Author: John Turley Page 17 of 32

Understanding Fall Risks in Older Adults

On July 16, 2025

Prevention and Awareness

This topic is very personal to me. In the past three years I’ve had two major falls. The first put me on crutches for several weeks. The second resulted in shoulder replacement surgery. I now find myself constantly worried about stairs, curbs, broken pavement, holes and roots in the lawn and many other elements that may put me at risk for another fall. I constantly remind myself that gravity is unforgiving and concrete even less so.

Fortunately, I was wearing my Apple Watch when I fell. I had left my phone on my desk but was able to use my cellular connected watch to call for help. I strongly recommend all seniors to get and wear a smart watch with a fall detector. When you fall it will query you and if you are unable to respond it will send your location to 911. I hope that this article may help you, your family, or your friends understand the increased risk of falling as we age and what we can do to help prevent it.

Falls are one of the most serious and preventable health challenges facing older adults. As we age, the simple act of walking becomes increasingly complex, and what once seemed like a minor stumble can have life-altering consequences. Understanding why falls occur more often in older adults, and knowing how to prevent them, is crucial for maintaining independence and quality of life.

The Startling Statistics

The numbers surrounding elderly falls paint a sobering picture of this health crisis. According to the Centers for Disease Control and Prevention, falls are the leading cause of injury for adults ages 65 years and older. More than 14 million older adults—that’s 1 in 4—report falling every year. These aren’t just minor incidents; they result in significant medical consequences and tragically, often death. Each year, approximately 3 million emergency department visits are directly attributed to older adult falls. The age-adjusted mortality rate from falls has more than doubled from 1999 to 2020, rising from 29.4 to 69.4 per 100,000 adults aged 65 and older.

Here’s What We Can Do

Be Prepared

Never engage in any physical activity alone unless you have some way to summons help, be it a cell phone, a cellular connected smart watch, or best of all, an exercise companion.

Strength and Balance Training

Regular exercise is perhaps the most effective fall prevention strategy. Programs specifically designed for older adults, such as tai chi, yoga, chair aerobics, or structured balance training, can significantly improve stability and reduce fall risk. Strength training helps maintain muscle mass and bone density, while balance exercises enhance proprioception—the body’s awareness of its position in space.

Medication Management

Work closely with your healthcare providers to review all medications. Many falls occur due to medication side effects or interactions. Doctors can often adjust dosages, switch medications, or eliminate unnecessary drugs to reduce fall risk while maintaining treatment effectiveness.

Vision and Hearing Care

Regular eye exams ensure that vision problems are promptly addressed. Updating eyeglass prescriptions, treating cataracts, and managing conditions like glaucoma or macular degeneration can significantly improve safety. Similarly, hearing aids help maintain awareness of environmental sounds that can signal danger.

Check Your Overall Health

Properly managing chronic conditions reduces fall risk. This includes controlling blood sugar in diabetes, managing blood pressure, treating depression, and following treatment plans for neurological conditions. Regular medical check-ups help identify and address health issues before they contribute to falls. It is vitally important that you tell your doctor if you are experiencing falls.

Home Safety Assessment

A thorough home safety evaluation should examine every area where daily activities occur. This includes checking for adequate lighting, removing or securing loose rugs, ensuring stairways have proper handrails, and eliminating clutter from walkways. The bathroom requires special attention to reduce the risk associated with wet surfaces and awkward positioning.

Lighting Improvements

Poor lighting contributes to many falls. Installing brighter bulbs, adding motion-activated lights in hallways and bathrooms, and ensuring light switches are easily accessible can dramatically improve safety. Nightlights help with navigation during nighttime bathroom visits.

Assistive Devices

When mobility becomes compromised, assistive devices can provide crucial support. Canes, walkers, and wheelchairs should be properly fitted by healthcare professionals. Grab bars in bathrooms, raised toilet seats, and shower chairs can make daily activities safer. However, these devices are only effective when used correctly and consistently.

Footwear and Clothing

Proper footwear plays a significant role in fall prevention. Shoes should fit well, have non-slip soles, and provide adequate support. Slippers, socks without grips, and high heels increase fall risk. Clothing should fit properly to avoid tripping hazards while allowing for easy movement.

Pay Attention

Older adults should develop habits of scanning their environment before moving. This includes looking for obstacles, wet surfaces, uneven ground, or changes in lighting. Taking time to assess the safety of a situation before proceeding can prevent many falls. It is also important to avoid rushed movements, especially when hurrying to the bathroom or standing up quickly. Rapid activities may lower our sensitivity to the risk of falls. Take distinct steps; don’t shuffle your feet.

When you first get up in the morning, take a moment to sit on the edge of the bed before standing and then another moment to stand still before moving. This allows your blood pressure and heart rate to catch up with your change in body position. It prevents a drop in blood pressure that can sometimes accompany position change. This is known as orthostatic hypotension and can cause dizziness or even fainting.

Recognizing Personal Limitations

Understanding and accepting changes in physical capabilities are essential. This might mean asking for help with tasks that were once manageable, using assistive devices even when feeling capable, or avoiding activities during times of increased vulnerability, such as when feeling dizzy or tired. Experiencing a fall or even fearing one may cause reduced activity, in turn increasing weakness and instability, further increasing the risk of falls. By recognizing this fear, you can take steps to compensate rather than completely avoid activities or situations.

Alcohol affects elderly citizens more significantly than younger people. As we age, our liver function declines, meaning alcohol is metabolized more slowly, leading to higher blood alcohol concentrations that persist longer, even when the same amount of alcohol is consumed. Age-related changes in brain chemistry make older adults more sensitive to alcohol’s effects on coordination, judgment, and cognitive function, impairing balance and coordination.

Communication with Healthcare Providers

Despite the high incidence of falls, fewer than half of older adults who fall inform their doctor. I will plead guilty to this, after my first fall I was embarrassed to admit it. But I recognized my error and know that open communication about fall experiences, near-misses, and concerns about balance or mobility is crucial. Falling is not shameful; we would not be embarrassed to report chest pain. Healthcare providers can offer valuable insights, resources, and interventions when they are aware of our fall risks.

Conclusion

Falls among elderly adults represent a serious but preventable public health issue. The statistics are sobering, 1 in 4 older adults fall each year and thousands die from fall-related injuries—but the path forward is clear. Through a combination of physical conditioning, medical management, environmental modifications, and increased awareness, the risk of falls can be significantly reduced.

Remember, preventing falls isn’t just about avoiding injury—it’s about preserving the freedom to live life fully and safely. Every step taken toward fall prevention is a step toward a more secure and confident future.

Peleliu: The Unnecessary Battle

By John Turley

On July 8, 2025

In History

Anyone with even a passing familiarity of the history of World War II knows about the major island campaigns in the Pacific: Guadalcanal, Tarawa, Iwo Jima and Okinawa. But unless you are a student of military history or perhaps a former Marine, you’ve probably never heard of the Battle of Peleliu

The Battle of Peleliu, fought from September 15 to November 27, 1944, stands as one of the most controversial and costly operations in the Pacific Theater. This assault on the small coral island in the Palau chain reveals much about the complexities of strategic decision-making during wartime.

Objectives and Strategic Rationale

The primary objective was to capture Peleliu’s airfield to prevent Japanese aircraft from interfering with General MacArthur’s upcoming invasion of the Philippines. American planners believed that Japanese forces based on Peleliu could attack the right flank of the Philippine invasion force. Additionally, the island was seen as a potential base for supporting further operations against Japan in the western Pacific.

Military planners, especially Admiral Chester Nimitz and his staff, believed neutralizing Japanese air power on Peleliu was critical to protecting the Philippineinvasion. The airfield on the island, if left in Japanese hands, could theoretically pose a threat to operations in the southern Philippines or even to the fleet.

However, this concern was based on a misreading of Japan’s actual capacity to project power from the island. By late 1944, Japan’s air forces were significantly degraded, and their capacity to use the Peleliu airfield was minimal, if it existed at all.

The operation was planned as part of a broader strategy to neutralize Japanese strongholds and establish forward bases for the final push toward Japan. Admiral Nimitz initially supported the invasion, viewing it as necessary to protect MacArthur’s Philippine campaign and to continue the island-hopping strategy that had proven successful elsewhere in the Pacific.

Admiral William Halsey argued the operation was unnecessary, as American bombardment had already isolated Japanese forces and rendered the airfield unusable. However, Admiral Nimitz approved the invasion, believing cancellation logistically impractical because preparations were too far advanced. Marine commanders initially predicted a swift victory, with Major General William Rupertus claiming the island would fall in four days.

The Strategic Reality

In retrospect, Peleliu’s strategic value was far more limited than initially assessed. The island’s airfield, while operationally useful, was not critical to the success of the Philippine invasion. The Japanese garrison of approximately 11,000 troops under Colonel Kunio Nakagawa had transformed the island into a fortress, utilizing the coral caves and ridges to create an intricate defensive system that would exact a terrible price from the attackers.

The 1st Marine Division, supported by the 81st Infantry Division, ultimately secured the island, but at enormous cost. American casualties totaled over 9,000, with nearly 1,800 killed in action. Japanese losses were almost total, with fewer than 200 prisoners taken from the original garrison.

Post-Battle Assessment

After the battle’s conclusion, many military leaders questioned whether the operation had been worth its tremendous cost in human lives. The strategic benefits gained were minimal compared to the losses sustained. The airfield was not essential to subsequent operations, and the island’s location proved less critical than originally believed.

Military historians increasingly view Peleliu as an example of how the initial strategic and tactical assessments proved flawed when planners failed to recognize the evolution of Japanese defensive tactics, which emphasized fighting from prepared positions rather than the banzai charges that had characterized earlier encounters.

Historical Significance

Peleliu is overshadowed in World War II histories by larger, more decisive battles like Iwo Jima and Okinawa. However, it served as a crucial learning experience for American forces, providing insights into Japanese defensive innovations that would prove valuable in later operations. The battle highlighted the importance of accurate intelligence and realistic strategic assessment.

The intense fighting on Peleliu also demonstrated the resilience and adaptability of American forces under extremely challenging conditions. The prolonged nature of the battle, lasting over two months instead of the predicted few days, tested logistics, medical support, and command structures in ways that informed future operations.

The Aftermath

While the immediate strategic gains from Peleliu were limited, the battle did provide several important advantages. It eliminated a potential threat to Allied shipping lanes in the region and provided valuable experience in assaulting heavily fortified positions. The lessons learned about Japanese defensive tactics, the importance of coordinated air and ground support, and the challenges of fighting in coral terrain all contributed to improved performance in subsequent operations.

Perhaps most significantly, Peleliu demonstrated the need for more careful strategic evaluation of objectives relative to costs. This lesson influenced planning for later operations and contributed to discussions about alternative strategies for ending the war in the Pacific. In specific, the battle demonstrated Japan’s willingness to fight to the death and perhaps may have indirectly influenced the decision to use atomic bombs to avoid similar carnage in a main island invasion.

The Battle of Peleliu remains a sobering reminder of the complexities of wartime strategy and the human cost of military operations. While its immediate strategic value was questionable, its role in the broader context of Pacific War operations and its lessons for military planning ensured its place in the historical record of World War II.

The U.S. Public Health Service: Guardians of America’s Health

By John Turley

On July 3, 2025

In Commentary, History, Medicine

The United States Public Health Service (USPHS) has quietly served as the backbone of the nation’s public health infrastructure for over two centuries. From its beginnings as a maritime medical service to its current role as a comprehensive public health organization, the USPHS has evolved to meet the changing medical challenges facing Americans and to protect and promote the health of the nation.

Origins and Early History

The U.S. Public Health Service traces back to 1798, when President John Adams signed “An Act for the Relief of Sick and Disabled Seamen.” This legislation established the Marine Hospital Service and created a network of hospitals to care for the merchant sailors who served America’s growing maritime commerce. The act represented one of the first examples of federally mandated health insurance, as ship owners were required to pay 20 cents per month per sailor to fund medical care.

The Marine Hospital Service initially operated a series of hospitals in major port cities including Boston, New York, Philadelphia, and Charleston. These facilities served not only sick and injured sailors but also played a crucial role in preventing the spread of infectious diseases that could arrive on ships from foreign ports. This dual function of treatment and prevention would become a defining characteristic of the USPHS mission.

The transformation from the Marine Hospital Service to the modern Public Health Service began in the late 19th century. In 1889, the organization was restructured and placed under the supervision of Dr. John Maynard Woodworth as Supervising Surgeon—later Surgeon General—marking the beginning of its evolution into a more comprehensive public health agency. The name was officially changed to the Public Health and Marine Hospital Service in 1902, and finally to the U.S. Public Health Service in 1912, reflecting its expanded mandate beyond maritime health.

Evolution and Expansion

The early 20th century brought significant expansion to the USPHS mission. The 1906 Pure Food and Drug Act gave the service regulatory responsibilities, leading to the creation of what would eventually become the Food and Drug Administration. During World War I, the USPHS took on additional responsibilities for military health and epidemic control, establishing its role as a rapid response organization for national health emergencies.

The Great Depression and World War II further expanded the service’s scope. The Social Security Act of 1935 created new public health programs administered by the USPHS, while wartime demands led to increased focus on occupational health, environmental health hazards, and the health needs of defense workers. The post-war period saw the establishment of the National Institutes of Health—originally called the Laboratory of Hygiene—as part of the USPHS, cementing its role in medical research.

Major Functions and Modern Roles

Today’s U.S. Public Health Service operates as part of the Department of Health and Human Services and supports major agencies and functions. The service’s mission centers on protecting, promoting, and advancing the health and safety of the American people through several key areas.

Disease Prevention and Health Promotion are the core of USPHS activities. It works with the Centers for Disease Control and Prevention (CDC), to lead national efforts in the prevention and control of infectious and chronic diseases. From tracking disease outbreaks to promoting vaccination programs, the USPHS a part of America’s first line of defense against health threats.

Regulatory and Safety Functions represent other crucial areas. The USPHS coordinates with the Food and Drug Administration (FDA) to ensure the safety and efficacy of medications, medical devices, and food products. It works with the Agency for Toxic Substances and Disease Registry monitoring environmental health hazards. Other USPHS components are involved in regulating everything from clinical laboratories to health insurance portability.

Emergency Response and Preparedness has become increasingly important in recent decades. The USPHS maintains rapid response capabilities for natural disasters, disease outbreaks, and public health emergencies. This includes the deployment of Commissioned Corps officers to disaster zones and the maintenance of strategic national stockpiles of medical supplies.

Health Services for Underserved Populations continues the service’s historic mission of providing care where it’s most needed. The Health Resources and Services Administration oversees community health centers, rural health programs, and initiatives to address health disparities among vulnerable populations. The Indian Health Service is an important part of the USPHS, providing healthcare to often isolated communities.

The Commissioned Corps

One of the most distinctive features of the USPHS is its Commissioned Corps, a uniformed service of over 6,000 public health professionals. Established in 1889, the Corps operates as one of the eight uniformed services of the United States, alongside the armed forces, NOAA Corps, and Coast Guard. Officers hold military-style ranks and wear uniforms, but their mission focuses entirely on public health rather than defense.

The Commissioned Corps provides a ready reserve of highly trained health professionals who can be rapidly deployed to address public health emergencies. From hurricane and disaster relief to pandemic assessment and treatment, Corps officers have served on the front lines of America’s health challenges, providing everything from direct patient care to epidemiological investigation and public health program management.

Contemporary Challenges and Future Directions

The U.S. Public Health Service continues to evolve in response to emerging health challenges. Climate change, antimicrobial resistance, mental health crises, and health equity concerns represent current priorities. The COVID-19 pandemic demonstrated both the critical importance of robust public health infrastructure and the challenges of maintaining public trust in health authorities.

As America faces an increasingly complex health landscape, the USPHS mission of protecting and promoting the nation’s health remains as relevant as ever. From its origins serving sailors in port cities to its current role addressing global health threats, the U.S. Public Health Service continues its quiet but essential work of safeguarding American health, adapting its methods while maintaining its core commitment to serving the public good.

The service’s history shows that effective public health requires not just scientific expertise, but also the institutional ability to respond rapidly to emerging threats, the authority to implement necessary interventions, and the public trust to lead national health initiatives. As new challenges appear, the USPHS continues to build on its more than two-century legacy of service to the American people.

One Big Disgusting Bill

By John Turley

On July 2, 2025

In Commentary, Politics

An Existential threat to American Democracy

Now that the Senate has shamefully capitulated to Trump and passed the One Big Disgusting Bill, we’re starting to see another flurry of articles appropriately denouncing it. Unfortunately these articles continue to focus on taxes, Medicaid and SNAP. They largely ignore the most insidious aspect of this bill—its assault on judicial review.

I’ve discussed this bill in a recent post and won’t go in to detail here. This bill represents a flagrant attempt to bypass judicial review and undermine the separation of powers. Given that Congress has willingly abrogated all responsibilities and allowed Trump to rule single handedly, the courts remain our only recourse. But since the bought and paid for Supreme Court also seems to be giving away their authority, I’m not sure whether we have any hope left.

The only course is to remove all Republicans from office and impeach Trump. It also may be necessary to impeach members of the Supreme Court, particularly those who blatantly accept bribes.

Congress has essentially given Donald Trump a fast pass to dictatorship. I think this represents the American version of the Enabling Act of 1933 where the German Parliament gave Hitler absolute authority to rule without question.

As we approach the 250th anniversary of the Declaration of Independence, I fear for our Republic.

“The accumulation of all powers, legislative, executive, and judiciary, in the same hands… may justly be pronounced the very definition of tyranny.”
James Madison, Federalist No. 47 , 1788

Declaring Independence: The Origin of America’s Founding Document

By John Turley

On June 30, 2025

In History, Politics

When Americans celebrate the Fourth of July, we imagine fireworks, flags, and a dramatic reading of the Declaration of Independence. We think we know the story—The Continental Congress selected Thomas Jefferson to write the declaration. He labored alone to produce this famous document. Congress then approved it unanimously and it was signed on the 4th of July.

But the truth is far different and more complex. The story behind this iconic document—the how, who, and why of its creation—is just as explosive and illuminating as the day it represents. Far from a spontaneous outburst of rebellion, the Declaration was the product of political strategy, collaborative writing, and a shared sense of urgency among men who knew their words would change the course of history.

Setting the Stage: Why a Declaration?

By the spring of 1776, the American colonies were deep in conflict with Great Britain. Battles at Lexington and Concord had already been fought. George Washington was attempting to transform the Continental Army into a professional fighting force. Thomas Paine’s Common Sense had ignited widespread public support for full separation from the British Crown. The Continental Congress had been meeting in Philadelphia, debating how far they were willing to go. By June, the mood had shifted from reconciliation to revolution.

On June 7, 1776, Richard Henry Lee of Virginia introduced a resolution to the Continental Congress declaring “that these United Colonies are, and of right ought to be, free and independent States.” The motion was controversial—some delegates wanted more time to consult their colonies. But most in Congress knew that if independence was going to happen, it needed to be explained and justified to the world, so they created a committee to draft a formal declaration.

The Committee of Five

On June 11, 1776, the Continental Congress appointed a “Committee of Five” to write the declaration. The members were:

Thomas Jefferson of Virginia
John Adams of Massachusetts
Benjamin Franklin of Pennsylvania
Roger Sherman of Connecticut
Robert R. Livingston of New York

This was not a random selection. Each man represented a different region of the colonies and had earned the trust of fellow delegates. Jefferson was relatively young but already known for his eloquence. Adams was an outspoken advocate of independence. Franklin brought wisdom, wit, diplomatic experience, and international prestige. Sherman brought New England theological perspectives and legislative experience, while Livingston represented the more moderate New York delegation and brought keen legal insight.

Jefferson Takes the Pen

Although it was a group project on paper, the heavy lifting fell to Thomas Jefferson. The committee chose him to draft the initial version. Why Jefferson? According to John Adams, Jefferson was chosen for three reasons: he was from Virginia (the most influential colony), he was popular, and, Adams admitted, “you can write ten times better than I can.”

Jefferson wrote the draft in a rented room at 700 Market Street in Philadelphia. He leaned heavily on Enlightenment ideas, especially those of John Locke, emphasizing natural rights and the notion that government derives its power from the consent of the governed. He also borrowed phrasing from earlier colonial declarations, including his own A Summary View of the Rights of British America and borrowed extensively from George Mason’s Virginia Declaration of Rights.

The Editing Process: Group Work Gets Messy

After Jefferson completed the initial draft (likely by June 28), he shared it with Adams and Franklin. Both men suggested revisions. Franklin, ever the editor, softened some of Jefferson’s sharpest attacks and corrected language for flow and diplomacy. His most famous contribution was changing Jefferson’s phrase “We hold these truths to be sacred and undeniable” to the more secular and philosophically precise “We hold these truths to be self-evident.”

Adams contributed to structural suggestions and to tone. He also contributed to the strategic presentation of grievances against King George III, understanding that the declaration needed to justify revolution in terms that would be acceptable to both colonial readers and potential European allies.

Sherman and Livingston played more limited but still meaningful roles. Sherman, with his theological background, helped ensure the document’s religious references would appeal to Puritan New England, while Livingston’s legal expertise helped refine the constitutional arguments against British rule. Otherwise, their involvement in the actual content of the declaration was likely minimal.

The revised draft was presented to the full Continental Congress on June 28, 1776. What followed was a few days of intense debate and revision by the entire body.

Congress Takes the Red Pen

From July 1 to July 4, the Continental Congress debated the resolution for independence and edited the Declaration. Jefferson watched as more than two dozen changes were made to his prose. The Congress cut about a quarter of the original text, including a lengthy passage condemning King George III for perpetuating the transatlantic slave trade that would have sparked deep division among the delegates, especially those from Southern colonies.

Other modifications included strengthening the religious language, toning down some of the more inflammatory rhetoric, and making the grievances more specific and legally grounded. Congress made 86 edits, removing about a quarter of Jefferson’s original content. Jefferson was reportedly frustrated by the changes, calling them “mutilations,” but he recognized that compromise was the cost of consensus

Approval and Promulgation

Despite the extensive revisions, the core of Jefferson’s vision remained intact and on July 2, 1776, the Continental Congress voted in favor of Lee’s resolution for independence. That’s the actual date the colonies officially broke from Britain. John Adams even predicted in a letter to his wife that July 2 would be celebrated forever as America’s Independence Day. He was close—but the official adoption of the Declaration came two days later.

On July 4, 1776, Congress formally approved the final version of the Declaration of Independence. Contrary to popular belief, most of the signers did not sign it on that day. Only John Hancock, as president of Congress, and Charles Thomson, as secretary, signed then. The famous handwritten version, now in the National Archives, wasn’t signed until August 2. But the document approved on July 4 was immediately printed by John Dunlap, the official printer to Congress.

These first copies, known as Dunlap Broadsides, were distributed throughout the colonies and sent to military leaders, state assemblies, and even King George III. George Washington had it read aloud to the Continental Army. This rapid dissemination was crucial to its impact, as it was needed to rally public support for the revolutionary cause and explain the colonies’ actions to the world.

Legacy and Impact

The Declaration wasn’t just a break-up letter to the British Crown—it was a manifesto for a new kind of political order. Its assertion that “all men are created equal” would echo through centuries of American history, invoked by abolitionists, suffragists, civil rights leaders, and more.

The creation of the Declaration of Independence demonstrates that even the most iconic documents in American history emerged from collaborative processes involving compromise, revision, and collective wisdom. While Jefferson deserves primary credit for the document’s eloquent expression of revolutionary ideals, the contributions of his committee colleagues and the broader Continental Congress were essential to creating a text that could unite thirteen diverse colonies in common cause.

This collaborative origin reflects the democratic principles the declaration itself proclaimed, showing that American independence was achieved not through the vision of a single individual, but through the collective efforts of representatives working together to articulate their shared commitment to liberty, equality, and self-governance. The process that created the Declaration of Independence thus embodied the very democratic ideals it proclaimed to the world.

Today, the Declaration of Independence is enshrined as one of the foundational texts of American democracy. But it’s worth remembering that it was created under immense pressure, forged by committee, and edited by compromise. Its authors knew they were taking a dangerous step. As Franklin quipped at the signing, “We must all hang together, or most assuredly we shall all hang separately.”

Understanding Chronic Kidney Disease: A Guide for Older Adults

By John Turley

On June 24, 2025

In Medicine

Chronic kidney disease (CKD) affects approximately 37 million Americans, with adults over 65 representing the fastest-growing group diagnosed. Often called a “silent disease,” CKD can progress for years without noticeable symptoms, making awareness and early detection crucial for preserving kidney function and overall health.

What Is Chronic Kidney Disease?

Chronic kidney disease occurs when the kidneys gradually lose their ability to filter waste products and excess fluid from the blood. Unlike acute kidney injury, which happens suddenly and can be quickly corrected, CKD develops slowly over months or years and is generally not reversable. The kidneys perform several vital functions beyond filtration, including regulating blood pressure, supporting production of red blood cells, and maintaining the body’s chemical balance. When kidney function declines, these processes become compromised, leading to serious health complications if left untreated.

The disease progresses through five stages, from mild kidney damage with normal filtration to complete kidney failure requiring dialysis or transplantation. Understanding this progression helps patients and healthcare providers make informed decisions about treatment and lifestyle modifications.

Risk Factors: Who’s Most Vulnerable?

Several factors significantly increase the risk of developing CKD, with diabetes and high blood pressure being the leading causes and accounting for nearly two-thirds of all cases.

Type 2 diabetes, which affects over 11% of the U.S. population, damages the small blood vessels in the kidneys impairing their filtering capacity. Kidneys also play a role in glucose management by clearing insulin from the body. As kidney function declines, insulin stays in the system longer reducing circulating glucose levels.

Hypertension creates a destructive cycle of progressive kidney disease. It damages kidney blood vessels, reducing their effectiveness, causing the kidneys to struggle to regulate blood pressure, creating further blood pressure elevation, leading to greater damage. This relationship makes blood pressure control essential for both prevention and treatment.

Age itself is a significant risk factor. After age 40, kidney function naturally declines by approximately 1% per year. However, this normal aging process can accelerate in the presence of other risk factors. Family history also plays a role, particularly for conditions like polycystic kidney disease and certain genetic disorders affecting kidney function.

Other risk factors include cardiovascular disease, obesity, smoking, and prolonged use of certain medications, particularly nonsteroidal anti-inflammatory drugs (NSAID—aspirin, ibuprofen, etc) and some prescription medications. African Americans, Hispanic Americans, and Native Americans face higher risks due to genetic predisposition and higher rates of diabetes and hypertension. As with all chronic medical conditions, the detrimental effect of smoking cannot be overstated.

Recognizing the Signs: Symptoms of CKD

The insidious nature of CKD means symptoms often don’t appear until after significant kidney damage has occurred. Early-stage CKD may produce no symptoms at all, which is why routine screening for at-risk individuals is so important.

As the disease progresses, symptoms may include persistent fatigue and weakness which are often dismissed as normal aging. Patients may have trouble concentrating, sleep problems, decreased appetite and persistent nausea. Swelling in the feet, ankles, or around the eyes can indicate fluid retention due to impaired kidney function.

Changes in urination patterns may occur, including increased frequency, especially at night, or decreased urine output. The urine may appear foamy, indicating protein spillage, or may be darker in color. Some patients experience persistent itching due to waste product buildup in the blood.

More advanced CKD can cause severe nausea, vomiting, muscle cramps, and shortness of breath. High blood pressure may develop or worsen, and patients might experience chest pain or irregular heartbeats. These symptoms warrant immediate medical attention.

Diagnostic Testing: Identifying CKD

Early detection relies on simple, routine blood and urine tests that can identify kidney problems before symptoms appear. Your doctor will order blood tests and urine tests, and possibly imaging tests such as ultrasounds to evaluate your risk for kidney disease. Frequently these tests will check for many other things such as anemia, high cholesterol or diabetes. All of these can contribute to chronic kidney disease.

Treatment Approaches: Managing CKD

While CKD cannot be cured, proper treatment can significantly slow progression and manage complications. The primary goals include treating underlying causes, slowing decline of kidney function, and managing associated health problems.

Blood pressure control is paramount, with target levels typically below 130/80 mmHg for most CKD patients. ACE inhibitors and ARBs (angiotensin receptor blockers) are preferred medications as they provide additional kidney protection beyond blood pressure reduction.

Diabetes management requires maintaining hemoglobin A1c levels below 7% for most patients. Newer medications like SGLT2 inhibitors show promise in protecting kidney function while controlling blood sugar.

Dietary modifications play a crucial role in CKD management. Reducing sodium intake helps control blood pressure and fluid retention. Protein restriction may be recommended in advanced stages to reduce kidney workload, though this requires careful monitoring to prevent malnutrition.

Managing complications becomes increasingly important as CKD progresses. This includes treating anemia with iron supplements or erythropoiesis-stimulating agents, managing bone and mineral disorders with vitamin D supplements and phosphate binders, and addressing cardiovascular risk factors.

For end-stage kidney disease, renal replacement therapy through dialysis or kidney transplantation becomes necessary. Early planning for these treatments improves outcomes and quality of life.

Prevention Strategies: Protecting Your Kidneys

Prevention remains the most effective approach to CKD. Maintaining healthy blood pressure through regular exercise, weight management, sodium reduction, and medication compliance are the foundations of kidney protection.

Diabetes prevention and management through lifestyle modifications and appropriate medical care significantly reduces CKD risk. Regular monitoring of blood sugar, blood pressure, and kidney function allows for early intervention when problems arise.

Avoiding nephrotoxic substances, including excessive NSAID use, staying hydrated, and not smoking all contribute to kidney health. Regular medical check-ups enable early detection and treatment of conditions that could lead to CKD.

Understanding chronic kidney disease empowers older adults to take proactive steps in prevention and to look for appropriate care when needed. With proper management, early detection, and comprehensive care, many people with CKD can maintain a good quality of life and slow disease progression.

The Origin of Juneteenth: America’s Second Independence Day

By John Turley

On June 16, 2025

In Commentary, History, Politics

The Juneteenth flag is red, white, and blue to reflect the American flag and includes a bursting star to symbolize freedom.

On June 19, 1865, an event that would forever change American history unfolded in Galveston, Texas. Union Major General Gordon Granger stood before a crowd and read General Order No. 3, announcing that “all slaves are free.” This proclamation marked the beginning of what we now celebrate as Juneteenth, America’s newest federal holiday and a day that celebrates the fulfillment of emancipation for all enslaved people in the United States.

Delayed Freedom

The story of Juneteenth begins with a troubling gap between law and reality. President Abraham Lincoln had issued the Emancipation Proclamation on January 1, 1863, declaring freedom for enslaved people in states “…in rebellion against the United States”. However, enforcement depended on the advance of Union troops and In the Confederate state of Texas—remote and beyond Union control—the proclamation went unenforced for more than two years. Many slaveholders deliberately withheld information about emancipation, and the absence of Union forces meant that freedom remained out of reach for thousands.

Even after the Civil War effectively ended in April 1865 with Lee’s surrender at Appomattox, news of emancipation remained deliberately suppressed in Texas. Some enslavers continued to hold people in bondage through the spring planting season. It wasn’t until federal troops arrived in Galveston in sufficient force to ensure compliance that the promise of emancipation became reality for the last enslaved Americans.

Birth of a Celebration

The newly freed Texans didn’t wait for official recognition to begin celebrating their liberation. They called it Juneteenth, a combination of June and nineteenth and celebrations erupted spontaneously across Texas as communities gathered to commemorate their freedom with prayer, music, food, and fellowship. These early celebrations were deeply rooted in African American culture, featuring traditional foods and drinks, spirituals and folk songs, and the retelling of the freedom story to younger generations.

As African Americans moved from Texas to other parts of the country during the Great Migration, they carried Juneteenth traditions with them. Throughout the late 19th and early 20th centuries, Juneteenth celebrations grew, often featuring parades, music, food, and family gatherings. The holiday’s popularity waned during the mid-20th century but experienced a resurgence during the Civil Rights Movement, as activists sought to reconnect with their heritage and the ongoing struggle for equality.

From Regional Tradition to National Recognition

For over a century, Juneteenth was primarily a regional and cultural celebration rather than an official holiday. Texas became the first state to make Juneteenth a state holiday in 1980, other states followed gradually. The movement gained momentum in the 21st century as Americans increasingly recognized the need to acknowledge the full history of emancipation.

The nationwide racial justice protests of 2020 brought renewed attention to Juneteenth’s significance. On June 17, 2021, President Joe Biden signed legislation making Juneteenth a federal holiday, acknowledging it as both a celebration of freedom and a reminder of America’s ongoing journey toward equality.

A Day of Reflection and Celebration

Today, Juneteenth serves multiple purposes in American life. It’s a day of celebration, honoring the resilience and culture of African Americans. It’s also a day of education, reminding all Americans about the complexities of emancipation and the ongoing struggle for civil rights. Most importantly, it stands for hope—proof that progress, however delayed, is possible when people demand justice and equality. It honors the struggles and achievements of African Americans, reminding us of the enduring importance of freedom, perseverance, and hope in the face of adversity. As communities gather each year to celebrate Juneteenth, they continue the tradition of remembering the past while striving for a more inclusive and equitable future

Juneteenth stands as a testament to the truth that freedom delayed need not be freedom denied.

Juneteenth is not an official state holiday in West Virginia. In prior years, former governor Jim Justice issued a proclamation declaring Juneteenth a paid holiday for state employees. The current governor has made no such proclamation. Those who are planning the Juneteenth celebration in West Virginia have scheduled a Juneteenth parade for June 20th, West Virginia Day, which is an official state holiday.

Anti-Vax or Disease Supporter

By John Turley

On June 12, 2025

In Commentary, Medicine, Politics

Between June 9 and 11, 2025, HHS Secretary Robert F. Kennedy Jr. dismissed all 17 members of the CDC’s Advisory Committee on Immunization Practices—a body that has guided U.S. vaccine policy for about 60 years. He followed this by appointing eight new members, the minimum under the charter, including several known vaccine deniers.

In light of this, I have decided to repost an article I wrote over a year ago. (With new artwork.)

“There are two ways to be fooled. One is to believe what is not true; the other is to refuse to believe what is true.”

– Søren Kierkegaard

Saturday morning, I was reading in the newspaper about the resurgence of measles in West Virginia. I find it appalling that this disease should be returning, given that we have safe and effective vaccinations. What is next, polio, smallpox, or even plague? It is only through the unexpected veto by our [former] governor that the ill-advised bill passed by our legislature to make all vaccinations optional with a little more than a request by the parents, did not become law. [The current governor has issued an executive rendering vaccinations virtually optional for school children.]

Some people may wonder why vaccinations are important. There are two principal reasons to ensure that a large portion of the population is vaccinated against communicable diseases. The first is that it reduces the individual vulnerability to disease. The person who is vaccinated is protected. But there is also a second, sometimes not well-understood, reason. That is herd immunity.

Communicable diseases require a large susceptible population to spread. When a significant portion of the population has been vaccinated the disease does not have the core of potential victims to allow spreading. This means that the vaccinated are protecting the non-vaccinated. However, it does require a large portion of the population to be vaccinated. The idea is that herd immunity will protect those who are unable to be vaccinated either due to age, allergies, or other medical conditions that would prohibit vaccination. It is never going to protect a large proportion of the population who just choose not to be vaccinated. For example, about 90-95% of the population needs to be vaccinated against measles to provide herd immunity.

So why do people who otherwise can be vaccinated choose not to be?

There are, of course, those who have true religious objections to vaccination. There are others who object to vaccination on the basis of personal autonomy. They believe their right to refuse vaccination outweighs any consideration of the health concerns of the frail members of our community.

There are many who mistrust the medical system. There were some cases in the past where unethical studies were conducted on unsuspecting populations. Given the rigorous oversight of medical research now, this no longer happens. Information about research into vaccinations and their safety and efficacy can be found on websites for the Centers for Disease Control and Prevention and the World Health Organization among others. (Website references are provided at the end of this post.)

What concerns me most are those who refuse to believe reputable medical authorities, government agencies, and mainline news services. They prefer to get their information from anonymous websites or from conspiracy theory websites that still give credence to the now-discredited 1999 study linking the MMR vaccine to autism. They completely ignore the fact that 10 of the 11 reported co-authors disavowed any part in the conclusions of the study. They also ignore the fact that the principal author was found guilty of fraud for personal gain as he was employed by the manufacturer of rival drugs. They also ignore the fact that he lost his medical license over his falsifications in this study. Yet, he is still cited in anti-vaccine literature as an expert source.

Equally disturbing is the fact that vaccine resistance has become a part of political identification. Certain reactionary political groups have, for some unfathomable reason, decided that refusing vaccination is a badge of their political allegiance. They seem to care more about maintaining their political purity than they care about science, public health, or even the welfare of their family and friends. Politicizing public health is dangerous for all of us. I’m not sure how we overcome this. It is easy to find the truth and verify it through fact-based studies, yet people refuse to do it. [See my post Choosing Not To Know.]

I encourage everyone to work hard to ensure that our political leaders do not remove vaccination mandates for school children. For those of us of my age, we already have immunity through vaccination or prior exposure to the disease. It is our grandchildren and their children and their children’s children who will suffer through the return of these deadly diseases.

Rather than “vaccine deniers,” they should be referred to as “disease supporters.”

SOURCES:

World Health Organization: https://www.who.int/health-topics/vaccines-and-immunization#tab=tab_1

CDC: https://www.cdc.gov/vaccines/index.html https://www.cdc.gov/vaccines/hcp/vis/index.html

WV DHHR: https://oeps.wv.gov/immunizations/Pages/default.aspx

Immunise.org: https://www.vaccineinformation.org/

No Kings Day, June 14, 12:00 Noon, WV Capitol

By John Turley

On June 12, 2025

In Politics

Be There!

Silencing the Gavel: How the ‘One Big Beautiful Bill’ Will Undermine Judicial Review

By John Turley

On June 8, 2025

In Commentary, Politics

In late May 2025, the U.S. House of Representatives narrowly passed a massive legislative package called the “One Big Beautiful Bill Act.” Touted by President Donald Trump and Republican leaders as a sweeping reform of tax policy, federal spending, and government regulation, the bill is now at the center of heated debate—not just over its fiscal and policy impacts, but also over its implications for the balance of power among the branches of government.

What the Bill Does—and Doesn’t Do

The “Big Beautiful Bill” is a reconciliation bill, meaning it can bypass the Senate’s usual 60-vote threshold and be passed with a simple majority. This process is designed to fast-track budgetary and tax legislation, but it also means the bill can only address certain policy areas directly related to the federal budget. At its core, the bill delivers major tax cuts, extends the Trump-era tax reductions, and makes permanent changes, principally reductions, to mandatory spending programs. It also includes provisions on agriculture, immigration, Medicaid, and technology, among other areas. The bill is viewed by critics as favoring the wealthy to the detriment of the poor.

Despite claims on social media, the bill does not give the president the power to delay or cancel elections. Multiple fact-checkers and legal experts have confirmed that such authority would violate the Constitution, which assigns election timing to Congress and state legislatures. The bill’s focus is on fiscal and regulatory reforms, not election administration.

While the bill ostensibly comes from Congress, it actually weakens Congress’s own institutional role in the separation of powers by removing one of the key mechanisms used by the judicial branch to enforce constitutional limits on executive power. If passed, this will be an unmitigated disaster for the Constitution and the country.

Democratic Representative Jamie Raskin called it an unprecedented power grab: “Instead of providing support for the judicial branch, this Judiciary Committee bill seeks to strip the courts of their power to hold the administration in contempt when the President violates court orders”.

The Hidden Provision: Section 70302

Buried within the bill’s 1,000-plus pages is a provision—Section 70302—that has drawn sharp criticism from legal scholars, civil rights groups, and even some lawmakers. The bill is not available for public examination, but it has been reported by the international news service Reuters that this section states that no federal court may use appropriated funds to enforce a contempt citation for failure to comply with an injunction or temporary restraining order unless the plaintiff posted a security bond when the order was issued.

Surety bonds are intended to protect the defendant in civil suits from incurring financial loss associated with legal expenses occurring from defending against frivolous or wrongful lawsuits. If the ruling is in favor of the defendant, the plaintiff must surrender the bond to cover the expenses of the defendant. For example, if I sue you for slander, I may have to post a cash bond and if the judge rules against me, the bond will be forfeited to cover your legal fees. If I win, the bond will be returned to me.

Historically, courts have often waived the bond requirement, especially when plaintiffs challenge government actions as unconstitutional. The rationale is that requiring a bond would make it prohibitively expensive for individuals or groups to seek judicial relief against unlawful government conduct. Section 70302 would change this, making it much harder for courts to enforce their rulings against the executive branch or other government actors unless the plaintiff can afford to post a bond. If this passes, it is conceivable that the administration may attempt to impose bonds of $1 million or more—effectively eliminating the ability of citizens to challenge government actions.

Why is It Important?

The federal judiciary is one of the three pillars of our constitutional government, and it plays a vital role in the balance of powers. It serves as an independent check on the executive and legislative branches, interpreting laws, resolving disputes, and safeguarding constitutional rights. Since Marbury v. Madison (1803), the judiciary has claimed the authority to strike down laws or executive actions that violate the Constitution. This power of judicial review is foundational to the principle of checks and balances. The proposed legislation seeks to shift that balance. Among its most concerning provisions are efforts to limit judicial oversight of executive actions.

How This Shifts Power to the Executive

The practical effect of Section 70302 is to limit the judiciary’s ability to hold the executive branch accountable for violating court orders. If a judge issues an injunction to stop an unconstitutional or illegal government action, but no bond was posted when the injunction was granted, the court would be barred from using its contempt power to enforce compliance.

This provision applies retroactively, meaning it would render thousands of existing court orders unenforceable overnight. Critics argue that this creates a “catch me if you can” system, where the government can violate constitutional rights faster than courts can stop them. Legal experts warn that this undermines the rule of law and the separation of powers, which depend on the ability of courts to check executive overreach.

While the bill does not explicitly allow the executive branch to completely bypass legal challenges, it makes it much harder for courts to compel the executive to comply with their rulings. This functionally increases the executive’s authority to resist or delay judicial oversight.

Current Status of the Bill

As of early June 2025, the “One Big Beautiful Bill” has passed the House by a razor-thin margin (215-214) and is now before the Senate where Majority Leader John Thune has expressed hope that the bill could reach President Trump’s desk by the July 4 holiday, but the path forward is far from certain.

The Senate is expected to make significant modifications to the House version, and some provisions—including Section 70302—could be stripped out or revised. The reconciliation process limits what can be included in the final bill, and the Senate Parliamentarian may rule that certain provisions are not eligible for inclusion.

Why This Matters

The “One Big Beautiful Bill” is not just about taxes and spending. It represents a bold attempt to reshape the relationship between the executive and judicial branches. By limiting courts’ ability to enforce their rulings, the bill tilts the balance of power toward the executive, making it easier for the president and his administration to ignore or delay compliance with court orders.

Critics argue that this threatens the rule of law and the constitutional system of checks and balances. Supporters, however, see it as a way to prevent frivolous lawsuits and give the executive more flexibility to implement its agenda and to move closer to the unitary executive theory.

Looking Ahead

As the Senate debates the bill, watch for the fate of Section 70302. The outcome will have lasting implications for the balance of power in Washington and for the ability of courts to hold the government accountable.

For now, the “One Big Beautiful Bill” remains a work in progress. Its final form—and its impact on American governance—will depend on the compromises and changes made in the Senate over the coming weeks.