April 29, 2016

"Its All in Her Head: A Case Study in Possible Sexism in Medicine




My research project on the factors causing diagnostic delays in patients seeking medical help has thus far yielded a plethora of information about gender bias, an increase in mis-diagnosis of symptoms being psychogenic in origin and how these two items in particular come in to play within medical systems under pressure to cut costs and caseloads.

Health care professionals at the Society to Improve Diagnostic Medicine add to the above mix, studies implicating doctor over confidence and cognitive error:  www.improvediagnostic rights.org. There is some sound advice for patients from this organization on how to prepare for appointments and how to ask the right questions of a provider. Glancing at these recommendations, however, I wonder at how effective such exhortations might be within the context of bias based upon race, gender and age and a medical climate which makes questioning a patient’s credibility so easy.

By way of illustration on how all these factors might come in to play, I found a convenient case study through a recent post by an allergy clinic in the Great Britain.

http://www.dailymail.co.uk/health/article-1378328/Is-allergy-real-just-reaction.html

In his post, we read about a case of "psychosomatic" allergy. A female patient comes in to a doctor’s office. He identifies her as "flustered looking." She claims that she is getting allergic reactions from her dog. The doctor then proceeds to inform us that the woman "admits to" a history of anxiety. Despite these initial observations, he proceeds to test, via blood and skin prick test analysis, allergy to pet dander. The negative test results are conclusive: the patient is assuredly not allergic to her dog.

Not convinced by negative test results and reassurance that there is nothing physically wrong with her, the patient reportedly consults a doctor in "alternative" medicine who advises her to give up her dog. She does so and reports to the allergy clinic that her allergies have ceased. Her reactions are attributed to "New Age Clap Trap."

The doctor most likely came to his conclusions based upon the analysis that "symptoms do not match results" a phrase invoked to allow practitioners to quickly and easily ascribe a patient’s symptoms as most likely psychogenic or some other "clap trap." But what if symptoms did not match results because the right results were not ascertained? Lets examine the case once more within the context of what might have happened with bias removed and an intelligent, inquisitive mind added.

A patient comes in to an allergist’s office. Instead of being judged immediately as "flustered looking," a more professional approach is applied and a calm and dispassionate medical history is taken. The immediate label of "flustered looking," is, of course, for the benefit of readers. In logic this is called "poisoning the well." It is a well known technique for prejudicing an audience against a person by casting aspersions against a person’s character or demeanor in order to discredit his or her story. It is a very effective tool for people not inclined towards rational discourse and easily accepted by a gullible public.

To proceed again with our imaginary doctor with his own head in science rather than "clap trap," he takes a dispassionate history. In the original case study the patient "admits" to anxiety. How exactly, does a patient "admit" to this? Did she have some kind of inquisition style confession extracted? So our rational doctor dispenses with this "clap trap" and instead asks the patient about her history of allergic reactions to various substances, takes a family history of allergies and comes up with a diagnostic plan. He does the requisite blood tests and skin prick tests. They are negative. The patient is not allergic to our dog.

But our new compassionate, scientific, doctor does not dismiss the patient. Instead, his curiosity is aroused." So he questions the patient again in an unbiased, rational and scientific manner. 
"Do you notice symptoms worse at some times rather than others?," he asks.  The patient responds in the affirmative.  "Tell me when those times are and what happened," he continues. 
The woman thinks about it a minute and says, "When my dog goes for a romp in the field behind my cottage, I sneeze and have watery eyes upon his return."
"Any other times?" he asks.
"Well... " the patient continues,  "When I picked him up after his bath at the vet's, my hands and arms broke out in a red, itchy rash"
"I wonder," the doctor then thinks to himself, if the patient is not allergic to her dog but something on her dog. He proceeds to run tests on other environmental allergies as well as tests for chemical allergies. Several allergies to grasses and pollen are found. Two chemical allergens are found: urea and paraben, both chemicals commonly used in pet care products. The patient is given some antihistamines is reassured, but this time the reassurance is based upon science rather than prejudice. She is advised to bathe her dog in paraben and urea free soaps only and to check the contents of flea and tick powders before using. She can keep her little dog. I do so love happier endings.

March 31, 2016

A Little More Horsing Around

For my last set of small horse statuettes, I used local raw clay from the Edisto River bed.  
To add some liveliness to the sculptures, I made a small grouping of them in various positions.  I kept them featureless and stream-lined, like  ancient Cycladic unearthed artifacts.  The coloring is very simple - just the raw clay and the smoke design from the fire.
statuettes I made from this material are quite small.  Each of them are only a few inches high.

Despite their size, this small set of horses did take a lot of time and effort to complete.  I roughed out each form, and let them dry overnight until they were leather hard.  I then carefully carved out the shapes, taking my time lest I break off a leg from all the tooling.  The carved forms were then sanded to refine them even mor

e after they had dried a second night and were bone dry.  In order to burnish the clay surface, I wet them down again and rubbed the surface with stones, small metal tools and plastic wrap.

In years past, I used to fire the raw clay in a pit fire but found that this method did not get the clay at a high enough temperature to vitrify well.  So like the rest of my recent pit fired works, these were bisque fired first for stability, then smoke fired for the nature made charcoal designs on the surface.
These and others like them will be on view tomorrow evening at Gallery West in Columbia.
http://www.columbiacvb.com/listings/Gallery-West/18493/
I am hoping that someone will buy the set and keep this small herd together.



March 30, 2016

Horsing Around at Gallery West

This Friday the exhibition I am participating in, “ Equine Art: A Family Portrait” opens at Gallery West in Columbia, SC.  I had put some revised drawings in to this exhibition then worked on a series of small sculptures of horses and two large sculptures.  One of the large sculptures broke and a small figurine broke as well but the rest made it through the burnishing, glazing, firing and pit firing nicely.  I patterned the larger horse after models in ceramic of Chinese horse statues from the Han dynasty.  The oversize saddles, sturdy haunches and thick arching necks were very attractive to me.  The one I have pictured here was prepared with a terra sigillata glaze and then smoke fired.
The smaller horses were either simply burnished raw clay and earth colored or white terra sigillata.  The terra sigillata has been aging for four to five years now so it went on just like melted butter.  The raw clay comes from a tributary of the Edisto river.  The caramel color of the clay was attractive enough to preserve by simply burnishing the clay surface without adding any extras.  Nevertheless my favorite horse in this collection is the one in the grazing position that I put a white terra sigillata glaze on.  The coloring of the smoke created a pattern that was very much like the coloring on an American Painted Horse.  Quite satisfying to obtain results here that I was intending.
The exhibition opens this Friday Evening at Gallery West.   http://www.columbiacvb.com/listings/Gallery-West/18493/ I’ll be in good company with the works of some accomplished painters and sculptors.

March 18, 2016

War of the Wicked Weeds and Weak Walls


Old, established gardens can be difficult to maintain.  Around my house, lack of time to devote to such maintenance combined with  poor planning on the part of the original owners of this abode make this even more of a challenge.  Since this is the year I have decided to make my surroundings  more sensible I am tackling the job.  It might seem like an odd thing for an artist with a semi-remission from chronic illness to choose.  There is some logic to it though: I’m using my gift of increased strength now to deal with problems I might not have the ability to care for in the future and reducing the number of maintenance chores in the yard frees me up to devote myself to art in the winter months.
Our house was constructed in the late 1930's or early 1940's by people  who loved gardens.  But they weren’t savvy about the growing habits of plants and trees, invasive plant species, nor were they particularly well versed about construction.  They made terraced walls with cement and granite chips that simply did not hold up due to their widths, missing reinforcements,  and lack of cement footings.  They placed plants like oak hydrangeas, with a mature root width of eight feet, in to terraced garden plots that were only eighteen inches to two feet in width.   When we moved in to the house, these hydrangeas were already too well ensconced in the bed to remove, having hermetically sealed themselves in to the porous wall.  Now that they are coming through the wall, they really will have to be removed.  This will probably mean having to dismantle the wall in parts, then chopping the stalks and roots out in bits and pieces.
Just about every large tree in this yard has a cement wall running alongside it that is cracked by the girth of a tree, and just about every composite wall or cement step  has a dogwood tree planted alongside it to crack that apart by its growth too.  What were they thinking? 
Attending to the aberrant landscaping and poor construction of this yard has led me to do research on native plants, heirloom plants and the numerous invasive species that are the bane of rural and suburban life in South Carolina.  It has been an ongoing process but this year I decided to systematically find out for certain what was growing here.  What I have encountered thus far were several invasive species taking over the yard: liriope siccata, Japanese vine ferns, nut grass, thorny olive trees and English ivy to name just a few. 
Of all the weeds, the  liriope is by far the worst.  Said to be even worse than kudzu, it rapidly forms a thick, intractable foot high carpet-like covering over everything.  Like most other bad plant ideas,  liriope siccata was imported from Vietnam as a cheap ground cover.  In the pattern of its growth from garden bed peripheries to now just about all of our three quarters of an acre, this plant indeed is worthy of its other name, creeping lily turf.  It seems to creep out by about a yard per year.  I regret that I did not know what it was sooner.  The person who originally built the house  obviously mistook it for a similar looking native species called liriope muscari, which is bunch growing and stays in its own place in garden borders.  I have been slowly digging  out the infamous liriope siccata and attempting to replace it area by area with Bermuda grass but all of my research tells me that it is futile as mowing will return seeds to the cleared areas and that the roots run so deep only a chemical herbicide applied multiple times will kill it.  That is ostensibly why Agent Orange was invented.  But I am still not quite ready to poison my environment yet, especially given my multiple chemical allergies.  So daily pulling, yanking and tilling is still the order of the day.
I am told by those who knew the original owners of this property  that the yard was filled with fountains, koi ponds and numerous garden plots.  They appeared to have had more enthusiasm than sense as the volume of these densely packed garden delights became impossible to maintain and left to go to ruin as the surviving widow aged.    To make matters worse, the second owners of the house were here so briefly that instead of repairing the mess they covered it up: wood chips on top of the liriope , plowed over garden walls, ripped out azaleas with unfilled in holes.  To this day when I try to plant a vegetable garden or dig out expired shrubbery I unearth fragments of brick and cement koi ponds and garden walls.  Occasionally I find interesting artifacts like old fishing lures or what look like vintage resin and hard plastic toys.  But more often than not I unearth old plastic detergent containers, barbed wire, and cement blocks. 
I have to confess though, that part of the garden from Hell scenario that I now face was my own doing  for not having recognized the extent of the problem early on and perhaps even adding  to it. 
This year I came to terms with the fact that I have to eliminate all the over planted gardens around the house that are too numerous for me to feasibly care for properly.  Part of the reason for there being too many was that I could not bear to throw out plants that were thinned  from the overgrown areas and therefore replanted them elsewhere, framing them with the  gravel granite concrete lumps that kept being unearthed every time I put shovel to soil.
The first thing I tore up was the rose garden.  I put the roses in another flower garden so they would all be in one place, replacing the blackberries with them, which were moved to the vegetable garden.  Next I took the old fashioned bricks from the rose garden and put those around the vegetable garden plot, marking the point at which I would expand no further.  Then I tore out an unhappy shrubbery that put out the most minute pathetic tiny white flowers that would fall off the stem if I tried to harvest them.  I tore out azaleas that were growing into a chain linked gate.  One of these I used to put against the chain linked fence along the property line in order to hide a pile of debris over the other side of it.  Then I removed all the blue hydrangeas and azaleas that were  impediments to mowing and watering  (I’ve got a few more large ones to go).  I kicked the cement blocks around them out to the curb.   I did put the hydrangeas in to unplanted areas around the house so they were preserved.   I tore out a stunted thorny olive next to another chain linked fence.  Well, it wasn’t exactly completely torn out because its roots were wrapped around the roots of a large tree so it had to be tediously hacked away. 
This will be all for a few days while I rest my body and do some light reading and drawing.

March 13, 2016

Getting Organized and Refreshed


My remade, resurfaced ocarinas and ideophones complete, I set myself to the chore of updating my archive.  Every time I get behind on updating my archive and it becomes too time consuming, I wonder why I allowed myself to be talked in to creating this digital library of my work.  But when it is complete and I can set about making new work I find myself grateful to the person who suggested the ultra-organized museum catalogue.  Despite that, I do sometimes forego processing things like small beads and such.  I do have my limits.
Keeping things in order does take time away from my preferred work, but having an image, a measurement and a date for everything at my fingertips sometimes grants a return on that time.  It is good not to have to hunt something up when a gallery or client wants to see it.  And it makes my online shop much easier to manage.

When my archive is updated, I get a very satisfied feeling of things being neat and clean - the feeling I get when the bed is changed with fresh sheets that I slide between after showering off the dirt of the day.  Keeping things up is indeed a challenge though, and best done steadily in small increments rather than all at once.  My recent experience with waiting too long to organize reminded me that virtual clutter can be just as demoralizing as the material form. 
To celebrate the updated order, I’m posting the last before and after photographs of my remade ocarinas.  Easter will soon be upon us and these things look rather egg-like after all, with their natural smoke based swirls and speckles.



March 10, 2016

Little Birds

My graphic designer and good friend recently wrote a series of remarkable children’s stories.  We toyed with the idea of having me illustrate them, which I will probably do at some point.  This was generous of her because most publishers of children’s books have their own in house illustrations with whom they contract to illustrate their manuscripts.  But my friend was familiar with my work and felt that it dovetailed so well with her literature that she was willing to forego some protocol and take a risk with publishers on making her own preferences known.
I was in the midst of preparing the final illustrations for a very long book of my own poetry and at the beginning of a new series of wild and wooly big drawings.  But I did find the time to look through my notebooks of drawings that I had made at a natural history museum in Scotland some time ago.   I recalled that some of the drawings I had made of their specimens of birds might be applicable to the stories my friend wrote.  I found these and revised them into more complete illustrations.  Instead of having the birds awkwardly propped up on specimen stands, I added twigs and branches to make them a little more lively.  Before filling in the backgrounds, I scanned just the subject so that if they are eventually used in a publication there will be more flexibility in formatting.
The finished products with the backgrounds filled in were a slight departure from my decorative, imaginary illustrations as they were based on actual birds.  They were also not in the format that my friend will eventually need: 5" x 7" portrait style.  These ended up being 4" x 6" landscape. No bother.  They served as examples.  And so I posted them on my Etsy site for sale while granting my friend permission to use them.

March 9, 2016

Cat Got Your Tongue

Almost four years ago, I had an idea about making large drawings graphically depicting commonly used idioms about bodily sensations.  I thought to start with the phrase, “the cat’s got your tongue.”    Such idioms as “it makes my skin crawl” and “I get all choked up” carry special associations as well.  What would it look like on paper to have these strange expressions made corporeal?
I finally got started on this project.  I suppose that part of my hesitation was because as an artist for hire, I do need to bear in mind that my work should have some potential commercial viability.  What clients would like to have a large expressionistic drawing of a cat biting someone’s tongue hanging on their wall?  Not many I think.  But when I get a notion about an art work that I would like to create, I never really feel settled until I eventually bring it in to being, anyone else wishing to actually acquire it notwithstanding.
For “The Cat’s Got Your Tongue” I rummaged up an unfinished drawing from my graduate school days that I could recycle.  Most people throw such things away but I keep them if the paper they were rendered on was expensive.   Saves me the expense and trouble of ordering more paper for something experimental.  The other plus to using recycled drawings, especially pastel or charcoal, is that this under drawing can be smudged and erased in a way to create an interesting texture from which to work. 
The drawing I selected was of a model seated on a bench next to a plant.  My short little attention span had not allowed me to finish it at the time.  The first thing I changed was the orientation.  I turned the drawing from portrait style to landscape, as it was better that way for two entities to occupy that space: cat and person.  After that I judiciously smudged and erased the drawing, leaving an all over texture that reminded me of textiles, wires, or grass spikes. 
Over this I blocked out two forms; a person with a long tongue and the cat biting it.  But wait!  This did not fit my vision.  Why?  The problem was too much space at the lower half of the composition.  It made the tongue too high on the picture plane and it needed to be center or slightly lower than center and it was the focus of interest. So I could erase everything and draw it over again.  Or just crop the picture down.  I chose the latter.









The cat biting a person’s tongue was now settled in to the right space.  The joy of fleshing them out, adding tonality and details made the drawing come to life.  Bodily Idiom Drawing number one, “The Cat’s Got Your Tongue” was complete.  Satisfied with the results, I ordered 100 oversize plastic drawing sleeves and an archival box.  This will house the rest to come.


March 4, 2016

The Cat Came Back

A large sculptural  rattle in the shape of a cat that I made from an experimental clay started disintegrating after firing.  I tried to save it at first, but then decided that he probably was not salvageable.  But I could not quite bring myself to break him up, bag him up and toss him away.  As a sculpture with eyes, ears and an open mouth that seemed to be begging for mercy, something moved me to allow a friend to take him off my hands.  Apparently he is still slowly disintegrating on her bookshelf.
I did like the primitive look of the rattle so I made it again, one third the original size and with a clay that I had previously used successfully.  I put the same white terra sigillata glaze on the sculpture, burnished it and added some oxide stains.  Letting the smoke of the pit fire have its own will, the sculpture was finished with grey and black swirls, imparting an antiquing effect. Restitution for the foolishness of using an untested clay in a previous incarnation of this form.

March 3, 2016

A Little Box of Local Treasures

What does one do with three dimensional art forms that are too small to be sculptures but too large to be jewelry?  Call them art objects, perhaps, and find a suitable way to display or store them.  The small pit fired ceramic sculptures I had made fall into that category.  They could be beads, but as pit fired ceramics they may be a little too delicate to be functional, wearable art.  But they are not quite large enough to make an impression as a sculptural objects.  So what to do with them?
Although art object might be the right technical category for such things, I like to call my small sculptures “art toys.”  They are toys because their size and shapes invite a person to set them up in various configurations and groupings.  Their flattened edges enable the player to turn them on their multiple edges so that they can stand different ways.  One can imagine them as sculptures but if they were to function as such, they would have to be large enough for a viewer to see their multiple aspects by walking around them.  Instead, their aspects are revealed through manipulation.
I recall that as a child my favorite types of toys were things that came in multiples and were housed in  cleverly shaped boxes; a plastic farmhouse filled with small animals, a hollow chicken filled with eggs, a wooden box for wooden blocks.  I do believe that artists sometimes recreate in adult life the things that we were enamored of in our youths.  In this regard, a box full of precious little things holds an attraction for me.  The need to put my smaller art work in to an appropriately designed container was satisfied by making a ceramic lidded vessel for my beads/sculptures/art objects.
 In fashioning this ceramic box, I used the same clay mined from the Edisto that I had used to make my miniature sculptures.  Alluding to what was to be housed within, I made a knob in the shape of these sculptural pieces.  I purposely made everything asymmetrical so that the lid only fits on one way.  I made the surface smooth and polished with terra sigillata thinned out in areas so that the raw, orange clay would show through.  This was  bisque fired then put aside for a month until my recent pit firing.
Both the ceramic box and the little clay objects were local products.  Not only was the clay mined locally, but everything that went in to the pit fire was local as well -down to the very camellia flowers from my front and back yard that were used to smother the fire.  Creating a reduction atmosphere with expended flower blossoms was a new experiment for me.  The results were rounded smoke designs rather than the linear ones created by the previously used Spanish moss.  The effect was satisfying and I will probably try this again.

February 29, 2016

Zebra or Just Another Breed of Horse? A Medical Maxim Examined for Rare Disease Awareness Day


 Zebra, or an Unrecognized Horse?  A Medical Maxim Put to the Test
“If you hear hoofbeats, don’t think zebras.”
-Medical School Maxim
Many in the medical community have heard the commonly bantered about medical school maxim, “If you hear hoofbeats, don’t think zebras,”  dissuading newly minted doctors from seeking a diagnosis of a rare disease for patients with unusual symptoms not explained by routine, standardized tests.  The maxim never made much sense to me.  For one thing, as a metaphor it falls rather flat and as a maxim it lacks the resonance of truth.  Why wouldn’t someone think of zebras when hearing hoofbeats?  Why not wart hogs, cattle, antelopes, giraffes, or any such bovine or quadruped in possession of hooves?  Horses are not the only animal that make hoofbeat sounds when they run.
Finding the origins of truisms can often shed some light on how they came in to being and how they may have become popularized, generally accepted over time, and eventually distorted.  What I found about the zebras and hoofbeats medical maxim is that it apparently originated with  Dr. Theodore Woodward in the 1940's.  Dr. Woodward had an excellent reputation as a diagnostician and was a well-respected medical school professor.  Interestingly, the phrase about zebras and hoofbeats used today is a distortion of what Dr. Woodward actually said, that being “Don’t look for zebras on Green Street.”  At the very least this statement does make more sense as an aphorism because while it is true that a zebra makes hoofbeat sounds, it is not likely that a zebra would present itself on a street in downtown Baltimore.   How would this phrase become distorted over time, becoming misapplied in such a way as to be a potential source of under diagnosis and misdiagnosis of human disease?
Everyone has probably heard at one time or another, of  the whispering parlor game.  Several people are seated in a row and a sentence is whispered to the first person, who then whispers it to the next person, who then whispers it to his neighbor, and so on, until the last person in the row is reached.  This last person then stands up and says out loud what had been whispered to him.  The first person says the original statement out loud and everyone has a good laugh at how distorted the sentence became over several whisperings. 
Perhaps in the same way, a maxim repeated over several decades gradually loses its original intent as modifications and omissions distort it in to a fragmentary misinterpretation.  The playwright Henrik Gibson, in his play “An Enemy of the People” perhaps reflected this best through his character Dr. Stockman:
“A normally constituted truth lives, as a rule, seventeen or eighteen years, at the outside twenty, seldom longer, after which it presumably becomes a lie, a ghost.”
Maxims can become distorted with time and retelling.  What else may be at work to give a maxim a shelf life?  Time itself brings new discoveries in to being.  A new social paradigm can make earlier beliefs no longer apt.  In the case of the “hoof beats and zebra” maxim, medical knowledge about diseases once considered rare but are no longer found to be so erodes the analogy in an increasing number of cases.  One such example is interstitial cystitis, once thought to be a very rare disease of post menopausal women.  But decades of patient advocacy, networking and fund raising for research has changed medical understanding of the disease to include both men and women of all ages in the diagnosis, as well as a significantly higher prevalence in the general population than originally thought.  Such is the changing paradigm of a disease that loses its “zebra on Green Street” status.  In fact, I would hold that many, if not most, so called rare diseases are simply under-diagnosed.  Something rarely looked for is rarely found.
Did the “zebra on Green Street” analogy, then, ever have any use, and if so, what might that have been and why?  There is a use in medicine for training towards the  counter intuitive.  A surgeon must train to overcome the natural instinct that cutting in to a living human being’s flesh is a force of destruction.  An emergency room doctor who recoils with horror at an accident victim instead of setting immediately and dispassionately to work would not be of much use.
 Research suggests that the human mind intuitively recalls with greater acuity that which is unusual or extreme than those things that are ordinary and mundane.  Perhaps that is just one of the brain’s defense mechanisms - strange things impress more deeply because something that is out of order can be a threat worthy of instant recall.   By extension a medical student confronting a patient with a rare disease would remember that patient more vividly than the one who presents with a common cold.  The suggestion here is that the novice diagnostician must use trained reason to counteract the possibility that a rare disease memory will cause him to somehow “hallucinate” this disease recurring in a larger population than is the medically accepted norm.  And that is where the “zebra on Green Street” maxim comes in to play.  It was originally intended to protect a patient from unnecessary tests and possible inappropriate treatments through the mind’s error of over inclusion.
But what if seeing a disease in a larger population than is the medically accepted norm, is in fact the correct perception?  As medical knowledge increases, the trend seems to be precisely a discovery of higher than originally accepted prevalence of the so-called rare diseases.  Even discounting the probable actual higher incidence of individual rare diseases, it might do well to consider that if the current figure of approximately  6000 recognized rare diseases is correct,  odds are that a given population will have a distribution of these.  And diagnoses of exclusion are therefore somewhat suspect, for the sheer volume of possibilities makes a full exclusion rather unlikely.  Some of factors involved in impediments towards excluding rare diseases: www.ncbi.nlm.nih.gov/books/NBK56184/
Given what medical science knows today, rare diseases may indeed be much more common than the possibility of seeing a zebra on Green street.  Perhaps we need a new metaphor to describe them and a counter maxim as an antidote to the errors of exclusion promulgated by a maxim in need of retirement.  Maybe a person with a disease considered to be rare is more like an uncommon breed of horse, or even a not so uncommon breed of horse destined to live in an era in which only a limited number of horse breeds are recognized.  I sometimes think of myself not as a zebra in a world of horses, but as a Shetland Pony in a world that only sees the more common quarter horses, American painted horses, Arabian and Appaloosa.  Is there a possible aphorism as an antidote to the zebra on Green Street?  Something light hearted that is an equally apt metaphor for the error of under inclusion? I think so.  It might be something like, “If you hear hoofbeats, don’t assume that it can only be an American painted horse in your grandmother’s barn in Alabama.”