Month: June 2020

One of my best teachers during my residency, Bill Arnold, MD, caught me criticizing the alternative medicine that one of his patients was using for her rheumatoid arthritis.  Bill explained that when there were no conventional treatments available, I should consider the use of less understood and studied alternatives.  

When you are out of options, considering “alternative medicine” makes sense. “Considering” does not necessarily mean using!  In considering the use of an approved treatment, your doc needs to weigh whatever evidence exists, the quality of that evidence, the known risks and drug interactions, to list just a few of the things that go into making a therapeutic decision.

In the early days of my practice, Bill’s advice was golden.  The internet changed everything.  The internet now spews a lot of really good sounding but lousy advice.  If you are trained in scientific research, it is easy to assess the quality of the information you are given.  To the untrained mind, assessing quality is next to impossible.  When dealing with nutraceuticals, assessing risk and drug interactions is also impossible.

Making matters worse, the internet sites pushing alternatives claim that doctors will not tell you about their products because doctors supposedly are shills for big pharma and pharma won’t manufacture their product because there is no profit in “natural” products.  Check out the profit statement of some of these “all natural” companies and the number of zeros will amaze you.

None the less, the medical system in our country is screwed up and makes most docs easy targets.  Unfortunately, the internet is winning, and more and more people are turning to unproven and sometimes dangerous alternatives when there are perfectly safe, conventional cures to be ad.

My music choice today is ZdoggMD’s newest music parody and its message is really good.  Just click on the underlined ZdoggMd above.  I’m sure he gets plenty of hate mail in response to his podcast.  From a personal point of view, receiving hate mail hurts and the anti-vaxers can dump an avalanche of crap on anyone who calls them out!

Here’s your joke for the day:

Every weekend I say, “Bob, you really need to stop drinking.  Luckily, I’m not Bob!”

Yep, it’s a whole new world. Covid-19 has changed everything.  It has created the need for social distancing (which is a very bad thing).  Humans need human contact. I know I do.  Why has the habit of shaking hands lasted centuries?  Why does a true hug feel so good? It’s easy to answer these questions.  Human touch and affection are a necessary part of a healthy life. Covid-19 denies us that contact.

It also distances us on an emotional level. Covering your face hides the facial signs we unconsciously use in communicating with others.  Joy, sorrow, empathy and hate are all hidden under that damn mask we are forced to wear to protect ourselves and others.  So, what can we do?

I think we should be developing “PODS.”  PODS represent People Of Distinct Safety, a group of people with similar risk mindset and respect for Covid-19 precautions with whom you can socialize, hug, shake hands and whatever.

By agreeing to a set of rules, PODS members can become your new social club.  Whereas, in the past, social clubs formed along the lines of ethnicity, hobbies, religion, etc. my proposed club would be formed around your approach to Covid-19 with the express goal of restoring human touch and closeness to our relationships.

A person who does not believe in any precautions would form a group with like-minded individuals and live as he/she has always lived.  An elder with high risk issues, such as mine, would form a club where the members masked whenever in public or with strangers, incessantly wash their hands and wiped down surfaces with antiseptics.  They would pledge to avoid risk takers and only have physical contact with the members of the group.

Is all this really necessary?  Unfortunately, I think it is and I think it’s going to be even more important in the future.  Covid-19 could have been or could become much worse.  Future pandemics may well involve more lethal characteristics.    Our number one weapon will always be social isolation and, as stated above, social isolation carries its own risk.

Oops, I promised not to be depressing.  So, look at the bright side.  You can socialize and fulfill your need for human touch by associating with those of a similar mindset and a pledge to abide by certain rules.

Here’s your music for the day.  Here’s a joke to make you LOL.

A man was in his front yard mowing grass when his attractive blonde female neighbor came out of the house and went straight to the mailbox. She opened it, then closed it and went back into the house.

A little later she came out of her house again and went to the mail box. She opened and shut it again. Angrily, she went back to the house.

As the man was getting ready to edge the lawn, she came out again, marched to the mail box, opened it and then slammed it harder than ever.

Puzzled by her actions, the man asked her: “Is something wrong?”

To which she replied: “There certainly is! My stupid computer keeps saying: ‘You’ve got mail!'”

Yesterday, I mentioned that I trained in Mexico.  At first, I was embarrassed to tell people I trained in Mexico.  I hated taking classes in Spanish and hated the professors who refused to speak to me in English even though I knew they were fluent in English.  Their attitude was that asking them to speak English was an insult.

Looking back at those years now makes me proud to have gone there.  I am grateful to have had the experience of living in a foreign country and learning a new language and lifestyle.  My Mexican education was a gift I could not have gotten in the US.  

I found that the majority of the Mexicans I came in contact with were family oriented, caring, hard working individuals.  As a student, we would go out into the countryside and set up temporary clinics for a week at a time.  We would be assigned a hut made from dirt with dirt walls and ceilings and handed a broom to start the day.  Imagine that you are dressed all in white and the first thing you do is sweep dirt, a lot of dirt.  Then we collected old medications from the town folks and set up our pharmacy.

On occasion, we ate lunch with the patients we treated.  If there was a piece of meat on the table, the host insisted that it be given to me.  Once, driving into Guadalajara, my water pump died.  I broke down in front of a dirt hut where a family of six lived.  Roadside assistance eventually fixed my car and filled the radiator with water from a rusty oil barrel.  I turned to my passenger and said, “I don’t want that shit in my car,” at the same time one of the kids scooped a cup full of the foul liquid and drank it.  They were actually giving me their drinking water.  I will forever be indebted to my Mexican hosts for giving the education I needed to practice medicine in the US.

My granddaughter is driving my daughter crazy.  She is at the age when every other word is “Why.”  “Why” is a major word/concept in the US.  It is a word you rarely use in Mexico.  The word for “why” is “por que.”  The word for “because” is “porque.”  When you ask someone “why” you answer your own question, “because.”  Por que?  Porque! 

Unless you’ve lived in another country, you don’t realize that the way we think is not necessarily how others think.  Understanding that what I think and how I react is not necessarily how you are going to think/react was probably the most important thing I learned from my four years in Mexico.

In order to do well in medical school, I had to assimilate.  I had to learn the language and customs of my host country.  To do anything less was considered an insult.  So, why don’t we expect our Mexican immigrants to learn our language and customs?  Obviously, the answer is “porque.” It’s sad, but rather than help them assimilate, we bend over backwards to learn their language and respect their culture.  

Here’s today’s song and joke.  

I owed you an article yesterday, but the day got away from me.  Ever have that happen.  When I was working in the office, the day never got away from me.  I was smart and designed a “no appointment necessary” practice so when I walked into the room, I was on time! 

No appointments meant I was always on time.  I loved it as did most of you.  In everyday life, I’m so timely I drive my wife and family nuts.  If I’m supposed to be at your house at 7 pm, I’m cruising the neighborhood at 6:50 knock and on your door a seven. Unfortunately, doing “well care” on a walk-in basis did not work well so I eventually added a limited amount of appointments.

When I added Concierge Medicine to the practice, I added more appointments but started them prior to opening in the morning so I could be on time.  All was well initially but, as the practice aged, the need for appointments increased.  Like well care, taking care of chronic disease is better achieved by appointment medicine.

As you can see, there is no perfect practice style that fits everyone and that is the point of this article.  Customization is the ideal in medicine, dieting, exercise and just about everything.  Unfortunately, in medicine, it is next to impossible.  If you practice by appointment, you either stick to the schedule cutting appointments off when necessary, or you run late.  If you practice walk-in medicine, getting the patient back for the follow up appointment is like pulling teeth.  

That reminds me of a story. In Mexico, the dental students worked alongside of us (the medical students).  They were almost all females, and most were too weak to pull a tooth out, so they had us help them.  It seemed like the treatment for every dental complaint was to pull the tooth so we got a lot of experience.  Needless to say, there were a lot of toothless people wherever we went.  The cost of doing the same thing for everyone in Mexico is losing your teeth (the hard way)!

I’m 2 pounds down in 1 week and doing well.  It’s not easy. I’m customizing my diet, tailoring it to my new lifestyle and environment.  I miss my Chicago favorites but being away from them helps.  I’m going out of my way not to make new Carolina favorites.  I’m getting a lot of support from my readers and I want to thank you all.  I will keep you appraised of my successes and failures.

Now to find a doc who customizes his/her practice to the patient’s needs.  I need some one who will listen to me.  I need someone I can be comfortable listening to.  While I would love to find doc who is on time, I’m too old to believe in fairy tales.  I’m working hard at being positive.

Here’s your music for the day.  Click on underlined words for song. Here’s your joke of the day:

Mickey – “Teacher, do farts have lumps.”

Teacher – “No Mickey, farts are not lumpy.”

Mickey – “Then I shat in my pants.”

I’ve talked a lot lately about balance.  There are times where being able to hold your balance is critical. I’ve been doing OK balancing the losses of leaving home to the rewards of establishing a new home.  Renee and the kids and grandkids have done a lot to keep me on my feet as well.

My Parkinson’s is worse.  I have more off time than on time.  It’s going to be time to find a Carolina expert and be a patient again.  I hate giving up my role of doc and taking on the role of patient, but it’s time to do both.  I’ll let you know what the patient experience of an old doc is as I learn about it.

Today’s article is about the loss of balanced caused by Covid-19 and how to restore it. As you know, Jeremy and family are visiting from Georgia. Lisa and family lives here.  Last night Renee and I had a full house and it was great.  Late in the evening we were all feeling no pain and playing a game of Sequence.  As usual, plans for a beach get away were discussed; we actually may be able to do it now that Renee and I live closer to the coast.

Anyway, I had mentioned that one of my favorite restaurants (I know I’m dieting) was Mrs. Wilke’s in Savannah and we should all plan to eat there together.  When asked what was so special about Mrs. Wilke’s, I explain how you are seated at a table of 10, sometimes with strangers, and 20 of the South’s most famous dishes are placed on the table in front of you. Dinner is served communal style. I was in the midst of a semi-orgasmic memory of the feast we had at Mrs. W’s when my daughter pointed out that NO RESTAURANT WOULD EVER BE ABLE TO SERVE THAT WAY IN THE FUTURE.  

That thought knocked me off my feet.  As usual, she was right. If Mrs. W’s offered to seat me with 10 strangers today, I would say she was nuts.  If a restaurant put 20 of the most amazing, savory, comfort foods in front of me today, I would struggle with not eating any and walk away.  One of the wonders of the world just disappeared (at least for a while).

So, when the world around you has gone crazy and become dangerous, how do you remain balanced?  I’ve decided that the answer is to make your world smaller, encompassing the family and friends you love and who make you happy.  Limit the intrusion of the outside world by limiting the background noise spewing from your TV and smart phone.   Most of all, make new memories to use when your old memories become too hurtful to experience, as they came from a different world that no longer exist. 

Here is your music for the day.  There is no joke that would suffice for today.

Yesterday I read something profound on Facebook. “Life is 10% what happens to you and 90% how you react.” — Charles R. Swindoll

I’ve heard it before but this time it really hit home. The world we live in has changed dramatically since Covid-19 struck.  I know that you don’t need me to tell you that.  The changes are evident wherever you go.

What I want to review today is Mr. Swindoll’s statement.  “LIFE IS 10% WHAT HAPPENS TO YOU.” Right now, the 10% he refers to is Covid-19 and it is happening to all of us.  What’s truly important is the “90% HOW YOU REACT.” Here, we all differ.

Jeremy, Allyson and RJ are visiting and helping make my new abode a home.  Last night we ordered take out from a local restaurant.  The place was mobbed, and we had to wait about an hour past the time they told us the food would be ready during which time 30 or so individuals picked up their dinners.

Of the 30 people I witnessed coming, some wore mask, and some didn’t.  Some kept proper social distances, and some didn’t. Some pushed passed the crowd and went into the restaurant, and some didn’t.  As per the usual, the people I saw acted as individuals as expected.  The problem is that acting as individuals is no longer a good thing when it comes to Covid-19.

We desperately need to isolate and destroy Covid-19.  At the same time, we need to open our community and businesses and establish a new norm.  To be successful, we need to be adult enough to follow the rules.  

We need to mask when in public.  We need a reliable source of certified appropriate mask made in the USA.  We need to learn how to properly use and maintain our mask.  We also need to learn how to communicate while wearing a mask as facial cues, integral to good communication skills, are lost due to the mask.

We need to establish our personal space; a 6-foot circle of protection.  People need to recognize and preserve their space and the personal space that belongs to others.  Life has to slow down a little.  Pushing past others to get to the front of the line has to stop.  I’ve always said that something good has to come from something bad in order to lessen the bad.  Slowing down and respecting other’s space will be the “something good.”

The 90% how we react is going to decide how fast we clear the Covid-19 attack and how safe our families and friends will be.  We cannot lapse back into our old ways and assume that Covid-19 will respect our personal space.

Bear with me for just a few minutes more.  Yesterday, I had made an appointment for a massage.  My miserable back calms down after a massage and I haven’t had one since February.  I cancelled that appointment!  I realized I was about to spend 60 minutes in close contact, in a closed room, with someone I didn’t know.

It dawned on me that my masseuse was an individual who might have gone out into the world without a mask.  She might not maintain her personal space.  She might have asymptomatic Covid-19.  

My doctor side kicked in!  In the early days of my practice I treated more venereal disease than in the latter days of my practice.  Why the discrepancy?  Over the years, we learned how to protect ourselves from sexually transmitted disease.  Those who practiced safe sex did well.  Those who didn’t suffered the consequences.

Practice safe sex (hopefully often).  Practice safe Covid-19 rules all the time!

Here’s your song and joke.

“When I was a kid my dad sat me down and showed me pictures of why I should always wear a condom,” a man told his buddy.

“Your dad showed you pictures of venereal diseases?” the friend asked.

“No,” the first said, “they were all pictures of me.”

In a recent article, I wrote about how important it is for adults to keep a little of their kid alive in themselves.  Today, my inner child came out to play and it felt good.

My bed in a box came today.  It’s a Restonic mattress that carries “The Property Brother’s” logo.  Renee and I are fans of their show.  Having never seen a bed in a box, the kid in me was excited when it was delivered. The box was large and heavy, and I should have waited for Jeremy and Allyson to get home but Renee and I wanted to experience our new bed so we shimmied it into the bedroom and onto the bed frame.  It was kinda like Christmas morning and we weren’t about to wait.

It was also really neat, almost miraculous.  On the bed frame was an unidentifiable mass covered in plastic.  When the plastic was removed the seemingly useless mass started to grow, becoming markedly larger and full. As the mattress erected itself into a useful bedroom necessity, all I could do was marvel at the whole process.  

It really was cool, reminding me of other such miraculous transformations I have witnessed over the years.  It’s important to keep some of your inner child alive.  Only then can you recognize the miracles that surround us every day.  

Renee, my inner kid wants to play.  Want to join us?  Alexa, play a love song.  Our new abode is becoming a home.  

On another subject, I watched a ZdoggMD podcast this morning.  Walgreen’s fired a pharmacist (MAURICE SHAW) because he started doing stand-up comedy during his time off.  It was a fascinating podcast; and, as I have said in the past, we ought to boycott Walgreen’s.  We need more humor in this world and this guy is funny as he introduces you to the difficulties pharmacists encounter on a daily basis.

Here is your song for the day and, of course, a joke.

Life is like a penis; long, soft, free and flowing until a woman comes along and makes it hard.

SO FAR, SO GOOD

I’m so busy moving in that I don’t have time to be homesick.  I’ve got to admit, this is easier than I expected.  The diet is also. In Chicago, every other block presents a restaurant with exceptional food.  You can’t drive by a Lou’s without thinking about eating a slice of deep-dish pizza and a salad. Then there is the Asia Noodle House with its fried Udon dishes, Kaufman’s for deli and the list goes on and on.

I’ve yet to explore the food opportunities in Charlotte and as long as I don’t, I’ll avoid the cravings, making my diet easier to follow.  I’ve fallen in love with the air fryer.  Its easy and does not heat up the house.  Last night I had panko crusted flounder fried without oil.  It was pretty good.  Fried fresh apples are phenomenal for dessert.

Slowly but surely, our house is becoming a home.  Today we are concentrating on hanging pictures. As I’ve previously said, each picture has a story and watching those stories unfold as we hang the pictures brings a smile to my face.  Each picture hung makes this place more like a home. I bought a picture today that I really like.  It makes me feel like I’m at the ocean and I always imagined that I would live by the ocean.  It’s definitely too big for our small abode but I don’t care!  At my age, I don’t have to be conventional.  Unfortunately, Renee is conventional and is not going to like it, so we’ll probably take it back.  What do you think?  If it looks a little distorted it’s because it’s wrapped in bubble wrap.

Jeremy, Allyson and RJ are coming this weekend.  I’m excited and can’t wait to play with RJ.  Due to Covid-19, it’s been entirely too long since I’ve seen them.  I expect we will be heading to Atlanta soon, so I’ll get a double dose of Jeremy’s family.

I’m going to take a nap now.  Our fire alarm went off at 1 this am and beeped the rest of the night.  It’s sad but true that “quality” and “pride” are two words that no longer exist when it comes to manufacturing.  Most of the furniture that we bought arrived with factory defects and has to be replaced.  The fire alarm is only 2 months old and already, the batteries are dead. Sorry, I’m bitching.  I promised myself I’d be upbeat and, I am.

Here’s your music and joke of the day:

Quality control at a Whack-a-Mole factory

…Is either hit or miss

Unfortunately, the jokes on us!

.

I’ve spent a lifetime making decisions for others.  Many times, the decision I made had life or death ramifications.  As a doc, it was my job to make those decisions and I made them if I wanted to or not.  Right of wrong, the weight of the decisions I made rested on my shoulders.

When I wasn’t playing doc, I avoided making decisions as much as possible.  I left most decisions to Renee whether it was fair or not.  She understood and took on the responsibility of running the home and business.  At times, I suspect my children wondered why I turned to their mother to make pretty much all family decisions.  I’m sure I appeared “whipped.”

The wonderful part of our marriage is that we seem to innately know what each other wants and make every attempt to fill those needs.  Sometimes we miscommunicated as do all married couple.  One of those instances involved a picture of a mother and her young daughter.

When we packed to move to NC, I realized that every piece of art in the house had a story to tell.  In my second year of residency we went to an art auction with one of my professors.  There was a beautiful piece by Vickers and I bid $350.   At that time in our lives, $350 was a small fortune.  I saw what I thought was a look of disapproval on my young wife’s face, so I stopped bidding and it sold for $450.  After the gavel came down, she asked me why I quit bidding.  She wanted that picture despite the expense but wasn’t willing to make the decision to buy it on her own.

To make a long story short, I found an identical piece at a gallery in New York and bought it.  I learned two things that day. Number one was that no matter how sure I am of what my wife is thinking, I had better verify it.  Number 2: If she is responsible for all non-medical decisions, I don’t have to worry about them.

Now that I’m retired and we have moved, we are sharing decisions more equitably.  I can tell you I don’t like it.  Making the decision to send you to surgery or not was nothing compared to where we buy the TV for the family room and whether we buy a brand name or not.  Even worse is deciding which towels we put in the guest bathroom.

Being retired is so stressful. I think I’ll take a nap! Do I nap in the family room or on the porch?  Renee, can you decide for me?  I’m tired.

Here’s your music for the day, as well as a joke:

What do you call two fat people talking?
A heavy discussion.

Two hundred and twenty-three massive pounds.  How is that possible?  I thought 165 pounds was too much.   Gaining that much weight was a long-term project.  It was a thoroughly enjoyable project with foreseeable major consequences.    My love affair with food has to end.  It’s going to be a messy divorce.  In the end, the nation’s food supply will be safe from my voracious appetite.

I’ve decided to follow my own advice and create a “Wellthy” plan.  I’m going to work on being positive about losing weight and not focus on all the luscious foods (stop that now,Stewart, I know you are thinking about Nothing Bundt Cake) I’m going to have to give up.  I know I teach that we never have to give up anything.  I preached that we simply have to cut back on/modify how we address food.

Are you old enough to remember the commercial that proclaimed, “I bet you can’t eat one?”  I am, and I lose that bet.  My children always said that in the Segal household, it was always “go big or go home.”  They were right.  One is not big.  One whole bag is!  In my case, it’s better to just not open the bag!

So, how is this going to work?  That’s the easy part.  I post my weight weekly and either I succeed, or I embarrass myself.  In other words, I put my money where my mouth is. While eating five-dollar bills doesn’t sound appetizing now, it may in a few weeks (maybe with some chocolate icing).  Yes, it’s best to keep a sense of humor abut such a grave matter (if I don’t, I’ll cry).

By the way, I want to thank one of my friends for sending me the air fryer.  It’s a marvelous device and will help me prepare new lower cal recipes

without sacrificing taste.  I’ll take any and all the help I can get in my long journey back to health and Wellth.  Being realistic, it’s going to take a year.  As I succeed, I hope others will join me and share their successes as well.

Here’s your music for the day.  Remember to click on the underlined words.  Here’s your joke:

What does one saggy boob say to the other saggy boob? If we don’t get some support, people will think we’re nuts.

Under the heading of jokes, I’d like someone to explain to me how you defund the police. Does defunding the police mean I can go 110 mph on the interstate?  Does it mean I can help myself to whatever I want as long as my gun is bigger than yours?  Who enforces the laws of the land?  I’m too old and fat to be a vigilante. 

Do they make diet MREs (field rations/meals ready to eat)?  It’s time to buy some.  Defunding the police can only lead to further chaos.  Maybe I should just enjoy eating and not worry about my weight.  Nah!  Got to get in shape now!