When is it ok to say, “I told you so”? Most of us suppress the urge to say, “I told you so” while trying not to make a friend or relative feel worse than they already do. After all, saying “I told you so” really doesn’t accomplish anything. Or does it? 

Does being right feel good? Most of the time, it feels great to be right. An “I told you so” loudly declares, “I was right!” I guess the polite thing to do is to feel good inside but, outwardly, be sympathetic. 

In my profession, I would rather be wrong about a great deal of things than be right and have to suppress my “I told you so.” Confusing, isn’t it? Let me explain. 

Mrs. “S” has smoked 2 packs per day for the 28 years I’ve known her. For many of those years, I’ve warned her that the price she would pay for smoking would be a life of misery. She ignored me. She felt fine. Her usual refrain was “I have a friend who is 95 and smokes three packs of Camels a day and he is fine. You, docs, just hate cigarettes.” 

Mrs. “S’s” was in the office the other day. She is recovering from pneumonia and can’t understand why she can’t breathe. She is using maximum doses of her albuterol, Spireva, and Advair and just can’t catch her breath. She wants me to do something. Her docs aren’t helping her and she wants me to speak to them. She feels horrible. Brushing her teeth is a chore. 

While Mrs. “S” lungs were marginal before she got pneumonia, she still had enough lung capacity to function. The pneumonia finished the destruction of her lungs she began 50 years ago. Mrs. “S” is out of lung and is going to be oxygen dependent for the rest of her life. Her lifestyle is changing rapidly. She is angry and demands “fix me!” Unfortunately, no one can. 

Sure, I will send Mrs. “S” to another pulmonologist. He will do a full battery of pulmonary function tests and diagnose her with end stage lung disease. He will start oxygen, maybe add pulmonary physical therapy, and switch her meds around. That’s what specialists do. Unfortunately, he has little to offer. Verifying the diagnosis will only serve to reinforce how bad her situation is. 

Mrs. “S” will become sedentary. She still insists she is cutting down on cigarettes and is only smoking 3 a day. I explained that “only three a day” is like saying “I only plunge the knife in my chest three times a day”. Why hassle her now, after all, her lungs are shot! The answer is easy. Oxygen is flammable. 

Mrs. “S’s” heart is strong. Her brain is sharp. She will probably have a long time to regret smoking. She may well end up in a hospital bed and then a nursing home before her life ends. Her treatments will be expensive. Medicare will pick up much of the bill. Eventually, her treatments will exhaust the nest egg she and her husband accumulated. Mr. “S” will become her caregiver. They will apply for Medicaid. 

Even a self-righteous “I told you so” couldn’t make me feel better. I would rather that I had been wrong about her smoking. I would have rather her be able to say, “See, doc, I’m 100 years old, still smoking and still breathing on my own.” That would have been great. Instead, I get to watch a 70-year-old struggle to find her next breath. 

Are you still smoking?

“Life sucks!”  I can’t tell you how many times a week I hear that expression.  I hear it from both young and old.  I hear it from the rich and the poor, the employed and the unemployed.  I hear it coming out of my mouth way too often. “Life sucks!”  

How can life suck?  Life, itself, is a gift.  Life carries with it limitless potential.  Every day you are alive is a day in which you may find success, happiness, love and wealth.  Happiness is a choice!  You can choose to concentrate on the good things in your life or ignore all that you have and concentrate on what you don’t have.

There are multiple articles on this blog aimed at helping you find health and happiness.  “Blessings List” is still my favorite.  Do you have a Blessings List?  You should.  You should accept every day as a gift from G-d and be thankful for what you have even if the only thing you have is life itself.  If all you have is your life, you are rich with potential!

What sucks is going to the wake of a young adult.  What sucks is mourning for the recently departed.  Life doesn’t suck but some days do.

Would you hire a painter and ask him to paint your house blindfolded?  Would you call your auto mechanic and ask him to repair your car over the phone?  Would you ask your attorney to draw up your will without sitting down with him and discuss your needs?  Of course not!

So, why would you call your doc and ask him/her to treat your body over the phone?  There are reasons:

• “I’m too busy.”

• “I’m too sick.”

• “I don’t have the money.”

• “The wait’s too long.”

These are among my favorites!

“But, doc, it’s just a cold!  I don’t have time to come in.  The last time you gave me the Zpack.  I promise I’ll come in if I don’t get better.”

Mr. C’s cold turned out to be heart failure.  Yes, Mr. C has a cough and congestion.  He also had swollen legs, a cough that worsened when he laid down and an EKG that suggested that Mr. C had suffered a recent heart attack.  Caring for Mr. C over the phone may well have been a fatal mistake. 

Mr. C was too busy to come in.  He had lots to do around the house and was having trouble finding time to do it all.  He also was not very productive as he was short of breath and weak. His heart was having trouble supporting any physical activity.

Mr. C was too sick to come in.  He didn’t know how right he was!  When you are too sick to be seen, you really need to be seen.  If you are too sick to come in, it may be time to call the paramedics.  

Mr. C didn’t have the money to pay his co-pay.  Mr. C drinks a lot.  His congestive heart failure is the result of too much alcohol.  At the price of a fifth a day, it’s no wonder he can’t afford to see the doc.

And yes, the wait is too long.  Mr. C called the office to get his Zpack.  The front desk had to answer that call and take a message.  The message had to be routed to a nurse who then called Mr. C to tell him to come in.  The front desk had already told him to come in and he had ignored them, asking to talk to the doc.  Mr. C ignored the nurse’s advice, telling her he was sure that “Stu” would take care of him. (For some reason, patients think calling me “Stu” infers that they are my personal friend.   My friends don’t call me “Stu.”)

Ultimately, I had to call Mr. C.  By the time I called Mr. C, it was too late for him to be seen.  I told him to go to the emergency room.  He ignored me and showed up the next day.  Shortly after being seen, the paramedics picked up Mr. C.  His wait time was short.  Everyone else’s wait time was excessive.

Not only is phone medicine potentially harmful, it is very time consuming.  With the new year comes new deductibles. Patients will try to avoid coming.  Patients will be putting off rechecks and instead, asking for refills over the phone.  Some of those patients desperately need to be seen.  

So, what’s a doc to do?  From my viewpoint, your doc should avoid phone medicine and see you.  I often end articles with a reminder: “The life you save may be your own.”

Do you worry? Does worrying ever keep you awake at night? Does your worry make you less effective at work and home? Does your worrying about this and that accomplish anything positive?

Most people worry. I worry about a lot of things! Worrying about lots of things is usually unproductive and downright unhealthy. Tonight, I saw a patient who was exhausted due to being sleep deprived. He wanted a sleeping pill or something to take the edge off. He stated that when he went to bed (11 p.m.), he couldn’t turn his mind off. He would toss and turn until he finally fell asleep at 2 a.m. Three hours of misery and wasted time.

Mr. W has a lot to worry about. The economy stinks. He has bills to pay. His health is failing. His friends are in trouble. He worries about what goes on in Washington and the Middle East. The list goes on and on. When I asked him what he has been able to accomplish by worrying, he realized that he always worries about the same things. Nothing ever changes.

Years ago, one of my mentors taught me an excellent technique for helping worriers. I told Mr. W that a sleeping pill or tranquilizer was like patching a leaky pipe with chewing gum. Instead, I asked Mr. W to schedule an hour of “Worry Time” every night.

“Worry Time” is the solution to sleepless nights. The first half hour of worry time is spent making a list of everything you are worried about. Once you have the list, divide it into those things you can control and those you can’t. The second half hour of “Worry Time” is spent designing solutions to the problems you are worrying about. The solutions to those problems that are totally out of your control are to take them off your list or give them to someone else to worry about. Once your list is complete, you can go to bed knowing that your concerns have been addressed.

“Worry Time” is only part of the solution. Mr. W’s second task was to schedule a half hour of “Resolution Time” during his morning breakfast. During “Resolution Time,” Mr. W is to start acting on the solutions he designed the night before.

Mr. W’s first impulse was to insist he did not have one-and-a-half hours to work on a worry list, solution list, and resolution action plan. I pointed out that he had been wasting three precious hours every night in unresolved worries. My plan would not only free up one-and-a-half hours but, for the first time, effectively relieve some of his worries. I think Mr. W is going to do great.

So, if you worry a lot, can’t sleep, and never resolve the issues that plague you, schedule yourself a little “Worry Time.” Let me know how it goes. On my list of worries today was writing tomorrow’s article. I can go to sleep now. 

For some reason I cannot fathom, the following article showed up on my phone today.  It appears to have been published on KevinMD in 2016 which would have been around the time I had one of the hardest conversations I’ve ever had with the family of one of my patients.

My patient had a massive MI followed by an equally devastating stroke.  He was in the ICU of a local hospital, intubated as he was not able to breathe on his own.  He had multiple large gauge IV lines, an arterial line and a bladder catheter.

The MI and stroke were not unexpected.  My patient was overweight, suffered from hypertension, high cholesterol and diabetes.  He drank too much and despite all of my warnings, failed to take care of his body and health.

The nurse informed me that the family was waiting in the ICU waiting area and wanted to meet with me.  Family conferences are one thing I was particularly good at, but I was not looking forward to this one.  Telling his children that he was unlikely to recover from his MI and stroke and that, if he did, the chances of any meaningful life was slim to none was going to be very difficult.  Stripping a family of hope is a lousy thing to do.

Nonetheless, it was my job to give them as true of a picture of their loved one’s condition as possible and help them as best I could.   As death was emanate, I also needed to discuss a DNR order so my patient could die in peace.  My patient and I had many prior conversations about quality of life and illness; and, while he told me he was going to sign a living will and DNR papers, he never got around to it.

His family took the bad news well.  They knew it was coming.  They, too, had tried to get him to care for himself.  They knew he was not taking his medications as directed.  They knew he was drinking too much and ignoring their pleas.

Despite everything discussed, they ended the conversation with, “DOC, do everything humanly possible to bring him back.  NO, we want a full code status and will not sign DNR documents!”  I was dumbfounded, got no where after further discussion of his condition and subsequently notified the nurses he would be a full code.

Over the next few days he coded multiple times.  We used every tool at our disposal, added more tubes, broke a few ribs compressing his chest, started tube feedings, etc.  I met with the family again.

As it was apparent that we were not getting anywhere with the family and, in my mind, torturing my patient, I asked his family, “What did he do to you all to make you want to torture him?”  I know that my question was harsh and, for a moment, thought that his eldest son was going to hit me.

He was outraged, proclaiming his love for his father.  He actually eulogized him without realizing it.  “How dare you ask such a question.”  I explained my actions.  I told them that I prayed that he did not feel the pain from the fractured ribs, tubes and intensive care he was receiving.  I told them I knew they loved him but that very love was prolonging his life at great physical and emotional cost.

The answer to the dilemma we were dealing with hit me like a bolt of lightning.  “I have been taking care of your family for many years.  Like you, I want to do everything humanly possible for your loved one.  And we have, save one thing. The one thing we are not doing that we should be doing is letting him go.  I can’t let him go until you give me permission, but I know in my heart that he is ready and willing to meet his maker.”

In the end, the family found some peace in knowing that they did the hardest thing to do, they let him go.  So perhaps the next family who finds themselves in a similar situation will read this and realize that sometimes, the loving thing to do is nothing.  I’ve given you a link to two excellent commentaries on this topic.

Warning, I cry whenever I watch “Ain’t the way to die”

AIN’T THE WAY TO DIE

The family said, “Do everything.”

DEBBIE MOORE-BLACK, RN | CONDITIONS | JULY 27, 2016

Have you seen my friend, Will Power?  Will and I have been hanging out together since I published my book.  Will’s my best friend.  He’s the sensible one, always keeping me out of trouble.  With Will Power at my side, I have flourished.

Today, Will and I walked into the Garden Fresh Super Market together.  Will thought we should stop for lunch first but I was in a hurry to get home and prepare dinner.  On entering the store I noted an attractive young woman standing at a table selling her goods, so I stopped to see what she was offering.  Will was with me one minute and gone the next.  I figured he wandered off for a moment and would return shortly.  Mr. Will Power is a loyal friend; he wouldn’t abandon me!

Anyway, this young woman was sampling a multitude of cheese spreads on delicious, gluten free, crunchy, whole grain crackers.  Any idiot knows not to walk into a grocery store when he is hungry but I figured I was safe since Will Power was with me.  Unfortunately, with Will missing in action, I was doomed!  They sure were delicious.  All seven varieties!

I quickly gained my composure and started searching for Will.  Searching the aisle at Garden Fresh was like maneuvering through a mine field.  One aisle over was another sampling of cheesy treats.  Two more aisles to the north and I was accosted by samples of fresh baked goods.  

I figured Will Power would be waiting for me in the healthy produce area so I ate my way through the mine field, seeking refuge in the green leafy aisles.  They were waiting for me and Will was nowhere in sight!  Taco salsa and guacamole dip and chips tripped me as I turned the corner.  They assaulted my mouth with jalapeño peppers.  Over by the celery was another woman, offering tastes of hot dogs and queso blanco.  I searched for Will while working my way towards safety in the fruit aisle and the hope of getting to the checkout counter without any other treats.

I’m home now.  I’m calling everyone, asking for help finding my friend.  I’m not worried about Mr. Will Power.  He’s tough and can handle himself.  I’m worried about me.  Without Will Power, I’m afraid I’ll fall off the wagon.  I know what they say, “If you fall three times, get up four;” but, without Will Power’s help, it’s going to be tough.

When I find Will, I’ll apologize for not listening to him.  I’ll never go grocery shopping when hungry again.  I’ll also walk right by pretty young women peddling their wares.  

If you see my friend Will, tell him I miss him!

Lose 5 pounds

I’m frustrated and mad, and then I’m pleased and happy.  Then it starts all over again.   I publish uplifting articles designed to help others get through trying times.  I write a book about living a Wellthy lifestyle that has helped hundreds find their way to health and happiness.  So, why can’t I find my way past the plateau I’m currently standing on?  I guess it boils down to the fact that I’m human.

I’ve lost the same 5 pounds seven times now.  Yes, I lose it, then find it then lose it again, then find it again!  Do the math.  I’m up 25 pounds in total since my surgery and retirement.  I should be down 35 pounds (pounds times 7 successes).  So, what can I do?

According to Mr. B’s father, “if you fall down seven times, get up eight!”  The answer is simple. I get up, dust myself off and go back to working on being healthy.  “Success is a journey, not a destination.”  I am on a journey.  

According to the dictates of “Diets and Other Unnatural Acts,” all I have to do is define what my problems and goals are and then refine myself, chicken stepping my way to health.  Let’s see:

1. I need time to exercise more.  Solution –I hate exercise! As it stands, I feel rotten from the time I wake up until the time I go to bed.  Of course, my present state of obesity would make anybody feel crappy.  Time to start exercising.  I’ll start today.  I’ll drive by a gym.
2. I’m overworked. Napping 3 times a day is time consuming and doesn’t jive with #1.  Napping is a full-time job.  Time to retire from my napping job and find something more productive to do.

• I’m overdue for my deposit in my 90-day plan.  Solution – Time to take a vacation from retirement in the midwest.  “Renee, pack a bag.  It’s time to head south.”

See how easy it is to change one’s life and get back on track!  Now, it’s time to lose those troublesome 5 pounds for the last time, and then, five more.

Easier said than done!  These days, everyone is worried! They’re worried about their insurance, their jobS, their parents and just about everything other than the one thing they should be worried about.  That one thing is their health!

You can and will deal with an insurance company.  Sure, your doc may not be in your plan.  Sure, the care you need may not be available to you based on your plan’s restrictive policies.  You may have to suffer with an inferior medication or drive to a distant place for a needed procedure to be covered.  But you will still be free to get the care you need and want by going outside your plan and paying for it!  You haven’t lost your freedom of choice; it just got more expensive to get what you need and want.

I know, your finances are a mess.  Your job sucks.  Everything costs more.  So, what do you do?  One of my friends is a defense attorney.  I once asked him how an incarcerated felon affords to pay his legal fees.  His answer was that the felon can’t afford to pay him.  The felon’s family can’t afford to pay him either, but they do.  They find the money; they mortgage their house, take out loans or whatever they need to do to try to protect their loved one.  Sure, they could rely on the public defender’s office; but, when the stakes are high, they want the best and the best is expensive.

Do you want the best healthcare possible?  If you do, I can tell you where to find it.  It starts at home!  It starts in your kitchen!  What’s in your pantry and refrigerator?  Is it healthy?  If not, pitch it!  Have you ever heard, “You are what you eat?”  It’s true.

Good health starts in your bedroom.  Do you sleep well?  Is your bed comfortable?  Is your room healthy, free from allergens, noise pollution and other distractions?  Do you or your spouse snore?  Are you up all night worrying?

Good health starts in your neighborhood.  Are you taking 30-minute walks daily?  Are you taking long bike rides?  Do you go to the local gym?

Good health starts with your family.  Are you and your spouse getting along with each other?  What about your children?  Are you spending quality time with the ones you love?

The best healthcare is not dependent on your insurance policy; it is dependent on you caring for yourself and those you love.  If you and your loved ones are healthy, then you will rarely need to access the healthcare system.

Invest in self and remember, “A smile is contagious.  Be a carrier!”

Normal is a word I love. It’s great to call a patient and tell him his lab is normal, his chest x-ray is normal, his exam is normal. It feels good to reward someone for being healthy by telling him he is “normal.” 

Normal is a word I hate. It is the spawn of the devil. It makes people feel bad because they aren’t normal. It scares people. It makes people do stupid things trying to be “normal.” 

Years ago, I treated a perfectly healthy, delightful, intelligent and, quite literally, beautiful female patient who felt bad because her BMI (body mass index) was in the abnormal range. Her BMI, a measurement calculated from her weight and height, was in the obese range (according to recognized medical normalcy charts). She was not obese. She was not overweight. Her “normal” was simply different than the recognized norm. She was healthy until she found out what her BMI was and what it implied.

“Normal” is one of those concepts that can be hard get a handle on. In the laboratory, normal values are set by international organizations that set standards, by the laboratory equipment itself and by the population you are studying. If normal range is 80 –100 units and your value is 101, are you normal? It depends on whom you ask. When your doctor orders an EKG, there are excepted normal wave forms. If your EKG has an abnormal waveform, are you normal? Maybe! If you were born with it, it may be normal for you.

I received a phone call from an anxious patient. Her MRI of her brain was interpreted by the radiologist as being abnormal. Her neurologist told her it was normal for her age. Who is right?

Normalcy is subjective. I have spent a great deal of time on this site discussing how remarkably different and unique my patients are. Because people are so individually distinct, each defines normal in a different way. Work at being happy within your own norm. As long as you are healthy and happy, try not to get overly invested in being like others. 

When it comes to medical issues, work with your doctor to understand what each individual test means and how the results pertain to your health. Define how important it is to “normalize” your results. Set realistic goals. When it comes to a disease like diabetes, the closer you are to having normal blood sugars, the better off you will be. When dealing with your BMI, if you are healthy and have no weight related medical problems, relax!

Concentrate more on being healthy and less on being “normal.”

Often, when “high rollers” came into the office to be seen, my stress level would soar. “High rollers are those patients who bet their lives on the premise that they “know their bodies” or they are “healthy”. Their bet is a real one; and, when they lose, they either lose their lives or suffer major losses to health and dignity. No matter what I say or do, “high rollers” insist they understand the risks involved and will live with the consequences of their decisions if they are wrong. The problem is that they really can’t imagine what the consequences of having a stroke or heart attack are until it is too late. They really can’t understand what the consequences of an untimely death are and never will. They will not be here to witness the aftermath.

To make my point, let’s examine two typical, but fictitious, all too real patients. Patient number one is a male in his mid-fifties. He comes into the office complaining of chest discomfort. He has had some “discomfort” in his chest off and on for a few months. “Doc, it’s not bad. Doc, I think it’s my meds or something I ate.” He has significant risk factors for heart problems and I explained that he may well have angina pectoris, a condition stemming from a serious vascular problem with his heart. I advise him to see a cardiologist in the very near future and start him on medication. He states he that is too busy and won’t seek further help or diagnostic tests until after New Years. I warn him that he is gambling with his health and may not see the New Year. “Doc, I know my body! It’s just my medication. It’s not bad! It’s no big deal.” I hope he is right, but I fear he is wrong. I tell him about Tuesday’s article and the cartoon my mother sent me. Would you rather spend two hours of your busy life assuring your heart is ok or 24 hours a day being dead?

Patient number two is a sixty-year-old female who feels perfectly healthy. She just wants her refill and to go home. Because she feels well, she does not have her annual health exam, pap and mammogram. After all, she is healthy! The problem lies in the fact that most people are healthy until they are not. Preventative healthcare’s goals are to find problems and fix them before they find you! Every year I diagnose the earliest stages of cervical, colon, breast, and prostate cancer and eradicate the cancer prior to its devastating course. I find subtle signs of heart disease and stop it in its tracts. Those patients are blessed with the knowledge that they have a curable disease, treat that disease and live long lives. During the same year, I have to diagnose cancers in their late stages and then witness the devastation caused by metastatic disease. I meet patients in the cardiac intensive care unit after a major heart attack and talk about rehabilitation and limitations. The healthy “high rollers” bet that they will always be healthy. Some win, many lose. The loss is often catastrophic. Many are afraid of what I will find if they come in for an annual physical. To those patients I say, “Be more afraid of what finds you than of what you and I find”.

May you be so blessed as to never know what disease you prevented! Have a happy and healthy New Year.