MEAL PLANNING

It’s amazing how I could preach meal planning for years and yet, skip this most important task.  I’m a self-proclaimed food addict and a food addict should never go to the grocery store hungry.   A food addict should never wait until the last moment to decide on what he/she is going to eat.  Before going into a restaurant, a food addict should have studied the menu, and, when full, should decide what he/she is going to order.

There is a temptress around every corner in every grocery store and restaurant.  The food industry hires experts to advertise and place food in such a way that’s it’s almost impossible not to buy and eat it.  The Giant Open Air Market in Norfolk was a perfect example.  When they opened, they piped the smells of bakery fresh bread into the store entrance.  From the minute I walked into the store, I wanted hot bread even though it was not on my grocery list.

In order to protect yourself from buying and consuming the wrong types of food, you should plan your meals in advance.  Yesterday, I planned my meals for the week, went to the grocer, bought what I needed. Made six meals and froze extra for next week.

Last night, I prepped for my breakfast by putting measured amounts of oatmeal and water in a microwaveable bowl with Sweet N Low and cinnamon and left it in the microwave.  This am, I hit the on button and waited for the ding that signified the beginning of today’s eating orgy.  Actually, now that I have my meals setup for the week, it’s no longer a food orgy.  

So, it’s time for me to follow my own advice.  By planning my meals in advance, I should be able to control my appetite and improve my intake.  In the past, I would have told you, “the truth is in the pudding.”  Unfortunately, pudding is not on my diet and “the proof is in the fig” just doesn’t sound right.

Give me 1 month and I’ll report how I’m doing.  One thing is for sure!  I’m going to lose this weight!

Here’s your music for the day and a joke. 

The problem isn’t that obesity runs in your family.

It’s that nobody runs in your family.

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PASSING OUT

It’s not uncommon for me to hear, “Doc, I passed out yesterday.”  As a matter of fact, I just received that very call, only my friend passed out earlier in the week.  When a patient loses consciousness, there are long list of things I want to know:

  • Was the loss of consciousness witnessed?
  • Did he/she hurt him/herself?  What injuries were suffered?
  • Did they go to the ER?
  • Were they confused when they awoke?
  • Have they passed out before?
  • Did they experience any chest pain?
  • Did they soil themselves?
  • How are they now?

These are but a few things I need to know in order to safeguard their wellbeing.  The immediate questions I need to answer are:

  • Is there an immediate risk posed by their injuries?
  • Why did they pass out and what risk does the underlying cause pose?
  • Are they at risk of passing out again?
  • Is there any evidence of a head/brain injury?

Again, these are but a few of the things I need to know.  The possible reasons for passing out are just about anything you can think of and, particularly on the first episode, need to be investigated promptly by a physician.  You would be surprised to know that a huge percentage of men will refuse to go to the ER.  In my experience, women are much more likely to be seen in the ER because their spouses/loved ones rightly call the paramedics.

Why are women less likely to dial 911?  The answer is simple.  Men can be stubborn assholes.  My favorite and most often heard interchange between loved ones is:

Women – I’m calling 911. You need to be checked out.

Man – “I’m telling you, don’t call the paramedics!  I’m fine!  I just passed out.

Women – “I’m calling the paramedics; you don’t look fine!”

Man- “If you call the paramedics, I’ll never speak to you again.”

I want to point out two critical flaws in the above conversation.  First, there is no such thing as “just passed out.”  Passing out needs to be treated seriously until proven otherwise.

Second is that, if you stay home and die from an otherwise treatable illness or injury, you will definitely never speak to your loved ones again.  Also, you will always regret not having dialed 911.

So, if your gut tells you to call the paramedics or take a loved one to the ER, do it!  If they are mad at you for caring, at least they will be alive.  If all else fails, call your doc and ask for his/her advice.

Here’s today’s music and a joke. 

A cucumber, gherkin, and cock are sitting around discussing how fucked their lives are.

“My life sucks,” said the cucumber. “When I get big and fat, they cut me to pieces and chuck me in a salad.”

“That’s nothing,” said the gherkin. “When I get big and fat, they squash me in a jar with the rest of my family and cover me in vinegar.”

“You two are living on easy street,” said the cock. “When I get big and fat, they pull a plastic bag over my head, stick me in a dark, damp room and bang my head against the wall until I throw up and pass out.”

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THINK FOR YOURSELF

Think for yourself was the theme of a recent podcast by Zdogg that I just listened to.  What a novel concept!  Lately, I’ve been barraged by video clips and articles posted on the internet, each one telling the world the gospel.  My patients want my opinion as to the veracity of the information.  I also have been bombarded by political rhetoric with the Trumpers telling me their side of the story; and the democrats, likewise, telling me their truth.

What amazes me is that, in many cases, the people who send me the above-mentioned information, aren’t really interested in my opinion.  Instead, they are selling me someone else’s opinion that they have bought in to.  Why would I say this?  At first, I responded to each and every article and video clip I received.  Often, after analyzing the information, I would find flaws in the material; and, naturally, I would point those flaws out.

After pointing out the flawed logic, false information and, in some instances actually debunking the report, I would then receive an email telling me why I was wrong and trying to sell their viewpoint.  It soon became apparent that the reason that there is so much shit on the internet is because people are buying the shit at face value.  Rather than critically assessing the material themselves, they buy in and then sell it to their internet community.

So, here’s what I know:  

Number one on the list is that this year should be named, “The year of the grand conspiracy.” There are so many conspiracy theories circulating on the web that I can’t keep track of them.

Number two is that the influence of the web and what it is telling you to think is unbelievable.  A clever individual with a particular mindset can sell his/her ideas on the web and influence millions of people and actually change history. You’d be shocked at the number of people who don’t believe that the holocaust actually existed.

Number three is that the divide between the Democrats and Republicans is so deep that both parties are ineffectual.  The divide between blacks and whites has also deepened to dangerous levels.  In reality, our country is on the verge of splitting apart. 

If you look back in history, all of the great empires ultimately destroyed themselves.  Are we about to do the same?  I think so!  One thing I sincerely believe is that we need to calm down and start thinking for ourselves.  We need to think before we react.  We need to research all sides of an issue, not just buy the best-looking podcast or journalists’ attitude.  We need to listen to every source with more than a grain of salt.

We also need to put aside political correctness and speak our minds.  There are evil people who have found new voices on the web and in the media and are succeeding at furthering the rifts in our country.  They need to be recognized for who they are and outed.

The holocaust did happen.  You have to obey the law.  The vast majority of the police are good people doing a thankless job.  All lives matter. The list is too long to post here.

The trick is learning to think for yourself again.  In the old days, learning meant going to the library and reading printed material.  It was a slow process and allowed time to digest what you read.  Reading has become a thing of the past. Information is dumped on your desktop in large volumes, repetitively, and opinions are prepackaged for you.

There is no music or joke that goes with this article.  It’s no joking matter.  

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FAILED

Failed again!  This time, I followed the dietary instructions to the letter.  After 1 month on Weight Watcher’s Green, I’ve lost a total of ZERO pounds. I’ve increased my exercise as much as I can tolerate and have yet to gain any endurance or strength.  I’m frustrated!  I am also not giving up.

I’ve quoted Bruce’s father many times and will do so again.  “If you fall down six times, get up seven.”  Well, I’m on my feet and ready to move on.  After careful research, I’ve decided to stay with WW and switch to the purple plan.  Those of you who read my book, know I don’t like diets.  Diets are temporary changes people make to lose weight, only to regain their weight when they resume their normal eating habits.

I’ve chosen WW as it allows me to eat food I normally eat.  WW is compatible with my Wellthy plan.  WW Purple is a diet I could stay on long term and be happy.  Now to figure out why I’m not losing weight. Either I’m still eating too many calories or not burning enough calories.

One problem with WW is the zero list.  My children always said that the Segal Motto was “Go big or go home.”  When given a Zero/free list of food, my tendency is to overeat.  This time around, I’ll concentrate on limiting serving size.  I’ll continue my exercise and increase in small, safe increments.

Health is a major part of WELLTH.  Wealth is worth working for, no matter how difficult. Frustration is my enemy.  My readers support has been one of my best tools and I thank you for your suggestions and support.  

If you need to lose weight and to increase your Wellth, develop your own diet and exercise program.  Define what your ideal diet should be and then refine your current diet until your weight begins to fall.  If you are not exercising, start.  If you are exercising, increase your exercise.  Whatever you do, do no give up until you’ve reached your goal.

Let your friends and colleagues know what you are doing.  Their support is priceless.Here’s your music for the day and a joke. Today at the bank, an old lady asked me to help check her balance

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AGING

David sent me an email full of jokes this morning.  The one I liked best proclaimed that today most conversations begin with, “Did I tell you this already,” or, “Now what was I saying?” Obviously, the jokes were about old people and were not really jokes.  Instead, they were astute observations which clearly elucidate my current stage of life.

Now that the pool is opened, Renee and I are meeting our new neighbors.  I’ve never been good with names so it’s not surprising that I can’t remember the majority of the names of my new neighbors.  What’s scary is when I can’t even remember meeting them yesterday and the day before.  I have CRS (Can’t Remember Shit) as do the majority of the new residents in my community.

One of the advantages of living in an elder community is being around people of similar ages makes you realize how normal you really are.  Most of my neighbors have moved here from colder environments and are looking forward to a snowless winter.  Many are widows.  Men just don’t last as long as women.  My buddy likes to attribute the early deaths of his male friends to their being married to women and lack of sex.  Thank God that Renee takes care of the sex issue by taking advantage of my CRS.  She constantly reassures me that we just made love and that I was great!

I’ve seriously considered starting on one of the OTC memory enhancers but can’t find any articles that prove they work.  Besides, I’m already taking pills 4 times a day.  I play memory games frequently.  I’m particularly fond of “Hide and Seek,” where I put my keys down somewhere and have to find them.  Renee plays that game with me!  I also love word games where Renee’s task is to figure out what word or name I’m trying to remember.  I give her clues like, “We met them 10 years ago in Mexico.  He has the big wart on his nose, and she has huge hangers.  She just about can sweep the floor with her fallen breast.”  “What were their names?”

Of course, there are other games like, “What do you want for dinner?”  Often, the game goes on for a full day. Getting old is not easy.  I’ve found that having a sense of humor is important, especially if you’re playing, “Who cut the cheese?”  Renee always wins that game!

Well, it’s time to play Barbie with Kenzie!  Here’s your music for the day and, of course, a joke.  

A man was driving home one evening and realized that it was his daughter’s birthday and he hadn’t bought her a present. He drove to the mall and ran to the toy store and he asked the store manager, “How much is that new Barbie in the window?”

The Manager replied, “Which one? We have, ‘Barbie goes to the Gym’ for $19.95 …

‘Barbie goes to the Ball’ for $19.95 …

‘Barbie goes Shopping’ for $19.95 …

‘Barbie goes to the Beach’ for $19.95…

‘Barbie goes to the Nightclub’ for $19.95 … and

‘Divorced Barbie’ for $375.00.”

“Why is the Divorced Barbie $375.00, when all the others are $19.95?” Dad asked surprised.

“Divorced Barbie comes with Ken’s car, Ken’s House, Ken’s boat, Ken’s dog, Ken’s cat and Ken’s furniture.”

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“YOU’VE GOT TO KNOW WHEN TO FOLD THEM”

Can you believe it?  I’m finally out of things to say.  After publishing in excess of 2000 articles, I’ve reached the point where either I have covered all the aspects of medical care or I have a real writer’s block.  I’ve been struggling for weeks trying to come up with informative, entertaining and uplifting articles.  Last night, I asked myself the age-old question, “When is it time to quit?”

In my experience, most humans don’t know when to quit.  One of my most difficult tasks, as a family physician, was taking a patient’s license to drive away.  Men and women, alike, put up a fight.  Often, my patients would become verbally abusive; and, on occasion, they actually became physically threatening.   Many times, they would leave my practice.  Their families were afraid to confront them; and many times, they allowed their loved one to drive against my advice.  On occasion, the results were catastrophic.  I vividly remember one patient’s story.

Mr. V’s memory was bad.  As long as he did not vary from his daily routine, he functioned fairly well but once his routine broke down, he was in trouble.  One summer day I received a call from the Indiana State Police:

Officer – “Dr Segal, do you know Mr. V?”

Dr. Segal – “I certainly do.  He’s been my patient for 20 years.  Is he ok?”

Officer – “He’s fine.  He stopped at the fire station and asked them how to get to your office.  He showed them your card and stated he had a 10 am appointment with you.  It’s 4 pm here.  He’s on the southside of Indianapolis and doesn’t know how he got here.”

When Mr.V’s family told me that he refused to quit driving, I told them to take his keys away and sell the car.  They stated they could not do that to him.  Instead, they had to drive down to Indianapolis to pick him up (and they were the lucky ones).  They were lucky he didn’t die in the middle of a corn field or cause a major accident. They were lucky they didn’t have to go to a morgue to identify his body.

When is it time to quit driving? Work? Sky diving? Climbing ladders? Operating machine tools? There is probably a time when we should quit doing everything, even sex.

So how do we know when it’s time?  Certainly, when loved ones tell us it’s time to quit, we should, at the very least, listen to their advice.  We should weigh the risk of continuing to do what we want to do vs. the benefits of it.  We should assess our impact on others.  Perhaps, we should also discuss our thoughts and decisions with our physician and/or clergy. We should review all of our alternatives carefully.

Ultimately, when to quit whatever is a personal decision as long as it doesn’t adversely affect others’ health and safety. When the health and safety of others are at risk, family and friends have to step up and help their loved one find a way to gracefully and safely quit.  

When I started in practice, taking away someone’s driver’s license was crippling as he/she became isolated and dependent.  In today’s world, Uber can be at your doorsteps in minutes and can take you anywhere.  Finding alternatives to help our aging loved ones as their skill sets diminish and they need to quit is paramount to helping them age gracefully and safely.

So, if someone you love is too old to safely ________(fill in the blank), help them find a way to quit while maintaining their dignity and safety.  If you need to quit ________, don’t be stubborn or prideful.  Don’t refuse help, embrace it.

And by the way, have a sense of humor.  When it’s time for me to quit driving, I’m buying Lisa a chauffer’s hat and vest and sitting in the backseat.  I’ll be the world’s best backseat driver!

Here’s your music.  Kenny Rogers, “Gambler,” sums it up nicely.  “You’ve got to know when to hold them, know when to fold them.” Here’s your joke for today:

 A bus load of Senior citizens was traveling to a casino. Halfway into the trip, a little old lady walked up to the front of the bus and told the driver they had a pervert on the bus.

The driver told her he would check it out at the Casino. So she went back to her seat and sat down. Five minutes later a second little old lady walked to the front of the bus and told the driver they had a pervert on the bus … Since this was the second complaint in five minutes, he thought he had better check it out. He pulled the bus to the side of the road and walked to the back of the bus.

There he found a little baldheaded old man crawling around on his hands and knees. The driver asked, “What the hell are you doing down there?”
The baldheaded man looked up and said, “I lost my toupee and I’m trying to find it. I thought I had it twice, but mine is parted on the side.”

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IDEAL OR REAL

I have spent a great deal of time writing about the ideal way to care for yourself and those you love. When I recommend a treatment course, whether it be diet or medicinal, I recommend the ideal approach. When I prescribe a medication, I recommend the ideal brand or generic, whichever is best. 

I recognize that there is often a difference between the ideal and the real. That difference is getting wider every day. The poor economy, the insurance industry, the government and the internet all are having a negative impact on our ability to live up to the ideal. Life, in general, and the practice of medicine have become compromises.

When is it ok to compromise? How much are you willing to compromise? What is the cost of compromise? These are all important questions. It is clear from looking at my parking lot that many of my patients will not compromise on transportation. They drive very safe, very nice cars. The price of those cars is often exorbitant, leading them to compromise elsewhere. Does it make sense to drive a Mercedes and compromise on medical care and treatments?

Case in point:  a Mercedes owner complained that he could not have a procedure because he had a high deductible and the test would be in excess of $2,000. Having the test is ideal; the real is something quite different. In his case, the answer was simple. His Mercedes has every safety feature imaginable and safety was the reason he bought it. He had been in a life threatening accident and wanted the best protection even if it was not truly affordable. The ideal test for his condition is a valuable safety feature for his health. Without it, he may be heading for a major accident. After explaining this to my patient in terms he could relate to, he relented and will find a way to afford the test.Make sure you inform your doctor when the ideal is truly not possible. Be ready to negotiate and compromise. In order to make the safest decision possible, find out why the ideal choice is the best choice. Find out what the risks of compromise are. Compare the financial, physical and emotional costs of both the ideal treatments and the negotiated treatments are and then make the best decision you can. Most importantly, be prepared to live with your decision and its effects on you, your family and friends. 

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IT’S JUST A MIGRAINE

I’ve been headache free since retiring.  I used to get migraines as well as headaches from allergies, stress, and lack of sleep.  This morning, I woke up with a headache for the first time in over a year.  I have allergies and I’m certain that my headache is allergy induced and will go away shortly. One of the most common complaints I used to hear was, “Doc, I’ve got a migraine.  Can you prescribe something?  It’s justmy usual migraine!”   

True migraines can be much more than a headache.  As evidenced by Serene  Branson’s episode of gibberish during an on air news report, migraines can simulate a stroke.  What most people don’t know is that migraines can actually cause a stroke.

Over my years in practice, I diagnosed five patients with migraine induced strokes and two of those patients have residual neurologic deficits (loss of function or sensory changes).  Do you have migraines?  There are a multitude of types of headaches, including migraine, tension and chronic daily headaches.  Most people refer to any bad headache as a migraine.  It is important to know what type of headache you have as the treatment and possible consequences of a headache differ depending on cause.

If you are still reading this article, you or a loved one probably have headaches.  Don’t underestimate your headache.  Don’t put off seeing your doctor.  Please don’t learn to live with it or let it control your life.  We have excellent treatments for all types of headaches.  When you see your doctor, he/she will want to know the following things in order to help classify your headache and provide proper treatment options.

  1. How frequent is your headache?
  2. How severe are your headaches on a 1 to 10 scale?
  3. Where in your head are your headaches?
  4. What is the quality of the pain? Piercing? Stabbing? Throbbing?
  5. Describe the onset.  Does it build in intensity?  Is it sudden and severe?
  6. What makes your headache worse?
  7. What makes it better?
  8. Are there associated changes in your ability to think, speak, feel or move parts of your body?
  9.  What have you taken for your headache? 

Treatments for migraines and other headaches are often divided into rescue and preventative modalities.  Rescue medications are designed to help you stop a headache after it has started.  Preventative treatments, sometimes called controllers, are designed to stop the headache prior to its onset.  Obviously, in the case of the newscaster, it would have been better to stop her from losing her ability to speak.

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

One of the best, patient oriented resources I have ever seen is available online for free.  Dr. L. Robbins is the headache specialist I referred patients to during my years in practice.  His web site is an excellent resource for headache suffers.

Remember, read and learn as much as you can about what ails you so that you can be an effective member of your medical team.  The life/brain you save may be your own.

Here’s your music and a joke to brighten your day.

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EXPECTATIONS

I recently reviewed an article about expectations in medicine.  Expectations can make or break a relationship.  They can be the source of great excitement and joy or of great disappointment and sadness.  Expectations, in medicine need to be clearly defined and, when possible, successfully met.

Many years ago, I did a full physical on a new patient.  Patient “X” had been referred to me by a mutual friend and I did my usual, thorough job.  I was dismayed when my friend called me to report how disappointed patient “X” had been!

I called patient “X” to discuss the results of his exam and why he felt I did a “crappy” job.  Mr. “X” started with, “Doc, I like you, but you did not do/order a stress test, Carotid Doppler, lung function test, PSA or colonoscopy.  I went to Dr. “Y” and he ordered them for me!”  To Mr. “X’s” surprise, I asked him why he thought he needed those tests.  Mr. “X” responded, “My partners’ docs ordered those tests.”

In retrospect, the problem was obvious.  Mr. “X” had expectations I did not meet.  I had expectations, as well.  My expectation was that Mr. “X” wanted a thorough, customized physical.  “Mr. “X”, I’m sorry you were unhappy.  Let me venture a guess:  your partners are all in their mid-sixties.”  His answer was “yes”.  “Mr. “X”, had you been in your sixties, I would have ordered those tests and perhaps more.  You are 41 years old and, with your personal and family history, as well as excellent physical condition, I did not feel you warranted any of those tests.”

Mr. “X” cancelled all of his tests and sees me yearly for his exam.  I learned a valuable lesson.  My patients’ expectations may not match mine.  Setting realistic expectations are an important part of any doctor-patient relationship.  Patients must recognize that doctors have expectations and doctors must realize that patients have their own, distinct expectations.

Expectations can range from fantasy to reality.  In the medical arena, it is crucial that expectations be founded in reality.  As your doc, I expect you to follow my instructions.  I expect that, if you are going to vary from my instructions, you will let me know.  These are realistic expectations.  

An example of false or unrealistic expectations would be if you were 75 pounds overweight, drank a bottle of wine and six cocktails, and smoked two packs a day; and I expected you to lose your excess weight while giving up smoking and alcohol simultaneously within 6 months.  (I would give the above patient at least 6 1/2 months). 

Sometimes I set unrealistic expectations for myself and my patients.  When the stakes are high enough, you do what you have to do in order to survive.  Unrealistic expectations can be met when truly necessary!

Patients often set unrealistic expectations.  The most common example of an unrealistic expectation is when the patient, mentioned above, expects his doc to cure his cough, repair his damaged liver, and save him from the heart attack he is about to have.  Doctors don’t heal patients; they help patients heal themselves.  Expecting your doc to save you from a sinking ship while you are punching holes in the hull is another example of false expectations.

So, what can you do?  Discuss your expectations with your doc.  Let him/her know exactly what you want; what you are thinking.  Be sure of what your doc expects of you.  Expect that your doc will work at meeting your expectations.  If he/she falls short, discuss it with him.  Work at meeting your doc’s expectation.  Expect that your doc will confront your shortcomings, as well.  Most of all, be honest with yourself and your doctor.

P.S. – I believe in miracles.  I have been blessed to see many miracles in the last 28 years of practice.  It is ok to have false or “fantasy” expectations, as long as you know that the only way they will come true is to receive a miracle.  It is not OK to sell yourself on false hope as the vast majority of time it will end in disaster.  

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INFLUENZA VACCINE

As we live in an unpredictable world, I don’t often make predictions. However, 35 years of practice has taught me that the one thing I can predict is the severity of the local flu season.

The years that I administered my influenza vaccine to large numbers of my patients, we have a mild flu season. The years that I had vaccine left over at the end of October, we have a nasty flu season. Either way, I use up my vaccine.

In the past four years, my patients have gotten vaccinated early and we’ve cruised through the flu season. Will this year be a good year or bad year? In the next month, all of you should get your flu vaccine. Whatever you do, don’t forget the long lines, winding for blocks that accompany a major flu epidemic. Please don’t forget that the flu can kill.

So, get in soon and be proactive, or come in at the last minute and hope and pray that you didn’t wait too late. Good season or bad season, it’s up to you.

Here is your music and a joke. 

My dad told me never to go to a cheap, sleazy, dirty, raunchy strip club, because you’ll see something you really shouldn’t.

So, I went. 
And I saw my dad.

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