Month: July 2020

I usually agree with Zdogg and enjoy his videos.  On July 4^th, Zdogg posted “Should We Try To Save Everyone.”  In his podcast, he refers to a “Culture of Safetyism” and the consequences of such a culture.  At the beginning of his podcast, he freely admits that the topic is controversial.  He clearly states the obvious: people are going to die!

He goes on to discuss the risks associated with shutting down society and ends by reiterating the need for face masks, social distancing and hand washing.  In my opinion, the gist of this podcast is to do what you can, within reason, and people are going to die.  He uses an iceberg analogy (what you see is the tip of the iceberg, what you can’t see is the bulk of the iceberg which is hidden under water) to illustrate the risk of shutting down the US economy again.

What I disagree with is the general premise that ‘PEOPLE ARE GOING TO DIE.”  I would have worded this differently. I would say, OTHER PEOPLE ARE GOING TO DIE BUT NOT MY FAMILY OR ME.  

I agree, we should not shut down our society again.  It didn’t work the first time and it won’t work this time.  However, just because the US stays open doesn’t mean I have to.  I’m shutting down the Segal Household.  I’m not worried about the risk of alcohol abuse, spousal abuse or child abuse (although I occasionally drive Renee crazy) that Zdogg talks about.  I’m worried about dying alone in an ICU in Carolina.

I think you should be, too.  If you can afford to shelter in place at home, do so!  If you can’t, do whatever you have to do, as cautiously as you can.  Just don’t pretend that this isn’t real.  Don’t pretend that statistically it won’t hurt you or your family.  Don’t pretend that because you are young, you are safe.  YOU MAYBE YOUNG BUT YOUR PARENTS AREN’T.

As to what I think about a culture of safetyism, I’m still trying to figure out what it is!  If it’s founded on the premise of better safe than sorry, I’m onboard.  Are you?

Did I tell you I occasionally drive Renee crazy?  I’m about to do it again.  Renee, I’m bored.  Can we play a game?  I’ll be the doctor (and that’s my joke for today).

Here’s your music for today.  We need a catchy commercial for Covid-19 protection.

I am!  I read spy novels.  In the books I read, the hero is an ex-special forces soldier who saves the world by tracking down the bad guys and foiling their plot!  

The bad guys often plot to destroy the world with biologic or chemical weapons.  Often, the bad guys’ scientist will have figured out how to aerosolize a virus or bacteria and how to deliver it to its target. The authors of these books use the words aerosolize and weaponize interchangeably. 

Yeah, it’s fiction and the good guys almost always win.  Don’t they?  If you are a sci-fi fan, you know that sci-fi of the past often becomes the reality of the future.  Are we living in the real version of the book I’m reading?  It seems that we are actors in a thriller/horror story in which the bad guy is winning!

This am, NBC is reporting that scientists now believe that Covid-19 is aerosolized, meaning that it’s not just transmitted by large droplets alone, but also by tiny droplets.  CNN is reporting that early studies suggest that infection does not necessarily confer immunity.  ABC is reporting that the numbers of hospitalizations are increasing.  CBS reports that Arizona is out of hospital beds.

Scare?  Hell, yeah!  I’ve never seen anything like this before and I spent 40 years treating viruses.  Have we been attacked?  Most definitely!  This virus continues to attack us and it’s winning.  We need to fight back, and the first step is taking this seriously.

In a previous article, I discussed the chances of a lightning strike killing you and raised the question, “Would you stand outside in a lightning storm holding a lightning rod?”  Obviously not!  Ignoring COVID-19 is like standing outside in a lightning storm holding a lightning rod.

I’m coming in and getting out of the storm. LITERALLY!  Renee and I are going to honker down, going out for essential items only.  It’s back to home food delivery and Amazon.  We will carefully assess those people we come in contact with and try to establish a POD of friends with similar health habits.

It’s time to pull out my surgical masks and hunt for N95 masks.  If COVID-19 is truly aerosolized, it should be considered to be weaponized.  While the data looks like cloth masks help, I want the most airway protection I can get.  Of course, if I isolate myself, I don’t need a mask.

There will be those who will call me an alarmist.  I AM!  I’ve saved many lives over the years by being an alarmist.  In the office, “doc, I’ve got chest pain” almost always set off my alarm and the trip from my office to the hospital by ambulance is what saved my patients’ lives.  My patients often were adamant that they were fine and didn’t need an ambulance. Some protested strongly!  Some refused to go.  Those who went lived even if they had a bad heart.

I always told my patients the same thing.  “I’ll be happy to be proven wrong!  I’ll be happy to apologize for making you go to the hospital by ambulance as soon as I know your heart is fine.”  I was funny like that.  I liked being proven wrong because proven right meant you were sick and in trouble!

I really want to be wrong about COVID-19!  Unfortunately, I’m right and it’s back to being shut ins.  It’s going to be boring.  You can only put on a mask and play doctor but so often before your wife quits the game.  Got any ideas about two-person fantasy games that shut ins can play?

Seriously, go home and stay there.  Weigh your contact decisions against the risk of being infected by COVID-19 and passing it on to family, loved ones and friends. 

Here’s your music for today.  Be careful who you let in.  Here’s your joke.

What’s a 6.9?  Another great thing screwed up by a period.  (I know, I’m pushing it but I’ll be 69 in a few weeks.)

I want to tell you a true story but first, a little background.  For the purposes of this article, I want to assume that all cases of dementia, regardless of their cause, eventually end up in the same place.  While there are always outliers and exceptions, the vast majority of the dementia patients I treated over the years could be broken down into two categories; happy dementia and paranoid dementia.

Mrs. “X,” a 78-year-old delightful female I had the pleasure of caring for 20 years, was in the 4 final stages of dementia.  She was in the “happy” stage of dementia and she smiled at everything.  Unfortunately, her dementia continued to worsen and, on this particular visit, she didn’t know me.

Her devoted daughter was with her at every visit and lived to care for her mom.  Mrs. “X” had a cough and fever so her daughter brought her in.  A careful history and exam led to a diagnosis of pneumonia and discussion of her treatment options and long-term prognosis.

Me – “Your mom has pneumonia and we’re going to start her on antibiotics.  If her condition worsens, she’ll need to be hospitalized.  I should see her in 2 days to evaluate how she’s doing.”

Daughter – “Can you call the prescription into Osco?  Can I give her any cough meds?”

Me- “Absolutely, you can give her Tylenol and Mucinex if she needs something.  I’m more concerned about her dementia.  It’s getting worse; and, as we’ve discussed before, at some point you should consider withholding treatment and letting nature takes it course.”  

At this point, let me interject the fact that this is one of the most difficult conversations a physician can have with a patient and their family.  It was particularly difficult in the case of Mrs. “X” as she and her daughter were both delightful individuals who always brighten my day.

Daughter – “She’s so happy!  She’s always smiling!  We need to do everything humanly possible to keep her alive.”

Me – “I know she’s happy.  What scares me is that the vast majority of patients I’ve cared for eventually transition to the paranoid stage of dementia.  If we keep them alive long enough, they no longer know you and your family.  They no longer can be cared for at home and end up in a nursing home, in restraints and on heavy doses of medications.  It’s not fair but it’s reality.”

Daughter – “We’ll deal with it when we get there.  For the time being, I want you to treat whatever you can treat.”

I agreed with reservations.  My number one reservation was that Mrs. “X’s” dementia was progressing and there was nothing that could be done to stop it.  Reservation number two was that Mrs “X’s” daughter had no idea how bad the paranoid stage of dementia could be!

Me – “When she’s better, you should start interviewing memory centers as eventually you won’t be able to manager her at home.”

Daughter – “I’ll think about it.”

Me – “I worry about you as much or more than I worry about your mom.  If I can help you in anyway, let me know.  Aren’t you do for a BP check?”

I hate nursing homes and every time I had to place a patient in a nursing home, it broke my heart.  My family knows never to put me in a nursing home.  If things get bad, I’ve instructed them to withhold treatment, put me in hospice and let me die at home.

Back to Mrs. “X”.  She recovered nicely from her pneumonia.  She developed recurrent pneumonias from aspiration of food particles and an incompetent cough.  She developed recurrent urinary tract infections as well.  Overall, she responded to treatment and remained in her happy state for the next few years.

Then it happened.  Right off the pages of a Steven King novel, she developed paranoia.  She complained bitterly that her daughter never visited her.  She couldn’t understand why her daughter abandoned her.  After all, she was a good mom, wasn’t she?  During this time, she was still living with her daughter.  Her daughter was in the exam room with her at every visit.  When I pointed this out to her and introduced her to her daughter, she became agitated.

Mrs. “X” – I DON’T KNOW WHO THIS LADY IS BUT SHE’S NOT MY DAUGHTER!  SHE’S NOT NICE TO ME!  SHE MAKES ME TAKE PILLS!  I THINK SHE IS TRYING TO POISON ME

We had finally arrived at paranoia.  I never saw Mrs. “X” smile again.  I never saw the happy Mrs. “X” again.  Instead, I cared for a miserable sole locked in the prison of her demented brain.  She was in a living hell.  

Strangely enough, Mrs. “X” stopped getting pneumonia.  She stopped getting urinary tract infections.  She stopped getting sick and lived another 3 years.  It was depressing as hell.

Mrs.” X’s” daughter was caught in this nightmare as well.  Her days were spent trying to care for a hostile woman who did not know her and was afraid of her.  She suffered from the chronic verbal abuse her daughter hammered her with on a daily basis.  Despite everything, her daughter stayed with her till the end.

There are times when you just can’t win!  If her daughter had withheld treatments while her mother was in the happy stages of dementia, she would have felt guilty when her mother died.  Instead, she lived in hell for years and felt “RELIEVED” when her mother died.  She ended up feeling guilty about feeling relieved.

In olden times, we died from pneumonia or other infections.  We died at a younger age.  Now, almost every disease is preventable or treatable and we die at an older age.  The cost of living longer can be devastating as in this case.  If you are suffering from a disabling disease or memory disorder, have an end of life discussion with your doctor and family.

Here’s your music and joke for the day.

Robert Benchley said, “Nothing is more responsible for the good old days than a bad memory.”  (Think about it!)

The older I get the less I like about birthdays. My 69^th birthday is right around the corner.  Sixty-nine has always been my favorite number so I should really be excited about being 69 years old for a full year, but I’m not.  

When we are kids, we got excited about birthday parties, presents and the new privileges that came with age.  At 69, there are almost no presents.  Presents are for kids.  Parties were fun when we lived in Long Grove.  Friends spent the day at our pool and the grill ran continuously.    In North Carolina, the grill still provides scrumptious eats; but there is no pool and friends are 100s of miles away.

The privileges that came with age years ago are now going away.   Yep, as a doctor, I witnessed the degradation that comes with the aging process.  Now, I’m witnessing this as a patient. So far, I’ve been lucky.  I’m still independent and able to drive safely.  As my Parkinson’s worsens, my ability to remain independent is threatened.  My hearing is going so I have hearing aids.  My vision is going so I have glasses.  My arthritis is worsening and my back sucks.  Despite all of the losses, I still function relatively well.  (There is one significant gain with age: weight!)

Unlike my father, I have dressing aids, including a dressing stick, stocking donner (assist putting on socks), and leg lifter strap.  I have a handicapped ready house with rails in the shower and crapper.  The one thing I need most, new effective medications, still doesn’t exist.  I’m on the same medications my father was on 30 years ago.

The hardest loss to deal with is the loss of the ability to drive.  I’m glad to announce that my driving skills are still excellent (I’m much more cautious).  My years practicing medicine taught me how to evaluate a patient’s ability to drive and how to decide when it was time to take away a person’s right to drive.  It also taught me how emotionally devastating it is to lose your license. 

When it comes to taking away the car keys, men are by far the worst.  Patients, who I cared for over 25 years, would curse me and transfer their care to another doc.  These same patients would fight with their wives and family, insisting that they were good drivers despite the fact that no sane person would get in the car with them.  If you are dealing with an elder who is not safe behind the wheel but still insists on driving, you should refer them to a driving assessment course at your local rehabilitation center. You should also sell the car or store it off premises.

When it’s my time to quit driving, I won’t put up a fight.  I’ll UBER.

My generation is lucky to have UBER.  Uber will allow me to maintain my independence and dignity. The older we get the smarter we need to be if we are expected to enjoy living.  Losses are inevitable so it is of paramount importance that we recognize/admit to the losses and look to technology to help overcome our lost functions and keep us functional.

Of course, there will always be losses that can’t be overcome, Alzheimer’s being one.  I think the saddest thing in the world is watching someone you love slowly drift away as their memory leaves them.  Often, all that is left is an empty shell and misery.  I’ll address Alzheimer’s in a future article but, for the purposes of this article, know that I think we keep bodies alive way too long, ensuring that they are miserable and their families are miserable.

As for me, I will make the best out of what abilities I have left with one exception.  If I’m no longer able to enjoy life or really only the shell that used to be Doc Segal, then send me away, but not to a nursing home!  Send me to meet God.  (I’ll delve into my thoughts about euthanasia at a later date.)

Here’s today’s music and a joke.

You Know You’re Middle Aged If…

• You’ve come to the annoying realization that your parents were right about almost everything.
• The bag boy volunteers to help load groceries into your car—in the “ten items or less” lane.
• You’ve stopped supporting your children and started supporting your parents.
• You’ve found yourself discussing rain gutters.
• You remember your kid’s names, just not always the right one.
• You have nightmares about forgetting to move the garbage cans to the street for the garbage collector.
• Your high school yearbook is now home to three different species of mold.
• You buy “age-defying” makeup and “antiwrinkle” creams and believe they work.
• You’ve realized that all those geeky people in Bermuda shorts walking around Disney World include you.
• You recognize Led Zeppelin songs that have been turned into elevator music.
• As a public service, you have agreed to never appear on the beach in a Speedo again.
• You’ve had three opportunities to buy every single Disney Animated Classic—“for the last time in a generation”
• You’d pay good money to be strip-searched.
• Wal-Mart and target seem to share your fashion sense.
• The only way you know to stop a virtual pet from beeping involves the patio and a sledgehammer.
• You can pack two suits, Five shirts, five ties, five pairs of underwear, five pairs of socks, a pair of shoes, and half of your bathroom into a carry-on bag—in less than five minutes.
• You know what Earth Shoes are.
• You think if you hear “Stairway to Heaven” one more time your head will explode.
• Your weight-lifting program seems to have no effect on your muscles, but the veins on the backs of your hands are bulking up quite nicely.
• On Saturday night, when your wife mentions “hot oil, a little friction, and squealing,” you tell her you’ll have the car looked at first thing Monday morning.

Anonymous author

Here’s an interesting premise for you.  A group of people decide not to follow the guidelines for prevention of infection and spread of Covid-19. They decide that the chances of getting Covid-19 are about the same as that of being struck by lightning. They ignore the fact that only 4 individuals in the US have died from a lightning strike this year and feel just in their decision not to wear masks or keep social distancing.

There are many different opinions about the risk of infection and how that risk should be handled.  There are those who believe it is a hoax or that the figures are skewed by the media/government/doctors/pharma or whichever group is under fire today.  Then there are the scientists, who despite their differences, have formulated guidelines to try to keep us safe.

‘

For the sake of not arguing, I’ll give you all the excuses and say they are right, with one exception: It’s not a hoax.  I still have one question.  Would you stand outside in the midst of a thunderstorm?

I don’t think so!  Walking around without a mask, gathering together in large social venues (where a 6-foot safety zone can’t be maintained) and not properly washing your hands are like standing outside holding a lightning rod in the midst of a lightning storm.

Yep, you’ve got rights.  So, do what you are going to do, just don’t do it around me.  I may be ready to die but not the Covid-19 way.  The Covid-19 way is to die all alone, surrounded by strangers in white coats with tubes, lots of tubes!  Tubes to be stuck everywhere.  It’s definitely not my cup of tea.  

Please realize that, if you are wrong and you get Clovid-19 despite never having been struck by lightning, you put your entire family and their friends at risk.  (Old people always have to hit you with a little guilt!)

Enough said.

I was going to tell you that my 4^th was a bust when I realized it was not a bust.  I spent the whole day with Renee and that makes it a precious day.   Thanks for putting up with me.

Here’s a song and a little humor.

I never thought I could hate the 4^th of July, but I do.  My first 4^th of July in Long Grove was unexpectedly phenomenal!  My house sat in the middle of a farmer’s corn field.  We were the first and only house in the development.  We set up chairs, coolers and fireworks (from Wisconsin) when an unbelievable event occurred. 

The sky lit up! We had a 360-degree view of every surrounding villages’ fireworks.  My God, it was awe inspiring.  In the middle of this spectacular show, we heard a loud explosion in our back yard.  We ran (we were young) towards the sound.  What we found completed the night.  For the next 30 minutes, we witnessed a professional display of fireworks in our back yard.

Thanks to a nearby by country club, we have had our private viewing of 4^th of July fireworks ever since.  4th of July became a three-day pool party with games, swimming and a continuously running grill.  Parties always ran into the early am hours and often we had 20 kids sleeping in the basement.

NOT THIS YEAR!  This year two things are ruining the 4^th.  Clovid-19 has put an end to parties, as well as fireworks.  Can you imagine having a pool party with red tape demarking 6-foot safety zones that only one only family can occupy?  I can’t.

Of course, living in a senior community in North Carolina makes partying by my pool in Long Grove impossible.  Unfortunately, my new community’s pool is not close to being completed.  Renee and I will spend the day on our porch eating holiday food and trying to bolster each other’s spirits while missing our friends and Long Grove home. 

I suspect that this year’s fourth is going to be the first of many private celebrations as the world really has changed.  In previous articles, I have discussed forming PODS of individuals who practice the same precautions as you do.  Yesterday, my daughter pointed out the fallacy of my plan.  Renee and I had to get our licenses and licenses plates transferred to NC.  We also had to establish a bank account.

That’s three trips into the public and three opportunities to contract Clovid-19.  Lisa pointed out the fact that, if we were in a POD, we’d have to go into isolation for 2 weeks, temporarily banning us from our POD.

I’ve been working hard at staying positive.  Today, I’m going to have to work extra hard.  So, I’m going on a NO NEWS fast.  I’m going to call friends, reminisce about prior 4ths and enjoy Renee’s company.  Who knows, perhaps I can light her fuse.  In the old days, we could have an indoor fireworks display.

Renee?

Here’s your music and jokes. 

What do you call a duck who likes fireworks? A firequacker!

Looking back in time, it seems like science fiction of the past has become the reality of today.  Does it seem that way to you?  Remember the HAL 9000 computer in “2001, A Space Odyssey”?  ALEXA, need I say more.

Yesterday, I could have sworn I was starring in a bad Sci-Fi movie.  There were people in masks, masks with face-shields, face shields alone and fancy cloth face coverings with monstrous-like adornments.  Of the people not wearing masks, there was one standout who wore a mask-like structure on his elbow.  He was cool (NOT)!

Renee stood in line at the NC License Plate Office (while I waited in a boiling hot car) where she tried to maintain social distance.  The state office worker responsible for keeping order, in the line, kept bunching people up, even when there were markers on the floor.  The whole thing was ridiculous and, from a distance, looked like a horror movie.  

Now, everybody seems to have a different opinion about what we should do.   Some are hyper paranoid, anointing themselves with antiseptics on a regular basis and wearing total body condoms while others are acting like it’s a joke. Personally, I’m looking out for Zombies! 

Yep, look around you.  The world has radically changed in just a few short months.  People are worried and scared, as they should be, but life is full of risk and we take risks every day. We also take precautions to mitigate those risks.  My fear of Zombies is nowhere as bad as my fear of shutting down America again.  Zombies I can deal with.  Bankrupting America, I cannot!

The jerks that ignore the new rules of society, masking and keeping a 6 foot or more personal space, are not going to kill me.  I’m going to run from them as fast as my feet can carry me (that’s actually pretty damn slow).  They are going to kill themselves and their loved ones. Let them, but don’t let them force another shut down!

Of paramount importance is getting the kids back to school.  This morning I came across a document from the American Academy of Pediatrics that stresses the need for kids to physically be in school.  I’ve hyperlinked to that article.  I agree that, while it places our kids at some risk, the risk of not being in school outweighs the risk of being in school.  Certainly, proper precautions must be developed and instituted to lessen the risk of infection. 

So, keep an eye out for Zombies, wear your mask, wash your hands, keep your distance and get your kids back to school.  Covid-19 has disrupted our lives.  It has turned the world upset down.  Let’s right the world for our kids now!  Otherwise, I fear that social isolation combined with a failed education system will lead to a future worse than any witnessed in the Sci-Fi world of yesterday or today.

Here’s today’s music video and a joke.

Are you wearing your mask?  I hope so!  As usual, there are a multitude of attitudes about wearing mask ranging from the guy I saw yesterday who was masked while driving his car to the women I saw in Food Lion who glared at everyone, daring anybody to say a word about her not wearing a mask.  There are people who will tell you there is no proof that masks help and those who will quote the latest research and data.  I’ll tell you that if there is even a small chance that mask work, you should wear a mask.

ZdoggMD did an excellent 3-minute podcast yesterday debunking some of the misconception surrounding wearing mask. Click on the underlined text to view that podcast. I couldn’t have said it better.

Please learn to put your mask on properly.  Click on the underlined words to watch s short instructive video.

Here’s your song of the day and a joke or two.

What’s the difference between a G-spot and a golf ball? A guy will actually search for a golf ball!

Why does it take 100 million sperm to fertilize one egg? Because they won’t stop to ask directions.

Does it ever feel like the world is conspiring against you?  Does it ever feel like if you didn’t have bad luck, you’d have no luck at all?  Does it ever feel like you just can’t win?

I’m taking a poll.  I really want to know if these are universal feelings or if I’m just screwed up.  My hypothesis is that these, in fact, are universal feelings and that healthy individuals get over them fast.  On the opposite side, I believe that depressed and emotionally labile individuals live with these feelings.

Why is this important?  Quite frankly, it’s important because I woke up this morning convinced that the universe hates me.  Yes, Covid-19 has gotten to me.  The move has gotten to me.  Parkinson’s has gotten to me!  Right now, life sucks.

Yesterday, my dear friend sent me pictures of my home in Long Grove.  I’ve been trying unsuccessfully to sell it but buyers are scarce and looking for an open floor plan, so it remains on the market.  Yesterday’s pictures were heartbreaking.  New water pipes are being installed in the neighborhood and my front lawn and driveway have been excavated.  

In the end, new water pipes will be a good thing, but for the next month I fear it makes my house unsellable. I never expected to have two houses; but I do, and it is a burden.  Parkinson’s is enough of a burden; I didn’t need another problem. So, given the circumstances of my life, what do I do?

It’s easy, I write about it!  Writing about this is like puking up a bunch of bile. It’s miserable when you are puking but feels better once you’ve vomited it all up.  If I was a betting man, I’d bet that the vast majority of my readers answered yes to the questions above.  I’d also bet that each of us has our own way of cleansing ourselves of these feelings. 

Cleansing yourself is important.  If you don’t realize that you are no different from everybody else and put an end to feeling persecuted, worsening depression sets in and you can spiral into abject misery.

The point of this article is that you need to review and shore up your coping mechanisms.  Covid-19, social unrest and whatever the next crisis is are going to keep impacting us and how we handle the emotional strain of life is directly related to how happy or depressed we are.

I woke up this morning convinced that the universe hates me.  I no longer feel that way.  In writing this, I remembered that yesterday afternoon a friend/patient sent me an air fryer cookbook, just because.  I remembered that Bruce, one of the most remarkable people I’ve ever met, called to check on me.  Bruce has a book of positive sayings that he has accumulated over his lifetime.  I kept a copy of that book in my office and used to pull hopeful sayings out of the book to share with people in need.  Bruce is sending me a new copy.

Yesterday, I spent the day with my granddaughter.  She showered me with love and smiles. Nothing is more cleansing than a child’s unconditional love.  I’ll spend next week with my grandson.  Turning to family and friends for support, during trying times, is healthy.

Talking about family and friends, my most valuable weapon against depression is the love of my life, Renee.  Waking up next to her every morning and going to sleep next to her every night can get me through anything.  Yes, she edits these articles, and yes, my usual motive behind mentioning her in glowing words is trying to get lucky, but this time it’s simply to say, “I love you and everything will be fine.”

Here’s your music for today and a joke.  

I love everyone. Some people I love to be around, while some of them are people who I love to avoid. And then there are some who I would love to punch in the face.

,Love is getting mad at someone, telling that person to go to hell, and hoping that they get there safely.