The Claim - Drinking Extra Fluids Helps Beat a Cold

The advice for conquering a cold is time-honored: Get plenty of rest and drink lots of fluids.

While it’s hard to argue against getting proper rest, some scientists suspect that loading up on liquid— that is, beyond the normal amount required in a day— may not do much good.

Theoretically, taking in extra beverages like water and juice helps replace fluids lost fromfeverand respiratory tract evaporation, and it helps loosen mucus. But when a team of scientists at the University of Queensland in Australia set out to determine whether this was indeed the case, they found a surprising dearth of data in the medical literature.

Fortheir report, published in the journal BMJ in 2004,“we examined references of relevant papers and contacted experts in the subject,” they wrote, yet were unable to find even a single clinical trial in the last four decades that specifically studied whether increased fluid intake reduced the severity of an infection.

They did find some evidence that in some children with moderate to severepneumonia, consuming extra fluids might contribute tohyponatremia, a blood-sodium deficiency. Butother scientists pointed out in responsethat those findings should not be extrapolated to any respiratory infections besides pneumonia.

Ultimately, the Australians did not argue against maintaining proper hydration during a cold or otherupper respiratory infection, but they said the advice to drink more fluids than usual should be rigorously studied because it is so widespread.

THE BOTTOM LINE

Studies have not validated the age-old advice to drink extra fluids to help beat a cold.ANAHAD O’CONNORscitimes@nytimes.com

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Lifting a Veil of Fear to See the Benefits of Child Fever

As a pediatrician, I know fever is a signal that the immune system is working well. And as a parent, I know there is something primal and frightening about a feverish child in the night.

So those middle-of-the-night calls from worried parents, so frequent in every pediatric practice, can be less than straightforward. A recent paper in The Journal of the American Medical Association pointed out one reason, and a longstanding discussion about parental perceptions reminds us of the emotional context.

The JAMA studylooked at over-the-counter medications for children, including those marketed for treating pain and fever: how they are labeled, and whether the droppers and cups and marked spoons in the packages properly reflect the doses recommended on the labels.

The article concluded that many medications are not labeled clearly, that some provide no dosing instrument, and that the instruments, if included, are not marked consistently. (A dosing chart might recommend 1.5 milliliters, but the dropper has no“1.5 ml” mark.)

“Basically, the main message of the paper is that the instructions on the boxes and bottles of over-the-counter medications are really confusing,” said the lead author, Dr. H. Shonna Yin ofNew York University Medical Center, who is a colleague of mine and an assistant professor ofpediatrics.

Too small a dose of an antipyretic (fever medicine) may be ineffective; too much can be toxic. But the dose depends on the child’s weight, which of course changes over time, and on the concentration of the medicine, which depends on whether it is acetaminophen or ibuprofen, children’s liquid or infant drops.

“We always make them get the bottle,” said Kathleen Martinez, a pediatricnurse practitionerwho is clinical coordinator of the After Hours Telephone Care Program at the Children’s Hospital in Aurora, Colo.“What do you have at home? Is it the ibuprofen infant drops or the children’s? Have the bottle in hand and verify the concentration.

“And then we have to verify the instrument, and then we give the right dose based on weight. It’s time-consuming, and then of course it changes with the weight, so the poor parents have to call back.”

Concerns about fever— how worried should I be, and how much medicine should I give?— account for many of the calls that parents make at night to their children’s doctors. For me, these tricky measurement questions evoke memories of many conversations, often from a crowded, noisy place (my own child’s Little League game, the supermarket), trying to answer a question about a small child with fever.

One recent night, I talked to the mother of a toddler with fever andabdominal pain. I was more worried about the pain, and about whether he was drinking enough to stay hydrated; she was more worried about the fever, and no matter what I asked she kept coming back to that number on the thermometer.

Finally, I got so worried the child was dehydrated that I told her to go to the emergency room. And when she got there, she told them she was scared because the child had a high fever.

Fever can indeed be scary, and any fever in an infant younger than 3 months is cause for major concern because of the risk of serious bacterial infections. But in general, in older children who do not look very distressed, fever is positive evidence of an active immune system, revved up and helping an array of immunological processes work more effectively.

Of course, that may not be reassuring to a parent whose child’s temperature is spiking at midnight. (Fevers tend to go up in the late afternoon and evening, as do normal body temperatures.)

In 1980, Dr. Barton D. Schmitt, a professor of pediatrics at theUniversity of ColoradoSchool of Medicine, publisheda now classic articleabout what he termed“feverphobia.” Many parents, he wrote, believed that untreated fevers might rise to critical levels and that even moderate and low-grade fevers could have serious neurological effects (that is, as parents we tend to suspect that our children’s brains may melt).

A group at Johns Hopkins revisited Dr. Schmitt’s work in 2001, publishing a paper in the journal Pediatrics,“Fever Phobia Revisited: Have Parental Misconceptions About Fever Changed in 20 Years?”Their conclusion was that the fears and misconceptions persisted.

In fact, fever does not harm the brain or the body, though it does increase the need for fluids. And even untreated, fevers rarely rise higher than 104 or 105 degrees.

As many as 5 percent of children are at risk forseizures with fever. Theseseizurescan be terrifying to watch but are not harmful and do not causeepilepsy. Still, a child who has a firstfebrile seizureshould be checked by a physician. (These seizures tend to run in families, and children who have had one may well have another.)

“Parents are telling us that they’re worried that fever can cause brain damage or even death in their children,” said Dr. Michael Crocetti, an assistant professor of pediatrics at Johns Hopkins and lead author of the 2001 study.“I’ve been doing this for a long time, and it seems to me that even though I do a tremendous amount of education about fever, its role in illness, its benefit in illness, it doesn’t seem to be something they keep hold of from visit to visit.”

Dr. Janet Serwint, another author of the study and a professor of pediatrics at Johns Hopkins, agreed.“I personally think there should be much more education about this at well visits,” she told me, adding that parents need to understand“the helpfulness of fever— how fever actually is a well-orchestrated healthy response of our body.”

Other studies have looked at attitudes among medical personnel, who can be just as worried about fever as parents.

“Doctors are part of the problem,” Dr. Schmitt said. Some of the phobia“comes from doctors and nurses,” he added—“doctors and nurses who weren’t taught about fever and all the wondrous things fever does in the animal kingdom.”

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The Movement to Restore Children’s Play Gains Momentum

Ms. Wilson lives in Stroudsburg, Pa., a small town in the Poconos. Many days, her home is strewn with dress-up clothes, art supplies and other artifacts from playtime with her two small children, Benjamin, 6, and Laura, 3.“I let them get it messy because that’s what it’s here for,” she said.

Ms. Wilson has embraced a growing movement to restore the sometimes-untidy business of play to the lives of children. Her interest was piqued when she toured her local elementary school last year, a few months before Benjamin was to enroll in kindergarten. She still remembered her own kindergarten classroom from 1985: it had a sandbox, blocks and toys. But this one had a wall of computers and little desks.

“There’s no imaginative play anymore, no pretend,” Ms. Wilson said with a sigh.

For several years, studies and statistics have been mounting that suggest the culture of play in the United States is vanishing. Children spend far too much time in front of a screen, educators and parents lament— 7 hours 38 minutes a day on average, according to a survey by the Kaiser Family Foundation last year. And only one in five children live within walking distance (a half-mile) of a park or playground, according to a 2010 report by the federalCenters for Disease Control, making them even less inclined to frolic outdoors.

Behind the numbers is adult behavior as well as children’s: Parents furiously tapping on their BlackBerrys in the living room, too stressed by work demands to tolerate noisy games in the background. Weekends consumed by soccer, lacrosse and other sports leagues, all organized and directed by parents. The full slate of lessons (chess, tae kwon do, Chinese, you name it) and homework beginning in the earliest grades. Add to that parental safety concerns that hinder even true believers like Ms. Wilson.

“People are scared to let their kids outside, even where I live,” she said.“If I want my kids to go outside, I have to be with them.”

Kathy Hirsh-Pasek, a developmental psychologist atTemple Universityin Philadelphia, concluded,“Play is just a natural thing that animals do and humans do, but somehow we’ve driven it out of kids.”

Too little playtime may seem to rank far down on the list of society’s worries, but the scientists,psychologists, educators and others who are part of the play movement say that most of the social and intellectual skills one needs to succeed in life and work are first developed through childhood play. Children learn to control their impulses through games like Simon Says, play advocates believe, and they learn to solve problems, negotiate, think creatively and work as a team when they dig together in a sandbox or build a fort with sofa cushions. (The experts define play as a game or activity initiated and directed by children. So video games don’t count, they say, except perhaps ones that involve creating something, and neither, really, do the many educational toys that do things like sing the A B C’s with the push of a button.)

Much of the movement has focused on the educational value of play, and efforts to restore recess and unstructured playtime to early childhood and elementary school curriculums. But advocates are now starting to reach out to parents, recognizing that for the movement to succeed, parental attitudes must evolve as well— starting with a willingness to tolerate a little more unpredictability in children’s schedules and a little less structure at home. Building that fort, for example, probably involves disassembling the sofa and emptying the linen closet. (A sheet makes an excellent roof.)

“I think more than anything, adults are a little fearful of children’s play,” said Joan Almon, executive director of the Alliance for Childhood, a nonprofit pro-play group.“Some people have a greater tolerance for chaos and have developed a hand for gently bringing it back into order. Others get really nervous about it.” Megan Rosker, a mother of three (ages 6, 3 and 2) in Redington Shores, Fla., has learned to embrace the disorder. She set aside the large sunroom in her home for the children and filled it with blocks, games, crayons, magazines to cut up and draw in, as well as toys and dress-up clothes.“I think a big part of free play is having space to do it in, a space that isn’t ruled over by adults,” she said.

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When Insurers Put Profits Before People

Nataline’s case was not all that different from the more than 200 liver patients I had seen successfully transplanted every year at that institution. She was critically ill, as close to death as one could possibly be while technically still alive, and her fate was inextricably linked to another’s. Somewhere, someone with a compatible organ had to die in time for Nataline to live.

But even when the perfect liver became available a few days after she was put on the list, doctors could not operate. What made Nataline different from most transplant patients, and what eventuallybrought her case to the attention of much of the country, was that her survival did not depend on the availability of an organ or her clinicians or even the quality of care she received. It rested on herhealth insurancecompany.

Cigna had denied the initial request to cover the costs of the liver transplant. Andthe insurer persisted in its refusal, claiming thatthe treatment was“experimental” and unproven, and despite numerous pleas from Nataline’s physicians to the contrary.

But as relatives and friends organized campaigns to draw public attention to Nataline’s plight, the insurance conglomerate found itself embroiled in a public relations nightmare, one that could jeopardize its very existence. The company reversed its decision. But the change came too late. Nataline died just a few hours after Cigna authorized the transplant.

Not long afterward, I spoke with a former nursing colleague who had cared for Nataline. The anger in her voice was still palpable as she recounted the protests in which she had been involved.“This was a 17-year-old girl,” she said.“How could anyone with a conscience— anyone who is human— do this to another person?”

While the public fury over Nataline’s death has abated, that question of conscience in a health care system dependent on for-profit insurers has lurked behind nearly every debate over health care reform. While few politicians have dared to openly address this inherent conflict of interest, one unlikely individual has consistently spoken up over the last year and a half to remind us of this moral dilemma.

Inarticles,interviews,op-edsandtestimonyon Capitol Hill, Wendell Potter has described the dark underbelly of the health care insurance industry— unkept promises of care, canceled coverage of those who get sick and fearmongering campaigns designed to quash any change that might adversely affect profits.

He should know what he is talking about. For 20 years, Mr. Potter was the head of corporate communications at two major insurers, first at Humana and then at Cigna.

Now Mr. Potter has written a fascinating book that details the methods he and his colleagues used to manipulate public opinion and describes his transformation from the idealistic son of working-class parents in eastern Tennessee to top insurance company executive, to vocal critic and industry watchdog. Using little of the fiery rhetoric or lurid prose that usually marks corporate exposés or memoirs of redemption, the book,“Deadly Spin” (Bloomsbury, 2010), is an evenhanded yet riveting account of the inner workings of the health care insurance industry, a cautionary tale that doctors and patients would be wise not to miss.

For a man who has spent his professional life tinkering with impressions, Mr. Potter has astartlingly straightforward narrative voice; he wastes no time cutting to the chase:“It was my job to enhance those firms’ reputations. But as one of the industry’s top public relations executives and media spokesmen, I also helped create and perpetuate myth that had no other purpose but to sustain those companies’ extraordinarily high profitability.”

Mr. Potter goes on to describe the myth-making he did, interspersing descriptions of front groups, paid spies and jiggered studies with a deft retelling of the convoluted (and usually eye-glazing) history of health care insurance policies.

The most moving section is devoted to Nataline Sarkisyan. We learn that executives at Cigna worried that Nataline’s situation would only add fire to the growing public discontent with a health care system anchored by private insurance. As the case drew more national attention, the threat of a legislative overhaul that would ban for-profit insurers became real, and Mr. Potter found himself working on the biggest P.R. campaign of his career.

As busy as they might have felt in the days leading up to Nataline’s death, he and his staff were inundated with calls from the news media immediately afterward. To bolster what was seen as a fight for its survival, Cigna hired a large international law firm and a P.R. firm already well known to them from previous work aimed at discreditingMichael Mooreand his film“Sicko.” Together with Cigna, these outside firms waged a campaign that would eventually include the aggressive placement of articles with friendly“third party” reporters, editors and producers who would“disabuse the media, politicians and the public of the notion that Nataline would have gotten the transplant if she had lived in Canada or France or England or any other developed country.” A“spy” was dispatched to Nataline’s funeral; and when the Sarkisyan family filed a lawsuit against the insurer, a team of lawyers was assigned to keep track of actions and comments by the family’s lawyer.

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Dining Experiences, All Illicit, That Extend Beyond the Palate

In an old converted warehouse in San Francisco’s Mission district recently, about 65 gourmands dined by candlelight atThe Wild Kitchen, an event presented by the groupforageSF.

One after another, courses arrived from the kitchen: fish soup, duck fat potatoes, fusilli con cinghiale (pastawith wild boar). With each bite and sigh of delight, the crowd eagerly participated in a crime— a scrumptious one, but illegal nonetheless.

Welcome to the world of underground dining: gourmet pop-up restaurants that operate outside the system of health department licenses and inspections. Food lovers have attended these clandestine feasts for years, but the general public’s growing appetite for adventurous eating has caused the popularity of these events to rise and could produce a new generation of culinary stars.

Unless they get busted first.

“They’re renegade restaurants,” said Alison Bing, food writer and San Francisco Lonely Planet guidebook author, who has tracked the phenomenon.“People are willing to pay for a unique experience.”

Being illicit is part of the excitement, with diners learning the secret locations only hours before service. There is also a heightened level of camaraderie, since attendees eat together at large tables.

“It has a lot to do with the communal dining experience,” said Anil Margsahayam, co-founder of another underground eatery, the Stag Dining Group, so named because all five owners (chefs, hunters, marketers, performers and conservationists) are unmarried and want diners to mingle.

The Wild Kitchen’s menu— $100 per person (B.Y.O.B.) on two packed consecutive nights— was inspired by a recent trip to France by Iso Rabins, 29, a chef and the scruffy, charismatic founder of forageSF. As the group’s name implies, the dishes contained ingredients— mushrooms, leafy greens and seaweed— that were gathered in the wild.

Mr. Rabins described foraging as“collecting food that won’t run away.” The exception was the wild boar, which was hunted, shot and skinned on private property near Paso Robles. (After many hours of cooking, it tasted like pulled pork.)

Mr. Rabins, whose first name, Iso, means“seashore” in Japanese—“My parents were hippies,” he said— is one of the more prominent faces of the underground dining scene. He has taped segments for two coming Travel Channel programs,“Bizarre Foods” and“The Wild Within,” where he prepared“roadkill raccoon.” (The raccoon was supplied by the TV show, he noted.) He has about 22,000 subscribers to his newsletter, which promotes the dinners and a monthly Underground Market.

Attracting some 2,500 fans, the market allows home cooks to sell their creations— from fresh baked fruit tarts to savory meat dishes— an idea that runs afoul of health codes. At the first market in December 2009, city health department inspectors arrived.

“I was terrified,” Mr. Rabins said.“They said,‘This is illegal.’ ” The contretemps was resolved by making the market a membership event where attendees sign a release acknowledging the risks.

The restaurants, however, are not as easily legalized, since the meals are not prepared in inspected, commercial kitchens, and because ingredients that are foraged are not subjected to government safety regulations.

“People are taking a risk. If we get complaints, we’ll investigate,” said Richard Lee, manager of restaurant inspectors for the San Francisco Department of Public Health. But Mr. Lee said he knew of no cases where diners had become ill at the events.

Ms. Bing, who has attended underground dinners, said she had mixed feelings about the lack of health department oversight. As a food journalist, she considers inspection scores essential when covering restaurants, and she raised possible concerns about fair wages and compliance with environmental laws.

“We are close to a zero-waste environment, a zero-landfill environment,” said Matthew Homyak, a co-founder of Stag Dining.

As far as employees are concerned, volunteers work the events for now, but there are ambitions to become a thriving legal business, perhaps even to obtain a catering license.

In the meantime, they say they are following the same food preparation rules of any clean restaurant.“We’re keeping ourselves safe,” said Jordan Grosser, one of two professionally trained chef-owners with Stag Dining.

Mr. Rabins did not attend culinary school. He has a film degree from Emerson College and had limited professional cooking experience before this venture. His passion for foraged food, like city snails to make escargot, seems more of a personal calling.

“It really changes the way you view the natural environment,” he said.

Scott James is an Emmy-winning television journalist and novelist who lives in San Francisco.
sjames@baycitizen.org

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Health Spending Rose in 2009, but at a Low Rate

Still, health care accounted for a larger share of a smaller economy— a record 17.6 percent of the total economic output in 2009, the report said. The economy contracted while health spending continued to grow.

The nation spent $2.5 trillion on health care in 2009, for an average of $8,086 a person, and therecessionhad a profound influence.

“Many consumers decreased their use of health care goods and services, partly because they had lost employer-based private health insurance coverage and partly because their household income had declined,” said Anne B. Martin, an economist and principal author of the report, issued by the office of the actuary at the Centers for Medicare and Medicaid Services.

In many cases, Ms. Martin said, people decided to“forgo health care services they could not afford.”

The number of visits to doctors’ offices apparently declined. Manyhospitalsreported fewer admissions, as patients put off medical procedures. Spending on dental services declined slightly. Many hospitals and other health care providers reduced their capital investments. Spending on doctors’ services in 2009 increased at the slowest pace since 1996, according to the new federal study, being published in the journal Health Affairs.

Partly offsetting the slowdown in private health spending was a rapid increase inMedicaidspending, driven by the addition of 3.5 million people to the rolls.

Medicaid, created in 1965 to provide health care for low-income people, is financed jointly by the federal government and the states. The economic stimulus program approved in February 2009 temporarily increased the federal share, to help states in dire fiscal straits cope with a growing need.

“Federal Medicaid spending increased 22 percent in 2009, the highest rate of growth since 1991,” Ms. Martin said, while“state spending decreased 9.8 percent, the largest decline in the program’s history.”

Federal officials emphasized that none of the data reflected the impact of the new health care law, whichPresident Obamasigned in March 2010.

Spending on health care by private insurance companies grew a modest 1.3 percent in 2009, as the number of people with private coverage declined by 3.2 percent, or 6.3 million people. At the same time, out-of-pocket spending by consumers rose just four-tenths of 1 percent, compared with an increase of 3.1 percent in 2008.

Despite the economy’s downturn, retail spending on prescription drugs“increased more rapidly in 2009 than in 2008, as a result of more rapid growth in the prices of drugs and in the number ofprescriptionsdispensed,” the report said.

Retail purchases of prescription drugs account for $1 of every $10 spent on health care, almost $250 billion of the $2.5 trillion total in 2009.

Medicaid spending accounted for 15 percent of all health spending and totaled $373.9 billion in 2009, the report said. Many of the new Medicaid recipients are relatively healthy children and adults of working age. The new health care law calls for a major additional expansion in Medicaid eligibility, starting in 2014.

The recession ran from December 2007 to June 2009. Even after it ended, the economy was sluggish, and unemployment continued to rise. So the growth of health spending outpaced the growth of the overall economy in 2009, federal officials said.

The share of the economy devoted to health care rose one percentage point in 2009, the largest one-year increase in a half-century of record-keeping.

Health spending, as tracked by the government, has grown at a slower rate every year since 2002, when it increased 9.5 percent. The slowdown was more pronounced in 2008 and 2009 because of the recession.

Out-of-pocket spending by consumers— which includes deductibles, co-payments and the purchase of goods and services not covered by insurance— accounted for 12 percent of all health spending and totaled almost $300 billion in 2009, the report said.

In addition, it said, health insurance premiums increased more slowly in 2009 than per-person spending on medical benefits under private health plans. Insurers spent more on prescription drugs and“more on benefits for existing enrollees,” it said.

Republicans pounced on the new numbers.“No one should take solace in the fact that health spending grew at a lower rate in 2009,” said SenatorOrrin G. Hatchof Utah, who is in line to be the senior Republican on the Finance Committee.

Mr. Hatch said the new health care law could lead to“crushing increases in health costs and premiums.”

By contrast, the chiefMedicareactuary, Richard S. Foster, has estimated that the new law will lead to an increase of only nine-tenths of 1 percent in national health spending over 10 years.

Uninsured people who gain coverage will use more health care, Mr. Foster said, but the law is also supposed to reduce the growth of Medicare payments to many health care providers.

Medicare spending reached $502 billion in 2009, meaning that the program, for older Americans and the disabled, accounts for $1 of every $5 spent on health care. Enrollment in the traditional fee-for-service Medicare program declined, as some beneficiaries chose to enroll in private Medicare Advantage plans, federal officials said.

Over all, Medicare spending rose 7.9 percent in 2009, the same rate as in 2008, while enrollment grew about 2 percent, the report said.

Medicare spending increased an average of 2.3 percent for each person in a private Medicare Advantage plan and 6.9 percent for each person in the traditional program.

The new health care law cuts Medicare payments to private plans. Many studies have found that Medicare spends more on people in such private plans than it would spend for the same beneficiaries in the original Medicare program.

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With New Heart Pump, Cheney Slowly Resumes Old Life

WASHINGTON— A few days before Christmas, former Vice PresidentDick Cheneyended a self-imposed sabbatical from partisan politics to headline a fund-raiser for Maria Cino, a party operative and Bush administration official who is running to replaceMichael Steeleas head of theRepublican National Committee.

The fund-raiser for Ms. Cino, held at the Alexandria, Va., home of Mr. Cheney’s former aideMary Matalin, was his first major foray into partisan Washington political theater since receiving a mechanical heart pump in July that has, most doctors say, saved Mr. Cheney’s life by taking on the task of helping to push blood through his arteries.

Mr. Cheney, as he did at several holiday receptions in Washington, chatted about his new pump. At one cocktail party, he even opened his coat jacket to show it off. While Mr. Cheney is noticeably thinner— his trademark stiff, one-sided grin now shows up on a markedly leaner face— he is returning, associates say, to his old life, including hunting and socializing.

But for the most part, Mr. Cheney, 69, has put aside his public role as the fiery, combative political figure of the last two years, who seemed to relish every opportunity to engage in verbal jousting withPresident Obama.

WithGeorge W. Bushhaving decided to stay largely silent during Mr. Obama’s tenure, Mr. Cheney embraced the role of public critic, accusing the new, young president of rolling back Bush-era policies and undermining the nation’s security. In 2009, Mr. Cheney and Mr. Obama gave dueling speeches on the same day.

Now, however, family members and friends paint a portrait of a man less focused on the day-to-day back-and-forth in Washington and one more interested in documenting his years of service in a memoir and navigating life with his new pump.

Mr. Cheney’s heart will never beat at full strength again, doctors say. His new mechanical pump, a partial artificial heart known as a ventricular assist device, leaves patients without a pulse because it pushes blood continuously instead of mimicking the heart’s own beat. Most pulse-less patients feel nothing unusual, but the devices do pose significant risks of infection. They are implanted as a last resort either for permanent use or as a bridge to transplant until a donor heart can be found. Mr. Cheney, who has participated in some of the nation’s toughest decisions for decades, now faces a crucial one of his own: whether to seek a full heart transplant.

It is a decision he will most likely be forced to make within months. He is old enough that soon he will no longer qualify for a transplant, doctors say. And while it is possible for some patients with Mr. Cheney’s device to live for years, the long-term prospects remain unknown.

His family and friends will not talk publicly with any specificity about the former vice president’s heart condition or the steps he might be taking to confront it.

But in the meantime, Mr. Cheney has begun resuming his old activities. Besides the Cino fund-raiser, he attended a round of holiday parties in Washington— leaving whispers in his trail about his weight loss.“For all of the caricatures of him, he never lets it get under his skin,” said Ms. Matalin, a close friend.

Mr. Cheney, who spent the holidays at his ranch in Wyoming, recently had a class ofWest Pointcadets over to his house in McLean, Va., to talk about his experiences working for four of the last five Republican presidents and what it was like to work at the White House. In Wyoming, he has been spotted in local grocery stores, stocking up to make chili and spaghetti sauce,“as well as walking me through how to cook Christmas dinner,” his daughterLiz Cheneysaid in an e-mail.

But most of all, Ms. Cheney said, her father has been working on his book, which is scheduled to come out this fall.“He still prefers to write in longhand on yellow legal pads despite my efforts to introduce a laptop into his process,” Ms. Cheney said.

By supplementing the amount of blood pumped through the body, Mr. Cheney’s pump allows him to do many things he would do with a working heart. Such patients can bicycle, golf, play tennis, drive, shop and generally do what they did before they developed severe heart failure. They need to take an anticoagulant, like warfarin (sold under the brand name Coumadin), and have blood tests to monitor the amount.

Mr. Cheney’s pump was placed near his heart. With most patients, a power line emerges about waist level and connects to a controller, a minicomputer that plugs into a pair of one-and-a-half-pound, 12-volt batteries. Patients wear a black mesh vest over their clothing that holds the controller and batteries.

Mr. Cheney’s friends and family say he is making plans to get out in 2011 and give more speeches. On Jan. 20, he is to fly to Texas for the 20th anniversary of the Persian Gulf war with the first President Bush, the emir of Kuwait and a host of alumni of that administration, includingBrent Scowcroft, the former national security adviser, andColin L. Powell, who was chairman of theJoint Chiefs of Staffat the time, when Mr. Cheney was defense secretary.

On Dec. 28, Mr. Cheney was the host of a fund-raiser at the home of some friends in Jackson, Wyo., for a scholarship program that he and his wife, Lynne, have begun at theUniversity of Wyoming. They donated $4.5 million to help create scholarships for students to study overseas. In his remarks, Mr. Cheney said that after getting kicked out of Yale twice, he owed getting his life back on track to the University of Wyoming.

Mr. Cheney’s heart pump is also allowing him to go to the movies.

“He and my mom went to see‘True Grit’ at the Teton Theater here in Jackson a few days ago,” Ms. Cheney said. Her parents, she said, gave it“two thumbs up.”

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