Dutch men have the tallest average height of any country, almost 6 feet. The Swedes are not far behind at number 2, 5’11”. This explains the placement of their urinals. The men of East Timor average 5’2”. I never heard of East Timor until I found out that the men are really short, the shortest in the world. Obviously, the name East Timor implies that there is a “Timor” or a “West Timor.” One could go on and on about the geophysical and political issues of East Timor but for the purpose of this column just remember that the men are the shortest in the world. A dubious accolade but if one is deciding how high or more importantly how low to place a urinal, this might matter. Intimidation:intimidation.

Ironically, the Dutch controlled the western segment of the island that East Timor is located. A boundary between West Timor and East Timor was established in 1914. Currently the Dutch side is under the jurisdiction of Indonesia. But not without a fight that cost the lives of over 100,00 East Timor inhabitants. There was even the “Battle of Timor” during WWII between the Japanese and Allied forces. The Japanese won and 50,000 Timorese were killed. Is this a country worth fighting over?

Who am I to judge. People have been fighting over the one mile square city of Jerusalem for thousands of years. I had never heard of East Timor until the urinal revelation.

I’ve been to Sweden as faculty for the EVF HOW meeting. Great meeting. High urinals. Intimidation. The East Timorese would know what I mean. Stockholm, Sweden is a city built on 14 islands. There must be a lot of bathrooms. Perhaps they can allocate a few for the rest of the world’s population that don’t have an average height of almost 6 feet. Most of these would be for male tourists. They wouldn’t need to be labeled: “Short Mens Bathroom,” only surreptitiously as: “Male Tourist Bathroom.” We’d get the hint. Us tourists would know that this is a place where we could continue to aim low. But getting Swedes to consider this could be a challenge as our wise friend and Swede Bo Eklof is fond of saying, “You can tell a Swede but you can’t tell him much.”

In VEIN this issue we don’t aim low but we do tell you much, much about value-based healthcare and Medtronic’s leadership in this space. It is a very modern and interesting concept that can transform health care in a way that we all share in. Read their insights. If value-based healthcare was already embraced, we may not have needed to go through the machinations with Medicare Novitas regarding coverage for C2 disease. There would hopefully be a less contentious relationship with payers. However, this is not the case, Keith Darby chronicles ACP’s journey into this arena. Hopefully, this is not something we will need to cover often. The challenge for reimbursement for new technologies is well outlined by Jim Harmon of BTG. The work needed to obtain coverage and payment for new technologies is long and hard. Most do not come easily.

Learning and teaching is a good thing. The EVF HOW meeting has a lot of both. Unique in its structure and unique in it’s teaching model. I have been faculty for many of these and it is a meeting worth looking at. Peter Neglen takes us through the meeting origins and growth in his article. And you only thought the man knows how to stent iliac veins. Not so.

He, Bo Eklöf and the other course directors understand teaching. Learning a new specialty such as Phlebology, if you haven’t learned it in your training, presents challenges, some global and some unique to a specialty. Our roundtable this month addresses the IR world and what they may encounter when entering the vein world. All of our panelists are well known IRs who teach and treat vein care. Read their perspectives on the issue. Other expert vein specialists discuss pelvic congestion syndrome, Dan Clair and DVT issues, Issac Nyamekye.

Finally, our cover article speaks about lymphedema, not solely from the therapeutic angle, but more from an awareness and branding viewpoint. The LE&RN title says it all. This is an article unlike any other you have read that discusses lymphedema. There is a real lot in this issue. I am sure our Swedish friend Bo Eklof will be happy we told him everything we did in this issue. I know he reads VEIN.

What we didn’t tell him or our readers is that the world’s sperm are in big trouble. An article by Nicholas Kristoff in the NY Times last month delivered the bad news. Worse than high urinals. After reading it, I am glad that I don’t need mine anymore. Four children are enough. I’ve done my part. My sperm can rest. But we do need our species to survive.

Sperm counts have universally decreased in the last 75 years. What is worse is those that are around can’t swim properly. They swim in circles, curved lines knocking against things and some have two heads. In this case, two heads are not better than one. How can Mr. Sperm find Ms. Egg if he is off course? Studies show that 90% of sperm can’t swim. Only 10% have a shot at finding Ms. Egg.

A study of sperm donors in the Hunan Province of China found that in 2001 56% qualified as healthy and in 2016 only 18% qualify, Why is this happening to unsuspecting men, boys and sperm? Endocrine disrupting chemicals. They disrupt the formation of sperm into virile, viable men. Sperm can’t get enough male hormonal influence due to these disrupters when the sperm are hanging around waiting to be called to duty like Woody Allen’s scene in the movie, Everything You Wanted To Know About Sex.

These endocrine disrupting chemicals are ubiquitous much like the various specialties embracing vein care–plastics, pesticides, ATM and gas receipts etc. As another wise Scandinavian, the Danish fertility scholar, Erik Skakkeback, suggests that if sperm keep getting worse, “ It is a matter of whether we can sustain ourselves.” If this comes to be, then high urinals are the least of mankind’s problems.

In the vein world we don’t face the Intimidating:intimidating issues of high urinals or low sperm counts but we do need to sustain ourselves. We will continue to publish articles that move us in a healthier direction. We don’t want to add to the anxiety of our younger readers. The health of vein care is our job. Regarding sperm and the survival of our species, you are on your own.