I live. They phoned, emailed and text messaged me: "Snow Closure: Due to expected heavy snowfall, the University of Denver will be closed today."

Compare this with the notifications I have so far received from my employer, the University of Colorado Denver. They have also emailed and texted me. However, their message says "A Winter Storm warning is in effect today 3/26 for the Denver area. 8-16 inches of snow and 45mph gusts of wind are expected. For more info call 1-877-463-6070."

We also got an email telling us where to find closing information, should they decide to close later today.  Since the same information is on the public weblink I am pasting the information here "New number to call when severe weather hits: The University of Colorado Denver now will provide weather and other emergency-related information, as appropriate, on a toll-free phone line effective immediately. The number is 1-877-INFO-070 (or 1-877-463-6070). You'll want to make a note of this number. Take a minute now to program it into your cell or home phone for easy access when conditions develop that may affect UC Denver's Anschutz Medical Campus in Aurora or the Downtown Denver-Auraria Campus. When extreme winter weather conditions do develop, UC Denver's normal business operations can be affected. Students, faculty and staff should check local broadcast news media (television and radio) for announcements about closures or schedule adjustments. Information also will be available online at www.ucdenver.edu/alert. You should bookmark this for future reference. An email from “Emergency” will also be sent to all university mailboxes. Typically, decisions to close the campuses or delay start times is determined in time for the 6:00 A.M. news broadcasts however this depends on when the severe weather arrives.. 1-877-INFO-070 (or 1-877-463-6070) www.ucdenver.edu/alert Students, faculty and staff connected to the Downtown Denver Auraria Campus can also check for recorded updates on the Auraria line 303-556-2401. The safety of our students, faculty and staff is a top priority. When snow and icy conditions do develop, always use extreme caution to ensure you arrive safely."

All I see is white from my window. Working from home today. I'll post more photos as the snow deepens. It's pretty amazing seeing it come down. This photo was taken at 8 AM about 1 hour after it started snow.

Traveling Companion Needed

I went to the movie Yes Man at Christmas with friends. I do not normally go to movies of this kind, but I enjoyed it and think of it still. I find myself saying "yes" more often to things I intended to do eventually. I'm just doing them sooner. It's all part of my quest for Bliss and my realization that there is only now.

My friend Martha is always the executive director of some health related non-profit. This year it's Dani's Foundation which focuses on Ewing's Sarcoma.

Dani's Foundation recently held a fund raising dinner (video here) with several hundred silent auction items. I started the bidding on four items and 'won' two of them, both on my "to do eventually" list: 1 week at a bed and breakfast in Hawaiiand 3 nights in Napa Valley at the Meritage Resort- complete with airfare, limo tour, and wine train tour.  Side note: it's really a sign of our economy when the opening bid on items such as these are the winners.While there are some blackout dates, I essentially have until March 2010 to go on these journeys. People ask me when I'm going. I am not yet sure. I need to line up a traveling companion. While I can easily chill in Hawaii by myself for a week, I definitely want a wine loving traveling companion for Napa Valley. Let me know if you are interested...

For my birthday I finally got the Kindle 2. I'm currently reading Outlierson it, another book by Malcolm Gladwell. Like one of his prior books, Blink, I am utterly enjoying this book. I cannot overstate how much I am enjoying my Kindle: it's smaller than a trade paperback and with its Leather Cover is much, much sexier.

I did not achieve the 6-pack abs I wanted for my birthday. I have been working out regularly - 5 or 6 times a week. However, for every 350 calories I've been burning off per workout, I've probably been eating an extra 600 or so. So, yes, I'm stronger and faster but also heavier. Oops. For the most part, my clothes are still fitting but I'm up a few pounds that need to be shed to see the muscle underneath. I currently belong to two athletic clubs. I really need to decide which one to stick with going forward.

While I have not been writing much on-line (my offline writing is going strong), this has been an amazingly good month. My friend who had the stroke last fall, is now almost fully recovered and back at work.  To quote a physician friend of mine "Cathy I don't believe in miracles, but A's recovery is a true miracle." Indeed. I went to her welcome back party earlier this month. I've never seen so many delighted people at a work event such as this.

Work has been insanely busy, but in a great way. We opened our annual business plan competition to the entire state of Colorado, not just our University family. So far, we're getting terrific interest from the community. We've been filming our orientation sessions (feel free to watch the first one). If you are a local reader and know someone who is starting a company, please have him or her contact me. Executive summaries are due April 16th so it's not too late to participate. We award more than $100,000 in cash and in-kind awards to the winners. The CEO of one of our incubator companies has been working with me on my presentation skills. He used to do corporate training for public speaking among other things. Since I open each session, I will soon have ample video footage for him to review and critique. This is not exactly fun, but will eventually make me better.

The face is like the penis

Do I have your attention? I know that phrase caught mine today when I read it. I almost spit coffee; and laughed for about 10 minutes.

A friend of mine loaned me Blink: The Power of Thinking Without Thinking by Malcolm Gladwell. I read it in one sitting. I was utterly mesmerized. I plan to read it again, pausing to digest the more important and insightful passages. I need to add it to my library. The only real question is whether to get the printed book or finally invest in the new and improved Kindle 2: Amazon's New Wireless Reading Device (Latest Generation) and get the electronic version of the book. The future is certain; a loaned copy is not enough.

“The face is like the penis!” (page 210 of the hard cover). In context, and this is very important, I used to feel badly that I did not have a poker face. Now I see this is good, for me and those around me: “Whenever we experience a basic emotion, that emotion is automatically expressed by the muscles of the face. That response may linger on the face for just a fraction of second or be detectable only if electric sensors are attached to the face. But it’s always there. Silvan Tomkins once began a lecture by bellowing, “The face is like the penis!” What he meant was the face has, to a large extent, a mind of its own. …. our involuntary expressive system is in many ways even more important: it is the way we have been equipped by evolution to signal our authentic feelings.” Since being authentic and real is important to me, I really cannot be dismayed anymore that all that feel is written on my face at all times.

My friend had shared a gem from this book with me a few months back. Relationship failure can almost entirely be predicted by evidence of contempt. It may be the single most important sign that a marriage (or any relationship really) is in trouble (or doomed). I’ve pondered this for months and cannot find a single exception in my past. Indeed, looking back, I remember a conversation I had at age 13 or 14 with a friend about love where I wondered whether it could exist for me without respect (the antithesis of contempt). It’s amazing how you can lose these simple insights over time. The four horsemen of relationship doom are: contempt, defensiveness, stonewalling and criticism. I personally have to add disgust, which was listed as an elevated form of contempt. If you’ve hit disgust, really, it’s done. C’est fini. Cut your losses.

There is an entire chapter in Blink dedicated to information overload. The scientist in me cringes at this but more data is not always good or helpful; it can confound your analysis and ruin your interpretations. Actually this is not so surprising to me. I was building my scientific career as all of the –omics became household names: genomics, proteomics, pharmacogenomics, metabolomics, etc. All of us wanted to identify biomarkers for a disease or specific therapeutic group. But more data was not always better, indeed it was almost impossible to analyze in a timely or statistically meaningful fashion. Therefore, I loved the passage in Blink on updating the Cook County ER to effectively triage for myocardial infarction using only a handful of symptoms. More information is not always more helpful. As scientists we call this confounding data, and it can truly muck things up.

Enough writing about Blink: The Power of Thinking Without Thinking. I'm going to go read it again. It's that good.

Shameless Self-Promotion

I serve as the Executive Director of the Bard Center for Entrepreneurship at the Business School of the University of Colorado Denver. Each year we host an annual Business Plan Competition. This year we are making a number of important changes to the competition, most importantly, new prize categories and opening it up to everyone in Colorado.

The Bard Center Business Plan Competition—the premier academic business plan competition in Colorado—seeks to promote the development of high-caliber business plans, recognize the most outstanding plans with cash and in-kind awards from area businesses, and encourage the creation of new businesses. Over the years the Business Plan Competition has grown from a smaller University of Colorado Denver focused event to a statewide competition that includes plans from throughout Colorado. Historically cash and in-kind awards totaling nearly $100,000 have been awarded annually. This year the competition is moving to new a level, increasing prize awards and categories of prizes. Promotion of the competition will also greatly increase. Our vision is to significantly grow the competition year by year until it is the leading business plan competition in the Rocky Mountain Region.

The six best aspiring entrepreneurs and their teams are chosen among all of the applicants to compete in a public competition. The Bard Center Business Plan Competition seeks to promote the creation and development of high caliber businesses by recognizing the most outstanding plans for early stage Colorado Companies with cash and in-kind awards from area businesses.

When: Wednesday, June 10, 2009

Where:Grand Hyatt-Downtown Denver (1750 Welton Street)

• 8:30 a.m. – 12:00 p.m. Six Finalists Present (free & open to public!)

• 12:00 – 1:00 p.m. Luncheon Keynote

• 1:00 – 1:30 p.m. Awards Ceremony

Historical Prizes*: • 1st Place $10,000 • 2nd Place $5,000 • 3rd Place $2,500  • 4-6th Place $1,000  •Best Bioscience $5,000 • Best Nonprofit $5,000 • Best International $1,000 • In-kind over $80,000 in services and support

* New Industry Specific Awards are actively being solicited.

Eligibility: The Bard Center was founded in part to promote economic development in Denver and the Rocky Mountain region. This competition is for early stage Colorado based companies. You must not have been a Bard Center business plan winner in prior years. You must not have received Angel or Venture Capital funding to date. The Bard Center solicits the best business plans from community members as well as faculty, staff, students, alumni, at all Colleges & Universities in Colorado. You do not need to be a college graduate to compete.

Application Process: Executive summaries are due on April 16, 2009. The top 20 businesses will be asked to submit full business plans by May 7, 2009. The top 6 businesses will publicly promote their businesses at our June 10, 2009 Business Plan Competition.

Important Dates:

March 12: Meet a judge, Business Plan Competition process discussed – Chris Onan, Appian Ventures

March 19: How to write an Exec Summary – TBD

April 9: Preparing Financials for your Exec Summary – TBD

April 16: Executive Summary Due, Competition Application Due

April 23: Business Plan Structure & Scoring – TBD

May 1: Top 20 Competitors invited to submit full Business Plans

May 7: Business Plans due – (only Top 20 business plans invited to submit)

May 14: Elevator Pitch Practice - TBD

May 28: Notify Top 6 finalists

June 3: Finalist Pitch Practice, Bard Center, all day, hosted by Business Catapult

June 10: Business Plan Competition

Testimonial: "As an aspiring entrepreneur going through the MBA program at UC Denver, the Bard Center gave birth to my second career and life. Not only did the Bard Center provide the tools and knowledge to become a successful entrepreneur, it also provided a great launch pad for my business concept, MetroBoom. Participating in the 2004 Bard Center Annual Business Plan Competition changed everything for me. Winning the first place honor served as "the wind behind the sail" my business concept needed for an ideal launch. The cash prize of $10,000 combined with over $15,000 worth of donated services from in-kind sponsors were extremely valuable resources. All the press and exposure I received from winning the competition gave MetroBoom the right type of attention and credibility it needed as a start-up. The Bard Center was also a great source for networking. I have met intelligent, motivated, and caring entrepreneurs and supporters of entrepreneurship. Without the help from the people I met through the Bard Center, it would not have been possible for me to launch MetroBoom. And, the support hasn't slowed down since my business opened. The networking opportunities still provide me with great sources for business leads and knowledge. The administrators, faculty members, students, board members, and alumnae provide immense amount of support for MetroBoom. They all serve as our ambassadors. The financial, emotional, and functional support from Bard Center motivates young entrepreneurs like myself to take the leap of faith into entrepreneurship with confidence and pride."

- Jung Park, MetroBoom, 2004 Business Plan Competition Winner – still going strong in 2009: www.metroboom.com  

---

Please contact me if you are interested in attending, participating in or sponsoring our competition.

Month 1 Update Goals 2009

Where did January go?

You know that it's been too long when your mom emails to find out why you have not been blogging. 

I have three major goals for 2009- improved fitness, learning Spanish and seeking out bliss.

While I have not been good at writing down my progress, I have been actively pursuing my goals.

Fitness - I joined the new LifeTime Fitness Center in my neighborhood. I have been meeting a friend there about 5 times a week. I have started swimming again. I'm getting stronger and faster. I'm not sure why I'm willing to drive about 10 miles to work out when I've had a membership to a gym about 2 block from my work that I rarely used. I think it's because I've had a friend who has consistently met me there, either mornings or evenings depending what will work for my schedule. Knowing someone is waiting or would be waiting helps me get there.  

I want to see my abs again this year. I'm close. I weighed and measured recently. I estimate I need to lose 5 or 6 measly pounds of fat to reach this goal.

Spanish- I have not made as much progress adding a new language. I did move the first 30 lessons from CD to iPod but that has not helped much.

Bliss - Ah the bliss. I think this must be my real goal for 2009. The bliss is everywhere. It's been a great month. Seeing my friend, who was in a coma for about a month after her stroke last fall, walk a few blocks to enjoy a meal at Chipotle with me. Having her talk about returning to work any day now. Going for my first motorcycle ride to the mountains with a good friend because it was sunny and 70 in January. Getting home before the snow blew in. Getting a massage; a facial; a manicure; a pedicure. Taking my very first ski lesson. Not falling. Sitting on an outdoor deck in the snow looking up on the mountains sharing conversation with a good friend over lunch. Connecting with someone who could become important. Having him cook dinner for me. Watching the people walk by on sunny days sharing conversation over coffee with good friends.

And, I finally have some closure on my home situation. My now ex-husband and I filed for divorce in July and promptly put our house on the market. Our divorce finalized in October. After 6 months, more than 54 showings, a price drop of 12.5% and no offers, my ex and I came to an agreement. Yesterday we met at the bank, transferred money to him and the title on the house to me. I cannot express how relieved I am to know that I can move my belonging out of the garage and into the house; that I can count on the house being locked when I get home; that I can leave the bed unmade from time to time; that I won't get 15 minutes warning to leave for 2 hours on Saturday mornings.

Short Notes

I love reading other people's blogs. I had a few things catch my attention this weekend.

(1) Scott Adams has an interesting post on practice that ended with this sentence. "It makes me wonder if the passion part of our brains will ever be manipulated by drugs so that passionless people get just enough OCD to obsessively practice something until they get good at it."

(2) Kyra has a wonderful post (rant) on health and fitness (and the obesity epidemic in the USA) on a budget which reminded me of Maggie's posts on frugal dieting and fitness. Truly, I can (and often do) spend more on meal than Maggie would spend on a week of healthy eating.

(3) Clay Lowe was interviewed and included in that interview was an amazing poem. I'm going to grab a snippet.

Her dreams have all gone to bed by Clay Lowe

The wind whispers between
raindrops of yesterday’s past
the memory of her last kiss
fades to black

She can see her happiness
stagger out the front door
into the arms of another
perfumed night

Her broken dreams have
all gone to bed haunted by
ghosts of lines left unsaid

...

go read the rest. And be sure to check out Clay's blog. I can't wait for his book to be published in March. I don't even normally like poetry but Clay's poems tend to resonate with me.

(4) I follow Ben Casnocha on Twitter and read his blog regularly. This tweet resonated with me today: "We unconsciously dislike / repel people in whom we see parts of ourselves that we cannot or do not want to accept. (DFW)"

I see this everyday and could not agree more.