Month: November 2019

One of my octogenarians stated that the “Itis” family was a problematic bunch and Arthur Itis (arthritis) was the worst of the bunch. After I stopped laughing and regained my composure, I realized that he was right and that I should share her wisdom with you.

The Itises are many. This time of year we see rhinitis, sinusitis, and bronchitis just to name a few. Of course, my patient’s arthritis is seen year-round and tends to become more problematic with age.  Frankly, all of the Itis family can be nasty and most need to be dealt with sooner rather than later.

Unfortunately, most of my patients put up with the Itises too long and allow them to entrench themselves in the body where many of them proceed in wreaking havoc. If you are plagued by Arthur or any of his extended family, see your doc and learn how to get rid of them and stop them from coming back. Arthur Itis indeed may be the nastiest of the bunch, and, while we may not be able remove him, at least we can contain him and limit the damage he is likely to cause.

Out of the mouth of octogenarians comes great wisdom.

In November of 2010, I published “Try.”  Over the years, not much has changed.  Many of my patients are still “trying” to get healthy and failing.  The following article is being re-published in its entirety in hopes of convincing people to stop “trying” and go to work at being healthy and “Wellthy.”

Sometimes I wish my patients would stop trying.  They try to stop smoking.  They try to lose weight.  They try to take charge of their medical issues and get healthier.  The problem is that something always stops them from succeeding.  Today’s patients were stymied by work stresses, college weekend with the children, an anniversary celebration and depression over a lost marriage.   The problem lies in the fact that today’s patients got sicker despite being warned about the consequences of not taking care of themselves. 

The remarkable thing about today’s patients is that they are all hard working, successful people.  Despite the stresses of work, the celebrating and the grief, each of these patients went to work every day since I last saw them.  Each of these patients was successful at work despite their other problems.  

The difference in the word “work” versus the word “try” is the difference between failure and success.  When you work at a job, you go to work day after day regardless of whether you want to.  When you work and make a mistake, you correct that mistake and learn not to make it again.  When you work at a job, you resolve to finish it no matter how long you have to work to accomplish your task.  Sure, jobs are stressful; but going to work provides for your daily needs.

When you” try”, you give yourself an out.  In my experience, “try” is always followed by “but” and implies failure.  “Doc, I tried, but my cat ate your instructions. I’ll try again.”  What that really means is it’s not my fault.  Can you imagine going to your boss and saying, “I tried to finish the project but failed?  I’ll try harder next time.”  I think you’d be fired.  When your heart fires you by failing or your feet fire you by going numb from diabetes, you’re plain out of luck.

So, this New Years when you make those famous resolutions, resolve to work on your health care issues.  Hire yourself to lose weight, or stop smoking, or start exercising.  Actually schedule that colonoscopy, that physical exam or the appointment with the counselor.  While you are at it, use the same work ethic and skills that have made you successful to accomplish your health care goals.  Then revel in your new found health and live long and healthy.

Despite the authority’s warning about the rapidly approaching flu season and their encouraging docs to immunize their patients, many people still refuse to get immunized.  

What was truly frustrating was that I would spend 5 minutes teaching each patient about the importance of the flu shot despite the fact that I made my living treating the flu!  Yes, while I made a few bucks off the vaccine, I would make a lot of bucks treating an individual with the flu.  If my patients listened to my advice, I would not see them very often.  Medicine is a weird business!

Like it or not, my job was to prevent disease and injury when possible, even if it put me out of business.  Today I want to share another valuable health fact with you in hopes of saving you pain and suffering.

Four decades ago, in a place far, far away (Arlington Heights), a much younger version of me worked as an ER doc.  Practicing Emergency Medicine was thrilling.  You almost never knew what was coming through doors and had to be ready to treat any and everything!  There were times when you could anticipate what you would see and one of those times was the first snowfall of the season.

The first snowfall always brought “ATTACKS!”  Take your choice, heart or back, the attacks poured through the door and were bad.  Snow removal is hard on the body even if you have a snow blower.  Think about it.  Do you train for the heavy work of snow removal?  Do you stretch prior to going to work at heaving shovels full of snow?  DO you cold acclimate?  Of course not!

You are superman or woman.  Despite your sedentary lifestyle, you get into your winter gear and start shoveling.  You start to sweat.  Your pulse rises.  You get short of breath.  An elephant sits down on your chest.  Two hundred thousand dollars later, you have a triple bypass.  Now, you exercise at the hospital (cardiac rehab).  Eventually, you go back to work.  

For $200,000 dollars, you can have a professional plow your driveway for the next 75 years!  Yes, you could have gone to work, collected your salary, and saved yourself the scar that you now wear down the middle of your chest if only you had treated yourself to a snow removal service.

You say your heart is fine?  How’s your back?  Shoveling snow is definitely hard on your back.  Heave, hoe and feel the zinger in your back that takes you to your knees.  The damn pain shoots right down your leg!  If you are unlucky, it also shoots into your groin.  Certainly, the back attack is preferable to the heart attack, but not by much.  I know, my back is a chronic source of problems.

As your doc, I strongly advise you to hire out your snow removal and go to work at whatever job you have.  Pay a professional and avoid seeing me.  Do it yourself and you’ll still pay a professional, only that professional will be me and my colleagues.  Your choice!

Selling health is what I do best.  Treating you when you ignore my warnings is what pays the bills!

PLEASE DON’T

Hey you!  Yeah, you know who you are.  Your wife wants you to stop.  So do I.  You’re going to hurt yourself.  I know you’re bright.  I know you’ve mastered the internet.  

Let me share a secret with you.  Your internet searches don’t trump my 40 years practicing medicine and my M.D. degree.  It also doesn’t trump the pharmacist’s training and knowledge.

Adjusting your medications by yourself and adding in handfuls of nutraceuticals is downright dangerous, bordering on suicidal.  Let me give you some examples.

Patient number one came into the ER at our local hospital bleeding severely from multiple sites.  He was on coumadin for a cardiac problem and the ER doc followed protocol administering Vitamin K to reverse the effects of the coumadin.  It should have been a slam dunk, but it wasn’t.  Patient number one spent a week in the ICU.  Unbeknown to his doc (me), he had started himself on multiple herbals for an assortment of complaints.

While his internet searches promised him enhanced health, vitality and a never-ending erection, he failed to appreciate the interactions between his miracle herbs and coumadin. 

Patient number two has an assortment of medical problems and medications, some prescribed and some self-prescribed.   So far, he’s been lucky.  Yes, lucky!  He has yet to have any serious side effects, but 40 years of experience has taught me that just because you’ve never experienced a problem doesn’t mean you won’t.  Actually, the longer you screw around with your meds, the more likely you are to have a problem.  Like Patient number three.

Patient number three stopped taking a critical medication because Dr Google told him his medication was a poison.  Patient number three will never recover from his fooling with his meds.  So as not to break HIPAA, I will not share any details but, trust me, fooling with his meds ruined his life.

SO, PLEASE DON’T SELF MEDICATE, CHANGE YOUR MEDICATIONS OR ADD NEUTRECEUTICALS WITHOUT YOUR DOCTORS PERMISSION AND/OR KNOWLEDGE.  THE LIFE YOU SAVE WILL BE YOUR OWN.

Go to Zdogg Pharmacist for an excellent description of your local pharmacists’ job and why you should include them on your team.

“Could” is a word I would do without if I had my way!  Unfortunately, my patients love it! 

“Doc, could my headache be from stress?”

“Doc, could my husband be suffering from depression?”

“Doc, could my son have ADD?”

“Doc, could …?”  is a question I hear multiple times a day.  The funny thing is the answer is always the same.  Realistically, anything “could” be true.  So every time a patient asks the question, “could,” the answer is yes. 

“Yes, your headache could be from stress.”

“Yes, your husband could be suffering from depression.”

“Yes, your son could have ADD.”

Unfortunately, the “could” question often mislead my patients.  While the answer to a problem could be stress, depression, or ADD, often those are unlikely sources of the problem at hand.  Explaining why they could, but are unlikely, is time consuming and stressful for the patient and the doctor.  I particularly hate when a parent asks the “could” question in front of their child.  It is not uncommon to see fear immediately consume the patient’s face.

The question my patients should be asking is, “Doc, what is the probability that stress, depression, or ADD is the problem?”  Differential diagnoses are based on probabilities.  A differential diagnosis is a list of the probable causes for an illness ranked from most likely to least likely or most dangerous to least dangerous.

Knowing what my patients’ concerns are is critical.  Cyberchondria is real and the internet stirs up trouble on a regular basis.  Learning to avoid the word “could,” and using “probable” instead, helps allay a lot of fears!

Could this article help you find the answer to what’s bothering you?  I hope so!

“Doc, I’ve got a migraine.  Can you help me?”  

In February of 2011, I published “Migraine, Its Not Just a Migraine.”  In that article, I advised that patients “Don’t underestimate your headache. Don’t put off seeing your doctor. Please don’t learn to live with it or let it control your life. We have excellent treatments for all types of headaches. When you see your doctor, he will want to know the following things in order to help classify your headache and provide proper treatment options.”

Today’s article covers all those other types of headaches.  Patients tend to refer to any bad headache as a “migraine.”  A migraine is one specific type of headache.  According to Wikipedia, the International Classification of Headaches delineates 13 headache groups divided into primary and secondary headaches.  Today’s article will focus on headaches in the primary group:  migraines, tension-type headaches, cluster headaches, and trigeminal automomic headaches. Headaches caused by cough, exertion and sexual activity, daily-persistent hypnic and thunderclap headaches also fall into this group.

“Doc, I’ve got a migraine” often leads to a wrong diagnosis.  The patient’s self- diagnosis is often quoted in the nurse’s intake note as the patient’s chief complaint.  When the busy doc enters the room, he is likely to review the nurse’s note and then begin taking his history.

“John, I see you’ve got a migraine.  How long have you had the headache?”

“It started yesterday!  My whole head hurts.”

At this point, an experienced doc who has time on his hands would take a full headache history and discover that the patient does not have a migraine.  A busy doc who has patients waiting to be seen, patients waiting to be called, rounds to make at the hospital, and a family he would like to have dinner with might make the mistake of accepting the patient’s diagnosis, coding the visit as a migraine, and then treating the patient’s “migraine.”

Fortunately, the patient’s headache is likely to get better.  Unfortunately, the patient now has a misdiagnosis of migraine which he will carry from doc to doc until someone finally diagnoses his headache appropriately.

Headaches are often complex.  Many patients have several types of headaches lumped into one complaint.  Proper diagnosis of a headache disorder requires a careful history, both taken by the doctor and given by the patient.  Prior to going to your doctor, ask yourself the following questions:

1. How severe are your headaches on a 1 to 10 scale?

• How frequent are your headaches?

• Do you have visual changes?  Do lights or sounds bother you? 

• Where in your head are your headaches? 

• What is the quality of the pain? Piercing? Stabbing? Throbbing? 

• Describe the onset. Does it build in intensity? Is it sudden and severe? 

• What makes your headache worse? 

• What makes it better? 

• Are there associated changes in your ability to think, speak, feel or move parts of your body? 

1. What have you taken for your headache? 

Share your answers, along with your thoughts, about your headaches with your doc but resist calling it a migraine headache.  It may not be a migraine even if you have a long history of migraine headaches.  In August of 2011, I published “Your Doctor, the CSI Tech.”  Like a good CSI (Crime Scene Investigator), keep an open mind and investigate your headache carefully.  

If you have headaches, keep a headache diary. Learn everything you can about your headache by collecting clues. Read about headaches on WebMD and other reliable sources. Once you have collected as much knowledge as you can, see your family doctor. Let your doctor verify the type of headache and discuss treatment options, both for rescue and control. Certain types of migraines may require consultation with a specialist and your family doc will help you find the right consultant.  

The resource page at www.lzftc.com has lots of helpful links to reliable medical information.  Be happy and live “Wellthy” by conquering your headaches.

After spending an entire weekday at home, I am sure of one thing; daytime TV can rot your brain!  Not only can daytime TV destroy brain cells, it highlights the worst traits of the human race.  Jerry Springer, Judge Judy, and multiple other TV personalities parade some of the human race’s most embarrassing individuals in front of their viewing audiences.

If you don’t believe me, channel surf like I did!  It was enlightening and frightening.  This article is all about the frightening side of my day at home.  As I was perusing the channels, I was mesmerized by a commercial segment I happened upon.  During that segment, five different law offices were mining for gold.   

“If you have been injured by the use of surgical mesh, call 1-800-We-Just-Won- The-Lottery!”

“If you experienced a bleed on Pradaxa, call 1-800-You-Can-Get-Rich!”

“If your child was born with a birth defect, call 1-800-Make-A-Fast-Buck”

“If your loved one developed a bed sore or fell in a nursing home, call 1-800-Collect-Millions now!”  

“If you developed a blood clot on Yaz, call 1-800-Screw-Them-Safely-And-Get-Rich.”

Yes, we have a healthcare crisis in the US.  Providing healthcare becomes more difficult and expensive every year.  Doctors are criticized for doing unnecessary tests and practicing defensive medicine.  Defensive medicine and the defense of unfounded lawsuits adds to the cost of care in our country.

Is it any wonder that doctors practice defensive medicine?  Frightening is an understatement when describing these commercials.  To make matters worse, each smiling attorney makes one promise:

“We promise that we won’t charge you anything unless we collect on your claim.”  Yes, you can sue a healthcare doctor for free!  You can roll the dice without any financial risk!  You can play the odds.  Just call 1-800-Increase-Everyone’s-Healthcare-Costs and hope your doc’s insurance company settles rather than financing a winning defense.

Why would they settle?  It’s simple math.  Pay out $50,000 to settle an unfounded claim or spend $300,000 to win in court.  Luckily for me, my insurer does not settle cases.  Fortunately, they would rather spend $300,000 and win.  Unfortunately, the cost of malpractice insurance is shared by every patient seen in this country.

Frightening?  You bet!  The sharks are circling and all of us are the food they live on!

“Doc, I’ve got a migraine.  Can you help me?”  

In February of 2011, I published “Migraine, Its Not Just a Migraine.”  In that article, I advised that patients “Don’t underestimate your headache. Don’t put off seeing your doctor. Please don’t learn to live with it or let it control your life. We have excellent treatments for all types of headaches. When you see your doctor, he will want to know the following things in order to help classify your headache and provide proper treatment options.”

Today’s article covers all those other types of headaches.  Patients tend to refer to any bad headache as a “migraine.”  A migraine is one specific type of headache.  According to Wikipedia, the International Classification of Headaches delineates 13 headache groups divided into primary and secondary headaches.  Today’s article will focus on headaches in the primary group:  migraines, tension-type headaches, cluster headaches, and trigeminal automomic headaches. Headaches caused by cough, exertion and sexual activity, daily-persistent hypnic and thunderclap headaches also fall into this group.

“Doc, I’ve got a migraine” often leads to a wrong diagnosis.  The patient’s self- diagnosis is often quoted in the nurse’s intake note as the patient’s chief complaint.  When the busy doc enters the room, he is likely to review the nurse’s note and then begin taking his history.

“John, I see you’ve got a migraine.  How long have you had the headache?”

“It started yesterday!  My whole head hurts.”

At this point, an experienced doc who has time on his hands would take a full headache history and discover that the patient does not have a migraine.  A busy doc who has patients waiting to be seen, patients waiting to be called, rounds to make at the hospital, and a family he would like to have dinner with might make the mistake of accepting the patient’s diagnosis, coding the visit as a migraine, and then treating the patient’s “migraine.”

Fortunately, the patient’s headache is likely to get better.  Unfortunately, the patient now has a misdiagnosis of migraine which he will carry from doc to doc until someone finally diagnoses his headache appropriately.

Headaches are often complex.  Many patients have several types of headaches lumped into one complaint.  Proper diagnosis of a headache disorder requires a careful history, both taken by the doctor and given by the patient.  Prior to going to your doctor, ask yourself the following questions:

1. How severe are your headaches on a 1 to 10 scale?

• How frequent are your headaches?

• Do you have visual changes?  Do lihts or sounds bother you? 

• Where in your head are your headaches? 

• What is the quality of the pain? Piercing? Stabbing? Throbbing? 

• Describe the onset. Does it build in intensity? Is it sudden and severe? 

• What makes your headache worse? 

• What makes it better? 

• Are there associated changes in your ability to think, speak, feel or move parts of your body? 

1. What have you taken for your headache? 

Share your answers, along with your thoughts, about your headaches with your doc but resist calling it a migraine headache.  It may not be a migraine even if you have a long history of migraine headaches.  In August of 2011, I published “Your Doctor, the CSI Tech.”  Like a good CSI (Crime Scene Investigator), keep an open mind and investigate your headache carefully.  

If you have headaches, keep a headache diary. Learn everything you can about your headache by collecting clues. Read about headaches on WebMD and other reliable sources. Once you have collected as much knowledge as you can, see your family doctor. Let your doctor verify the type of headache and discuss treatment options, both for rescue and control. Certain types of migraines may require consultation with a specialist and your family doc will help you find the right consultant.  

The resource page at www.lzftc.com has lots of helpful links to reliable medical information.  Be happy and live “Wellthy” by conquering your headaches.

Having chest pain?  Please don’t drive.  Short of breath?  Please don’t drive.  Feeling faint?  Please don’t drive.  Is the room spinning?  Please don’t drive.  I am amazed at how many people get behind the wheel of a car when they are physically or emotionally impaired!

Once a week, we call the paramedics.  I guess I should be pleased that patients think enough of my care that they drive themselves to my office rather than calling the paramedics.  I’m not pleased.  It scares the crap out of me.  It’s one thing to underestimate how sick you are and die as the result of your own misjudgment.  It’s quite something else to arrive at the pearly gates with a stranger’s family in tow!

Pass out behind the wheel and the car drives off the road or into oncoming traffic.  What might well have been a treatable illness turns into a disaster of major magnitude.  Having such severe pain that you have to pull off on the shoulder leaves you all alone in your time of need.  I’m afraid that one day one of my most faithful patients is going to literally drive into my lobby.  Don’t let innocents get hurt because you don’t want to bother a friend or call the paramedics!

The paramedics are well trained professionals.  Their ambulance is a mobile intensive care unit.  Breathing is a funny thing.  My patients are always breathing until they are not.  They never know when they are going to stop breathing; it just happens.  It usually happens when they have a severe respiratory tract infection with cough and shortness of breath.  It happens when they are having the crushing chest pain of a heart attack.  The paramedics can breathe for you.  They can successfully start a heart that is no longer beating.  They save lives, yet many people are hesitant to call them.

Don’t be macho about driving.  This is one case where both men and women are alike.  Men can drive when they are half dead just because they are men.  Women are embarrassed to make a fuss by having the paramedics show up.  Dying needlessly is something to be truly embarrassed about.  Driving into a ditch or through a school yard is something to be embarrassed about.  Think about your family, neighbors, and friends.  Call them for help if you don’t think you need the paramedics.  Just don’t drive them off the road when you lose control of your car.

Treat illness like alcohol.  Don’t drive impaired.  Help is just a phone call away.  The life you save may not just be your own; it may well be the lives of the innocent!  

On April 20, 2012, KevinMd published an excellent article by Barbara Bronson Gray, RN entitled “How to create a health culture at home for your kids.”  Since it’s hard to improve on perfection, I have reprinted, below, some of her tips on raising a healthy family:

“Here are some more proven tips for creating a health culture within your family:

• Don’t use food as a reward for anything. Food is about nutrition, food can be fun, food can be celebratory, but you don’t get a candy bar for exercising or a cookie for turning in your homework. People who have learned to use food as a reward tend to develop weight issues and sometimes even eating disorders.
•  Be calm about visits to the doctor and don’t make a big thing about injections or simple procedures. Explain why the “shot” will help them, dry their tears if they cry, give them a hug and move on. Kids will benefit if they don’t learn to associate health care with drama. Don’t reward kids for getting a shot. Make health care a regular part of life.
• Serve balanced meals and avoid fast food.
• Kids aren’t cows; they don’t need to graze constantly. Snacks, if really necessary, should be fruits and vegetables, a small handful of nuts. They should sip water, not juice (because it’s high in calories and natural sugar and can cause cavities without brushing soon after drinking).
• Make sure your kids brush their teeth thoroughly twice a day.
• Set a bed time that ensures enough sleep and stick to it. (You’ll benefit from this, too!)
• Make sure everybody gets 30 minutes of exercise every day, including you. If you can, do things together. Shoot baskets. Take the dog for a walk. Play ping-pong. Grab a bike. Run around the neighborhood. Take a walk. Swim. Rollerblade. (Helmets, please; my only addition)
• Go outside together. It’s far more likely to get you moving than staying between four walls.
• Refuse to start the car unless everyone has their seat belts fastened. Period.
• For teenagers who drive, set an ironclad rule about the car: no talking on the phone, texting, or eating while driving. Period.
• Together, read books and watch videos that teach kids about their bodies and how they work.

Model healthy living for your children: no smoking, responsible drinking, exercise, stress management and active engagement in health care.”