Diversion On A Rolling Tortoise

Chronic underinvestment in the education and training of health workers in some countries, and the mismatch between education and employment strategies in relation to health systems and population needs, are contributing to ongoing shortages. These are compounded by difficulties in deploying health workers to rural, remote, and underserved areas. Moreover, the increasing international migration of health workers may exacerbate health workforce shortfalls, particularly in low- and lower-middle-income countries. Human resources for health information systems are often weak in tracking selected health workers from the public sector. So, here are some quotes for introducing some thoughts on the topic:

“In 2030, all Baby Boomers will be age 65 or older, accounting for 1 out of every 5 Americans. This group will be an increasingly large part of the U.S. population in the future. They will need a robust, well-trained long-term services and support (LTSS) workforce to meet their needs.”

National Center for Health Workforce Analysis, U.S. Department of Health and Human Services, December 2025

“A severe, growing shortage of healthcare workers is driven by an aging population requiring more care, while a large portion of the experienced workforce retires. This imbalance is worsened by intense staff burnout, high stress, and demanding working conditions—intensified by COVID-19—leading to many leaving the field.”

Kaiser Permanente

“To do what nobody else will do, in a way that nobody else can do, in spite of all we go through…that is what it is to be a nurse.”

Rawsi Williams, RN – a BSN who also holds a Law Degree and describes her skill set as a change-agent and proven Turn-Around Specialist

“10 million. That is the projected global shortage of healthcare workers by 2030. Behind that number aren’t just vacancy rates or spreadsheets—they are people. They are the doctors, nurses, and support staff who hold our health systems together, often while facing burnout, exhaustion, and a feeling that they are pouring from an empty cup.”

Kelsey Fuller, MS, Director, System Value Performance and Transformation Communications @ University Hospitals, Value-Based Healthcare Operations, Cleveland, Ohio

Now, read the next page, where I have included an article I wrote in 1976 on “Lacidem”

Opinions and Reflections

An Interesting Diversion On A Rolling Tortoise – The following story comes from Popular Science on a tortoise who adapted to his predicament through unconventional means. A group of Philippine veterinarians provided the creative intervention for solving the problem where he had lost the function of his hind legs. So, they created a “scooter” for the Aldabra tortoise (the large type that are found in only a few places in the world). As a result, the tortoise has become “…quite the mover and shaker in his homeland area.

Here’s what the article reported: “According to Popular Science, a private zoo brought the injured tortoise to Nielsen Donato, the chief surgeon at Vets in Practice. After finding no dislocations or fractures, the team suspected the leg weakness might be neurological or the result of interactions with larger companions at the zoo. In addition to anti-inflammatory therapy, they decided to install four wheels onto the bottom of its shell for an extra mobility boost — as you can watch here (highly recommend). The tortoise was eventually sent home after showing mobility improvements, and we’re happy to share that the reptile is walking normally again without wheels.”
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​I thought of this diversion because we’ve just come through “turtle season” here in Maine, where we are encouraged to “help the turtles” cross the road when we see them during our commutes or drive-abouts! That way, surgery will not be needed…😊

Information for your Consideration…

A Personal Note – One aspect of The Fickenscher Files is that I try to share perspectives from all sides. However, a number of my more conservative readers seem to have abandoned me. I’m disappointed. I’ve always tried to present those perspectives when those with alternative thoughts share their viewpoints, and I have done so anonymously. Given the tenor of the times, however, I’ve found that we seem to be facing a deconstruction of the healthcare marketplace of the norms we’ve developed over many years. I’m clearly not a fan of RFK, Jr. I predict that his tenure as Secretary of DHHS will go down in history as one of the worst – if not the worst – in USA history. And, as importantly, the leadership of the USA on the healthcare front is now being seriously debated across the continents. But, if you disagree – let me know!!

FROM Rohan Solgarkar – The global Artificial Intelligence Market (AIM) valued at US$14.92 billion in 2024, stood at US$21.66 billion in 2025 and is projected to advance at a resilient CAGR of 38.6% from 2025 to 2030, culminating in a forecasted valuation of US$110.61 billion by the end of the period. The growing incidence of chronic diseases, linked with an increasing geriatric population, puts substantial financial pressure on healthcare providers. There is a rising need for the early detection of conditions such as dementia and cardiovascular disorders. This can be done by analyzing imaging data to recognize patterns, which helps create personalized treatment plans.

The Medical Perspective on “Healthy Diets” – Much has been in the news of late on the question of “healthy diets”, especially with RFK, Jr.’s focus on “highly processed foods”. While there is some perspectives on these foodstuffs, the emphasis should be on “some”! In essence, we do have a problem in the USA. It’s particularly evident when one looks around because 28+% of the USA population is obese (NOTE @ 100M obese Americans versus 349M total USA population). That’s particularly stark when one travels around the world. You really begin to notice how evident the problem is in the USA. And, obesity is caused primarily due to consumption of “highly processed foods, sugar-sweetened beverages, and excess sodium”. However, that is not the total problem. It’s also over-consumption of foods in general, lack of exercise (remember JRK’s fitness program from the 1960’s (I do 😊) that was aimed at bolstering youth health under the auspices of the President’s Council on Physical Fitness? It became a national obsession for the under-18 crowd (at least for a while…)

In an effort to counteract the amount of misinformation that has been disseminated in the last year related to dietary modification (among any number of other health issues), the AMA has developed a set of webinars to assist physicians by providing “evidence-based education” that the physicians can use as guides for use by their patients. You can check out the free AMA dietary webinars. Now, just so everyone believes the above, please note that one of my close colleagues always reads the FickFiles with a focus on dietary missives. She’s a noted dietician and fact checks me regularly. If I’m wrong, I will hear from her and let you know her thoughts as well!!

Acetaminophen (= Tylenol) Exposure During Pregnancy NOT Linked To Offspring Autism – a new study was recently published in JAMA Pediatrics by Danish researchers who reported that the use of acetaminophen “by women during pregnancy was not associated with autism in their children.” Specifically, they examined the records of “more than 1.5 million children ‌born between 1997 and 2022, including 31,098 exposed to Tylenol in the womb. Autism was later diagnosed in 1.8% of exposed children and 3% of the unexposed group.” Furthermore, the data examined was not restricted to consumption only, but also accounted for the dose of the drug and in which trimester the Tylenol was used. Furthermore, the study echoes the results of a 2024 Swedish study that also “found no link between autism and pregnancy use of Tylenol.” No doubt, further studies are in the works. If reports become available, I’ll try to make sure you hear the results. We need to remember that science is built on data analyzed to find the truth, not on selectively inaccurate information that does not adhere to scientific analytic principles!!

MAHA Disappointments – Many of you are no doubt inundated with unrequested emails of one political persuasion or another. Erica Schwartz, MD, the former Deputy Surgeon General is now the CDC Surgeon General nominee. She is the 4^th (I believe that is correct) person to be selected for the role over the last two years. Not only does she have extensive experience in public health but she’s also had a lot of experience in government work both in the military and with the DHHS. The Friday Pulse is a compilation of observers including:

• “She hasn’t earned a reputation for pushing back on Covid-19-era vaccine requirements and prolonged school closures…”

• “During the pandemic, Schwartz took on a role as the official physician ordering Covid tests for drive-through testing sites nationwide…”

• “…She doesn’t have a history of publicly questioning the safety of routine vaccinations.”

• “Aaron Siri…Kennedy’s personal attorney…criticized Schwartz for her role in writing smallpox and anthrax vaccine mandates for some Coast Guard members during her time overseeing its health system.”

• And, a final counterpoint from Friday Pulse: “…This agency does not need another cheerleader for industry; it needs a regulator over industry,”

But, the major issue seems to be that even though she is clearly qualified for the role given her background and experiences, RFK, Jr. – as DHHS Secretary – can overrule the guidance that she and her team develop. So, the question becomes – how to manage RFK, Jr.

Ruminations On Aging – It appears, based on some new research described in WebMD.com, that aging and happiness often follow a U-shaped curve in life. As a trial of 1, I can concur with the findings of this new study. When we are young and on into our middle years, the line slowly dips. As an example, it was in those middle years that I started bike riding on the prairies of North Dakota, and I quit smoking abruptly due to worries about my health. The evolution continues on into the 40s – 50s, where our “happiness” index starts to rise again. When we reach the 60s, about 1/3 of people in those years are contented – which is a tish more than those under the age of 35. And as a member of the golden decades group, we are presented with new challenges appearing on the horizon. It’s not uncommon that we start to perseverate about our health, our economic capacity for weathering those years, the increasing number of death among our loved ones as well as the iconic public figures in our lives from prior decades. In fact, the “top of mind” list of concerns for those in 60+ era includes the following: 1) cancer risk, 2) hearing loss, 3) weight creep (in both directions), 4) skin changes (dry, scaly, wound healing problems), 5) heart troubles (oy vey), 6) brain power (double oy vey), 7) vision problems, 8) bone and joint issues, 9) sleep quality or lack thereof, 10) increased blood pressure, 11) bladder control (my assessment is “frequency”), 12) immunity to diseases and circulating “bugs”, 13) dental issues, and 14) add your own areas of focus to the list. These issues compound to the point of perseveration at times. So, to manage these issues, I’ve taken to (attempting) to walk 10,000 steps a day and modifying my dietary intake towards the Mediterranean style diet (except for chocolates and a few other goodies). Consider the alternative!! It’s a real motivator!!

Notes From The Keri Report – Given my interest in all things culinary, I recently joined a semi-regular podcast by Keri Gans, a Registered Dietitian (RDN) and host of The Keri Report podcast. Shortly after joining, I noticed a podcast on “What to Eat Before Bed for Better Sleep”. You should check out the longer version. Here is the essence of her suggestions. First, she noted that our sleep cycle is affected by the hormone melatonin, which has a major influence on the sleep-wake cycle. However, I was not aware of the fact that certain nutrients affect and support the brain chemicals involved in sleep. It makes sense on the face of it. So, here are some suggested pre-sleep ingestible foods to consider for enhancing your sleep:

• Kiwi – A fruit that has grown in the USA in recent years is marked as a good source of magnesium. The pill form is part of my daily routine for mitigating my peripheral neuropathy, it also supports the production of melatonin as well as mitigating the neuropathy.

• Turkey – For the meat-eater types, turkey offers up tryptophan, an essential amino acid that facilitates the production of melatonin and serotonin - hormones that regulate our mood and the sleep-wake cycle.

• Eggs – another option to consider that affects tryptophan because of the fact that eggs contain the essential substance. Also, eggs contain Vitamin B6, which according to dietary research, also contributes to the conversion of tryptophan to serotonin.

• Tart Cherries – imagine that!!! Evidently, an article in a 2025 article in the journal Food Science & Nutrition reported that consuming an ounce of tart cherry juice for seven days increased the total amount of sleep that people were able to achieve. Their sleep was also more efficient in that time in bed devoted to sleep increased as well. So, definitely switch from red wine to Tart Cherries. I’m on it

• Milk – serves as a great source of protein, plus it offers tryptophan and calcium – an essential vitamin that provides support to signaling by nerve cells. Calcium is another one of my daily consumptive elements, although in place of milk, I use a nightly dish of ice cream. I just hope the transfer is just as complete. My informal report is that ice cream before bedtime is a must, plus my two dogs appreciate the bowl licks following my consumption.

• Bananas – are high in magnesium and potassium, which facilitate muscle relaxation and, like eggs, contain Vitamin B6.

I could go on with the list that includes bananas, avocados, sweet potatoes, walnuts (I like the honey-coated type), But, in addition to the dietary intake to facilitate sleeping, my suggestion is to stay away from alcohol, too much coffee (although for a coffeeholic like me, it does not seem to be a problem), tea, colas and other such offerings. But, check out the full article as noted above. It’s worth the read!!!

Musings from a foodie…

Almost Ready To Move – We’re just returning from a wonderful six-day trip to Sicily, where the adventures were quite incredible – but I’m not about to start a travelogue. Rather, it’s simply a report on two of my favorite culinary experiences over the last several weeks. In years past, when I traveled extensively overseas, I was able to offer up a large variety of experiences. In recent years, my observations have been primarily USA-based. However, with our trip, we were able to go out every night. So, my two suggestions are: Don Camillo in Siracuza [⭐⭐⭐⭐ ] and Tratoria Malvasia [⭐⭐⭐⭐ ]– both in Taormina on the Sicily coast.

I must admit that Don Camillo had an extensive antipasto, pasta, and main menu with a fixed price for x2 and x3 options. However, there were two major critiques of the whole experience that resulted in a downgrade on the non-food front. The first was the fact that the four of us (we were with friends) were seated at a rather large round table capable of seating upwards of eight quite easily, which made the conversation somewhat repetitive since I kept saying “what did you say” – politely, of course. The second was that there was a “pretentious” atmosphere underlying the whole experience. On the food front, the menu offered an interesting culinary tour:

• Tomato ice cream with spiced celery

• Mussel in a canapé shell with the appearance of a mussel shell

• Sliced bread (= 1/8 of an inch thick) dried with butter and garlic – loved it!!

• Carpaccio of bacalao topped with caviar and citrus jellies plus seaweed

• Smoked local shrimp with onion cream

• Multiple Salted breadsticks between courses

• THE BEST beef ravioli with cheese sauce

• Pasta shell stuffed with swordfish & eggs with an outstanding tomato sauce

• Rabbit with tomato sauce

• Lamb loin, which was the weakest link during the entire culinary experience, not because of taste but because I have an aversion to eating lots of fat…😊

Don Camillo was established in 1985 and received a Michelin rating in 2025. I could go on, but I was wondering if they kept it in 2026? And, while the foods were tasty, the other elements of the experience reduced their star rating. It was a once-in-a-lifetime experience. AND, regardless of foody experiences, I fell in love with Sicily.

The second experience was with Trattoria Malvasia [ ⭐⭐⭐⭐⭐], also located in Taormina. The antipasto was simple but wonderful with Prosciutto and Mozzarella Cheese. We opted for their “House Specialty” of Ravioli with Shrimp. The sauce and ravioli were exquisite with small shrimp. It was a treat. They also surprised us with sea urchin, and our table conversation drifted toward the fact that Maine is one of the largest Sea Urchin producers in the world, although most of them are evidently shipped to Japan. However, the best part of the dinner was the Branzino with a simple but exquisite olive, caper, and tomato dressing. The chef (I did not catch her name) was also present and welcoming of folks following dinner. It was a delightful, open-air trattoria that you need to consider if you travel to Taormina. If I get back, I’ll give them a try again.

While I’ve traveled to Italy many times and had lots of experiences on the mainland, Sicily is a treasure unto itself and should be experienced at some during life. If you like pasta, you’ll fall in love like me!!

The ongoing saga…

The Great – When gasoline prices drop back down to the $2.00+ range, we will all be very happy. Hmmmm…

The Good – The snow has melted in most of Maine and around the nation, with the daffodils reaching full bloom. It’s created a sense of energy.

The Bad – When I asked my wife for advice on “What is Bad right now?” her response was: “What isn’t bad?”

The Ugly – The failure of leadership by the legislative, executive, and administrative branches of the USA government due to the abyss of ideological infighting at multiple levels that is not solving real issues of concern to the American – and international – community!