IF ONLY

During the next week, many of us will be busy preparing for the holidays, excited to be with family and friends, looking forward to the New Year.  The New Year brings many things, starting with the New Year’s resolutions.  While most of us look forward to a new beginning, hopeful that things will be better, many spend time pondering about the past and saying “what if?” and “if only I had”.

Thirty years in practice has taught me that ruminating on the past and the “what if” question and the “if only I had” reply is detrimental to your health.  After all, you cannot change the past.  While you are busy regretting past errors, you may be missing future opportunity.  Today, a friend told me that one of the most important moments in her life was when I helped her through a moment of self doubt and self recrimination.  She had made a decision many years ago that had long term consequences for her child’s health.  At the time she made that decision, it was the right decision.  Many years later, it was still the right decision, but when viewed through the “retrospectascope”, could be questioned.

All of us are called on to make decisions on a daily basis. As individuals and parents, who do not have a crystal ball with which to look into the future, we make the best decision we can.  All of us, when looking back in time through the “retrospectascope”, realize that some of those decisions turned out to be wrong, some foolish, and some absurd.  What is critical is to remember they were right at the time we made them.  

When you make a decision that affects you or a loved one, take the time to gather as much knowledge as you can.  Follow your heart and your mind!  Give pause, then decide and carry out that decision with great care.  Later, if the decision turns out to be the wrong choice, live with it.  Learn from it.  Do not do the “what ifs”.  “What ifs” serve no purpose.  They lead to self-doubt, anxiety and depression.  They make you less capable and, therefore, more likely to err in the future.  Residing too long in the past steals your future.  Look forward to the future and all of its possibilities.

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BLESSINGS LIST

BLESSING LIST

Do you ever feel overwhelmed? Do you have too much on your plate? Your husband is out of work. You have a full-time job during the day and you are mom at night. Your parents are getting old. Your house needs work. You have too many bills and your children are needy, whiny and unappreciative. Dinner conversations are all about “needs,” that four-letter word. Life needs balance!

Often, we are so focused on our curses and problems that we can’t see our blessings. By adjusting your viewpoint, you can reduce your stresses and better address your problems. Try this exercise:

  1. Your husband is out of work; you are blessed to have a husband.
  2. You have too much on your plate; you have a table to put your plate on and food to put on that plate.
  3. You have a full-time job during the day and are a mom at night; you are lucky to have a job and blessed with children.
  4. Your parents are getting old; your parents are alive.
  5. Your house needs work; you have a roof over your head.
  6. You have too many bills; I can spend less and live with less as long as I have a roof over my head, food on the table to feed the children and a husband I love.
  7. My children are too needy; they will learn the difference between wants and needs and learn to be appreciative of what they have.
  8. Whiny kids are healthy enough to whine and they will grow up eventually.  

So, make a blessings list. Include everything you are lucky enough to have, everything that makes you smile. Place that list on your bathroom mirror and every morning and night, brush your teeth for two minutes. While you brush your teeth, count your blessings. If you start the day blessed and end the day blessed, whatever happens during the day won’t be too bad. By the way, count the fact that you have teeth to brush as a blessing!

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TOMORROW

Tomorrow

I grew up in a world where “tomorrow” played a critical role in everything you did.  People saved for tomorrow.  People planned for tomorrow.  “Tomorrow” was the day you were going to enjoy life.  “Tomorrow” also was to be feared.  It might be a rainy day and you had better be prepared for the storm.

My parents worried about me.  “Stewart, you’re spending too much on the kids!  You need to save for the future!”   So life’s cardinal rule was to work hard TODAY so that one day you could relax and enjoy life.  

Flash forward to today.  My mother was right, I should have saved more. Today, the economy is thriving.  I no longer have a medical practice. I didn’t save for the future, but I’ll survive.  Many of those that worked every day and saved their money are finding that the value of their labor has seriously depreciated as their health worsened with age.  Over the years many have lost money in the stock market and other investments.  They find themselves in the same place I am, but they never really enjoyed spending their money.  I did!

There are also those patients who are no longer with us.  They died unexpectedly, seemingly without reason.  Their nest eggs did them no good.  They worked every day, year after year, saving for the future.  Then they died!  Oops, no tomorrow.  So what’s a guy to do?  Plan for tomorrow or live today?

I’ve been thinking a lot about this since I’ve gotten older. witnessed young patients die, and others who lose their health and wealth a little at a time.  I think I’ve discovered a great truth.  “Tomorrow” doesn’t exist.  It is a mythical entity.  Confused?  Think about this.  When you got up today, what day was it?  It’s today, of course!  Every morning, when you get up and out of bed, it’s today, isn’t it?  So, if every day is today, does “tomorrow” really exist?  If “tomorrow” doesn’t really exist, shouldn’t we strive to enjoy today?

I think my parents had it wrong.  I think the old American ideal of working every day, day after day, in order to enjoy a mythical “tomorrow” needs to change.  We need to learn to enjoy the day we have!  When I was in Europe, I learned that Europeans think Americans “live to work” while Europeans “work to live.”  I think they have it right!

So, live your life today and every day!  Laugh, love, and share your life with others.  Hope for lots of “TODAYS;” and, yes, save some of your money, but not at the expense of today’s joys.  Remember, a wasted day is a precious commodity that, once lost, is irretrievable.

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EXCESS

One of my readers asked me to write an article on the problem of “excess” and its effect on our health and happiness.  I have alluded to our excess in past articles (refer to November 15 and December 7, 2010, “Four Letter Word” and “Suicide by Food”).  Excesses in food, stressors, nutraceuticals, medications, drugs, electronics, communications and possessions have become the norm in our society.  Those excesses have taken a toll on my patients and their families.

Just prior to Christmas every year, I would treat very successful middle-aged men for depression.  George was successful in every aspect of his life.  He had a beautiful family, four children and a wife.  His family has lived in luxury as my patient was also very successful in the business world.  He even shot in the low 80s on the golf course.  So why was he depressed?  He was affected by the Lexus commercial.  The commercial showed a husband and his son waiting outside in the snow to surprise his wife with a Lexus with a red bow on the roof.  My patient felt that, at his age and station in life, he should be able to give that Lexus to his wife.  He saw himself as a failure despite all of his success because he couldn’t purchase a Lexus for his wife.  

When is enough, enough?  That is an age-old question.  When you have a beautiful family, roof over your head, and food on the table, do you really need a Lexus?  When you are overweight and your weight is harming your health, it’s enough.   In “Suicide by Food,” I reviewed the case of a patient’s excessive food ingestion causing him to go into heart failure and be admitted to the hospital.  When Barrington youth are so desperate as to commit suicide, it’s enough!  In “The Four-Letter Word,” I reviewed how everything has become a “need” and how dangerous being needy is.

My patients stress over everything.  In “Worried Sick,” I reviewed how worry and stress can become a disease and be more harmful than the disease you are worried about.  Yesterday, I wrote about depression.  Work and financial and family stresses are seriously affecting my patients.  Retirement, aging, illness and moving are affecting me.

Throughout this website, I have worked to involve my patients in self-care.  My patients are taking too many medications.  Often, they are on too many medications because of their personal excesses.  I remember working with a patient who had a “healthy” (according to the patient), 1400 calorie breakfast despite the fact that his weight had become a major health issue.

Many of my patients want to be on “all natural” supplements.  Rather than eating healthy, whole foods, they look to the nutraceutical world for health.  They often come in with dozens of supplements (not an exaggeration) none of which are natural.  A few patients do in depth study of their supplements and the companies that manufacture them.  Most do not.

The younger generations live on the internet, Facebook, and twitter.  They text incessantly and are always connected.  They “need” new cell phones, 5G, and Wi-Fi to be happy.  They worry about computer viruses, not the common cold.

So, what can we do?  Maybe I’m not the best person to answer this question.  My children always say that, in the Segal house, the tenant is “Go big or go home.”  I’m currently paying the cost of all of my excesses as I work on downsizing my life. It certainly would have been easier to downsize when I was healthy.  One of my favorite ways of dealing with depression is making a Blessings List. (click on hyperlink) 

Talking about health, wouldn’t it be great to have excess health?  What about replacing Facebook and Twitter with research into appropriate nutrition and exercise.  Try using your smart phone and computer to tract your weight, nutritional intake and output.  What we can do is focus on “Living Wellthy”! 

Also, we can all learn to be thankful for what we have!  Have a great holiday season and a “Wellthy” New Year!

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WISDOM FROM FACEBOOK

Every once in a while, I read something on Facebook that hits home. Are you a glass half full or a glass half empty sort of person. As I age, I see my glass emptying.  Recently, it has felt as if my glass has a gaping hole in it.

Last night I said goodbye to my pinball and Galaga machines.  They had been in my basement for 30 years and have been played by hundreds of kids and adults, including my grandchildren.  While they were full of memories, it was time to part with them as Renee and I prepare to downsize. Today, the estate salespeople are in the house cataloging our belongings.

The Facebook post I referred to at the beginning of this post stated that, if your glass was half empty, you should pour its contents into a smaller glass, leaving you with a full glass.  I’m trying to do just that.  It’s not easy but parting with material goods isn’t really what’s got me down.  Leaving you guys is next to impossible.

Yesterday,Jerry and I reviewed my new house’s electrical schematics in the am, I lunched with Pat, and, on the way to the car, bumped into Alice and got a great big hug.  In the afternoon, Linda called and set up a lunch.  In the mail was an invitation from Lynn and Charlie.  Bill, as always, posted something nice on Facebook.  As I say goodbye to my patients and transition them into the friend column, I realize how much I’m losing, and I cry.

Then I realize how cold it is.  I realize how gray the sky is.  I remember how much I hate Chicago weather.  I feel how bad the cold is on my joints. I think about how much I miss my grandchildren and my family, all living on the East Coast now.   

When life gets you down or is overwhelming and you feel like you are drowning, look for a lifeline. Then grab it and pull yourself out.  I moved to Illinois for an education fully intending to move to the outer banks of North Carolina to set up my practice.  Meeting Jerry, Pat, Linda, Lynn, Alice, Bill and many others kept me in Illinois.  It’s time to complete the circle and settle down in NC.  I’ll take all of you with me on this journey.  I’ll pack you guys up and carry you in my heart.  

And I’ll work on writing more uplifting articles in the future.  I’m downsizing to a smaller, full glass and will be happy.

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CYBERCHONDRIA

I first read the term “Cyberchondria” on KevinMD.com.  I immediately fell in love with the term, as it aptly described a phenomenon I see on a regular basis.  Out of every 10 patients who Google about their healthcare, I get one cyberchondriac.  That one cyberchondriac is miserable, locked into a perceived diagnosis that threatens his very existence. 

ON 12/20/10, I wrote an article about a patient who was so worried she had a disease that her stress was making her sicker than if she actually had the disease she was worried about.  “Cyberchondria” can make you sick.  It can make you sicker than if you actually had whatever it was that you were worried about!  “Cyberchondria” is a very expensive illness.  Google will inform you that you should have a large number of laboratory and radiologic procedures and see multiple specialists.  Google will also give you dietary advice and sells you vitamins, herbs and snake oil. 

“Cyberchondria” is one of those symptom complexes that I hate to deal with.  It is worse than fatigue.  It is a lose, lose situation for me and the patient.  Despite my degree and 30 plus years of experience, Google trumps me every time.  I am forced to admit that my patient “could” have XYZ disease, even though XYZ disease has only been reported in the wilderness of South Africa.  I am pressured into running expensive tests to prove my patient doesn’t have XYZ disease, and once I have proven my point, I am confronted with the other possibility Google mentioned, CDF disease. 

I published “Possible vs. Probable” on October 11th, hoping that it would help patients when they search the internet and explore their health.  I should publish a companion article entitled “Could and Would” as well.  When my patient asks me, “Could I have..?”, the answer is always yes, you could; however it is not probable.  So, how do you prevent becoming a cyberchondriac? 

Be careful when you Google anything.  Google brings you lots of really good information thrown in with lots of garbage.  The garbage is cleverly packaged by experts in marketing and looks so good that I have trouble discerning what is real and what is not real.  I had created a resource page at https://lzftc.com/that offered hyperlinks to the websites I use for research.  Feel free to logon and search!  (The site is now defunct but clicking on the link took me back in time and put a smile on my face.  I hope it does the same for you.)   When you search the internet, try to remember that everything is possible.  What you are truly searching for is the probability that you have a given disease.  

Most importantly, try not to anchor yourself to any diagnosis.  “Anchoring” occurs when you grab hold of a diagnosis so tightly that you can’t see the other possibilities.  “Anchoring” is a phenomenon physicians and patients alike should avoid.  It leads to errors.  

Once you have the information you are looking for, see your physician.  Keep an open mind.  Rely on your physician to help you find the truth and then find a solution.  Do not self-treat.  Most of all do not worry yourself sick!   

Knowledge can empower you.  Knowledge can also cripple you.  Use your newfound knowledge well.  The life you save may be your own. 

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DIETS

I wrote this article February 8, 2015; and with a few exceptions, it holds true today. The most evident exception is in the first line.  What’s a bookstore?  Do they still exist?  The world I live in really is changing radically and I’m feeling older by the day.  Both the bookstores I used to frequent are now medical centers.  Go figure!

The second exception is that, in today’s world, many diet gurus are taking a psychologic approach, using phone apps to track your habits and provide positive feedback and rewards for good behavior.  I like this approach!

I’m on the Weight Watcher’s new point plan which does not vilify any particular foods but instead gives you points to spend on food and a long list of “free foods” that, within reason, you can eat at will.  WW blends nicely with my Live Wellthy non-diet plan.  Its phone app is quite useful.

By the way, I’m on WW because I’m in shit shape.  Between the back surgery, back pain and the Parkinsons, I’ve gained 30 pounds and get very little exercise.  One thing is for sure, you don’t want to “Pity Eat,” and gain 30 pounds.  And, for sure, walk, jog and run as much as you can, NOW!  You don’t realize how precious those abilities are until you lose them!

February 2015

I was in the bookstore the other day and was blown away by how many diet books were on the shelves. Each book proclaimed its plan’s ability to help you lose weight and become healthy. Most of the books turned certain food into villains, banning you from eating some essential nutrient and proclaiming that “medical research” has determined that fat/carbohydrates/protein/gluten/ etc. are bad for you.

My patients, looking for rapid weight loss, eliminate whichever essential nutrient has been vilified and, in fact lose weight. Unfortunately, they gain their weight back (plus some) later. I don’t believe that G-d made bad foods. I believe that we take good foods and turn them into villains in our never-ending quest for culinary satisfaction.

As an example of what mankind does with nature, let’s look at a cucumber. Cucumbers are low in calories (15 cal/100 g) and sodium and high in fiber, vitamins C, A, and K. Cucumbers also are a good source of beta-carotene, one of nature’s beneficial antioxidants; and they contain lutein (recommended by ophthalmologists for ocular health). In addition, cucumbers have diuretic properties beneficial for weight loss and in hypertension.

Now, let’s take a healthy cucumber and soak it in brine and spices, add some sugar and turn it into a spicy sweet pickle. While it tastes great, it’s now full of salt and sugar and no longer a healthy vegetable. Let’s go one step further, coating it in flour and frying it the way they do in the south.

I was just in Atlanta and can attest to how great fried pickles, dipped in a mayo based spicy pickle sauce, taste. Fried pickles are addictive! Fried pickles are also lethal. Greasy and rich in salt and sugar certainly fulfills our culinary needs by tantalizing our taste buds. The cucumber, which once served as a diuretic and lowered our blood pressure, when converted to fried pickles, raises our pressure and increases our weight.

Foods are not inherently bad for you! What you do with them is the real problem. Read “Diets and Other Unnatural Acts” (available on Amazon) and refine your own diet.   (It’s not a great book but it’s an easy read and the concepts presented are important to your health.)Learn how to make a healthy cucumber taste great without dowsing it in salt, sugar and grease.

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FINDING A DOC

Establishing a new life in North Carolina is both exciting and scary.  The scariest thing on the list is finding a new doc.  The public is not aware of how bad things have become for docs in general, but I am.  My Virginia friends were complaining about how hard it is to find a new family doc and that a new patient appointment takes 4-6 months to obtain.

Things are going to be worse here.  In the last few weeks, local healthcare institutions have fired 60 docs, replacing them with nurse practitioners.  Doctor suicides are at an all time high.  ZdoggMD recently did a podcast on the subject of unhappy docs (click on the highlighted words).  Take note of the fact that this brilliant, passionate healer is near tears when he speaks about what has happened to his beloved medical profession.

The really depressing part of his podcast is that he advises his audience (M.D.s) to find what makes them happy and then do it, giving up the practice of medicine.  Unfortunately, despite all the negative changes in medicine, I still loved practicing and would have continued to practice until I dropped.  (My wife pointed out that, in fact, I did practice until I dropped.)

Now, I have to find a new family doc, neurologist, urologist, neurosurgeon, podiatrist, dentist, etc. in North Carolina.  Getting old is a bitch!  I suspect finding my way through the medical maze in Charlotte is not going to be easy.  Afterall, I am looking for an endangered species.  Most of all, I’m looking for a physician who appears to care about how I am doing.  I’m looking for someone in their late 50s with a fair amount of experience under their belt.  I’m looking for an independent thinker who is aware of modern-day protocols but not afraid to ignore them.  I’m looking for someone who listens then speaks.  I’m looking for someone who still loves practicing medicine.  I think I’m looking for a miracle.

Of note should be that I am not necessarily looking for a brilliant physician.  A physician who cares and listens will find the knowledge necessary to take care of me.  One last point, I’m looking for someone who will allow me to be the patient and then lay out his/her plans as if I was not a doc.

I know many of you have been frustrated and have yet to settle in with a new doc.  I want to encourage you to find that new doc while you are well and not wait to find yourself questioning whether the new doc is good or not while you are in the midst of a major illness.

Meanwhile, I have a bad cold.  I don’t want to sound like a baby, but I am when it comes to nasal congestion, cough and just feeling yucky!  Do you want to know the real solution to the common cold?  It’s a secret but I’ll share it with you. Sex!  As much as you can tolerate.  Now, if I could just get a prescription for some and someone to fill it, I’d be on my way to recovery.

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A MOVING EXPERIENCE

Several of my readers have suggested that my recent blogs have been somewhat depressive.  They are right.  Getting old can be depressing.  Getting sick is depressing.  To make matters worst; retirement sucks!

I belong in the office, caring for my patients. I was born to be a doc and there is nothing quite like watching a newborn grow into a man.  Being a family doc is like raising a family of thousands.  Sure, there are tough times.  Patients get old, sick and eventually die.  You mourn for them just as you would a family member and then move on to the next new patient, welcoming him/her into the practice.

I always thought that I would die in my office while caring for my patients.  With that in mind, I wasn’t at all prepared for retirement.  I have no hobbies.  Living the life of a family doc, I never had time to develop hobbies.  I imagined that if I had to retire, I might work with wood. Parkinsons makes woodworking somewhat perilous.  Even as a young man, I stunk at golf.  I used to bowl.  My fused back and persistent back pain make even thinking about bowling a painful experience.

So, I guess my readers are right, my writing can be depressing at times.  I have counseled thousands of elderly patients over the last 40 years, teaching them to accept the losses of aging gracefully while concentrating on what they can do, not on what they have lost.  Frankly, I’m surprised that no one laughed at my suggestions.  Maybe they did when they got home.

Maybe my advice was valid, and I just have to work harder to find my happiness.  Despite the worsening Parkinsons, my life is still full of blessings.  My family continues to grow and thrive.  My youngest has moved to Charlotte, NC.  All of my kids and grandchildren now live on the East Coast.  

My patients are meeting me for dinner and offering to be there if I need them.  Their friendship and kindness put a smile on my face and lifts my spirits.  Pat has been a God sent blessing.  We have a weekly lunch date.  We eat fine food (not good for my diet), laugh a little and spend a few hours solving the world’s problems.  Pat’s transition from patient to dear friend is one of the best things that came out of my retirement.

Unfortunately, my weekly social engagements will be ending all too soon.  I love my house, my pool, my screened in porch.  I love picking pears, sour cherries and apples on my property.  I love harvesting fresh vegetables from my very fertile soil.  I hate the frigid cold, grey winters.  I also miss my family.

Renee and I have bought a new home in Charlotte, NC and will be moving in the spring.  Charlotte is beautiful.  We will be 4 ½ hours from Jeremy in Georgia and Erin in Virginia.  While Charlotte has a winter, it is much milder and sunnier.  The house is in a 55 and older community so hopefully there will be new friends and more for me to do.

Moving away from my friends and former patients will not be easy.  Starting over is both exciting and horrifying!  I HOPE TO SEE MANY OF YOU BEFORE WE MOVE!

In the meantime, if you know someone looking for a beautiful home with a 25 x 50-foot pool, magnificent screened in porch, fruit trees, vegetable garden and fantastic neighbors, contact me.

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FLU SEASON

It’s that time of year again! As the season changes, physician offices around the country gear up for the cold and flu season of 2019. Most of us start getting busier, as congested, coughing and feverish patients flock through our doors seeking relief and, hopefully, a cure.

The medical business world is unlike any other. If you are in the hardware business, you are currently stocking your shelves with snow shovels, salt for the sidewalks, and portable heaters. You are hoping for a frigid winter which will increase your sales, pay your bills, and leave you with a nice profit.

If you are in heating and air conditioning, you are selling preventative maintenance, cleaning and starting home furnaces, and hoping for a frigid winter which will bring you more business and pay your bills.

Most merchants are stocking up on winter gear, looking forward to the type of weather that causes customers to empty their shelves. If you’ve got something to sell, you want conditions to be such that it drives demand, and, with demand, allows you to sell your highest priced goods.

Doctor’s sell health, but the bulk of their profits comes from treating illness. If doctors were good businessmen and women, they would never sell a flu shot, pneumonia vaccine, or any preventative care. The profit margin on a flu shot is minuscule. The profit on a patient with Influenza is tremendous!

Imagine. Your temperature is 103 degrees. Every muscle in your body is aching. Coughing causes searing pain. You can’t stop shaking. You are lying on the table in your doc’s office; your wife is at your side. Your wife is not sick, yet. Hers won’t hit her for another three days. Your doc spends 20 minutes with you. There is a lab fee and an office visit fee. You got to your doc too late for him to effectively treat you. You will be sick for 2-3 more weeks, generating 2-3 more office visits. If you get worse, you may spend several days in the hospital, generating daily visit fees.

Your wife gets sick three days later. Your children get sick shortly thereafter. Influenza is a bonanza for a medical office. It’s better for business than a blizzard is for the merchants in your local town. Influenza pays the bills with plenty of profit to boot!

What’s the best business decision? You decide. Sell flu shots that prevent the flu, take in a minuscule amount of money and safeguard your patients’ health; or forget about the flu shot and go for the bonanza?

Docs are lousy businessmen. They have this crazy notion that their job is to keep you and your family safe. They promote the very shot that stops them from financially prospering. Think that’s crazy?

Here’s something more insane. Patients refuse the flu shot. “I’ve never had the flu! Why should I get a shot?” I hear it all the time. I teach patients about the flu. I tell them the flu is a killer, killing up to 30,000 people a year. I tell them the flu probably won’t kill them. It will just make them wish they had died. They may well miss 3 weeks of work. They still refuse to be vaccinated.

“I had a flu shot in 1977 and it made me sick! I don’t want one.” If you think being sore after the flu shot is sick, wait till you have the flu.

I often respond to the above false sense of security with the following analogy. I ask my patients if they have ever been rear ended by a semi at 40 mph. I point out to them that they buckle up every time they get in the car despite never being forcibly ejected through the windshield because, once struck, it’s too late to buckle up. Seatbelts save lives.

Your flu shot is your seatbelt against being struck from behind by Influenza. Influenza is a speeding semi and I guarantee that, when it hits you, you will feel like you have been catapulted through the windshield and hit the pavement hard. 

Guess what. Many patients still don’t get vaccinated. Too bad for them but great for business! A sick Influenza season pays a lot of bills. Some days I wonder why I waste my time trying to keep my patients healthy.

There are many times my wife doesn’t listen to me or follow my advice. Imagine that. However, she does get her flu shot every year. Thank G-d, that’s one “I told you so” I’ll never get.

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