Kwanzaa Reflections in 2020, by J.D. Meyer

We aren’t meeting in the Tyler, Texas Library in 2020 for Kwanzaa because of the coronavirus pandemic. I’ve been delivering official Kwanzaa speeches off-and-on since 2002—all but Faith Night out of seven nights. Of course, I check out Rev. Reginald Garrett for that last night.  I’ve published articles as well over the last couple of decades, and I’ve given some general Kwanzaa talks

But we need to do som’n in cyberspace for Kwanzaa. I want to go in the direction of health, specifically the OTC vitamins/minerals that I take on a daily basis. We need to boost our immune system, in case we catch the pandemic COVID19 virus!  OK, I’ve been on SSDI for a while for COPD, and I was invited to join the local Community Health Workers (CHW) coalition because of my Word Press articles and whatnot.

Here’s a great article about four great vitamins to boost your immune system: Vitamin D, Vitamin C, Zinc and something called Quercetin. https://www.fox29.com/news/studies-suggest-4-vitamins-to-prevent-severe-cases-of-covid-19?utm_campaign=trueanthem&utm_medium=trueanthem&utm_source=facebook&fbclid=IwAR2mhleKuo_ULIzTTnIKZoO7X3LsDdEK9T7K3F9ZgwNE0LFKRZIhv-5S-Jw It’s a well-known fact that Vitamin D is activated by sunlight darkening your skin. So darker people need more Vitamin D.

Not all multiple vitamins are alike. Spring Valley Super Vitamin B-Complex has 9 vitamins–including C & B12. Nature Made B-Complex has 6 vitamins–including C. Ocuvite for macular degeneration has zinc, among 6 vitamins and minerals plus lutein.

Meditation in Ruism (Confucianism) by J.D. Meyer

Meditation in Ruism is analyzed as a component of three major concepts. It’s (1) the attention aspect of Reverence, (2) the empathy aspect of Benevolence, and (3) the perspective aspect of Pattern-Principle.

Reverence= 敬  Jìng

Benevolence= 仁 Rén

Principle= 理  Lǐ

……………………………………..

Attention= 注意 Zhùyì

Empathy=  同情  Tóngqíng

Perspective= 透視 Tòushì

…………………………………………………………………

My Illnesses & Pills: Strengthening the Immune System–One Way to Battle the COVID-19/Coronavirus Pandemic, by J. D. Meyer (2nd Edition)

Dang, I’ve been feeling good for four years! But I fit the stereotype of someone that ought to be “fixin’ to get sick”—lungs illness, namely COPD (since 2005) and asthma (since 1986). I got on the combination of SSDI, Medicare, and Medicaid by 2012. I’m writing this article about my illnesses and pills because medical professionals may find clues to finding a way to battle the COVID-19/coronavirus pandemic. Dealing with the pandemic takes three routes in the medical community: building the immune system, finding antibodies, and discovering a vaccination. My article represents the way for educated laymen to contribute.

I take at least 15 pills per day (11 different pills)—a motley mix of prescription drugs, vitamins/minerals, and OTC drugs. I have more health issues than Asthma-COPD Overlap Syndrome (ACOS). Quitting cigarettes was important as was quitting snuff tobacco. Nowadays, I occasionally indulge with Smoky Mountain Herbal Snuff (Wintergreen Flavor). It’s made from corn husks and molasses; it’s made in Sandy Hook, CT.

Here are the rest of my diagnoses: Mixed hyperlipidemia E 78.2, Essential (primary) hypertension I10, atherosclerosis heart disease of native coronary artery without angina pectoris I25.10, and macular degeneration. Furthermore, I get monthly allergy shots for Bermuda and Johnson grass, and I have sleep apnea.

Now let’s check out my daily pills. Prescriptions: Daliresp, Montelukast, Dilacor (DILT), Omega 3 Acid Ethyl Esters (4, Take two twice daily), and Prednisone. Vitamins/Minerals: Magnesium, CoQ10, Vitamin D (2), Ocuvite (Vision Health). That last pill is a mix of Vitamins A, C, E and Zinc, Selenium, Copper, and Lutein. Over the Counter Medicine (OTC): Vitamin B-Complex with C (general health)& Loratadine (non-drowsy generic pill for allergies).

Here are the drugs that I inhale. Obviously, I have a rescue inhaler, and it’s Combivent (albuterol + ipratropium). I graduated from the albuterol inhalers a while back. But my nebulizer fluid is albuterol only. Then I take Advair twice daily, an anti-inflammatory.

Here are the occasional OTC drugs and vitamins/minerals: Sudafed (nasal congestion), Mucinex–aka. Guaifenesin (chest congestion/bronchitis). , Milk Thistle (liver health) and rarest of all—Turmeric Curcumin (anti-inflammation). Before I got health insurance, Mucinex and Sudafed were very frequent companions. I’ve become a member of the Chris Cuomo Fan Club and explained the joy of Mucinex on his website.

Let’s hope that my list of medicines and illnesses helps medical researchers during our pandemic crisis. I was invited to join the local Community Health Workers (CHW) coalition several years ago because of my explanation of lung health issues for the layman. I used to be a teacher–mostly Developmental English/Writing (college level), ESOL (English for Speakers of Other Languages)for all levels, and all-level/ most subjects substitute teacher.

Some of those drugs and whatnot represent a journey! Magnesium is a new friend. First I was put on statins and developed heart issues. Then I found CoQ10 and that helped. Then I had a phase of Red Yeast Rice–a more organic, mellow statin. Then I read a couple of journal articles against it and stumbled onto Magnesium. Magnesium is the super mineral. It’s good for excess fat, arthritis, COPD, and even more issues!

My most recent drug is prednisone—previously som’n just for acute attacks. I passed a recent chest X-ray, but my pulmonologist felt that I needed prednisone. After all, I’ve had a low moderate Forced Exhale Volume (FEV) for years. I may be 6’2” and 61 years old, but my FEV is comparable to a short elderly lady’s lungs, or just one lung, or a very short child’s lungs. Stop smoking, stay indoors, or wear a mask/bandanna when shopping.

COVID-19/Coronavirus Annotated Link Page, by J.D. Meyer (2nd Edition)

1. Q & A on Coronavirus (COVID-19) by WHO (World Health Organization). Answers to 23 questions, two information links, subscribe to WHO newsletter. https://www.who.int/news-room/q-a-detail/q-a-coronaviruses?fbclid=IwAR0cSHcLD8YtFmTG8sq-w8E3p4BVui6L41CieOoR0C1fu_9fbROHjcUcaHQ

2. Oxford COVID-19 Evidence Service. By Centre for Evidence-Based Medicine. Updates began on March 17, 2020. Click for Questions under Review. Top 3 Most Viewed: COVID-19 Signs & Symptoms Tracker, Assessing dyspnea, Global Covid-19 Case Fatality Rates, TRIP database COVID-19 updates. https://www.cebm.net/oxford-covid-19/

3. How the Novel Coronavirus and the Flu are Alike…and Different
Symptoms, Transmission, Degree of Mild vs. Severe Cases, Length of Hospitalization, What % of the Population Will Get Each Virus, Death Rate, Treatment, Vaccines, Impact of Seasonal Weather. https://www.npr.org/sections/goatsandsoda/2020/03/20/815408287/how-the-novel-coronavirus-and-the-flu-are-alike-and-different?utm_campaign=storyshare&utm_source=facebook.com&utm_medium=social&fbclid=IwAR0-_S-NHB2OHGoJs6EHu-OBPDp8Qh6xYB6BPxB11ePdN_519YgFeIheNCE

4. Why ‘Death Rates’ from Coronavirus Can Be Deceiving. “The answer involves how many people are tested, the age of an infected population and factors such as whether the health care system is overwhelmed, scientists say.”
https://www.npr.org/sections/goatsandsoda/2020/03/27/821958435/why-death-rates-from-coronavirus-can-be-deceiving?utm_campaign=storyshare&utm_source=facebook.com&utm_medium=social&fbclid=IwAR1P6Dzb5ug-mG-CAY3rfsrl2dJ1c-1YPu2KitdIXl9e4ruNHVP858JqAfE

5. Can a Supplement Protect Me Against the New Coronavirus? “Doctors say there’s limited evidence on how any supplements may or may not affect coronavirus spread and the resulting disease. Here’s what we know right now.” The following supplements are analyzed: elderberry, Vitamin C, Vitamin D, apple cider vinegar, turmeric. https://www.everydayhealth.com/infectious-diseases/can-a-supplement-protect-me-against-the-new-coronavirus/

6. Faces of Coronavirus: One Woman’s Road to Recovery. “…the first signs that she had the disease caused by the novel coronavirus were some aches and a dry cough. Her symptoms quickly escalated to difficulty breathing and fever.” This interview was reviewed by an M.D. https://www.everydayhealth.com/coronavirus/faces-of-coronavirus-one-womans-road-to-recovery/

7. Loss of smell and taste could be the strongest symptom of Coronavirus, experts believe. Loss of smell and taste are stronger predictors than fever and cough—triple other symptoms. The Covid Symptom Tracker App has created a model that also lists new continuous cough, fever, fatigue, diarrhea, abdominal pain and loss of appetite. https://www.manchestereveningnews.co.uk/news/uk-news/loss-smell-taste-could-strongest-18019703

8. COVID-19, Asthma, Allergies: You’ve Got Questions….(Video with Transcript). “Allergy & Asthma Network compiled a list of questions regarding COVID-19 (novel coronavirus) that people asked during our “Distinguishing the Difference: COVID-19 vs. Allergies vs. Flu” webinar on March 17. The webinar was hosted by Allergy & Asthma Network President and CEO Tonya Winders and board-certified allergist and immunologist Purvi Parikh, MD.” https://www.allergyasthmanetwork.org/covid-asthma-and-allergies-frequently-asked-questions/ General Questions (25), Asthma Management Questions (13), School Questions (3).

9. COVID-19 COMPARISON: Coronavirus vs. Cold vs. Flu vs. Allergies (Chart comparing 12 symptoms among 4 Illnesses) https://coronavirus.health.ok.gov/sites/g/files/gmc786/f/fb-covid-comparison-8.5×11-eng.jpg

10. Coronavirus is not the flu. It’s worse. This 6 ½ minute YouTube video is from the CDC (Center for Disease Control). Twice as contagious , longer incubation period, no shot or immunity, 25% hospitalized > 2%. At least 10 times the fatality rate. Older and compromised people are more vulnerable. https://www.youtube.com/watch?v=FVIGhz3uwuQ&feature=youtu.be&fbclid=IwAR2oMqPwP76ZMdL_U8GTRjXy4LNaONjc-c_6oHaZ9XnkKOJykpZDo8UnOH4

Cactus (Nopalitos): Why Fresh is Better than Pickled, by J.D. Meyer

I’ve been a major fan of sliced cactus (nopalitos) for many years.
I’d compare the flavor and texture to a cross between a bell pepper or
poblano pepper and okra. Admittedly, I’ve never bothered to buy the
whole pad from the vegetable section of the grocery store and carve
the quills out of them in my kitchen. However, usually I get the pickled
variety in a jar, and I save the jars for leftovers. Fresh bags of sliced
nopalitos in the vegetable section are confined to Mexican grocery
stores—such as La Michoacana. Cactus (Nopalitos) seems to find its
way to restaurants/taquerias either with beef fajitas or scrambled eggs
in a breakfast taco.

Finally, I read the nutritional information from two empty bags of
fresh nopalitos, and two jars from pickled nopalitos. The nutritional
data is staggering. Vinegar and salt deplete nutrients!
Let’s start by looking at that fresh bag of sliced cactus by Latin
Specialties. One cup contains the following: Calcium—39%,
Potassium—17%, Vitamin A—22%, Vitamin C—36%, Dietary
Fiber—20%, Iron–8%, Sodium—2%, Protein—6%, Carbohydrate—3% &
Fat—0%. The statistics for Ortega’s Nopalitos are virtually the same,
except the Potassium amount is unknown.

On the other hand, let’s look at the convenient pickled cactus in a
jar. Two tablespoons of Dona Maria Nopalitos has no Calcium, no
Potassium, Vitamin A—2%, no Vitamin C, no Dietary Fiber, no Iron,
Sodium—23%, No Protein, Carbohydrate nor Fat. Meanwhile, a half
cup of El Mexicano Nopalitos has the following: Calcium—5%, no
Potassium, no Vitamin A, no Vitamin C, no Dietary Fiber, Iron—6%,
Sodium—21%, Protein—2%, Carbohydrate—1% & Fat—0%.

Blood Cancer Research Annotated Link Page—Including Eastern & Natural Medicine By J.D. Meyer

1. http://www.hematology.org/Patients/Cancers/ Three Kinds of Blood Cancer: (1) Leukemia, (2) Lymphoma, and (3) Myeloma.

2. https://www.ncbi.nlm.nih.gov/pubmed/25136372 “Treatment of acute lymphoblastic leukemia from traditional Chinese medicine.” Highlights from Abstract: “Methotrexate (MTX) is a drug used in the treatment of various cancer and autoimmune diseases……Therefore, MTX can inhibit the synthesis of DNA. However, MTX has cytotoxicity and neurotoxin may cause multiple organ injury and is potentially lethal…..Our results show that the TCM compounds adenosine triphosphate, manninotriose, raffinose, and stachyose could have potential to improve the side effects of MTX for ALL treatment.”

3. https://en.wikipedia.org/wiki/Adenosine_triphosphate “ATP is a complex organic chemical that provides energy to drive many processes in living cells, e.g. muscle contraction, nerve impulse propagation, chemical synthesis. Found in all forms of life, ATP is often referred to as the “molecular unit of currency” of intracellular energy transfer.[1] When consumed in metabolic processes, it converts either to adenosine diphosphate (ADP) or to adenosine monophosphate (AMP). Other processes regenerate ATP so that the human body recycles its own body weight equivalent in ATP each day.[2] It is also a precursor to DNA and RNA, and is used as a coenzyme.”

4. http://www.itmonline.org/arts/leukemia.htm TREATMENT OF LEUKEMIA USING INTEGRATED CHINESE AND WESTERN MEDICINE, by Subhuti Dharmananda, Ph.D., Director, Institute for Traditional Medicine, Portland, Oregon. Highlight: “While specific nutritional approaches have not been developed for leukemia, certain general methods can be applied:
a. Make sure the individual is receiving adequate basic dietary nutrients, such as proteins, fats (preferably unsaturated), and carbohydrates. Monitor body weight and muscle strength, and take further action if there is not improvement, including recommending easy-to-use concentrated nutrition sources.
b. Provide additional nutrients and a high level of antioxidants using supplements (11). General anticancer substances may be tried, including flavonoids (quercetin, genestein, tea polyphenols), minerals (selenium), and vitamins (high dose vitamins A, C, and E). Even if these fail to produce a cancer-inhibiting action, they may provide other benefits for persons in the age group that suffers from chronic leukemia.
c. When possible, use Oriental dietary techniques to match the dietary components to the symptom/sign pattern (12). For example, use cooling foods for fevers, astringent foods for sweating, yin-nourishing foods for yin deficiency patterns, etc. Make sure the suggestions include using foods that can reasonably be obtained and prepared.”

5. https://blog.yinyanghouse.com/posts/one-more-reason-to-eat-your-veggies-significant-leukemia-risk-reduction Highlight: “Their analysis found that there was a significant decrease in leukemia risk as the vegetable intake was increased. Interestingly, they did not see a significant raised risk from red meat, poultry, fish, or fruits. The primary factors in elevating the risk were frequent intakes of “fat, deep-fried, and smoked” foods. They concluded that “diets rich in vegetables and adequate amount of milk reduce the risk of adult leukemia.

6. http://www.a-healthy-body.com/the-top-10-health-benefits-of-turmeric-plus-how-to-use-it-in-everything/#comment-92 “The Top 10 Health Benefits of Turmeric (Plus, How To Use It In Everything).” The most relevant benefits vs. cancer are probably #3 “Turmeric helps boost your immune system” & #5. “Turmeric can help treat and prevent cancer.”

FOOTNOTE (Initial Reaction): “I’m sorry to hear of your father’s illness. If my health research turns up anything, I’ll let you know. CoQ10 is great for cardiovascular diseases, and Dr. Peter Langsjoen of Tyler is one of the major authorities on CoQ10 in the world! But that may not apply for cancer.”

“Skillful Teaching through Facilitating Discussion—Teaching skills is an essential pillar of a competent CHW and CHWI,” a lecture by Dr. Shannon Cox-Kelley, summarized by J.D. Meyer

This was the first lecture at the 2018 Community Health Workers Conference for the NE TX CHW Coalition, July 13, 2018.

The NE TX CHW Coalition Conference featured two main lectures and three breakout sessions. The first main lecture was by Dr. Shannon Cox-Kelley –Dean of Health Science–who teaches in the Community & Public Health degree program at NE TX Community College. She received all of her degrees at Texas A&M at Commerce and is a noted online distance educator.

Dr. Cox-Kelly cited four occasions to use discussion: (1) Evaluate evidence. (2) Formulate application of principles. (3) Foster motivation for further learning. (4) Articulate what has been already learned—theory behind the discussion.

Memory is linked to how deeply we think about something. A research interest cited in Dr. Cox-Kelley’s biography really clicked with me: “the impact of educational attainment on health outcomes in diverse communities.” My disabling condition is COPD, but as a Master’s degree holder and former all-level teacher (mainly Developmental English/Writing: the Pre-College Composition course), I’ve learned to study my conditions. (Yes, I have other health issues). I write Word Press articles on health and make binders full of info on medicine, ER reports, and journal articles.

Returning to Dr. Cox-Kelley, she notes that relationships are key, and we have a need to know why and how information is needed. The CHW Instructor could start with controversy like a “devil’s advocate,” but one should announce it in advance to maintain trust. Uncertainty arouses curiosity; switch sides. Focus on solving problems rather than the solution.

Many students are passive and quiet since we’re taught to memorize in secondary education. An increasingly popular practice is to flip the class and have the lecture at night on You Tube or something like it. Then the classroom becomes a place for total discussion. This flip improved passing rates at Dr. Cox-Kelley’s junior college. Think, don’t memorize.

How to start with questions means to start with desired outcomes. Factual questions increase problem-solving. Application and interpretation questions find connections. Problem questions can induce critical thinking. Comparison questions can evaluate readings.

Dr. Cox-Kelley cites principles behind case studies: (1) Increase focus. (2) Break cases into sub-problems. (3) Socratic questioning, and (4) Lead students toward intended outcomes. Once again, passive students can be a possible barrier, as well as failure for students to see value.

Dr. Cox-Kelley cited Discussions as a Way of Teaching, by S.D. Brookfield and S. Breskill (1999) as a fine relevant book. Students can experience a fear of looking stupid and the inability to consider alternative sides because of emotional attachment. Are they trying to find a correct answer or explore? Helping emotional reactions includes asserting the value of discussion and keeping opinions and verbalization in perspective. To conclude, collaboration is better than competition.

“Skillful Teaching through Facilitating Discussion” lived up to its subtitle of teaching skills being an essential pillar of both the Community Health Worker (CHW) and CHW Instructor (CHWI). Furthermore, Dr. Cox-Kelley’s lecture reached out to teachers looking for a second career or a stimulating cause in retirement.

SOL18: Assisting a Local Journalist: Future Story About Coping with Obstacles to Success Faced by Locals

I received a Facebook message from our star local newspaper’s photojournalist that she was in the process of co-authoring an article about obstacles to success faced by locals: poverty, medical/mental disabilities, incarceration, and lack of housing. I was flattered that she wanted my input; she’s been a favorite acquaintance and neighbor for a few years. You’ll notice that I added “coping” to this article.

I’m a former teacher who is disabled with COPD and asthma. To get on SSDI, I went for tests at a local hospital–East Texas Medical Center. Later I got on Medicare and became connected with the East Texas Council for independent Living (ETCIL) and entered a nursing home for eight months. I got two overdue surgeries while I was there. However, I couldn’t get discharged until I got on Medicaid and was turned down the first time. So I went to the Records Department of ETMC and got a complete list of my Emergency Room visits for the previous four years. Most of y’all have probably heard that Texas is the largest state not to have Medicaid expansion. It’s so wonderful to have Cigna health care. I get maintenance medicine, have a pulmonologist and a G.P. that are really great and nice, and discovered what else was wrong with me health-wise. I study my Asthma-COPD Overlap Syndrome and have a binder and a couple of folders on the illness; some articles are by me on my Word Press.

I mentioned that I went to the City of Tyler Neighborhood Services to get an apartment rental discount through the Department of Housing and Urban Development (HUD). The local center for independent living relocation specialist facilitated the process. Later when I moved across town, I did it all myself. Before I got on Meals on Wheels and SNAP Food Stamps, I went to a couple of local food pantries once per month.

Besides specifically telling her to call Neighborhood Services and ETCIL, I told her about my main volunteer activity: East Texas Human Needs Network (ETHNN). We have five committees: Education, Employment, Healthcare, Housing, & Transportation. Transportation is my main focus because I ride the bus regularly, as I quit driving several years ago. I’ve arranged field trips with lunch for all five lines. We went to both shopping centers, two grocery stores, and Neighborhood Services. I also attend Education and Healthcare committee meetings.If more people rode the bus, we’d have less traffic, pollution, and more bus routes.

Just between us for now, I’ve really been trying to advertise the importance of finding a match between personality and college major choice/vocation. The local university wants to improve its graduation rate, so I sent my article on the topic to a couple of friends who work there. Furthermore, career counseling centers should advertise the free online Myers-Briggs Type Indicator (MBTI) instruments.

To conclude for now, I told the photojournalist that I may not make much money, but I don’t spend much either. Just because one may be a retired teacher (prematurely, in my case), a teacher never quits teaching.

Questions to Ask Someone with COPD (2nd Edition), by J.D. Meyer

1. What inhalers do you use? A rescue inhaler, like Pro-Air, was my first. Now, I usually take Combivent.

2. Do you use a nebulizer with albuterol or albuterol-ipratropium? Nebulizer fluid is an extra strength version of rescue inhalers with the same chemicals.

3. Do you use a twice daily inhaled corticosteroid, such as Advair or Symbicort?

4. Do you have a pulmonologist? I go to Pulmonary Specialists of Tyler on Fleishel, behind ETMC. Dr. Luis Destarac is my doctor. I get allergy shots there too. I’m allergic to Bermuda & Johnson grass.

5. Do you have lots of phlegm sometimes? Take Mucinex, and you can get the generic version at Family Dollar that’s cheaper.

6. Have you ever been to the ER for an exacerbation? Have you been there lately? More often or less often over the years?

7. Do you have sleep apnea? Do you have a C-PAP?

8. Do you have an oxygen machine with nasal canula?

9. Do you still smoke cigarettes? I quit a few years ago.

10. Have you ever had asthma? Child asthma can go away, & it’s more common. I developed asthma at age 28 & COPD at age 46. Asthma-COPD Overlap Syndrome (ACOS) is characterized by more dyspnea (breathlessness), more phlegm, but better response to inhaled corticosteroids (such as Advair). Some COPD inhalers, like Onoro, can be fatal to those with asthma also!!

http://www.healthcommunities.com/copd/early-stage-copd.shtml Early COPD.

https://bohemiotx.wordpress.com/2017/02/05/dealing-with-a-bad-copd-exacerbation-maybe-dodging-an-e-r-visit/ On reducing ER Trips.

Budget ACA: 3-10 Essential Benefits, 2nd Edition, by J.D. Meyer

1. Ambulatory patient services. [Outpatient care]
2. Emergency services.
3. Hospitalization. [Inpatient care]
4. Maternity and newborn care
5.Mental health and substance use disorder services, including behavioral health treatment.
6. Prescription drugs.
7. Rehabilitative and habilitative services and devices.
8. Laboratory services
9. Preventive and wellness services and chronic disease management;
10. Pediatric services, including oral and vision care.

Health insurance plans must cover these benefits https://en.wikipedia.org/wiki/Essential_health_benefits

Right now, it’s all ten or none. Pay a fine if you choose none……. How about a budget version: (2) Emergency Services, (6) Prescription Drugs, & (1) Ambulatory patient services [Outpatient care]? Limit eligible clients to those who make $20K/year or less.

Let’s change the paradigm from younger healthy people would rather pay a fine than go for all ten. My new proposed paradigm is let the poor choose the three most important!

I know what it’s like to work over 40 hours/week with three part-time jobs and no insurance: adjunct instructor at a community college, construction assistant, and substitute teacher. This was my career from 1994-1999. I’d developed asthma in 1987. Trust me, summer is construction asst. only, and that faded out of the picture after I got a full-time teaching job (2001-2006), followed by COPD (2005).

Why did I choose those three benefits? Emergency Room visits are very expensive, and in the USA, we let the sickly get help and hopefully pay later. I got on Medicaid by showing my record of ER visits from 2008-2012 to social workers, despite living in Texas—the largest state not to expand Medicaid.

I could afford an inhaler and nebulizer fluid, but not Advair. Fortunately, I learned about botanicas from living in a predominantly Mexican-American neighborhood and got gordolobo (mullein leaves) and eucalyptus.

I went to clinics that generally served the poorer part of the population. Through “Ambulatory patient care [Outpatient care],” more would be able to afford the office visits themselves and have a regular doctor.

I hope my “Budget ACA: 3-10” brings a helpful new angle to American Health Care. It’s such a hotly debated topic, and we seem to have more difficulties than most OECD nations. My first edition was mistaken in choosing 9. Preventive and Wellness Services and Chronic Disease Management over 1. Ambulatory Patient Services [Outpatient care]. Outpatient care is more basic.I bet plenty of poor people would rather buy “Budget ACA: 3-10” than pay a fine–looking forward to feedback.