Month: March 2021

My Parkinson’s patients have raved about it.  The literature verifies its ability to stabilize and improve Parkinson’s.  I’ve participated in 3 classes over the last week.  Yesterday’s class wiped me out!

Rock Steady is built around boxing.  We train for 75 minutes, 15 of which involves boxing.  We are learning about the boxer’s stance, hooks, jabs and undercuts.  We box with a dummy, a heavy bag and a speed bag.  I actually like hitting the dummy!  I’ve never been a violent person but find great pleasure in hitting the CEO of a major insurance company that for years has given me the blues.

We do laps in the gym.  We do stretch and balance exercises.  We do some endurance training.  The group is highly supportive of each other.  Yesterday, my legs wouldn’t work.  They gave out on the first lap.  I almost fell twice.  Two of the guys walked me out to the car. 

I have avoided going to any group activity involving Parkinson’s and Rock Steady is such a group.   Whenever I was around a person with Parkinson’s, I wanted to cry.  I saw myself in him/her and knew that one day I would be as bad as that person was.  I was foolish.  Now I’m the second worse in the group and vying for the honor of being the worst. 

I’ve written about denial before.  When in my doctor’s outfit, I was Superman.  Denial stopped me from recognizing how bad I had gotten.  While skeptical of its ability to improve my life, I know that doing what exercise I can tolerate will be good for me even if it doesn’t slow my progression.  Being in this group and being able to compare myself with others afflicted with Parkinson’s will, at least, keep me out of denial.

As a physician, husband, parent and friend, my job is and was to help my patients, relatives and friends who are in denial see the light of day.  Think of a person who is in denial as a person who has blinders on.  Taking those blinders off may be difficult and may even damage your relationship with your loved one; but, in the end, it will be worth it.

Denial is particularly bad in heart disease, lung disease and colon cancer.  I had a 48-year-old male who had a complaint of severe indigestion.  He had taken all of the over-the-counter meds to no avail.  I told him that one of the possible causes for his symptoms was heart disease.  He told me he walked 3 miles a day, followed a healthy diet and recently had a normal EKG.  I told him that a normal EKG was meaningless. I explained that, even though he exercised and ate appropriately, his family history (father and uncle with coronary artery disease) and symptoms required a more extensive workup.  He accused me of driving up the cost of medical care by doing “unnecessary tests.”

He sought a second opinion from a gastroenterologist who scoped him and put him on more meds to no avail.  His symptoms remained the same and he had a large MI shortly after starting on his new medications.  Remember the statement I posted the other day, “Uncertainty is the only certainty there is and knowing how to live with insecurity is the only security.”

When you’re deep in denial, there is no room for uncertainty and insecurity as you are certain and secure in the belief that you are right.  I don’t care how unlikely the diagnosis of heart disease was, the risk of missing the diagnosis of heart disease is too great and the penalty too grave not to do a further assessment. 

In other terms, when making a list of possible causes for an illness, if there is anything potentially life threatening on the list, it should go straight to the top of the list even if it is highly unlikely.  I would rather waste money than waste a life!

Here’s your joke for today:

A woman puts an ad in the paper looking for a man who wouldn’t run away at the sight of commitment, who wouldn’t hit her, and could fulfill her sex life.

Two weeks go by and nothing. Finally, one day the doorbell rings. She opens the door and sees a no-armed, no-legged man.

She looks at him and asks, “How do you expect to fulfill my wishes?”

He explains, “I have no arms to hit you with and no legs to run away.”

Then she says, “And the sex life?”

He looks at her and says, “I rang the doorbell, didn’t I?”

Posted on the kitchen wall in my office, I had a picture of footprints on a beach showing two sets of prints leading into one set of footprints.  The poem that went with the picture was:

One night I dreamed a dream.

As I was walking along the beach with my Lord.

Across the dark sky flashed scenes from my life.

For each scene, I noticed two sets of footprints in the sand,

One belonging to me and one to my Lord.

After the last scene of my life flashed before me,

I looked back at the footprints in the sand.

I noticed that at many times along the path of my life,

especially at the very lowest and saddest times,

there was only one set of footprints.

This really troubled me, so I asked the Lord about it.

“Lord, you said once I decided to follow you,

You’d walk with me all the way.

But I noticed that during the saddest and most troublesome times of my life,

there was only one set of footprints.

I don’t understand why, when I needed You the most, You would leave me.”

He whispered, “My precious child, I love you and will never leave you

Never, ever, during your trials and testings.

When you saw only one set of footprints,

It was then that I carried you.”

I don’t know who wrote it, but the poem is truly beautiful.  Over the years I was in practice, I was lucky enough to see evidence of God’s interventions in my patients’s lives.  On several instances, I felt the hand of God guiding my care and therapies.

About 10 years ago, God’s presence seemed to vanish.  I tried, in vain, to figure out what happened but never could.  I finally decided that God went on vacation and didn’t tell anyone.  When I look at the world we live in, I have trouble with the fact that bad things happen to good people and that good things happen to bad ones.

I read multiple books on the subject and talked to the clergy about it and have yet to hear an explanation I can get comfortable with.  My trip through the past reminded me of how many of my mentors have died and, once again, has brought my questions to the surface. 

I know people are born to die but many of my mentors left our world while still young.  Add to that the half million people who have perished from Covid and I think you can see my point.  Is God a vengeful deity who happens to be pissed off at the low attendance in his/her churches, synagogues and mosques?  Is he/she on vacation?  What’s up?

There is, of course, one more very important question:  Why me?  When I first got Parkinson’s, I assumed that God had enrolled me in a course on handling chronic illness as part of my ongoing education.  That assumption led to this thread on my blog.  I was at peace with that idea.

Then, Parkinson’s, along with my back problem, took my practice away.  I didn’t have a good explanation for that.  That pissed me off and I spent a lot of energy on being angry with God.  I asked lots of questions and got no answers.  Today, someone sent me the poem I copied above.  I remembered the picture on the wall in my old office and my anger dissipated.

If there is an afterlife, I assume I’ll get answers to my questions then.  It is said that the pathologist knows everything, just a few moments too late. Will my answers come too late?  I’ll add that question to my afterlife list.

Meanwhile, I’ll try to connect with God and continue to communicate with my former patients and teach through this blog.  I know that some of what I write will offend a few of my readers but I believe that striving to be politically correct stifles original thought and education.

I use vulgarity on occasion.  There are just some sentiments that are best described by vulgar words.  I apologize in advance if I offend you in anyway. 

Here’s your joke for the day:

God said “Adam, I want you to do something for Me”. Adam said “Gladly, Lord, what do You want me to do?”

God said, “Go down into that valley”. Adam said, “What’s a valley?”

God explained it to him.

Then God said, “Cross the river”. Adam said, “What’s a river?”

God explained that to him.

And then He said, “Go over to the hill…” Adam said, “What is a hill?”

So, God explained to Adam what a hill was.

He told Adam, “On the other side of the hill you will find a cave”. Adam said, “What’s a cave?”

After God explained, He said, “In the cave you will find a woman”. Adam said, “What’s a woman?’

So God explained that to him, too.

Then, God said, “I want you to reproduce”. Adam said, “How do I do that?”

God first said (under His breath) “Geez…”

And then, just like everything else, God explained that to Adam, as well.

So, Adam goes down into the valley, across the river, and over the hill, into the cave, and finds the woman. Then, in about five minutes, he was back…

God, His patience wearing thin, said angrily, “What is it now?” And Adam said, “What’s a headache?”

Spring is here!  It’s my favorite time of the year.  Kenzie, my 3 year old granddaughter, has started in soccer and RJ, my 6 year old grandson, in baseball.  Kenzie lives here so I get to see a lot of her “games.”  Once our vaccines are done, we’ll be on our way to baseball in Georgia.

Thanks to the magic of the internet, we get to see Jackson play baseball and Hannah play volleyball in Virginia.  Sooner or later, we’ll work our way up to Virginia.  I have two elderly uncles in the Norfolk area.  One turns 99 soon and I really want to celebrate his birthday with him this year.

The builders are here this am putting in my raised garden.  I love growing fresh veggies.  I love tending to and nourishing my garden, watching it bear fruit.  In Illinois, LZFTC was my garden; and the infants, children, and adults I cared for over 34 years were my precious fruits. 

I watched my families grow into second and third generations.  I’ve lost track of most of them but am secure that they are doing well.  The kids of the kids I took care of when I first opened LZFTC are graduating from college, getting married and having babies.

Now, my children and grandchildren are my main focus and Renee and I will tend to them and nourish them for as long as we can.  I’ve complained bitterly that there is not much I can do.  In reality, I have my family to tend to and, by the end of the day, my garden.

I’ve had two really bad days in a row.  This morning it took me 10 minutes to move from one end of the house to the other to get to this laptop so that I could write this article.  The journey from my room to the kitchen has left me wondering, “Will I be able to tend to my garden?”  We shall see. The journey from the kitchen to the garden is about the same distance as from my bedroom to the kitchen. 

They say, “Where there is a will, there is a way.”  My will is strong. I’m going to pick fresh greens spring and fall.  I’m going to have gazpachos and cold cucumber soup made from fresh tomatoes and cucumbers picked fresh every morning. 

When I say “I,” I really mean Renee and me.  She has become my hands and feet and has taken on a huge amount of what I used to do.  I need to buy her a cap and vest for when she is the chauffeur, a chef’s hat and apron for when she’s cooking and a skimpy, lacey outfit for when she’s dressing me or . . .

Spring is a time to renew and grow.  My recent articles have been a form of spring cleaning. I’m ready to plant seeds in the garden, ideas in those who read this blog.

Today’s seed to plant and nourish:  be happy with what you have, enjoy it while you can as you never know what tomorrow holds.  Don’t put off the happy!

Here’s your joke for the day:

Two boys were walking in the forest…

… and they came across the most beautiful women taking a bath in a hot spring. Upon seeing this, one boy took off running, and the other went after him. When he caught up to the other, he asked “Why did you run off?” To this the other replied, “Well, my mom told me that if I ever saw a naked woman I would turn to stone, and I felt something getting hard!”

Another?

John Snow was at a bar outside the great wall drinking. A beautiful girl comes inside and her eyes meet his. She likes him, so she goes and introduces herself.

-Hello, handsome. My name is Jenny Spring. What’s yours?

John laughs and continues with his drink.

-Why is this funny?

John Snow responds,

-Nothing. I just imagined how rare it would be to have 7 inches of Snow in Spring…

I just realized that I have a job.  Yep, I’m not really retired, instead I’m working for the department of water works.  My full-time job is making sure that I know where the nearest urinal is and that I can get there in time.  Turns out a lot of people my age work at the same job!  I was in Costco’s bathroom the other day and it was packed with old men.  It helps that big box stores put their bathrooms in the same place at every location.  How many of you know where the bathroom in Bed, Bath and Beyond is?  My second full time job is working on my mining for poop.

Constipation, what an exciting topic to write about.  I find it interesting that, at the age of 69, poop talk still makes me want to laugh.  Poop talk leads to all kind of jokes.  My opening line could have been, “Constipation, a shitty topic to write about.”  I had another opening line.  It’s on the tip of my tongue and I can’t quite put it on paper.

Seriously, the older you get the more important and difficult your bowels and bladder become.  For many, their golden years revolve around both poop and pee.  Time for a joke now:

Three old guys sitting at the breakfast table:

Guy 1 – Oy, it’s terrible.  I get up in the morning and sit for an hour straining to take a dump. I push and I push and all I get are little rabbit turds.  I’m miserable!

Guy 2 – I can poop just fine.  I can’t pee.  I get up in the morning and try to pee.  I get tiny drops that go everywhere except where I want them.  I strain and I strain and eventually I pee.  Then 15 minutes later, it starts again. It’s terrible!

Guy 3 – I don’t have a problem pooping or peeing.  The only problem I have is I do both an hour before I wake up!

The best humor comes from reality.  The reality is that I can fix the urinary problem with surgery.  The problem is I like my prostate just as much as I like the rest of my body parts and I’m not in any hurry to get rid of it.  I’ve had enough surgery.

The constipation is a different subject.  There are many causes for constipation.   Mine include my age (if I stop aging it resolves), Parkinson’s (same caveat) and my medications.  My choices appear to be either stop aging or deal with it.  I’ve decided to live so I’ll just have to deal with it.

True story – My fellow residents used to sit together at the 3 am free breakfast that Lutheran General Hospital provided.  We’d talk shop, review cases, and slam the attending physicians prescribing habits.  On one such occasion, I presented a case where the patient was on 13 different medications.  Half of the meds were given to treat the side effects of the other half.  We took an oath: we would never do that!

Fools that we were, we believed it.  Flash forward 30 years and I had patients on 13 meds, half treating side effects of the other half.  Flash forward 10 years more and I’m on 13 meds.  And I’m fricken constipated. 

I’ve seen my doc who told me my protuberant belly was from constipation.  I didn’t believe her.  I got a second opinion from a gastroenterologist.  He told me I was fat and constipated.  His answer, take more Miralax and start on Dulcolax.  Oh yeah, he told me to lose weight and then explained why I wouldn’t lose weight due to the myriad of problems and meds I had.

I’m losing weight and am down 1 ½ pounds in a week.  If Miralax wasn’t available as a generic, I’d buy stock.  I can’t get enough of it.  Same for Dulcolax.  I think today’s the day I get lucky and have a movement.  In the meantime, if you see me out and about, you’ll notice that I’m always scanning for the location of the nearest bathroom.  (I wish Yelp would rate public bathrooms.)

I almost forgot.  I stopped at a Harris Teeter to get some last minute supplies.  On entering the store, I headed directly to the bathroom.  The problem was the store design I was in was different from what I was used to.  I found the bathroom just in the nick of time. 

Next week, I’ll write about designer Depends.  If you are having problems with poop or pee, be sure to review them with your doctor.  Meanwhile, hydrate. 

Here’s some jokes:

At age 4, success means not peeing in your pants

At age 12, success means having friends

At age 17, success means having a driver’s license

At age 25, success means having sex

At age 35, success means having money

At age 45, success means having money

At age 55, success means having sex

At age 65, success means having a driver’s license

At age 75, success means having friends

At age 85, success means not peeing in your pants.

A wife sent a romantic text to her husband. 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.”

👍🏼

Yes, I’ve admitted that I didn’t follow my own advice.  I’ve also admitted that not following my advice was stupid.  I’ve got a little more crow to eat.  It seems that, even though I’ve warned literally thousands of patients against it, I’m playing the “would have, could have, should have game.” 

Males usually play, “It is what it is, move on!”  I’ve said that thousands of times yet, in retrospect, find that it’s a form of denial.  The purpose of my review of the past is to look for situations where I could have improved my life, my family’s life and patient care and then teach others how to avoid/react to those situations.

I’ve often said that of all the personal, carefully thought out and studied decisions I’ve ever made, fifty percent turned out to be right and fifty percent were wrong.  I might as well have been a weatherman!  There must have been a better way.

John Allen Paulos said, “Uncertainty is the only certainty there is, and knowing how to live with insecurity is the only security.”  People expect their doctors to be certain about their diagnoses and treatment options.  Children, while challenging their parents, really expect their parents to be certain about their decisions and keep them secure.

Paulos was right.  In the case of medical care, all diagnoses are provisional and as secure as possible given that doctors are human and science is fallible.  Everyone is asking me for my opinion regarding the Covid vaccines.  My provisional advice is based on existing research.  Current data strongly suggests that vaccines for Covid are as safe as other vaccines as far as immediate risks are concerned.  The provisional portion is that we have no idea what future problems might arise over the next 5-10 years.

I’m getting my vaccine on April 7^th.  I am secure in the belief that, other than an unforeseen allergic reaction, the vaccine will help prevent my chances of reinfection with Covid at extremely little or no risk.  I am fairly secure that there will be no future problems associated with the vaccine.

The takeaway message for patients is that your doctors are human and therefore, imperfect.  Science is constantly evolving, and therefore imperfect as well. Today’s best medical care will be replaced by tomorrow’s discoveries.

 When we emptied out the old office, I came across my rigid sigmoidoscope (a chrome pipe 60 cm long).  My first thought was that I really couldn’t have put that pipe in patients’ rectums!  Then I remembered that, when I started in medicine, the rigid scope was state of the art and I scoped people by putting them on an inversion table, flipping them on their head and ….. So, listen to your doctor, study your options, and then make the best decision you can.  If you are uncertain as to the veracity of your doc’s advice, get a second opinion from a doctor, not the internet, google or your neighbor.

My advice for docs is to never forget Paulos’ statement, “Uncertainty is the only certainty there is, and knowing how to live with insecurity is the only security.”  As long as you temper your certainty with the possibility that you could be wrong, and the security provided by the title of medical doctor with the insecurity of being human, then in retirement you probably won’t need to play the “would have, could have, should have game.” 

Remember the house call I wrote about previously. The whole family was vomiting and had diarrhea.  They had all eaten the same food.  They all appeared to have the same symptoms.  It was a certainty that they all had food poisoning, wasn’t it?  In fact, it was a trap.  Four out of five members of the family had food poisoning.  The fifth member had an acute appendicitis and I made by that diagnosis at my first visit.  My colleagues, upon learning of my diagnosis, wanted to know how I made that diagnosis when the symptoms and clinical findings were essentially the same as the rest of his family.

One of my mentors had taught me about Paulos and the value of his statement, “Uncertainty is the only certainty there is, and knowing how to live with insecurity is the only security,” creating enough insecurity and uncertainty in me to keep me on high alert.

Mentors are invaluable and the wisdom they shared with me has saved a lot of lives!

Here’s your joke:

A woman goes to the doctors with a piece of lettuce sticking out the top of her underwear.

The doctor says “that looks nasty”, the woman replies “that’s just the tip of the iceberg”

One more: What did the cannibal do after he dumped his girlfriend?

Wiped his butt.

First a story.  During a physical exam on a 67-year-old male, I asked him what his plans for retirement were.  He stated that he was going to retire in 6 months and had plenty to do around the house.  I explained that when you have 24 hours a day, seven days a week that whatever needed to be done around the house would be done in 3 months and that he needed to know what to do then.  We kicked around a few ideas and he decided he would go back to school and study history.  He loved history.  Years later, I saw him again.  He had gone back to school, met a young woman, left his wife and married his newfound love.  I learned that interventions, no matter how benign they maybe, have potential consequences.  He was happy; his x-wife was not.

According to feedback from my patients, I gave great advice.  Unfortunately, I rarely followed my own advice.  Part of my yearly physical involved asking my older patients what they planned to do after retirement.  Over the many years I practiced medicine, I had discovered that retirees who had no advanced planning became overweight sloths.  They tended to eat, sleep and watch TV while waiting for something to miraculously fill the long days and nights of retirement.

I found that those who planned their retirement activities in advance did well.  Golfers, tennis players and pickle ball enthusiasts did the best.  Women did better than men.  Even those women who had no plans found something constructive to do.  Women’s superiority over men is a topic for another article.

I truthfully didn’t expect that I would ever retire.  I told my patients that I would die in the office seeing patients and I meant it.  My only real outside interest was cooking.  I talked about working with wood; but, after building my family room furniture with a good friend, I realized that what I needed was missing.  I had no talent for woodwork; and, if I did, my bad back would get in the way.

When I opened the office, I installed double doors at the entrance.  I jestingly told patients that I had double doors as, on the inside, I was a fat man waiting patiently to escape from Dr Segal’s demands that I eat a healthy diet.  Well, the fat man finally won. 

Having no plans to retire or anything to retire to, my actual retirement was exactly as I had described it to my patients.  I became a sloth, eating, sleeping and occasionally pooping (constipation is another topic for future discussion).  If only I had listened to my own advice.

I’ve learned a valuable lesson.  Hippocrates said, “Physician, Heal thyself.”  That statement should be part of the Hippocratic Oath.  In order to care for others, you have to care for yourself.  There should be a firm rule.  What you tell your patients to do should be what you do!

So, what am I going to do with my free time?  One of my patients/friends suggested that I volunteer at the local dog rescue playing with dogs that need a kind human touch.  What a great idea!  I’m working on it but currently am hampered by Covid precautions.  I’m writing a book even though it may never be published.  I’m going to the gym and think I’m going to like boxing.  I’m chasing Renee around the house. We have a catch and release policy.  (If only I could remember what to do when I catch her).

I’m working at staying oriented.  When every day is the same as the one before and the one after, getting disoriented is easy!  I did not really understand the disorientation of retirement when I was well and practicing medicine.  I probably diagnosed a memory loss in too many patients and sent a lot of patients for neuropsych testing (documents cognitive disorders).  I’m going for neuropsych testing next week in preparation for deep brain stimulation.

I’m really nervous!  I don’t want to know what I’m missing/losing.  Am I in denial? Maybe!  I’m about to find out.  What I’ve learned is that a simple 4 hour memory test, that I routinely ordered, can be extremely anxiety producing.  Not recognizing the effects of ordering neuropsych testing meant I couldn’t prepare my patients for the anxiety that I’m currently experiencing.   

Being chronically ill is, indeed, an education.  The question remains, how to teach the lessons I’m learning to a healthy medical student or resident.

Here’s your joke for the day:

A man and a woman had a quarrel:

Woman: If I had known that my life would become like this, I should have just married the devil himself.

Man: But getting married with your relatives is a taboo, isn’t it?

When asked, “How are you doing?” my answer was always, “Fine!” Not wanting to complain is one thing.  Denial is something else.  For a long time, I hid from my illness by denying its effects on myself and my family.  Denial is a potentially fatal mistake.

As a physician, I knew to look for denial and, in life threatening instances such as heart attacks, to quickly confront it so that it did not jeopardize my treatment or my patient.  I thought I was pretty good at rooting out denial and removing it from the equation.

As a patient, I’ve discovered three things.  Number one is that a clever patient can hide his/her illness and thus deny it, and number two, that denial has protective qualities of its own. The third thing I already knew.  Having a patient advocate with you at office visits is helpful both to the patient and his physician but that denial can be so complete that it can be missed even by a loving spouse.

I’m the clever patient who hid the extent of my illness from my doctors, my spouse and myself.  By carefully timing my medications or even taking extra pills, I looked good whenever I saw my doctors.  Since I looked good, they told me I was good; and, rather than pay attention to how I really was, I convinced myself and others that I was “fine.” 

Doctors are always under the gun.  They have limited time with their patients and patient charting.  If their electronic medical record (EMR) does not prompt them to ask a question, they usually won’t.  In my case, the EMR did not ask about activities of daily living (ADL) so my physicians never asked.  Renee knew I was worsening as she was starting to take on more of my ADLs but either supported my denial or just didn’t bring it up as no one ever asked her.

Meanwhile, my condition quietly worsened.  Eventually, my self-deception was penetrated by the most unlikely of sources, my insurance company. It was then that I realized, for the first time in 40 years, how protective denial could truly be.  I had been taught that denial was a bad thing, and, as a physician, we had to recognize and treat it.

Forced to look at how bad I really was led to depression and the addition of depression to Parkinson’s led to me giving up.  I’ve made lots of excuses for my weight problem; but, in reality, I think it was a direct result from my quitting life and withdrawing to sleep and eating.

Once the veil of my denial was penetrated and I was forced to look at how much function I had lost, I had two choices.  I made the wrong choice.  The right choice was to fight this damned disease.  I’m back in the fight now.  I’ve started in a program called “Rock Steady” and am learning to box and exercise again.  I’m actively working on reducing my weight.  I’m working on the depression as well.  While I can’t reverse the damage from Parkinson’s, I can learn to live with what I have.

I’ve also stopped denying other’s offers of help.  Yes, I’ve accepted Renee’s help dressing and bathing.  I even have accepted that I have to give up cooking.  Maybe, given time, her bathing and dressing me will become fun (wishful thinking).  I let others hold the door for me, and, in a grocery store, I now use the scooter.  I even answer the question, “How are you doing?” honestly.  This morning, it’s not so good.  I’m freezing a lot and have come close to falling twice so far.

Researching dirty jokes is a great way to counter depression.  It’s impossible to stay depressed when you are laughing.  Renee is my editor and hearing her laugh at my daily jokes is marvelous.  Writing helps as well.

If you or a loved one are in denial, please see your doctor or counselor.  Denial must be handled with great care.  Like most things, it can be good, bad or a combination of the two.  Regardless, it needs to be recognized and dealt with; and the consequences of dealing with it have to be addressed.  Unfortunately, I had to get sick to learn this lesson.

Here are your jokes for today:

The seven stages of grief – Denial, Anger, Bargaining, Depression, Acceptance, Saturday, Sunday.

If lawyers are disbarred and priests are defrocked, then…

Electricians are delighted

Corpses are decrypted

Cowboys are deranged

Models are deposed

Underwear models are debriefed

Dry cleaners are depressed, decreased and depleted

Jilted women are debrided

HVAC technicians are deducted

Tennis linemen are defaulted

Florists are deflowered

Students are detested

Hostels are debunked

Spies are debugged and detailed

Corporations are deformed and delimited

Celibate people are delayed

Chauffeurs are derided

Record keepers are described

Plumbers are dethroned

Clerks are defiled

Traffic cops are defined

Naturists are denuded

Election officials are devoted

Accountants are decertified

Builders are deconstructed

Confused people are demystified

Intelligence officials are declassified

Interpreters for the deaf are designed

Road builders are degraded

Waiters are deserved

Horses put out to stud are desired

Castles are demoted

Organ donors are delivered

Anything certain is depending

And if you found this funny, you’re probably demented, defective and in denial

https://upjoke.com/denial-jokes

Well, my trip to the past is almost over.  The practice continued to grow.  Growth cycles were directly related to season of the year and how busy we were. The longer the wait time, the slower the growth.  As the growth slowed, wait times diminished; and, as wait time diminished, growth again accelerated.

It made sense.  When wait time was low, I could spend more time with the patient.  The more time I spent with a patient, the more referrals I received from that patient.  During the early years of the practice, I would freak when wait times diminished (growth slowed or reversed).  I drove Renee crazy.  I thought I did something wrong and didn’t know it.  Renee started charting numbers of patient seen monthly to show me the natural flow of the practice.  I finally relaxed.

The insurance companies and our government finally killed the practice.  Overhead continued to rise.  Maintaining the EMR was expensive.  Office staffing was expensive.  Replacing aging equipment was expensive. Taxes, snow removal, electricity and water were expensive.  Reimbursements from Medicare and the insurers decreased significantly.  Insurance company interference in patient care increased.  No matter how many patients I could see in a day, income per patient finally fell low enough to make it impossible to stay independent.

I swore I would never sell my practice.  I swore the big hospital-owned corporations buying private practices would be the end of medicine as I knew it.  I was right!  I also had no choice.  I sold to Amita.  Working for Amita was better than I expected.  They gave me plenty of time to see patients.  The other big hospital corporations would have given me 10 minutes per patient.  Amita gave me 30 minutes per patient.  I was actually having fun.

Unfortunately, my back worsened requiring extensive surgery.  My recovery was slowed by the ever-worsening Parkinson’s.  Two years ago, I was forced to retire.  I hate retirement.  I also became a full-time patient.  I hate that role as well.  I had given up and was waiting to die when I got Covid.  Covid kicked my butt.  It also woke me up.  Jeremy came from Atlanta; and Lisa, sick with Covid as well, called twice a day checking on us.  It warmed my heart.

I called on my friends, Will Power and Milo, and they showed up immediately. Covid cleared, Jeremy left, Lisa got well.  Will and Milo hung out.  Their job, to get me back on the right track.

There are plenty of stories to tell.  It will become obvious that my style of treating people was unique and not for everybody.  I was the kid who owned a pool company at the age of 15.  I was the young man who tended bar and short order cooked.  I was the boy who went to Mexico and came back a man with a goatee.  I was a little of each of them and of other characters.  Most of all, I was the 13 year old who told Dr Perlman I was going to be his partner.  Years later, I called him and told him I loved being a family doc.

One big difference between me and my cronies was you wouldn’t catch me with a tie on. Not at home nor in the hospital or office.  I wore polo shirts and sometimes jeans.  It took 20 years for my fellow doctors to learn that ties spread germs.  It took another 10 for dress codes to relax. 

Did you ever wonder why a man would put on a tie? I’m sure some brilliant woman decided that if she put a pretty noose around her husband’s neck and tightened it enough to slightly compromise the blood supply to his brain, she could better control her man.  The word spread and women around the world started dragging their men around by the tie.  “Honey, put on that blue tie and choke yourself almost to death.  We’re going out with the Segals and were going to have fun!

Oh yeah, the rest of this book will review the lessons I’ve learned since becoming chronically ill and how they would have influenced my practice of family medicine had I learned them earlier in life.  I would become a mentor and offer my knowledge to a young MD but you may have noted that too many of my mentors died.  Giving up the knowledge you have must kill you.

Here’s your joke for the day.  Actually, it’s not a joke.  I’m so fat that the post office offered me my own zip code.

I think its time to get my act together.

I must be boring you.  My readership is way down.  As stated before, the one topic that increases my readership is sex.  So, what facet of sex do you want to read about today?  How about senior sex since most of my readers are older than sixty.

Sex in the 70s usually goes like this:

Husband – “Fuck you.”

Wife – “No, fuck you!”

After five minutes of back and forth FUs, the couple finally reach a climax, husband yelling FU until exhausted, wife retiring to her room to calm down. 

Unfortunately, it’s no joke.  Most of our generation is suffering from hormonal and physiologic changes which cause all kind of problems.  Most of our generation are uncomfortable discussing anything about sex. 

Oh, you thought this was going to be a scientific discussion.  What do you want to know about?  If you have a topic you’d like to explore, write me or simply do an internet search.  As usual, the internet is full of information and products to sell you. 

There are pills to increase the males’ ejaculate, erection, orgasmic pleasure.  There are pills to prolong both the male and female sexual experience.  There are all sorts of toys for girls and boys.

There are pictures and movies portraying every sort of sex act you could conjure up in your mind and some you couldn’t imagine.  There are men who dress like women, men who are women and every permutation of the sexes imaginable.  Is any of it normal?  Is all of it normal?  Is normal up to the individual?  Is normal up to society?

Some things are for sure.  Orgasms are healthy.  Orgasms are for procreation.  Orgasms are for recreation. Orgasms are free (usually).  Orgasms are misunderstood.  Counseling is available but seldom used. 

It’s time to change our attitude and discuss our problems.

Here’s you joke for today:

How is life like toilet paper?

You’re either on a roll or taking shit from someone.

What’s the difference between a tire and 365 used condoms?

Ones a Goodyear. The other is a great year.

Beer Bottle: “You break me, you get one year of bad luck!”

Mirror: “You kiddin’ me? You break me, then y’all get seven years of bad luck!”

Condom: “Hahaha… (Condom walks off laughing)”

Here’s a link to a great site.

49 Best Inappropriate, NSFW, Dirty Adult Jokes To Tell Everyone In 2021 (scarymommy.com)

My kids will tell you that the Segal motto is, “Go big or go home.”  I went big.  The practice grew and I decided to rent the adjoining office space.  Sixty-five hundred square feet of medical office space and only one doc!  What was I thinking?  I still couldn’t find a doc who would care for my patients the way I wanted them cared for. 

Enter the era of physician extenders.  I started teaching physician assistants, P.A.C.s; and, in doing so, found Jack and Maki.  By hiring the two of them, I freed up some time.  You’d think I would spend that time at home, wouldn’t you?  You would be wrong!  “Milo” fell in love with teaching and research.  Big Pharma took notice and speaking engagements and research projects put “Milo” on the stage, literally.

My biggest gig was at Rosemont Convention Center where I was the opener for the grand masters of asthma treatment.  I had 650 people in front of me and the stage was mine for 45 minutes.  I was great!

My favorite lecture was on the treatment of influenza.  At a dinner conference in Elgin, I played the role of the flu of 1918.  Again, I was great.  I held the audience’s attention for an hour, then we got drunk and sang Christmas songs late into the night.

I loved teaching.  I liked being on the stage.  I liked the applause, and I liked the added income.   I didn’t like being away from home: but, to be a national speaker for Pharma, you had to travel, so I did.  I was appointed to Glaxo’s national speakers panel and developed expertise in the management of asthma and copd.  I found myself sitting at the table with the Gods of Asthma care and holding my own.  I impressed myself! I impressed other pharmaceutical houses and, for a short time, flourished. I was addicted!

Over a ten-year period, Pharma actually listened to its physician advisors and things were good.  As Pharma became hungrier for profits, things changed and my relationship faded away.  My opinion of Pharma has changed with time.  They are no longer my friend.  They are not your friend, either.  When you see their commercials touting their newest medications, turn off your TV.  No matter what the commercial says, you probably don’t need what they are selling.  If you do, your doc will tell you.

Now, a true story. Once upon a time, a kindly old lady came to see me.  She had 36 bottles of pills in a bag.  She had seen ads on TV and in magazines telling her how good the pills were.  She had pills for her breathing, her heart, her joints, etc.  As I took bottles out, she would explain why she was taking it.  She would start off with, “It’s all natural.”  I would explain that it was manufactured, not naturally occurring.  As we got to the bottom of her bag, I found prescription meds prescribed years ago and being refilled by other docs she was seeing but hadn’t told me about.

Despite all the pills, she related that her breathing/asthma was getting worse.  In the bag, I found two bottles that contained echinacea.  When asked, she admitted to being allergic to “ragweed.”  Echinacea is ragweed!  She didn’t know it, but she was poisoning herself. Her suffering was directedly tied to her buying into commercial and advertising pieces found on TV and in magazines.  She got well when she stopped taking her pills.

“But doc, it’s all natural,” is a statement I hear all too often.  My poop is all natural! I put in the freshest organic foods I can buy and it’s processed the way God meant it to be. I don’t think you want to take swallow it, do you?  Remember that the next time the ad implies that its good for you and safe because it’s “all natural.”

Looking back in time, I realize bigger is not better.  I realize I was addicted to being a family doc and to teaching.  My office was the small, private stage I performed on daily.  Pharma put me on a much larger stage.  My ego prevented me from seeing the damage done to my own family by never being home. 

Funny, as a family doc, you would think I would have been better at being a family man.  Oops, I’m getting on the should have, could have, would have train.  That trip goes to nowhere!

Here’s your joke for the day.

Just after my wife had given birth, I asked the doctor, “How soon do you think we’ll be able to have sex?”

She winked at me and said, “I’m off duty in ten minutes – meet me in the parking lot.”

Man: Doctor, all five of my boys want to be valets when they grow up!

Doctor: Wow! That’s the worst case of parking son’s disease that I have ever seen.