CASCADE

Do you ever feel lost?  I do! I lost my identity when my health forced me to retire.  The literature warns about retirement causing a loss of identity in physicians but there really was no way to prepare for it as my retirement was unplanned and sudden.

For years, I warned my patients about the losses of retirement and the need to plan for a life of retirement.  I told them they have to retire to a second life structured to keep them active, happy and alive.  It was good advice.  Unfortunately, I did not follow my own teaching.  I thought I would have more time to prepare.

I lost my identity at the same time I lost my health.  I’ve preached “Living Wellthy” for 40 years.  That, too, was good advice.  Unfortunately, my genetic heritage piggy backed on my bad back precluded living a “Wellthy Life.”

Nonetheless, I have tried to stay positive, to concentrate on my blessings list and not my losses.  Again, keeping a “Blessings List” is a great idea.  Again, I’ve got good advice for others but find I can’t manage to heed my own advice.  Covid 19 has really screwed with me, as it has for hundreds of thousands of people.  Yes, I’m blessed that my family and friends have survived its initial attack, but I’m afraid it has cost me one of my most precious of blessings.

In medicine, there is a fascinating occurrence we refer to as a cascade.  Typically, a severe illness causes damage that then progresses and causes further damage, all of which cascades into misery beyond compare and eventually death.  Our society appears to be in a cascade of biblical proportions. Between the political turmoil of the past months and 400,000 deaths from Covid, it’s hard to maintain a good attitude.

I’m in a cascade.  My physical abilities are diminishing rapidly.  I venture to say that my readers wouldn’t recognize me as I’ve gained 40 pounds and move like an old man.  Thank God for Renee.  She now helps dress me and wash me.  There was a time when that would have been fun.  Unfortunately, it’s not. 

I’m seeing a therapist.  I’m trying to focus on my blessings.  Some days are easier than others.  Some days the losses just can’t be ignored.  This is one of those days.

DOUBT CAN BE HEALTHY

“The whole problem with the world is that fools and fanatics are always so certain of themselves, and wiser people so full of doubts.” – Bertrand Russell

The older I get, the more Mr. Russell’s statement makes sense.  Certainly, Mr. Russell describes the political climate in our country.  My patients have been sending me articles and videos substantiating their beliefs as Trumpers or Anti-Trumpers.  Turn on the TV and flip between so called “news” programs and you’ll get different interpretations of the same facts.  Of course, CNN will tell you that FOX journalists are fools and fanatics and FOX will tell you the opposite.

Finding the truth is no easy feat.  I’m a doctor, not a politician or political commentator so I’ve stayed out of the fray.  I guess I am Mr. Russell’s wiser person because I’m full of doubts.  So, what does this have to do with yesterday’s article and the art of practicing medicine.

A wise doctor always maintains some level of doubt no matter how certain the medical experts are regarding any issue.  At this time, organized medicine will tell you there is no place for hydroxychloroquine in the treatment of Covid.  One of my docs is a big fan of hydroxychloroquine.  He has treated multiple patients with hydroxychloroquine with good results and has not seen any side effects or adverse effects from its use.  My other doc, the one I see in North Carolina, quotes the authorities and refuses to prescribe it.  What’s a patient to do?  In this case, I chose my NC doc.  She is on the ground here and will be my treating doc if I get in trouble.  Luckily, Renee and I are recovering nicely.

When your doc is certain, when he/she anchors to a single diagnosis, he/she is probably right.  The problem is that, if your doctor doesn’t maintain some level of doubt, he/she has blinders on and is more likely to miss a less common or evident diagnosis.  I once saw a family of six for food poisoning.  They were miserable.  Their youngest son was the most miserable.  By keeping an open mind, I was able to diagnose his appendicitis.  Five out of six had food poisoning.  What are the odds that the sixth would have an appendicitis?  Pretty low, but possible.

Your job is to ask a simple question: “Doc, what else could it be?”  I’ve written about the “differential diagnosis” in the past; and any time I diagnosed a patient I was always aware of the differential diagnosis (the other less likely causes).  Not having a differential diagnosis would be incredibly rare.  By asking “what else could it be,” you’ll force your doc to think outside of the box.

Here’s your joke today:  Whenever I start doubting my ability to finish all the icing…

… I remember it comes in a CAN, not a CAN’T.

ARE YOU SURE?

My brother said something brilliant yesterday and I want to share it with you. “Nothing is so uncertain as a sure thing.” Think about it for a minute. How many times have you been sure about something, only to be proven wrong, later?

This morning I realized that my training and practice of medicine was, in many aspects, tied to this statement.  As a physician, being sure of yourself can be a dangerous thing.  Being sure that your patient has a stomach virus causes you to miss the underlying appendicitis.  Being sure the resident’s assessment is accurate causes you to miss the one thing the patient forgot to tell the resident:  that thing being the piece of information necessary to make the proper diagnosis.

When I used to make rounds at the local hospital, patients would complain that everyone asked them the same questions over and over again.  “Doc, don’t you read the chart?  The cardiologist just asked me those questions.” One of the worst mistakes I made was during my second year of residency.  The patient came to the floor at 3 a.m.  I had been on shift for 32 hours and after examining the patient, I copied the cardiologist’s interpretation of the EKG into my note and moved on to my next patient.  I knew the cardiologist was one of the best and he had seen the patient in the ER; so copying his findings was no big deal, right?  Wrong!  Had I read the EKG myself, I would have found his error. ”Nothing is so unsure as a sure thing.”

Fortunately, the patient did fine and the erroneous reading of the EKG had no effect on her outcome. It did have a tremendous effect on my outcome.  It taught me the importance of doing my own history and evaluation no matter how many other physicians had evaluated the patient before me.

The moral of the story is simple.  When you are sick and seeing multiple healthcare providers, don’t complain if they ask you the same questions over and over again.  Complain if they don’t.  And remember, no matter how certain your doc is, he/she may be wrong.  There are no sure things in practice of medicine!

By the way, you can help your docs be more efficient by keeping a detailed personal history and medication list up to date and bringing it with you at each visit.

Tomorrow, I’ll address: “The whole problem with the world is that fools and fanatics are always so certain of themselves, and wiser people so full of doubts.” – Bertrand Russell

Here’s your joke for the day:  The owner of a sex shop hires a new clerk.

After the owner taught him the basics of running the store, he has to run an errand.

‘Could you run the store on your own for a couple of hours, Jeremy?’ he asks.

‘Sure thing, boss!’ Jeremy replied, ‘don’t you worry, I’ve got this.’

So the boss leaves for his errands, leaving young Jeremy in charge of the store.

Some time later, a woman walks in. She’s in search of a mechanized equivalent of the male boomstick of glory. Jeremy shows her the so-called model ‘Hercules’; huge, veiny and with a firm grip. The woman is very intrigued and leaves the store thrilled to bits.

Several other women pass by as well and Jeremy proves himself to be a keen salesman of battery-powered penises. All women leave the store satisfied with their purchase.

Then an elderly lady walks in the store in search of some private pleasure. Jeremy shows her the top of the stock, but the lady seems dearly unimpressed. Then, a spectacular model catches her eye. ‘What about that red one?’ she asks. ‘Oh, I see, my lady is a connoisseur!’ Jeremy replies. He shows her the model and with a light step and a big grin, the lady leaves the store.

Later that afternoon, the boss returns and asks how business has been.

Beaming with pride, Jeremy replies: ‘It was great! I sold quite a lot!’

‘Oh really?’ the boss asks, impressed, ‘what models did you sell?’

‘Well sir, 1 model Hercules, 1 model King Kong, 2 LongSchlong21’s and the fire-extinguiser.’

OPTIRECTIMITIS

My brother introduced me to a new word yesterday, “Optirectimitis.”  Simply put, optirectimitis is a connection between your eyes and your butt and accounts for a shitty outlook.  Right off the bat, I fell in love with the word.

I’ve been fighting my shitty outlook and having survived Covid should be winning.  I’m not!  One of the benefits of my Covid infection was the effect of the steroids my doctors put me on.  For 1 week, my back felt great, my legs fatigued less, my joints moved with relative ease, my trigger finger stopped triggering and my energy level increased considerably.    

Unfortunately, I cannot take steroids long term.  Long term steroids are fraught with problems including diabetes, osteoporosis, and hypertension amongst others.  This is one of those times when life is just not fair.  Steroids giveth and taketh away.  Coming off steroids has given me optirectimitis, causing my newly minted shitty attitude.

So, what’s a guy supposed to do?  Medical marijuana seems to help both the pain of arthritis, symptoms of Parkinson’s and shitty attitudes but is illegal in North Carolina. It also seems to adversely affect memory.  Again, marijuana giveth and taketh away.

Non-steroidal anti-inflammatories, like Aleve, help some but give me indigestion.  Exercise helps some but it is hard to get motivated to exercise due to pain.  Narcotic pain medications are completely out of the question. While they are addictive, living with chronic pain and disability is no way to live.  So, being addicted to pain relieving meds can’t be all bad, can it?  In the eyes of the law, it is bad.  Over the last few years, there has been a war on narcotics and most physicians I know are hesitant to prescribe them. Regardless, narcotics don’t agree with me, worsening my constipation and fuzzing my brain.

As you can see, there is no good solution.  So I’ll count my blessings and concentrate on what doesn’t hurt (my right big toe), watch a comedian or two and eat some junk.

Here’s your joke for the day:

A wife sent her husband a romantic text message… She wrote: “If you are sleeping, send me your dreams. If you are laughing, send me your smile. If you are eating, send me a bite. If you are drinking, send me a sip. If you are crying, send me your tears. I love you.” Her husband texted back: “I’m on the toilet, please advise.”

I SURVIVED

It looks like I’m going to survive.  Renee and I are doing better by the day.  What remains of Covid is Renee’s exhaustion and my abnormal taste buds.  Everything taste sickly sweet and metallic.  What’s scary is the potential for long term damage which Covid is known to cause.

Last night on CNN, the journalist was interviewing individuals who clearly stated that they thought Covid was not nearly as bad as it was reported to be and that the death statistics were exaggerated for some nefarious reason.  I want to assure you that Covid is the worse viral entity I’ve ever seen.  At the onset, I was convinced that I was not going to survive.  With early intervention and the grace of God, I did.

In the 40 years since I went to medical school, I’ve seen tuberculosis, smallpox, the plague, measles, and SARs just to name a few.  They pale in comparison to Covid.  Covid is far from over!  On Facebook today, someone posted the fact that the virus does not move on its own.  People move it around!  Do not be a host.  Don’t carry Covid to your friends and family.  Buy good masks and practice social distancing.  Isolate yourself as much as possible. 

If you are exposed, quarantine is the answer.  If you have risk factors, seek early medical intervention.  My pearl of the day is Vitamin D supplementation. There is evidence that Vitamin D augmentation may help prevent or mitigate infection.  Whether you believe that Covid is part of a grand conspiracy or not, wearing a mask and taking Vitamin D are harmless and may save your life.

One last plea.  Please get vaccinated at the first possible opportunity!  Remember, the life you save may be your own.

COVIDVILLE

If you are wondering where I’ve been, I’ve been on a trip to Covidville.  I’m sitting in my kitchen, oxygen canula in my nose, trying to recover from Covid.  Yes, Covid is real; it’s not fake news.  Despite all of my attempts to guard against infection, it found its way through my defenses.

My new doc really stepped up her game and found a hospital that would infuse the experimental monoclonal antibody serum that Trump apparently 
was given.  I had to drive 60 miles away to be treated.  The hospital staff was incredible and 5 hours later, I was on my way home.

Jeremy drove in from Atlanta and has been chief cook and bottle washer, as well as standing guard over us 24/7. I’m glad to say it looks like RENEE AND I HAVE TURNED THE CORNER.  Did I mention that Renee caught Covid as well?

If you are a doubter.  If you are so disillusioned by what’s going on in society today and don’t believe the numbers broadcast daily, then let me reassure you that Covid is very real and skilled at defeating our external safety precautions and our internal immune systems.  As knowledgeable as I am, I could not protect myself and my wife.  In retrospect, the only thing I could have done differently would have been living under a strict quarantine.   

If you get symptoms of Covid, call your doc immediately!  I still recommend wearing masks, social distancing and handwashing.  However, I would modify the social distancing rule and strive for a distance of 100 yards.  Yes, the size of a football field.  You really don’t ever want to be this sick or be fairly certain you were going to die.

(While the monoclonal antibody cocktail is experimental and comes with unknown risk, I gladly received it and got better promptly.  If there is an aftermath, I’ll deal with it.)

I’ll resume my regular blogs when I’m well.  My editor is not up to editing so please ignore any grammatical errors you may find.  There is no joke today as I’m not in a joking mood.  Music is soothing so here’s a tune for you.

THE DOCTOR’S DOCTOR

Last week, the world lost a great man.  Dr. Jerome Perlman was my family doctor for 25 years.  He was a caring, compassionate doctor who saw me through one of the worse times in my life and set me on course and guided me through my career as a doctor. 

At the age of 13, I told Dr. Perlman that I was going to medical school and eventually become his partner.  Every step of the way, from undergrad at UVa. to medical school in Mexico, I would call Jerome and update him on my practice.  Unfortunately, his health caused him to retire young and I never got to join him.

In 1982, I was an emergency room doc at Northwest Community Hospital.  While I was a board certified family doc, my family practice residency was so bad that I abandoned family medicine for the fast paced life of an ER Doc.  It soon became apparent that 90% of what I saw in the ER really belonged in an outpatient family practice and that I really was a family practitioner at heart.

For a little over a year, I asked each patient I saw one of 10 questions designed to determine why the patient chose the ER as opposed to going to their family doc’s office.  I then opened my own office in Lake Zurich and designed it to meet the top 10 needs of the patients I had surveyed. When I opened in 1984, I realized that I had recreated Dr. Perlman’s office and practice style. 

Over my 40 year career in medicine, I treated hundreds of thousands of people, all as a result of the work of one amazing man.  Thank you, Jerome.  Rest in peace.