Well: 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.

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European Union Moves Toward Bonus Cap for Bankers

BRUSSELS — The European Union moved a step closer early on Thursday to imposing strict curbs on bonus pay for bankers, which has been blamed by many politicians for inciting the risk-taking behavior that triggered the recent financial crisis.

A provisional agreement struck between the European Parliament, the European Commission and national representatives could mean that the coveted bonuses many bankers receive are capped at the level of their annual salaries starting next year.

The agreement, as it stands, was seen as some as a blow to Britain, which partly relies on generous remuneration packages to ensure that the City of London remains the biggest financial center in Europe and the overseas headquarters of banks from around the globe.

’We need to make sure that regulation put in place in Brussels is flexible enough to allow those banks to continue competing and succeeding while being located in the U.K.,” David Cameron, the British prime minister, said on a visit to Riga, the capital of Latvia. A majority of E.U. states still must give their final approval for the legislation to go into force and there are expected to be more discussions on the rules at the European Parliament and among governments.

The goal of the bonus cap proposal is to balance many different interests, including “the desire to limit bankers pay while maintaining a competitive European banking sector,” Michael Noonan, the finance minister of Ireland, which holds the rotating E.U. presidency, said in a statement after the talked ended.

Under the proposal, the bonus rules would also apply to bankers employed by E.U. banks but working outside the bloc, for example in New York. E.U. authorities are drafting separate rules that could restrict remuneration at private equity firms and hedge funds.

Mr. Noonan said he would present the plan at a meeting of finance ministers next week.

Alex Beidas, a lawyer with Linklaters, a global legal and consulting firm based in London, warned that the legislation represented “a major disadvantage in the global market” for banks and said there was “a real danger that this will result in bankers moving to the U.S. and Asia.” 

The rules were “also likely to lead to an increase in salaries which is undesirable as banks are trying to minimize their fixed costs,” she said.

Amid concerns that capping bonuses could mean bankers begin to migrate to banks in more economically dynamic locations, lawmakers emphasized that the proposal would include provisions for monitoring such side effects and, if necessary, allow leeway for remedies.  

“If the bonus cap is shown to cause bankers to begin relocating outside the E.U., then we will have the ability to swiftly look again at the provisions in place through an early review,” said Vicky Ford, a member of the European Conservatives and Reformists group from Britain.

Political leaders who hailed the preliminary deal included Martin Schulz, the president of the European Parliament and a German member of the Alliance of Socialists and Democrats.

"The cap on bonuses is a groundbreaking measure that in my view will make the economic system fairer and safer," Mr. Schulz said in a statement. "Exuberant bonuses often provided a wrong incentive for financial markets, encouraging risky behavior and short-term, purely speculative investment," he said.

An E.U. diplomat stressed that a significant amount of technical work still needed to be done before the rules were finalized by governments.

The diplomat, who spoke on customary condition of anonymity, said the rules would contain a review clause requiring authorities to assess whether the rules were having damaging effects on the banking sector. The envoy said no date was fixed for the review but that could be finalized during discussions over coming weeks.

The proposal would also allow higher bonuses if a sufficient number of shareholders agreed.

It is part of a set of laws requiring higher capital requirements for banks, called the Basel III rules, which the E.U. officials also approved early Thursday.

Mr. Noonan said the Basel III package would “make sure that banks in the future have enough capital, both in terms of quality and quantity, to withstand shocks” and that “will ensure that taxpayers across Europe are protected into the future.”

David Jolly contributed reporting from Paris.

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Race for L.A. city controller heats up

A previously low-profile race for Los Angeles city controller has begun to heat up as opponents of City Councilman Dennis Zine accuse him of "double dipping" the city's payroll and question why he is considering lucrative tax breaks for a Warner Center developer.

Zine, who for 12 years has represented a district in the southeast San Fernando Valley, is the better known of the major candidates competing to replace outgoing Controller Wendy Greuel.

The others are Cary Brazeman, a marketing executive, and lawyer Ron Galperin. Zine has raised $766,000 for his campaign, more than double that of Galperin, the next-highest fundraiser, and has the backing of several of the city's powerful labor unions.

He also has been endorsed by Mayor Antonio Villaraigosa and several of his council colleagues. Galperin is backed by the Service Employees International Union, one the city's largest labor groups, and Brazeman is supported by retired Rep. Diane Watson and several neighborhood council representatives.

With the primary ballot less than a week away, Brazeman and Galperin have turned up the heat on Zine, hoping to push the race beyond the March 5 vote. If no one wins more than 50% of the ballots cast, the top two vote-getters will face a runoff in the May general election.

In a recent debate, Zine's opponents criticized him for receiving a $100,000 annual pension for his 33 years with the Los Angeles Police Department and a nearly $180,000 council salary. Brazeman and Galperin called it an example of "double dipping" that should be eliminated.

That brought a forceful response from Zine, who shot back that he gives a big portion of his police pension check to charities.

"I am so tired of hearing 'double dipping,' " he said. "I worked 33 years on the streets of Los Angeles. I have given over $300,000 to nonprofits that need it.... That's what's happened with that pension."

In the same debate, Brazeman accused Zine of cozying up to a Warner Center developer by pushing for tax breaks on a project that already has been approved. The nearly 30-acre Village at Westfield Topanga project would add 1 million square feet of new shops, restaurants, office space and a hotel to a faded commercial district on Topanga Canyon Boulevard.

"The councilman proposed to give developers at Warner Center tens of millions of dollars in tax breaks even though it's a highly successful project," he said. "He wants to give it away."

City records show that less than a month after the development was approved in February 2012, Zine asked the council for a study looking at possible "economic development incentives" that could be given to Westfield in return for speeding up street and landscaping enhancements to the project's exterior.

The motion's language notes that similar tax breaks have been awarded to large projects in the Hollywood and downtown areas, and that "similar public investment in the Valley has been lacking." Westfield is paying for the $200,000 study.

Zine defended his decision before the debate audience, saying if the study finds that the city will not benefit, no tax breaks will be awarded. "If there's nothing there, then they get nothing," Zine said.

The controller serves as a public watchdog over the city's $7.3-billion annual operation, auditing the general fund, 500 special fund accounts and the performance of city departments. Those audits often produce recommendations for reducing waste, fraud and abuse.

But the mayor and the council are not obligated to adopt those recommendations, and as a result the job is part accountant, part scolder in chief. All the candidates say they will use their elective position not only to perform audits but also to turn them into action.

Their challenge during the campaign has been explaining how they will do that.

Zine, 65, says his City Hall experience has taught him how to get things done by working with his colleagues. He won't be afraid to publicly criticize department managers, he said, but thinks collaboration works better than being combative.

"You can rant and rave and people won't work with you," he said. "Or you can sit down and talk it out, and you can accomplish things."

Galperin, 49, considers himself a policy wonk who relishes digging into the details to come up with ways to become more efficient with limited dollars and to find ways to raise revenue using the city's sprawling assets. For instance, the city owns two asphalt plants that could expand production and sell some of its material to raise money to fix potholes, he said.

He's served on two city commissions, including one that found millions of dollars in savings by detailing ways to be more efficient. Zine is positioning himself as a "tough guy for tough times," but the controller should be more than that, Galperin said.

"What we really need is some thoughtfulness and some smarts and some effectiveness," he said. "Just getting up there and saying we need to be tough is not going to accomplish what needs to be done."

Brazeman, 46, started his own marketing and public relations firm in West Los Angeles a decade ago and became active in city politics over his discontent with a development project near his home. He has pushed the council to change several initiatives over the last five years, including changes to the financing of the Farmers Field stadium proposal that will save taxpayer dollars, he said.

As controller, he would pick and choose his battles, and, Brazeman said, be "the right combination of constructive, abrasive and assertive."

catherine.saillant@latimes.com

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The Strange Beauty of Historic Computers Brought Back From the Dead

When you open the door and walk into the room, it even smells like the 1960s. It reminds you of the old garage where your grandfather kept his twin Chevrolet Corvairs. But those aren't cars you smell. Those are computers.

This is the "1401 Room" on the first floor of the Computer History Museum in Mountain View, California — the room where Robert Garner and his motley crew of amateur technicians have spent the last decade reviving two of the massive IBM 1401 mainframe computers that littered the business world throughout the '60s and on into '70s.

As the door opens, you can see not only the 1401s themselves, but the mechanical punch-card machine where they take instructions from the outside world, the towering drives where they store data on spinning spools of tape, and even the desk-sized printer where they funnel information onto good old-fashioned paper. There's a gentle hum in the room. You can feel the heat coming off the machines. And, yes, you can smell them too. Garner says it's the odor of the oils used in some of the mechanical equipment, including the printer and the punch-card reader.

This assault on your senses is one of the chief reasons Garner and his cohorts have spent all these years restoring the two IBMs. They want to show a new generation what these machines were like -- and they want to show it as completely as possible. "This is the creation of a time machine," Garner says. "When people are here, experiencing this, it sparks their imagination. It transfers them back in time, but it also takes them forward in time. It makes them feel like they too can build new things."

Garner and his team also work on the IBMs because it's fun. "Though you might say that people who do this kind of thing are crazy — and you'd wouldn't be wrong — we enjoy doing it together," says Stan Paddock, another member of the group. But Garner is right: there's a larger payoff. And you feel it as soon as you step into the room.

In short, Garner and his team are historians — in the purest sense of the word. And thankfully, they're not alone.

At the Computer History Museum, volunteers have toiled to revive a wide range of artifacts from an earlier age of American computing, including the IBM 1620 and the DEC PDP-1. Across the Atlantic, in Great Britain, the Computer Conservation Society has sponsored an even longer list of restoration projects, overseeing the revival of such seminal machines as the WITCH (the world's oldest digital computer) and the Colossus (used to crack German codes during the Second World War). And then there are hobbyists like Bill Degnan, people across the globe who spend their free time rebuilding whatever old machines they can get their hands on — and occasionally flaunting their work at events like the Vintage Computer Festival.

Sadly, we can't show you what these machines smell like. Or what they sound like. Or what they feel like. But we can show you what they look like — or at least try. With the gallery of images above, we give you a few of our favorites.

Above

Behold, the 1401 Room. You can see the punch-card machine on the right, the tape drives against the wall at the back, the printer in the middle of the frame, and the 1401 itself on the left, with the blue stripe running across its top edge. This massive collection of machinery was the most popular business computer of the 1960s.

Robert Garner — a modern-day IBM researcher who has also worked for such tech giants as Xerox and Sun Microsystems — bootstrapped the restoration project in 2008 when the Computer Museum History acquired the remnants of a 1401 from an outfit in Germany. He sliped an ad into a Silicon Valley newsletter for IBM retirees, and soon, he had a team of technicians with the know-how to rebuild the thing.

A few years later, Garner was contacted by a man who who had a 1401 in his Connecticut home. This machine was built in 1961, but the man's family had used it to track expenses for the local country club through the mid-'90s. It was in slightly better shape than Garner's german 1401, so the museum bought it too.

If you're a Stanley Kubrick fan, the printer may look familiar. It's an IBM 1403, which makes a cameo in Kubrick's Cold War black comedy, Dr. Strangelove. There's a 1403 at the Air Force Base where Sterling Hayden's General Jack D. Ripper unilaterally launches a nuclear attack on the Soviet Union, and his second in command, played by Peter Sellers, doesn't realize what has happened until he finds a transistor radio tucked inside the lip of the printer.

If you visit the 1401 Room at Computer History Museum, you too will find a transistor radio — right where Sellers did.

Images: Computer History Museum

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The New Old Age Blog: Is the Pope Frail?

White-haired at 85, Pope Benedict XVI looks a bit hunched in photos. He has had a pacemaker for years, the Vatican recently confirmed for the first time — an indicator of long-standing heart problems. His older brother has said that age is taking its toll.

Observers have noticed the pope’s reduced energy. The Times has reported that he was ferried to the altar at St. Peter’s for Midnight Mass Christmas Eve on a “wheeled platform,” then appeared to doze off during the service.

Visiting Mexico last year, he awoke at night and couldn’t locate a light switch in his room, then fell — such a familiar scenario for caregivers of old people — and bloodied his head when he hit the bathroom sink.

Beyond these few facts, we know very little about the health problems that have led Benedict to announce his retirement after his final audience on Wednesday. We don’t even really know if his flagging stamina — “the certainty that my strengths, due to an advanced age, are no longer suited to an adequate exercise” of leading the church, as he put it — was the true reason behind his resignation. But people have been describing him as tired and increasingly frail.

In geriatrics, “frailty” has a specific meaning: It’s a syndrome, a collection of physiological symptoms that drain people’s reserves, leaving them less able to withstand stressors — like a long trek through St. Peter’s Basilica or around a foreign country.

Geriatricians diagnose frailty when a patient meets three of five criteria: Unintentional weight loss of more than 10 pounds in the past year. Weakness, as measured by a test of handgrip strength. Self-reported exhaustion. Slowness, calculated by how long it takes to walk 15 feet. Low physical activity.

“You feel a sense of vulnerability,” said Linda Fried, dean of the Mailman School of Public Health at Columbia University and a leading frailty researcher for 20 years. With significantly lower energy, “It’s harder to push the envelope.”

Frailty’s prevalence increases with age, “from a tiny proportion of people in their 60s, about three percent, to up to a quarter or a third of people 85 and older,” Dr. Fried said. Doctors have learned to pay attention because of the unhappy consequences. “It’s strongly associated with higher mortality, as well as loss of mobility, falls and other kinds of disability,” she said.

Is Benedict frail? Certainly he is reporting that he is exhausted, but does he fit the other criteria? “The pope has probably never done a grip strength test,” said Ken Covinsky, a geriatrician at the University of California, San Francisco.

But the odds are high that he has health problems, even if they’re unacknowledged by Vatican spokesmen. In the United States, at least, nearly half of those over 65 have two or more chronic diseases, like diabetes, hypertension and emphysema. “It would be a rare 85-year-old with only one thing wrong with him,” Dr. Covinsky said.

And frailty is one of those conditions that indicate all is not well.

People often recognize frailty, even without data on walking speed. “I’ve tested it out myself over the years” when speaking to groups, Dr. Fried reported. “I ask people what they’re seeing, and there’s great consistency between the things they picture and what science has measured.”

Frail elders, people tell her, are thin (although overweight people can also be frail), weak, slow, fragile-looking. “The term people use is, they look like they could be knocked over by a feather,” she said.

So if observers in Vatican City say Benedict looks frail, well, maybe he is.

But I’m pursuing this subject not to ask experts to diagnose the pope from afar, but to point out that paying attention to frailty makes sense for the rest of us and our elders. It’s one of the conditions people can do something about.

In frailty’s early stages, “there’s great potential to reverse it or slow it,” Dr. Fried said. The key is exercise. “You have to walk and move, maintain strength and muscle mass,” she said. “We don’t have a drug to prescribe, but even if we did, there’s no question in my mind that exercise will always be the foundation.”

The pope has said that he plans to move into the Mater Ecclesiae convent within the Vatican once it’s renovated for him. We have to assume the nuns, and perhaps a couple of physical therapists, will provide excellent care there.

“Often, people with frailty can live a pretty good life with good home care and social support, and almost every country does better at that than the United States,” Dr. Covinsky said. Our lack of a workable, affordable system of long-term care for the elderly and disabled poses a national crisis.

This is where being a former pope — something that is so rare that it shocked the world — may be a good way to live out one’s days.

“In the U.S., he could get M.R.I.’s and all kinds of expensive tests,” Dr. Covinsky noted. “But Medicare won’t pay for a home health aide four hours a day.” Luckily, the Vatican probably will provide it.

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Paula Span is the author of “When the Time Comes: Families With Aging Parents Share Their Struggles and Solutions.”

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DealBook: Wall Street Pay Rises, for Those Who Still Have a Job

7:39 p.m. | Updated

Wall Street may be shrinking — cutting thousands of jobs over the last year — but for those who remain, the pay is still very lucrative.

The average cash bonus for those employed in the financial industry in New York last year rose roughly 9 percent, to $121,900, Thomas P. DiNapoli, New York State’s comptroller, said on Tuesday.

Cash bonuses in total are forecast to increase by roughly 8 percent, to $20 billion this year.

The total, however, is down from 2010, when it was $22.8 billion. Wall Street’s peak came in 2006, before the financial crisis, with a total $34.3 billion in bonuses. The year-end bonus can account for the bulk of a finance professional’s annual compensation.

The report from the state comptroller’s office gives estimates on the bonuses, based on tax withholding data, data from banks and conversations with industry experts. It came the same day that JPMorgan Chase, one of the country’s biggest banks, announced it was eliminating 17,000 jobs over the next two years through layoffs and attrition, adding its name to a string of large banks that continue to cut jobs to reduce expenses.

Wall Street has regained 30 percent of the 28,300 jobs lost during the financial crisis, Mr. DiNapoli said. And firms are continuing to streamline as they cope with a sluggish economic recovery, difficult markets and a heavier regulatory burden. While financial industry employment in New York City was steady in the first half of 2012, it was down slightly in the second half of the year, the comptroller’s office said.

“Wall Street is still in transition, but it is very slowly adjusting to changes in its economic and regulatory environment,” he said.

In an effort to hold down — albeit temporarily — compensation costs, a number of financial firms have deferred cash payments to employees in recent years. Mr. DiNapoli said on Tuesday that part of the increase in 2012 was cash promised in recent years but actually paid out last year. He said that it was difficult to break out what percentage of the total was deferrals, but he believed that it was still a small part of the total.

The ebbs and flows of Wall Street pay have a major impact on the economy of New York City, where 169,700 are employed in finance. Local businesses like restaurants, luxury goods retailers and the upper end of the real estate market pin their fortunes to the flood of cash from year-end bonuses.

Before the start of the financial crisis, business and personal income tax collections from finance-related activities accounted for up to 20 percent of New York State tax revenue. In 2012, that contribution fell to 14 percent.

Yet finance remains the best paying sector in New York City, Mr. DiNapoli told reporters during a conference call.

All told, the average pay package for securities industry employees in New York was $362,900 in 2011, the last year for which data is available, almost unchanged from 2010.

“Profits and bonuses rebounded in 2012, but the industry is still restructuring,” Mr. DiNapoli said. Despite its smaller size, the securities industry is still a very important part of the New York City and New York State economies.”

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Mike Piazza softens stance on Dodgers' Vin Scully

PHOENIX—

— Calling Vin Scully "a class act" and saying he had "the utmost respect" for him, Mike Piazza on Monday defended what he wrote in his recently released autobiography about the Hall of Fame broadcaster.

In his book, "Long Shot," Piazza described Scully as instrumental in turning the fans of Los Angeles against him during the contract stalemate that led to his trade to the Florida Marlins in 1998. Piazza wrote that Scully "was crushing me" on the air, a charge Scully vehemently denied.

"I can't say that I have regrets," Piazza said. "I was just trying to explain the situation."

The former All-Star catcher was at the Dodgers' spring-training facility with Italy's World Baseball Classic team, for which he is a coach. Scully was also at the complex, to call the Dodgers' 7-6 victory over the Chicago Cubs.

"I'd love to see him," Piazza said.

The two didn't meet.

"I always liked him," Scully said. "I admired him. I think either he made a mistake or got some bad advice. I still think of him as a great player and I hope he gets into the Hall of Fame. I really do. Whatever disappointment I feel, I'll put aside."

Scully declined to comment further on Piazza or his book.

Piazza complimented Scully as he tried to defend what he wrote.

"Vin is a class act; he's an icon," Piazza said. "To this day, I have the utmost respect for him. But the problem is, you have to go back in time and understand that at that point in time in my career with the Dodgers was a very tumultuous time. I was more or less telling my version of the story, at least what I was experiencing. And I said at the end of the book, it's not coming from a place of malice or anger. I think anybody who remembers that time knows it was a very tumultuous time."

Piazza said his intent wasn't to blame Scully.

"I don't think anybody who read the passage from start to finish felt that way," Piazza said. "Anybody who reads it knows it wasn't me blaming. That was definitely not the only factor. There were other factors. The team made the mistake, I made the mistake, of speaking publicly."

Piazza acknowledged that he never heard Scully's broadcasts and that his impressions of them were based on what he heard from others.

"My perception was that he was given the Dodgers' versions of the negotiations, which, I feel, wasn't 100% accurate," Piazza said.

In his book, Piazza also took issue with how Scully asked him about his contract demands during a spring-training interview. Piazza said Monday that he was "taken aback" by the line of questioning because he previously hadn't talked publicly about the negotiations.

To reach the practice fields at Camelback Ranch on Monday, Piazza had to pass through a gantlet of Dodgers fans. Piazza said he wasn't nervous.

"I did a book signing a couple of weeks ago in Pasadena and the fans were really nice," he said.

Piazza denied that he hadn't returned to Dodger Stadium in recent years out of fear of being booed, as Tom Lasorda told The Times last month.

Piazza said he always associated the Dodgers with the O'Malley family, which sold the team to News Corp. in 1998.

"Since then, obviously, they've taken on a different identity," Piazza said.

Piazza was noncommittal about visiting the ballpark in the future. "We'll see," he said. "I'll never say never."

Wouldn't it be harder to return now that his portrayal of Scully has upset fans?

"I don't know," he said. "I can't answer that."

Piazza also spoke about falling short of being elected to the Hall of Fame in his first year of eligibility.

"I definitely couldn't lie and say I wasn't a little disappointed," he said.

He is hopeful he will one day be inducted. "I trust the process," he said.

Piazza wouldn't say whether he thought Barry Bonds and Roger Clemens deserved to be in the Hall of Fame. Both players, who have been linked to performance-enhancing drugs, also were denied election.

Piazza has denied using performance-enhancing drugs and has never faced detailed allegations that he did. Asked if he was upset that the indiscretions of others might have altered others' perceptions of him, he replied, "Unfortunately, that's the way life is sometimes. I can't control and worry about what people think."

dylan.hernandez@latimes.com

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The Ugly, Corrupted, Brilliant Games of Michael Brough

I’d never heard of Michael Brough when I downloaded his iPhone game Corrypt, and my first impression of it wasn’t entirely positive. It had stark, surrealist pixel graphics and very little animation. After solving the first couple of simplistic puzzles, I found myself hopelessly stuck on an early challenge involving lots of boxes in a cramped room. Frustrated, I quit the game and quickly forgot about it.

But Corrypt refused to go away. IndieGames.com hailed the PC version as the best free puzzle game of 2012, and another of Brough’s games, VESPER.5, was nominated for the 2013 Independent Games Festival’s prestigious Nuovo award for innovation.

What finally snared me was a glowing review of Corrypt penned by Frank Lantz, creator of Drop7 and the director of New York University’s Game Center. “This small game, with its rough edges and its cryptic, self-consuming typography,” Lantz wrote, “will repay the attention you give it a thousandfold.”

I decided to take another look. Corrypt, upon proper exploration, revealed itself to be a brilliantly designed puzzle game, unforgiving and unwilling to accommodate players who refuse to give it their full attention. Peel back one layer, and it reveals another more surprising one. Then it does that again, and again, then it flips itself inside out and laughs at your expectations.

“The way [it] works, you’re not sure if it’s something wrong with the game, or if it’s something intentional,” Brough says. His smile fills my Skype window. “I’ve had people e-mail me saying ‘there’s a bug in your game,’ and then describing it exactly as it’s meant to work.”

Brough, a 27-year-old New Zealand native, makes games that confound players’ expectations. Brough has grabbed numerous awards and captured the attention of the indie gaming community, but many respected developers say his games are too ugly to catch on with a mainstream audience. His games might be too weird, his style too divisive, for him to make any money in the ruthless games business.

Around the time Brough turned 11, his family bought a Tandy computer with BASIC installed. Brough spent countless hours of his childhood mucking about with the programming language, making text adventures and other simple games that he’d share with his parents.

While he tinkered with BASIC, Brough often encountered bugs. He’d make a small change in the code, and a game would break in an interesting way. But instead of immediately fixing the error, Brough became fascinated with the bugs themselves.

“The idea that a bug could produce strange and interesting effects,” he says, “is a mythology that I like.”

“If, when something goes wrong, it just crashes, that tells you nothing,” Brough explains. “If something goes wrong and it keeps going, that reveals something to you about how it works, and how the computer thinks.”

With modern hardware like the iPad, Brough complains that the fun of toying around with computers, “that feeling of being at a low level, feeling close to the way computers work,” is gone. For him, the oft-touted “magical” consumer-friendliness of Apple’s devices is a restriction on learning opportunities.

“Now you have an iPad, and you don’t know what’s going on under the screen,” he says. “It’s basically a piece of magic.”

After completing a degree in math and computer science at the University of Auckland, Brough moved to London and began working towards a Ph.D. He landed a decent-paying programming job while continuing his scholastic work, but continued making games, including the beautiful, abstract strategy game Vertex Dispenser, which even Brough admits may have been too esoteric. It combined elements of shooters and real-time strategy games with a complex puzzle system, and many players felt overwhelmed. “I just could not get my head around those concepts at the same time,” said one.

Halfway through the Ph.D., Brough burned out. He quit both his job and his schooling, becoming a full-time game developer. He followed his wife, now the family’s principal breadwinner, to Scotland, and has for the previous year worked tirelessly on his games, producing a diverse portfolio of Technicolor puzzlers, roguelikes and multiplayer games.

Take for example Helix, another Independent Games Festival nominee. It’s a space shooter in the vein of Geometry Wars, but without any shooting. Instead, players defeat enemies by carefully flying around them in circles.

Glitch Tank, an iPad game for two players, is an obvious manifestation of Brough’s lifelong appreciation of glitches. Its fat, stark pixel art pops and crackles on the screen, always seemingly on the verge of falling apart completely. Each player’s controls, a panel of four buttons, is unreliable, with new buttons shuffling in and out with use. It plays like a Game Boy cartridge that’s been dropped in a puddle and trampled by schoolchildren, but it’s all carefully, intentionally designed.

Even the game’s marketing seems glitchy. Brough uses the App Store product description space to describe it as “A digital board %ame⚡⌁ Competitive retro action/strate%* for two pla*ers░.”

Zaga-33, a roguelike with permadeath, is much more subdued, although it does its best to confuse players. Each time the game is played, the effects of all its items are randomized. What was once a teleport skill in one game becomes a deadly laser in the next, and a result each playthrough inspires the same sense of careful curiosity that an entirely new game would.

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Horse Meat in European Beef Raises Questions on U.S. Exposure

The alarm in Europe over the discovery of horse meat in beef products escalated again Monday, when the Swedish furniture giant Ikea withdrew an estimated 1,670 pounds of meatballs from sale in 14 European countries.

Ikea acted after authorities in the Czech Republic detected horse meat in its meatballs. The company said it had made the decision even though its tests two weeks ago did not detect horse DNA.

Horse meat mixed with beef was first found last month in Ireland, then Britain, and has now expanded steadily across the Continent. The situation in Europe has created unease among American consumers over whether horse meat might also find its way into the food supply in the United States. Here are answers to commonly asked questions on the subject.

Has horse meat been found in any meatballs sold in Ikea stores in the United States?

Ikea says there is no horse meat in the meatballs it sells in the United States. The company issued a statement on Monday saying meatballs sold in its 38 stores in the United States were bought from an American supplier and contained beef and pork from animals raised in the United States and Canada.

“We do not tolerate any other ingredients than the ones stipulated in our recipes or specifications, secured through set standards, certifications and product analysis by accredited laboratories,” Ikea said in its statement.

Mona Liss, a spokeswoman for Ikea, said by e-mail that all of the businesses that supply meat to its meatball maker  issue letters guaranteeing that they will not misbrand or adulterate their products. “Additionally, as an abundance of caution, we are in the process of DNA-testing our meatballs,” Ms. Liss wrote. “Results should be concluded in 30 days.”

Does the United States import any beef from countries where horse meat has been found?

No. According to the Department of Agriculture, the United States imports no beef from any of the European countries involved in the scandal. Brian K. Mabry, a spokesman for the department’s Food Safety and Inspection Service, said: “Following a decision by Congress in November 2011 to lift the ban on horse slaughter, two establishments, one located in New Mexico and one in Missouri, have applied for a grant of inspection exclusively for equine slaughter. The Food Safety and Inspection Service (F.S.I.S.) is currently reviewing those applications.”

Has horse meat been found in ground meat products sold in the United States?

No. Meat products sold in the United States must pass Department of Agriculture inspections, whether produced domestically or imported. No government financing has been available for inspection of horse meat for human consumption in the United States since 2005, when the Humane Society of the United States got a rider forbidding financing for inspection of horse meat inserted in the annual appropriations bill for the Agriculture Department. Without inspection, such plants may not operate legally.

The rider was attached to every subsequent agriculture appropriations bill until 2011, when it was left out of an omnibus spending bill signed by President Obama on Nov. 18. The U.S.D.A.  has not committed any money for the inspection of horse meat.

“We’re real close to getting some processing plants up and running, but there are no inspectors because the U.S.D.A. is working on protocols,” said Dave Duquette, a horse trader in Oregon and president of United Horsemen, a small group that works to retrain and rehabilitate unwanted horses and advocates the slaughter of horses for meat. “We believe very strongly that the U.S.D.A. is going to bring inspectors online directly.”

Are horses slaughtered for meat for human consumption in the United States?

Not currently, although live horses from the United States are exported to slaughterhouses in Canada and Mexico. The lack of inspection effectively ended the slaughter of horse meat for human consumption in the United States; 2007 was the last year horses were slaughtered in the United States. At the time financing of inspections was banned, a Belgian company operated three horse meat processing plants — in Fort Worth and Kaufman, Tex., and DeKalb, Ill. — but exported the meat it produced in them.

Since 2011, efforts have been made to re-establish the processing of horse meat for human consumption in the United States. A small plant in Roswell, N.M., which used to process beef cattle into meat has been retooled to slaughter 20 to 25 horses a day. But legal challenges have prevented it from opening, Mr. Duquette said. Gov. Susana Martinez of New Mexico opposes opening the plant and has asked the U.S.D.A. to block it.

Last month, the two houses of the Oklahoma Legislature passed separate bills to override a law against the slaughter of horses for meat but kept the law’s ban on consumption of such meat by state residents. California, Illinois, New Jersey, Tennessee and Texas prohibit horse slaughter for human consumption.

Is there a market for horse meat in the United States?

Mr. Duquette said horse meat was popular among several growing demographic groups in the United States, including Tongans, Mongolians and various Hispanic populations. He said he knew of at least 10 restaurants that wanted to buy horse meat. “People are very polarized on this issue,” he said. Wayne Pacelle, chief executive of the Humane Society of the United States, disagreed, saying demand in the United States was limited. Italy is the largest consumer of horse meat, he said, followed by France and Belgium.

Is horse meat safe to eat?

That is a matter of much debate between proponents and opponents of horse meat consumption. Mr. Duquette said that horse meat, some derived from American animals processed abroad, was eaten widely around the world without health problems. “It’s high in protein, low in fat and has a whole lot of omega 3s,” he said.

The Humane Society says that because horse meat is not consumed in the United States, the animals’ flesh is likely to contain residues of many drugs that are unsafe for humans to eat. The organization’s list of drugs given to horses runs to 29 pages.

“We’ve been warning the Europeans about this for years,” Mr. Pacelle said. “You have all these food safety standards in Europe — they do not import chicken carcasses from the U.S. because they are bathed in chlorine, and won’t take pork because of the use of ractopamine in our industry — but you’ve thrown out the book when it comes to importing horse meat from North America.”

The society has filed petitions with the Department of Agriculture and Food and Drug Administration, arguing that they should test horse meat before allowing it to be marketed in the United States for humans to eat.

This article has been revised to reflect the following correction:

Correction: February 25, 2013

An earlier version of this article misstated how many pounds of meatballs Ikea was withdrawing from sale in 14 European countries. It is 1,670 pounds, not 1.67 billion pounds.

This article has been revised to reflect the following correction:

Correction: February 25, 2013

An earlier version of this article misstated the last year that horses were slaughtered in the United States. It is 2007, not 2006.

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DealBook: Gupta Ordered to Reimburse Goldman Sachs $6.2 Million

A federal judge on Monday ordered Rajat K. Gupta, a former Goldman Sachs director, to pay the bank more than $6.2 million to reimburse it for legal expenses connected to his insider trading case.

Last May, a jury convicted Mr. Gupta, 64, of leaking boardroom secrets about Goldman to the hedge fund manager Raj Rajaratnam. The presiding judge, Jed S. Rakoff, sentenced Mr. Gupta to two years in prison. He free on bail while he is appealing the conviction.

Goldman had sought $6.9 million in reimbursement from Mr. Gupta, which represented the total amount that the bank had paid to its primary outside counsel at the law firm Sullivan & Cromwell for an internal investigation and other legal expenses. The bank filed the claim based on the Mandatory Victims Restitution Act, a law that allows corporations to get reimbursed as a victim of an insider trading crime by a rogue employee.

After reviewing the firm’s 542 pages of billing records related to the case, Judge Rakoff said that Mr. Gupta raised no “colorable challenge to the veracity of the records.” He cut the bill by 10 percent, he said, because he noted that there were some extraneous entries.

“On a few occasions,” Mr. Rakoff wrote, “the number of attorneys staffed on a task – while perhaps perfectly appropriate on the assumption that Goldman Sachs wished to spare no expense on a matter of great importance to it – exceeded what was reasonably necessary” under the statute.

Michael Duvally, a Goldman spokesman, said the bank was pleased the court ordered Mr. Gupta to pay it restitution. Gary P. Naftalis, a lawyer for Mr. Gupta, declined to comment.

Goldman is not the only bank that has asked to get paid back because of an employee’s insider trading crimes. Last March, a federal judge ordered that Joseph F. Skowron, a former Morgan Stanley hedge fund manager, pay the bank $10.2 million in legal fees and a portion of his past compensation. Mr. Skowron is appealing the ruling.

The money that Mr. Gupta now has to pay Goldman is separate from the cost of Mr. Gupta’s legal defense, which has thus far exceeded more than $30 million. That legal tab has been paid for by Goldman because the bank’s bylaws require it to pay the legal fees of its top officers and directors. But under a deal reached before his trial, Mr. Gupta agreed that if he was found guilty of insider trading, he would reimburse the bank for the legal fees advanced to him. Goldman must continue to pay his bills until the resolution of his appeal.

Mr. Gupta should be able to afford the $6.2 million payment to Goldman. In April 2008, he had a net worth of about $84 million, according to testimony during the trial. But the case also revealed that his assets took a major hit during the financial crisis.

For Goldman, Mr. Gupta’s case was a huge distraction. Among other hassles, the bank’s chief executive, Lloyd C. Blankfein, was forced to testify over three days in Federal District Court in Manhattan, reviewing for a jury the details and sanctity of Goldman’s boardroom discussions.

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