PATIENT FIRST!

I went with Renee to the physiatrist today to discuss what we are going to do with Renee’s neck.  Renee and I are competing for the “Who Has the Worse Neck Award.” You might say we are neck and neck coming into the home stretch.  The physiatrist said something that is worth repeating:

“There are two types of docs.  There is the doc that treats the patient with a problem and the doc who treats a problem with a patient attached.” While it may sound like a simple play on words, it is a significant play on words.

Back in the dark ages, when I went to medical school, we were taught to take care of the whole patient.  The doctor-patient relationship was sacred and practicing medicine was a calling.  Unfortunately, everything changed with the onset of the computer age.  The focus shifted to problem management and checking as many boxes as possible became the goal.  The doctor was demoted to the status of provider and the patient was demoted to the person who delivered the problem to the computer.

The story is sad but true. During my tenure as physician, I worked long hours caring for people.  Today’s provider works long hours poring over computer algorithms, assuring that the proper boxes have been checked and coding is completed.  By the way, the doc Renee saw today used two novel tools, paper and pen, to record her history and findings. Rather than looking at the monitor while he talked, he actually looked at us and talked to us.  Being cared for as a human was a pleasurable experience.

I feel sorry for Dr W. as I’m sure he’ll spend his night inputting his notes into NextGen.  Boy, I miss the good old days. I’ve now been on hold for 15 minutes.  I’ve been on the phone for 1 hour and twenty-four minutes with Verizon trying to correct a bill I received after terminating my service.  They claim that, once their compute generates a bill, nothing can be done to correct it.  They want me to pay $81 for zero service or else . . .  The computer, even when wrong, has to be fed. 

What next?

Here’re your jokes of the day:

Verizon made a new minimum-security prison; and, despite what many would believe, it’s very successful. It’s got no bars but you still can’t get out of it for 2 years.

What does Verizon wireless and abortion clinics have in common?  They both have early termination fees.

For more Verizon jokes go to: https://jokojokes.com/verizon-jokes.html

CHRONIC PAIN, END OF LIFE

This August has been quite a month.  Two weeks ago, Renee and I drove to northern Virginia to celebrate my niece’s daughter’s Bat Mitzvah.  On the way there, we stopped in Richmond to see old friends.  On the way back, we stopped in Norfolk to see my 95- and 98-year-old uncles and my sister -in-law.  My sister-in-law did not look good and I suspected that her death was imminent. She was miserable, living with chronic, unrelenting pain. I hate when I’m right!  I also hate to see anyone suffer like Chrissy was suffering.

Shortly after returning to our home in North Carolina, we received the call.  Chrissy had died soon after being admitted to hospice.  So, we packed up our loaner car (mine is in the body shop since Renee was rear-ended) and headed back to Virginia Beach.

So, why was Chrissy suffering with intractable pain?  The diagnosis of intractable pain is easy.  Finding the cause is not so easy.  There are many causes of pain.  Unfortunately, if there is no apparent cause, doctors and family members are quick to assume that the pain is either not real or that the person suffering with the pain is just being dramatic. 

Doctors often take a cynical approach to pain patients, having dealt with drug seekers throughout their careers.  Personally, despite the fact that I had seen a large number of drug seekers throughout my career, I always chose to believe my patients and treat their pain until either the drug seeker slipped up and revealed themselves or I found the underlying cause of the pain.  First, let me explain, psychological pain is just as real as physical pain.  That being said, if you pay careful attention to your patient, the drug seeker will always have a tell.

Patient “X” is a 45-year-old male supposedly hurt on his job.  He walks painfully and slowly to the exam room.  He has pain on all movements of his body, especially worse on taking off his shoes, socks and pants.  Every place I touch him and every time I move his legs and back, he winces in pain.  His reflexes are exaggerated.  I validate his pain and ask him to dress.  I watch as I write my note.  He dresses swiftly without any signs of pain.  He sits with ease and waits for his prescription.  When I tell him to take Tylenol and schedule a plain x-ray of his back, he gets angry and leaves.  I follow him to the front and watch him slide into the driver’s seat of his Camaro.

He is the fourth back pain that week. I look for and find the chalk mark on the front of my office.  While I found four drug seekers, I missed one.  The one I missed marked the wall with chalk alerting his/her friends to the fact that I prescribed a potent pain pill for his/her bogus pain.  Yep, they literally “marked” me if I let one slip through my defenses.

In addition to the curse of drug seekers who fake injury to get narcotics, there is currently a government driven war on docs who prescribed pain pills.  The poor patient with real pain suffers as docs are threatened by their government and challenged by fakers.  Most docs I know refer patients with chronic pain to pain specialist who are often inundated with referrals and take months to get seen.

So, what do you do when you are at the end of your rope, the pain is truly debilitating, and life is slipping away?  One of the tools I used was hospice.  Patients and docs alike often believe that hospice is only for patients dying from cancer and that death is imminent.  I found that hospice was available to anyone with a terminal diagnosis and who was expected to die within 6 months of starting hospice.  Hospice helps make patients comfortable and improves quality of life by offering services not routinely covered by Medicare.  I have had patients on hospice for as long as 2 years. 

Here’s your joke for the day:

A married couple is lying in bed.

The wife leans over and says, “I want you to say dirty things before we start”. So, the man starts to caress her neck and whispers to her, “Living room, Bathroom, Kitchen”.

FALL

With the help of my gardener guru, I planted my fall garden yesterday with mixed emotions.  On the one hand, sewing seeds for fall and winter vegetables signals the end of summer.  Summer has always been my favorite season, allowing me to bask in the sun and swim.  This past summer was highlighted by driving with the top down from doctor’s office to doctor’s office and going to my Rock Steady classes.  Believe it or not, most days it was too hot to swim.

On the other hand, planting a fall/winter garden is a new and exciting experience as it signals the coming of a mild southern winter.  While I loved living in Long Grove, I hated the grey sky of the Midwest fall and the arrival of winter snow.  This winter, I’ll have plenty of sunlight and no snow.  I expect to drive, top down, year-round.

I’m working on maintaining an “attitude of gratitude” despite the fact that I hate retirement.  Yes, I enjoy gardening and driving with the top down, but those activities only take a fraction of the time I have daily.  While seeing my docs takes up a significant amount of time, it is depressing. 

As a practicing doc, I never realized how depressing retirement could be.  I never realized how long a day could be.  I also never realized how hard following my advice could be.  I envisioned retirement as a glorious time when you could do whatever you wanted.  I never envisioned retiring to chronic illness where the only thing I really want to do is walk normally.

Yes, I’m depressed.  I can’t put the top down and go for a ride.  Someone forgot to break and smashed the back of my car.  Renee was driving and she has a mild whiplash.  Hopefully, Renee and the car will return to their pre-accident conditions soon.  While I have resisted taking more pills, I may need an anti-depressant for a while.

Getting my emotions onto paper has been my best therapy in the past, so I expect that I’ll return to daily publications for a while. I’ll work hard on being upbeat and am sure I’ll find my way out of my current state. 

Here’s the joke for today:

I was sitting on my own in a restaurant when I saw a beautiful woman at another table. I sent her a bottle of the most expensive wine on the menu. She sent me a note: “I will not touch a drop of this wine unless you can assure me that you have seven inches in your pants.” So, I wrote back: “Give me the wine. As gorgeous as you are, I’m not cutting off three inches for anyone.”

SEVEN KEYS

My neighbor threw a block party last night and it was great.  Renee and I really lucked out when we moved here.  As we left to go home, one of our hosts, Barbara Peters, offered us copies of her new books.  I started reading “He Said, She Said” this morning; and, while I hate reading, I am enjoying her book.

Barbara’s book is all about relationships and the “seven keys to relationship success”.  Chapter One is about communications; and, as expected, the author is an expert at communicating her ideas in a simple to understand format. If the rest of the book is as good as Chapter One, this book will be a must read.

In Chapter One, the author quotes an unknown source:

“Watch your thoughts, for they become words.

Watch your words, for they become actions.

Watch your actions, for they become habits.

Watch your habits, for they become character.

Watch your character, for it becomes your destiny.”

If these five statements were the only wisdom derived from this book by its reader, the reader would walk away enriched and buying the book would have been well worth the cost. So, I’m going to ignore the rest of the book’s contents for now and focus on the above five lines.

In my day, thoughts became words and words took time to travel.  Because there was a significant time lapse between the formation of words from thoughts and the subsequent dissemination of those words, the action caused by those words took longer to occur. Words could be rethought and deleted or changed, and actions could be tempered or stopped.

In today’s world, thoughts become words which lead to action in the blink of an eye. They travel along the internet at warp speed, perpetuating themselves into habits and forming one’s internet character and, I dare say, destiny.  

When I was in school, there was this theoretical “permanent record” in which everything you did was recorded.  Your permanent record could make or break you.  It was like Santa’s list of who was naughty or nice.  It, like Santa, was not real.

Unfortunately, fiction often becomes reality; and the internet has become your permanent record and realistically can determine your destiny.  It is imperative that we teach our children and grandchildren to watch their thoughts carefully so that, if they become words, they are righteous words, words that they can be proud of. In 2021, words published on the internet are eternal and may lead to harmful, unforeseen actions later in life.

One last thought. In olden times, people judged your character based on your interactions with them.  In 2021, people who don’t know you, have never met you and probably will never interact with you on a personal basis will judge your character based solely on your internet presence.  Like your words, your internet character will be irrefutable, carved in stone.

So, today’s lesson is to carefully watch your thoughts, validate them and then share them in person with those you trust before they turn to words or actions. 

Today’s joke follows:

If I ever win the lottery, I’ll give some of the money to charity.

And, if she isn’t dancing that night, I’ll give some to Destiny.

HUNGER

I’m hungry!  I know I have to survive the hunger that comes with a drastic drop in caloric intake.  I will survive the hunger.  It’s just unfair!  On days when I have Rock Steady or doctor’s appointments, the hunger is so bad.  Yesterday, I took Renee to the doc and skipped lunch altogether.  Part of the solution is staying busy.

Staying busy is not so easy.  Today is not a swimming day.  It’s 73 and rainy.  When you’re 70 and handicapped, finding something to do can be tricky.  Shopping is out of the question as there is nothing I need.  My hobbies are cooking, eating and writing.  When you’re 50 pounds over your ideal weight, cooking and eating is counterproductive.

Writing keeps me busy; but, over the last 30-40 years, I written about everything.  I have the severe form of writer’s block.  I call it Writer’s Constipation!  I know I have more words inside; I just can’t push them out. Even though I’m writing this, I’m still hungry.  Yesterday, Erin turned me on to Hearts of Palm noodles. I spent 1 hour looking for them in the store and unfortunately bought a lot of food I didn’t need.  Back to the Palm noodles; they are filling. A whole can is only 60 calories.  Unfortunately, they don’t taste great unless you cover them with a fattening sauce.

Daily Harvest tastes great.  Some of the dishes are filling as well; but it’s like eating Chinese food, your hunger returns quickly.  So, I guess the answer is getting used to the hunger and hiding in the bedroom to avoid the call of the refrigerator.  Right now, I can hear my fridge calling me. “Hey Stew, I’ve got some flatbread and pastrami for you.  Come and get it!”

Hiding from your own refrigerator is childish and sad.  I going to say bye for today and hide!

Here’s your joke of the day:

Every morning, the CEO of a large bank in Manhattan walks to the corner for a shoeshine.  He sits in an armchair, examines the Wall Street Journal and the shoe shiner buffs his shoes to a mirror shine.

One morning the shoe shiner asks the CEO: “What do you think about the situation in the stock market?”

The man answered arrogantly, “Why are you so interested in that topic?”

The shoe guy replies, “I have millions in your bank,” he says, “and I’m considering investing some of the money in the capital market.”

“What’s your name? ” asked the executive.

John H. Smith was the reply.

The CEO arrives at the bank and asked the Manager of the Customer Department: Do we have a client named John H. Smith? “Certainly,” answers the Customer Service Manager, “He is a high net worth customer with 12.6 million dollars in his account.”

The executive comes out, approaches the shoe shiner, and says, “Mr. Smith, I would like to invite you next Monday to be the guest of honor at our board meeting and tell us the story of your life.  I am sure we could learn something from your life’s experience.”

At the board meeting, the CEO introduces him to the board members.

We all know Mr. Smith, from the corner shoeshine stand, but Mr. Smith is also an esteemed customer.  I invited him here to tell us the story of his life.  I am sure we can learn from him.

Mr. Smith began his story.

“I came to this country fifty years ago as a young immigrant from Europe with an unpronounceable name.  I got off the ship without a penny. The first thing I did was change my name to Smith. I was hungry and exhausted. I started wandering around looking for a job but to no avail. Fortunately, I found a coin on the sidewalk. I bought an apple. I had two options, eat the apple and quench my hunger or start a business. I sold the apple for 25 cents and bought two apples with the money. I also sold them and continued in business. When I started accumulating a few dollars, I was able to buy a set of used brushes and shoe polish and started polishing shoes.

I didn’t spend a penny on entertainment or clothing, I just bought bread and some cheese to survive. I saved penny by penny; and, after a while, I bought a new set of shoe brushes and polishes in different shades and expanded my clientele. I lived like a monk and saved penny by penny.

After a while, I was able to buy an armchair so my clients could sit comfortably while I shined their shoes, and that brought me more clients.  I did not spend a penny on the joys of life. I kept saving every cent.

A few years ago, when the previous shoe shiner on the corner decided to retire, I had already saved enough money to buy his shoeshine location at this great place.

Finally, 6 months ago, my sister, who was a prostitute in Chicago, passed away and left me 12.6 million dollars.”

A NEW MANTRA

I could become a vegetarian if it wasn’t for the fact that I love meat.  I could lose weight if only I could exercise.  I wouldn’t be hungry if I could burn enough calories to account for the food intake I need not to be hungry.  Could is a great word.  “Could” offers lots of promise yet delivers very little.

I’ve written about three words in the past.  “Could have, would have, and should have” is a mantra that many learn at an early age.  It’s also a mantra that needs to be eradicated.  While “could have” offers promise, “would have” offers feelings of depression and “should have” is associated with guilt.

I could be much healthier if I hadn’t gained 50 pounds. I would have lost 50 pounds had I not been on the pity wagon; and I should have listened to my dear friend and diet consultant, Betsy Weisbach, a long time ago.

Finally, I’ve gotten off the pity wagon and replaced the “would have, could have, should haves” with my new mantra, “must have” 50 pounds of weight loss, the ability to exercise, and enjoy life.  Betsy has been offering to assist me by having me log what I eat and reviewing it with me weekly.  Having someone to be responsible to is helpful in accomplishing any task.

Step number one, logging and monitoring my intake, is set and ready to go.  Step number two is getting rid of my excess baggage.  Step number two is to recreate the Stewart diet by defining what the Stewart diet currently is and refining it so that it is healthy, calorie deficient, and something I can live on for a very long time.  Losing 50 pounds will take a year!

A long time ago, I bought a week’s worth of food from Daily Harvest.  The food was plant-based, healthy and tasted great.  The food was expensive and I’m cheap; so I did not reorder.  Last week, looking to make a clean break from my present diet and looking for a firm platform for my new lifestyle and diet, I ordered 24 meals.  Each meal contains between 300-400 calories and tastes great.  The bonus is that they are also filling!

I started on my Daily Harvest-based New Stewart Diet and am happy to report that I can do this!  I can convert to a vegetarian-based meal plan with the addition of an occasional meat-based dinner and lose my 50 pounds while enjoying what I’m eating and staying within the parameters of my personal philosophy, as outlined in “Diets and Other Unnatural Acts.”

Thanks, Betsy, for your support.  You’ll be getting my first log in 4 days. 

Should you want to try DH, use this code RE-7HRT6GR to save $35 on your first order.

Here’re your jokes for the day:

Preventing childhood obesity…

It’s as easy as taking candy from a baby.

A woman is suicidally depressed

She’s quite obese, unattractive, and lonely. Life having dealt her a bad hand, she buys a pistol and resolves to end her own life.

Wanting it to be quick, she calls her doctor to ask him where the heart is.

“It’s right under the left breast”, he replies.

So, she hangs up, takes a deep breath and shoots herself in the knee. 

EXERCISE PART 2

Sometimes, I amaze myself!  I’m getting over a nasty cold.  The cough is gone but I’m still troubled by body aches and fatigue.  Frankly, I felt like staying in bed and sleeping all day!  Did you ever feel that way?

I used to advise that my patients return to exercise as soon as possible when recovering from an illness.  I counseled my chronic fatigue patients, teaching them that the answer to their fatigue was exercise.  My patients did not believe me.  When your body is tired, wasted by disease, the last thing you want to do is exercise.

Yesterday, I did not want to go to Rock Steady, my Parkinson’s exercise class.  I was convinced that if I exercised, I would collapse.  I dressed to go but then told Renee I wasn’t going.  Fifteen minutes later, I left the house and headed for the gym.  When I got to the gym, I could barely walk in.  I was in agony!

I told my instructors I would do whatever I could do.  I warmed up, stretched, crawled a lap around the gym and, miracle of miracles, started to feel better.  Yep, it makes no sense.  Putting my socks on exhausts me to the extent that Renee has to put them on for me, yet 75 minutes performing my Rock Steady routine invigorates me.  Go figure!

One thing is for sure.  The advice I gave my patients over the years was good.  The treatment for fatigue is exercise.  Why it took me so many years to take my own advice is beyond me.  I’m just thankful I finally decided to join Rock Steady.  Now, to lose the weight that is weighing me down.  Stay tuned.

Here’s your joke for the day:

A beautiful college professor reminds her students of the big test tomorrow.

She says, “You cannot be absent unless you are wounded, seriously ill or you have a sudden death in the family.” One boy asks, “But what about extreme fatigue from a hot night of sex?” When the class is done laughing, the professor smiles and says,

“In that case, you can write with your other hand.”