Think Like a Doctor: The Man Who Wobbled

The Challenge: Can you solve the medical mystery of a man who suddenly becomes too dizzy to walk?

Every month, the Diagnosis column of The New York Times Magazine asks Well readers to try their hand at solving a medical mystery. Below you will find the story of a 56-year-old factory worker with dizziness and panic attacks. I have provided records from his two hospital visits that will give you all the information available to the doctor who finally made the diagnosis.

The first reader to offer the correct diagnosis gets a signed copy of my book, “Every Patient Tells a Story,” and the satisfaction of solving a case that stumped a roomful of specialists.

The Patient’s Story:

The middle-aged man clicked his way through the multiple reruns of late-late-night television. He should have been in bed hours ago, but lately he hadn’t been able to get to sleep. Suddenly his legs took on a life of their own. Stretched out halfway to the center of the room, they began to shake and twitch and jump around. The man watched helplessly as his legs disobeyed his mental orders to stop moving. He had no control over them. He felt nauseous, sweaty and out of breath, as if he had been running some kind of race. He called out to his wife. She hurried out of bed, took one look at him and called 911.

The Patient’s History:

By the time the man arrived at Huntsville Hospital, in Alabama, the twitching in his legs had subsided and his breathing had returned to normal. Still, he had been discharged from that same hospital for similar symptoms just two weeks earlier. They hadn’t figured out what was going on then, so they weren’t going to send him home now.

The patient considered himself pretty healthy, but the past year or so had been tough. In 2011, at the age of 54, he had had a mild stroke. He had no medical problems that put him at risk for stroke — no high blood pressure, no high cholesterol, no diabetes. A work-up at that time showed that he had a hole in his heart that allowed a tiny clot from somewhere in his body to travel to the brain and cause the stroke. He was discharged on a couple of blood thinners to keep his blood from making more clots. He hadn’t really felt completely well, though, ever since. His balance seemed a little off, and he was subject to these weird panic attacks, in which his heart would pound and he would feel short of breath whenever he got too stressed. Mostly he could manage them by just walking away and focusing on his breathing. Still, he never felt as if he was the kind of guy to panic.

And he had always been quick on his feet. The first half of his career he had been in the steel business — building huge metal trusses and supports. He and his team put together 60-plus tons of steel structures every day. For the past decade he had been machining car parts. After his stroke, work seemed to get a lot harder.

The Dizziness:

A few weeks ago, he stood up and wham — suddenly the whole world went off-kilter. He felt as if he was constantly about to fall over in a world that no longer lay down flat. His first thought was that he was having another stroke. He went straight to his doctor’s office. The doctor wasn’t sure what was going on and sent him to that same emergency room at Huntsville Hospital. After three days of testing and being evaluated by lots of specialists, his doctors still were not sure what was going on. He hadn’t had a heart attack; he hadn’t had a stroke. There was no sign of infection. All the tests they could think of were normal.

The only abnormal finding was that when he stood up, his blood pressure dropped. Why this happened wasn’t clear, but the doctors in the hospital gave him compression stockings and a pill — both could help keep his blood pressure in the normal range. Then they sent him home. He was also started on an antidepressant to help with the panic attacks he continued to have from time to time.

You can read the report from that hospital admission below.

You can also read the consultation and discharge notes from that hospital visit here.

He had been home for nearly two weeks and still he felt no better. He tried to go back to work after a week or so at home, but after driving for less than five miles, he felt he had to turn around. He wasn’t sure what was wrong; he just knew he didn’t feel right. Then his legs started jumping around, and he ended up back in the hospital.

The Doctor’s Exam:

It was nearly dawn by the time Dr. Jeremy Thompson, the first-year resident on duty that night, saw the patient. Awake but tired, the patient told his story one more time. He had been at home, watching TV, when his legs started jumping on their own and he started feeling short of breath. His wife sat at the bedside. She looked just as worried and exhausted as he did. She told the resident that when he spoke that night at home, his speech was slurred. And when the ambulance came, he could barely walk. He has never missed this much work, she told the young doctor. It’s not like him. Can’t you figure out what’s wrong?

The resident had already reviewed the records from the patient’s previous hospital admissions. He asked a few more questions: the patient had never smoked and rarely drank; his father died at age 80; his mother was still alive and well. The patient exam was normal, as were the studies done in the E.R.

The first E.R. doctor thought that his symptoms were a result of anxiety, culminating in a full-blown panic attack. The resident thought that was probably right. In any case he would discuss the case with the attending in a couple of hours during rounds on the new patients. Till then, he told the worried couple, they should just try to get a little sleep.

An Important Clue:

Dr. Robert Centor was definitely a morning person. His cheerful enthusiasm about teaching and taking care of patients made him a favorite among residents. At 7:30 that morning, he stood outside the patient’s door as Dr. Thompson relayed the somewhat frustrating case of the middle-aged man with worsening dizziness and panic attacks. Then they went into the room to meet the patient. He was a big guy, tall and muscular with the first signs of middle-aged thickening around his middle. His complexion had the look of someone who spent a lot of time outdoors. Dr. Centor introduced himself and pulled up a chair as the rest of the team watched. He asked the patient what brought him to the hospital.

“Every time I get up, I get dizzy,” the man replied. Sure, he had had some balance problems ever since his stroke, he explained, but this felt different – somehow worse. He could hardly walk, he told the doctor. He just felt too unstable.

“Can you get up and show us how you walk?” Dr. Centor asked.

“Don’t let me fall,” the patient responded. He carefully swung his legs over the side of the bed. The resident and intern stood on either side as he slowly rose. He stood with his feet far apart. When asked to close his eyes as he stood there, he wobbled and nearly fell over. When he took a few steps, his heel and toes hit the ground at the same time, making a strange slapping sound.

Seeing that, Dr. Centor knew where the problem lay and ordered a few tests to confirm his diagnosis.

You can see the review report and notes for the patient’s second hospital visit below.

Solving the Mystery:

What tests did Dr. Centor order? Do you know what is making this middle-aged man wobble? Enter your guesses below. I’ll post the answer tomorrow.

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Rules and Regulations: Post your questions and diagnosis in the Comments section below. The correct answer will appear tomorrow on Well. The winner will be contacted. Reader comments may also appear in a coming issue of The New York Times Magazine.

Friday March 1, 1:21 p.m. | Updated Thanks for all your responses! You can learn the correct diagnosis at “Think Like a Doctor: The Wobble Solved!”

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Incomes see largest drop in 20 years

U.S. consumer spending rose in January as Americans spent more on services, with savings providing a cushion after income recorded its biggest drop in 20 years.

Income tumbled 3.6 percent, the largest drop since January 1993. Part of the decline was payback for a 2.6 percent surge in December as businesses, anxious about higher taxes, rushed to pay dividends and bonuses before the new year.

A portion of the drop in January also reflected the tax hikes. The income at the disposal of households after inflation and taxes plunged a 4.0 percent in January after advancing 2.7 percent in December.

The Commerce Department said on Friday consumer spending increased 0.2 percent in January after a revised 0.1 percent rise the prior month. Spending had previously been estimated to have increased 0.2 percent in December.

January's increase was in line with economists' expectations. Spending accounts for about 70 percent of U.S. economic activity and when adjusted for inflation, it gained 0.1 percent after a similar increase in December.

Though spending rose in January, it was supported by a rise in services, probably related to utilities consumption. Spending on goods fell, suggesting some hit from the expiration at the end of 2012 of a 2 percent payroll tax cut. Tax rates for wealthy Americans also increased.

The impact is expected to be larger in February's spending data and possibly extend through the first half of the year as households adjust to smaller paychecks, which are also being strained by rising gasoline prices.

Economists expect consumer spending in the first three months of this year to slow down sharply from the fourth quarter's 2.1 percent annual pace.

With income dropping sharply and spending rising, the saving rate - the percentage of disposable income households are socking away - fell to 2.4 percent, the lowest level since November 2007. The rate had jumped to 6.4 percent in December.

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Pope Benedict quits Vatican with promise to obey successor

VATICAN CITY (Reuters) - Pope Benedict left the Vatican on Thursday after pledging unconditional obedience to whoever succeeds him to guide the Roman Catholic Church at one of the most crisis-ridden periods in its 2,000-year history.

The first pope in six centuries to step down, Benedict flew off in a white Italian air force helicopter for the papal summer villa south of the capital where he took up temporary residence.

As the helicopter took off, he sent his last message on Twitter: "Thank you for your love and support. May you always experience the joy that comes from putting Christ at the center of your lives".

Bells rang out from St Peter's Basilica and churches all over Rome as the helicopter circled Vatican City and flew over the Colosseum and other landmarks to give the pontiff one last view of the city where he is also bishop.

"As you know, today is different to previous ones," he told an emotional, cheering crowd holding balloons and banners after he arrived in the small town of Castel Gandolfo.

"I will only be the supreme pontiff of the Catholic Church until 8 p.m and then no longer. I will simply be a pilgrim who is starting the last phase of his pilgrimage on this earth."

He then turned and went inside the villa, never to be seen again as pope.

"I wanted to see him for the last time. I hope his successor follows in his footsteps. I feel very moved to be here," said Giuseppe Ercolino, a 19-year-old student from a nearby town.

In an emotional farewell to cardinals on Thursday morning in the Vatican's frescoed Sala Clementina, Benedict appeared to send a strong message to the top echelons of the Church as well as the faithful to remain united behind his successor, whoever he is.

"I will continue to be close to you in prayer, especially in the next few days, so that you are fully accepting of the action of the Holy Spirit in the election of the new pope," he said. "May the Lord show you what he wants. Among you there is the future pope, to whom I today declare my unconditional reverence and obedience."

The pledge, made ahead of the closed-doors conclave where cardinals will elect his successor, was significant because for the first time in history, there will be a reigning pope and a former pope living side by side in the Vatican.

Some Church scholars worry that if the next pope undoes some of Benedict's policies while his predecessor is still alive, Benedict could act as a lightning rod for conservatives and polarize the 1.2 billion-member Church.

Before boarding the helicopter, Pope Benedict said goodbye to monsignors, nuns, Vatican staff and Swiss guards in the San Damaso courtyard of the Holy See's apostolic palace. Many of his staff had tears in their eyes as the helicopter left.

Benedict will spend the first few months of his retirement in the papal summer residence, a complex of villas boasting lush gardens, a farm and stunning views over Lake Albano in the volcanic crater below the town.

Benedict will stay until April when renovations are completed on a convent in the Vatican that will be his new home.

PAPAL PROBLEMS

With the election of the next pope taking place in the wake of sexual abuse scandals, leaks of his private papers by his butler, falling membership and demands for a greater role for women, many in the Church believe it would benefit from a fresh face from a non-European country.

A number of cardinals from the developing world, including Ghanaian Peter Turkson and Antonio Tagle of the Philippines are two names often mentioned as leading candidates from the developing world who listen more.

"At the past two conclaves, the cardinals elected the smartest man in the room. Now, it may be time to choose a man who will listen to all the other smart people in the Church," said Father Tom Resse, a historian and senior fellow at the Woodstock Theological Center at Georgetown University.

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Study Finds Genetic Risk Factors Shared by 5 Psychiatric Disorders

Their study, published online Wednesday in the Lancet, was based on an examination of genetic data from more than 60,000 people world-wide. Its authors say it is the largest genetic study yet of psychiatric disorders. The findings strengthen an emerging view of mental illness that aims to make diagnoses based on the genetic aberrations underlying diseases instead of on the disease symptoms.

Two of the aberrations discovered in the new study were in genes used in a major signaling system in the brain, giving clues to processes that might go awry and suggestions of how to treat the diseases.

“What we identified here is probably just the tip of an iceberg,” said Dr. Jordan Smoller, lead author of the paper and a professor of psychiatry at Harvard Medical School and Massachusetts General Hospital. “As these studies grow we expect to find additional genes that might overlap.”

The new study does not mean that the genetics of psychiatric disorders are simple. Researchers say there seem to be hundreds of genes involved and the gene variations discovered in the new study only confer a small risk of psychiatric disease.

Steven McCarroll, director of genetics for the Stanley Center for Psychiatric Research at the Broad Institute of Harvard and M.I.T., said it was significant that the researchers had found common genetic factors that pointed to a specific signaling system.

“It is very important that these were not just random hits on the dartboard of the genome,” said Dr. McCarroll, who was not involved in the new study.

The work began in 2007 when a large group of researchers began investigating genetic data generated by studies in 19 countries and including 33,332 people with psychiatric illnesses and 27,888 people free of the illnesses for comparison. The researchers studied scans of peoples’ DNA, looking for variations in any of several million places along the long stretch of genetic material containing three billion DNA letters. The question: Did people with psychiatric illnesses tend to have a distinctive DNA pattern in any of those locations?

Researchers had already seen some clues of overlapping genetic effects in identical twins. One twin might have schizophrenia while the other had bipolar disorder. About six years ago, around the time the new study began, researchers had examined the genes of a few rare families in which psychiatric disorders seemed especially prevalent. They found a few unusual disruptions of chromosomes that were linked to psychiatric illnesses. But what surprised them was that while one person with the aberration might get one disorder a relative with the same mutation got a different one.

Jonathan Sebat, chief of the Beyster Center for Molecular Genomics of Neuropsychiatric Diseases at the University of California, San Diego, and one of the discoverers of this effect, said that work on these rare genetic aberrations had opened his eyes. “Two different diagnoses can have the same genetic risk factor,” he said.

In fact, the new paper reports, distinguishing psychiatric diseases by their symptoms has long been difficult. Autism, for example, at was once called childhood schizophrenia. It was not until the 1970s that autism was distinguished as a separate disorder.

But, Dr. Sebat, who did not work on the new study, said that until now it was not clear whether the rare families he and others had studied were an exception or whether they were pointing to a rule about multiple disorders arising from a single genetic glitch.

“No one had systematically looked at the common variations,” in DNA, he said. “We didn’t know if this was particularly true for rare mutations or if it would be true for all genetic risk.” The new study, he said, “shows all genetic risk is of this nature.”

The new study found four DNA regions that conferred a small risk of psychiatric disorders. For two of them, it is not clear what genes are involved or what they do, said Dr. Smoller. The other two, though, involve genes that are part of calcium channels, which are used when nerves send signals in the brain.

“The calcium channel findings suggest that perhaps – and this is a big if – treatments to affect calcium channel functioning might have effects across a range of disorders,” Dr. Smoller said.

There are drugs on the market that block calcium channels – they are used to treat high blood pressure – and researchers had already postulated that they might be useful for bipolar disorder even before the current findings.

One investigator, Dr. Roy Perlis of Massachusetts General Hospital, just completed a small study of a calcium channel blocker in 10 people with bipolar disorder and is about to expand it to a large randomized clinical trial. He also wants to study the drug in people with schizophrenia, in light of the new findings. He cautions, though, that people should not rush out to take a calcium channel blocker on their own.

“We need to be sure it is safe and we need to be sure it works,” Dr. Perlis said.

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Economic expansion weakest since 2011

The U.S. economy barely grew in the fourth quarter although a slightly better performance in exports and fewer imports led the government to scratch an earlier estimate that showed an economic contraction.

Gross domestic product expanded at a 0.1 percent annual rate, the Commerce Department said on Thursday, missing the 0.5 percent gain forecast by analysts in a Reuters poll.

The growth rate was the slowest since the first quarter of 2011 and far from what is needed to fuel a faster drop in the unemployment rate.

However, much of the weakness came from a slowdown in inventory accumulation and a sharp drop in military spending. These factors are expected to reverse in the first quarter.

Consumer spending was more robust by comparison, although it only expanded at a 2.1 percent annual rate.

Because household spending powers about 70 percent of national output, this still-lackluster pace of growth suggests underlying momentum in the economy was quite modest as it entered the first quarter, when significant fiscal tightening began.

Initially, the government had estimated the economy shrank at a 0.1 percent annual rate in the last three months of 2012. That had shocked economists.

Thursday's report showed the reasons for the decline were mostly as initially estimated. Inventories subtracted 1.55 percentage points from the GDP growth rate during the period, a little more of a drag than initially estimated. Defense spending plunged 22 percent, shaving 1.28 points off growth as in the previous estimate.

There were some relatively bright spots, however. Imports fell 4.5 percent during the period, which added to the overall growth rate because it was a larger drop than in the third quarter. Buying goods from foreigners bleeds money from the economy, subtracting from economic growth.

Also helping reverse the initial view of an economic contraction, exports did not fall as much during the period as the government had thought when it released its advance GDP estimate in January. Exports have been hampered by a recession in Europe, a cooling Chinese economy and storm-related port disruptions.

Excluding the volatile inventories component, GDP rose at a revised 1.7 percent rate, in line with expectations. These final sales of goods and services had been previously estimated to have increased at a 1.1 percent pace.

Business spending was revised to show more growth during the period than initially thought, adding about a percentage point to the growth rate.

Growth in home building was revised slightly higher to show a 17.5 percent annual rate. Residential construction is one of the brighter spots in the economy and is benefiting from the Federal Reserve's ultra easy monetary policy stance, which has driven mortgage rates to record lows. (Reporting by Jason Lange; Editing by Andrea Ricci)
 

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Chicago archdiocese to close or consolidate five schools

The Roman Catholic Archdiocese of Chicago is laying off about 10 percent of its work force and is planning to close or consolidate about five schools to reverse "unsustainable" deficits.

The downsizing, which apparently has been in the works for months, coincides with the arrival of Cardinal Francis George in Rome this week to participate in the conclave to choose a new pope.

In a lengthy letter to parishioners posted on the archdiocese website, George outlines cost-cutting measures for the archdiocese, which has been running operating deficits of more than $30 million every year for the past four years.

"Since this trend is unsustainable, I want to set out the measures we are taking to ensure prudent stewardship of our resources for years to come," George says in the letter.

At the Pastoral Center, 75 positions have been cut, including 55 full-time roles. That reduction is estimated to save $11 million to $13 million annually by fiscal year 2015, according to George.

“Our employees are faith-filled men and women who have worked tirelessly for the good of the Church.  Please keep them in your prayers,” he wrote.

George wrote in his Cardinal’s Column that other cost-cutting measures would include closing or consolidating “a few schools that are no longer sustainable.”

About five schools will be closed or consolidated, some of which have seen demographic changes or other challenges, according to the letter. The archdiocese plans to give out scholarships to children affected by the change so they can attend nearby Catholic schools.

The archdiocese will also reduce its annual aid to schools by $10 million next year. “We hope to return to a sustainable level of aid for those schools that will always be facing financial difficulties,” George wrote.

In addition, pastors received letters in the past month informing them there would be no more loans granted from the archdiocese bank.

No parish priests will lose their assignments in the downsizing, the Tribune has learned. But administrative staff at the pastoral center could be cut.

Earlier this year, the school system rolled out a strategic plan to make schools more self-sufficient.

"This review of archdiocesan finances has been necessary but difficult," the cardinal concludes in his letter. "Reductions in some services and in staffing will, of course, be particularly difficult for the persons and parishes directly affected by them.  These actions are being taken now because the financial situation imposes them.  We are also taking them, however, so that the archdiocese will have the resources she needs for her mission."

mbrachear@tribune.com

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Personal Health: Too Many Pills in Pregnancy

The thalidomide disaster of the early 1960s left thousands of babies with deformed limbs because their mothers innocently took a sleeping pill thought to be safe during pregnancy,

In its well-publicized wake, countless pregnant women avoided all medications, fearing that any drug they took could jeopardize their babies’ development.

I was terrified in December 1968 when, during the first weeks of my pregnancy, I developed double pneumonia and was treated with antibiotics and codeine. Before swallowing a single dose, I called my obstetrician, who told me to take what was prescribed, “reassuring” me that if I died of pneumonia I wouldn’t have a baby at all.

In the decades that followed, pregnancy-related hazards were linked to many medicinal substances: prescription and over-the-counter drugs and herbal remedies, as well as abused drugs and even some vitamins.

Now, however, the latest findings about drug use during pregnancy have ignited new concerns among experts who monitor the effects of medications on the developing fetus and pregnancy itself.

During the last 30 years, use of prescription drugs during the first trimester of pregnancy, when fetal organs are forming, has grown by more than 60 percent.

About 90 percent of pregnant women take at least one medication, and 70 percent take at least one prescription drug, according to the Centers for Disease Control and Prevention.

Since the late 1970s, the proportion of pregnant women taking four or more medications has more than doubled.

Nearly one woman in 10 takes an herbal remedy during the first trimester.

A growing number of pregnant women, naïvely assuming safety, self-medicate with over-the-counter drugs that were once sold only by prescription.

While many commonly taken medications are considered safe for unborn babies, the Food and Drug Administration estimates that 10 percent or more of birth defects result from medications taken during pregnancy. “We seem to have forgotten as a society that drugs pose risks,” Dr. Allen A. Mitchell, professor of epidemiology and pediatrics at Boston University Schools of Public Health and Medicine, said in an interview. “Many over-the-counter drugs were grandfathered in with no studies of their possible effects during pregnancy.”

Medical progress has contributed to the rising use of medications during pregnancy, Dr. Mitchell said. Various conditions, like depression, are now recognized as diseases that warrant treatment; drugs have been developed to treat conditions for which no treatment was previously available, and some conditions, like Type 2 diabetes and hypertension, have become more prevalent.

Misled by the Web

Now a new concern has surfaced: Bypassing their doctors, more and more women are using the Internet to determine whether the medication they are taking or are about to take is safe for an unborn baby.

A study, published online last month in Pharmacoepidemiology and Drug Safety, of so-called “safe lists for medications in pregnancy” found at 25 Web sites revealed glaring inconsistencies and sometimes false reassurances or alarms based on “inadequate evidence.”

The report was prepared by Cheryl S. Broussard of the Centers for Disease Control and Prevention with co-authors from Emory, Georgia State University, the University of British Columbia and the Food and Drug Administration.

“Among medications approved for use in the U.S.A. from 2000 to 2010, over 79% had no published human data on which to assess teratogenic risk (potential to cause birth defects), and 98% had insufficient published data to characterize such risk,” the authors wrote.

But that did not stop the 25 Web sites from characterizing 245 medications as “safe” for use by pregnant women, which “might encourage use of medications during pregnancy even when they are not necessary,” the authors suggested.

Furthermore, the information found online was sometimes contradictory. “Twenty-two of the products listed as safe by one or more sites were stated not to be safe by one or more of the other sites,” the study found.

The question of timing was often ignored. A drug that could interfere with fetal organ development might be safe to take later in pregnancy. Or one (for example, ibuprofen) that is safe early in pregnancy could become a hazard later if it raises the risk of excessive bleeding or premature delivery.

Fewer than half the sites advised taking medication only when necessary, and only 13 sites encouraged pregnant women to consult their doctors before stopping or starting a medication.

Doctors, too, are often poorly informed about pregnancy-related hazards of various medications, the authors noted. One woman I know was advised to wean off an antidepressant before she became pregnant, but another was told to continue taking the same drug throughout her pregnancy.

“In many instances the best bet is for mom to stay on her medication,” said Dr. Siobhan M. Dolan, an obstetrician and geneticist at Albert Einstein College of Medicine. She said that if a woman is depressed during pregnancy, her risk of postpartum depression is greater and she may have difficulty bonding with her baby.

Dr. Dolan, who is author, with Alice Lesch Kelly, of the March of Dimes’ newest book, “Healthy Mom Healthy Baby,” emphasized the importance of weighing benefits and risks in deciding whether to take medication during pregnancy and which drugs to take.

“In anticipation of pregnancy, a woman taking more than one drug to treat her condition should try to get down to a single agent,” Dr. Dolan said in an interview. “Of the various medications available to treat a condition, is there a best choice — one least likely to cause a problem for either the baby or the mother?”

She cautioned against sharing medications prescribed for someone else and assuming that a remedy labeled “natural” or “herbal” is safe. Virtually none have been tested for safety in pregnancy.

Among medications a woman should be certain to avoid, in some cases starting three months before becoming pregnant, are isotretinoin (Accutane and others) for acne; valproic acid for seizure disorders; lithium for bipolar disorder; tetracycline for infections, and angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor antagonists for hypertension, Dr. Dolan said.

“Many medications that are not recommended during pregnancy can be replaced with low-risk alternatives,” she wrote.

Dr. Broussard, who did the “safe lists” study, said in an interview, “We’ve heard about women seeing medications on these lists and deciding on their own that it’s O.K. to take them. “Women who are pregnant or even thinking about getting pregnant should talk directly to their doctors before taking anything. They should be sure they’re taking only what’s necessary for their health condition.”

A reliable online resource for both women and their doctors, Dr. Mitchell said, are fact sheets prepared by OTIS, the Organization of Teratology Information Specialists, which are continually updated as new facts become available: http://www.otispregnancy.org.

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Author tells businesses to be like Mike

CAPTIONS

MJ in 1982
Michael Jordan in his college days with teammates Matt Doherty (44) and Sam Perkins and coach Dean Smith. (AP photo by Robert Willett /October 14, 1982)

By Samantha Bomkamp




Tribune reporter

10:11 a.m. CST, February 27, 2013

An author of a new book has some sage advice for business leaders: Be more like Michael Jordan.

Bruce Piasecki, who penned "Doing More with Teams: The New Way to Winning," says Michael Jordan's long and storied career "is a shining example of how the best teams operate."

Jordan shouldn't be emulated just because of the Bulls star's individual success, the author says, but by the way he showed leadership and helped create a seemingly unstoppable team, meshing with different personalities such as the quiet Scottie Pippen and outrageous Dennis Rodman to create a basketball dynasty.

Those team dynamics are similar in the business world, the author says. And businesses are most successful when they are led by the right leaders and are composed of a mix of people with varying talents, he argues.

Jordan also is held up as an example in other tenets of good business teamwork the author describes.

-- Ego and individual goals have no place on teams.

"When we pin all our hopes on a single individual and ignore the context in which he or she operates, we will be disappointed," he says.

--  Failure is part of winning.

"Leaders must instill in teams a tolerance of losing," he said. "We must convey that failure is a part of life and thus a part of business."

Jordan, who helped the Chicago Bulls win six NBA championships, famously said "I've failed over and over and over again in my life, and that is why I succeed."

The book is set to be released next month but is available for pre-order on Amazon.com.

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Chicago pelted by snow, sleet

A winter weather advisory has been issued for today as the Chicago area is getting hit with sleet, freezing rain and snow from a storm that churned the southern Plains a day earlier.

The National Weather Service expects snow  to fall the heaviest between mid-day and early afternoon, though accumulations will vary in different parts the city.

"It does look like the early part of the rush hour will be most affected," said Mike Bardou, a Romeoville-based meteorologist for The National Weather Service.

The northern part of the city and the northwest suburbs could see 2 to 3 inches of snow by the evening rush hour, he said.

During a similar time frame, Chicago's South Side and southwest suburbs like Oak Lawn, Tinley Park and Joliet might only get 1 to 2 inches of snow, according to the agency. The far south suburbs could see less than an inch.

Snow will continue to fall, though at a lighter intensity, through the evening until early tomorrow morning, according to the agency, and temperatures are expected to hover right around freezing.

So far, the early mixture of rain, sleetr and snow has resulted in non-serious accidents on Interstate 90, I-94 and I-55, according to the Illinois State Police.

The threat of heavy weather has already prompted a large number of schools to cancel after-school activities, according to the Emergency Closing Center on ChicagoWeatherCenter.com, and many are even closing early.

The weather has also thrown a monkey wrench into scheduling of early-round games in the boys state basketball tournaments. Many games downstate have been postponed for a day and in the Chicago area, games at Chicago's St. Ignatius College Prep and at South Elgin High School have  been postponed as well.

The storm bore down on the southern Plains on Monday, dumping more than a foot of snow and creating blizzard conditions in Oklahoma, Texas and parts of Kansas still digging out from a winter storm last week.

Highways in the Texas and Oklahoma panhandles and parts of Kansas were closed by the heavy and drifting snow that cut visibility and forced flight cancellations at airports across the region.

A man was killed Monday when his car slid off Interstate 70 in Sherman County, Kansas, near the western border, Governor Sam Brownback said. And in northern Oklahoma, one person died when the roof of a home partially collapsed in the city of Woodward, said Matt Lehenbauer, the city's emergency management director.

"We have roofs collapsing all over town," said Woodward Mayor Roscoe Hill Jr. "We really have a mess on our hands."

The storm was slowly moving out of Texas on Monday, while residents of Kansas City in turn were preparing for a foot or more of snow into Tuesday.

Tornado watches were in place Monday evening in parts of Mississippi and heavy rain was expected through the night in parts of Alabama and Georgia, according to the National Weather Service. The weather service Monday also issued flood watches for parts of the Carolinas and an ice storm warning for portions of West Virginia.

Some 17 inches of snow fell near Amarillo, Texas, according to the National Weather Service. Other areas in the Texas Panhandle reported more than a foot of snow and Texas Governor Rick Perry activated Texas military forces to be ready to respond to calls for assistance.

Amarillo could break the all-time record for the amount of snow in one day of just over 18 inches set in 1934, said Kristin Scotten of the National Weather Service.

Airports in Amarillo and in Lubbock, Texas, were closed and Interstate 27 between the cities was shut because of blowing snow, state officials said. Wind gusts of 75 miles per hour (121 km per hour) were clocked at the Amarillo airport.

Visibility was near zero on some roads around Amarillo, said Paul Braun, a Texas Department of Transportation spokesman.

"I am hearing that we have a lot of vehicles that are stalled in the main lanes of our roadways and they can't be seen because of the blowing snow," Braun said.

Texas State Trooper Gabriel Medrano said the snow was too deep to measure in Lubbock.

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Recipes for Health: Roasted Carrots and Scallions — Recipes for Health

Andrew Scrivani for The New York Times

I bought incredibly sweet, thick red scallions and multicolored bunches of carrots from a farmer at my market and roasted them with fresh thyme. Then I sprinkled on some crushed toasted hazelnuts, which contributed a nice crunchy texture and nutty finish to the dish. If you have a bottle of hazelnut oil or walnut oil on hand, a small drizzle just before serving is a welcome touch.

1 ounce hazelnuts (about 1/4 cup)

1 pound carrots, preferably young small carrots, any color (but a mix is nice)

1 bunch white or purple spring onions or scallions

Salt and freshly ground pepper

2 teaspoons fresh thyme leaves

2 tablespoons extra virgin olive oil

Optional: a drizzle of hazelnut oil or walnut oil for serving

1. Preheat the oven to 325 degrees. Place the hazelnuts on a baking sheet and roast for 8 to 10 minutes, until they smell toasty and they are golden all the way through (cut one in half to check). Remove from the oven and turn up the heat to 425 degrees.

2. Immediately wrap the hazelnuts in a clean, dry dish towel. Rub them in the towel to remove the skins. Then place the skinned hazelnuts in a plastic bag or, if you have one, a disposable pastry bag and set on your work table in one layer. Use a rolling pin to crush the nuts by rolling over them with the pin. Set aside.

3. Line a sheet pan with parchment or oil a baking dish large enough to fit all of the vegetables in a single layer. If the carrots are small, just peel and trim the tops and bottoms. If they are medium-sized, peel, cut in half and cut into 4-inch lengths. Quarter large carrots and cut into 4-inch lengths. Trim the root ends and greens from the spring onions or scallions. If they are bulbous, cut them in half. Season with salt and pepper, add the thyme and olive oil and toss well, either directly on the pan or in the dish or in a bowl. Spread in an even layer in the baking dish or on the baking sheet.

4. Roast in the oven for 20 to 30 minutes, stirring every 10 minutes. The onions may be done after 10 minutes – they should be soft and lightly browned. Remove them from the pan if they are and hold on a plate. When the carrots and onions are tender and browned in places, remove from the oven. Add the onions back into the mix if you removed them and toss together. Sprinkle on the toasted ground hazelnuts, drizzle on the optional nut oil, and serve.

Yield: Serves 4

Advance preparation: The vegetables can hold for a few hours once roasted; cover and reheat in a medium oven.

Nutritional information per serving: 171 calories; 11 grams fat; 1 gram saturated fat; 1 gram polyunsaturated fat; 8 grams monounsaturated fat; 0 milligrams cholesterol; 16 grams carbohydrates; 6 grams dietary fiber; 89 milligrams sodium (does not include salt to taste); 2 grams protein

Martha Rose Shulman is the author of “The Very Best of Recipes for Health.”

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