FALLS-2

I’m tired of living in pain as were many of my patients over the years.  The older I get, the more places I have pain.  Just when I think it can’t get any worse, it does.  I can live with the pain that comes from doing something I shouldn’t have done and hurting myself.  (There’s no cure for stupidity).  I was on prednisone and felt fantastic.  I felt like I was young again, so I tried running the track at Rock Steady without my walker.  I hit the floor hard!  I remember my head bouncing on the floor and immediate pain everywhere.          

I also remember being embarrassed. I’ve fallen before and had never felt embarrassed.  Why this time?  Because I’m a doctor and know that Parkinson’s causes patients afflicted with it to fall. I should have been more cautious. To make matters worse, while lying on the gym floor, I felt like a beached whale (I’ve lost 10 pounds and have 40 to go). Nonetheless, I did a quick check of my body, diagnosed the broken toe and declared myself healthy and ready to exercise.  That’s when my elbow swelled to the size of a baseball.  You should have seen the look on every body’s faces.  My elbow was scary looking.  I decided it was time to go home so, again acting stupid, I walked myself back to the car.

If I was my own patient, I would have read me the riot act.  I would have been self-righteous and reiterated the fact that Parkinson’s causes falls, and falls hurt!  I would have admonished myself for not using the walker and I would have wanted to ridicule myself for walking back to the car by myself.  I would have said, “I told you so. If you don’t act your age, you are going to hurt yourself.”

Luckily, I’m fine.  No, I did not drive myself home.  Renee was there and waiting for me. She wanted to take me to the ER and I refused.  Again, machismo overwrites wisdom.  Once again, I get lucky and am fine.  The moral of the story is, “Do as I say, not as I do!”  If you are at risk of falling, be careful and follow your doctor’s rules.  If you fall and hurt yourself, get checked by your doc or local ER.  If your spouse tells you he/she is worried about you, listen to your loved one!

Now, here’s your joke of the day:

Me and my girlfriend were going to a Halloween party last year and my girlfriend came down the stairs wearing nothing but boots.

I asked her, “What are you supposed to be?” She said, “Puss in boots.” So, I went into the kitchen and put a potato on my penis. When I came back out, she asked me, “What are you supposed to be?” I said, “If you can be puss in boots, then I can be a dictator

DO NO HARM

One of the most important tenets in medicine is, “Do no harm;” yet all docs realize that everything they do carries the risk of causing harm. The disconnect between the commandment, “Do no harm,” and the realization that we are always at risk of doing harm is a major cause of physicians’ daily stress and has a tremendous effect on how physicians practice medicine.

Some physicians will take a strong defensive attitude in response to their duty to do no harm.  Defending against doing harm, of being accused of harm (malpractice), often leads to a form of medical care called CYA (cover your ass) which can lead to over ordering referrals and tests, as well as under or over ordering of medications.

Others realize that there is a risk-benefit ratio for everything we do in life and become comfortable with the necessity of taking and monitoring risk while working to eradicate or alleviate suffering.  Organized medicine’s approach to solving this dilemma is to rest on the shoulders of “Informed Consent,” a document designed to spell out the risks and benefits of procedures and signed by the patient verifying that he/she has read it an understands.  Every physician eventually figures out how to live with the risk of doing harm it.

Early in my practice, I was sued by a patient I had never seen and had no relationship with.  Sounds unbelievable, doesn’t it?  That suit taught me that worrying about lawsuits and practicing CYA does no good.  I accepted the risk of practicing medicine and mitigated that risk by partnering with my patients, providing with a realistic and practical approach to caring for them.

An example will help clarify my point.  Steroids are marvelous medications effective in the treatment of many diseases.  Steroids also have the potential of causing lots of harm.  While the risk of causing diabetes is real, it is theoretical until diabetes develops and that is fairly rare.

Currently, I am on prednisone (a steroid) and I am much improved.  I probably have PMR (polymyalgia rheumatica), a disease that responds well to the long-term use of steroids.  I am so much improved that I would call my improvement miraculous.  PMR is a tough disease to diagnose but one of the diagnostic tests for PMR is to see what the effect of a low dose of prednisone is.  Again, mine is dramatic.

As I mentioned previously, the long-term risks of prednisone are many.  I’m obese, have a family history of diabetes, and at risk of developing diabetes.  Prednisone will increase that risk. I have mild hypertension.  Prednisone can adversely affect BP.  The list of risks that apply to my health is long.

Most physicians would be afraid to give me long-term prednisone for fear of causing me harm.  They shouldn’t be!  What is real is that I have Parkinson’s, chronic pain and a highly significant disability that responds well to prednisone.  What’s real is my life is much better on prednisone.

Possible side effects or harm from steroids are theoretical.  They aren’t real until they develop, and they may never develop.  As I previously stated, I partnered with my patients.  Ultimately, my patients made the decision of how much risk they were willing to accept.  Frankly, if I knew for sure that prednisone would shorten my life, I would opt to live a shorter but less painful and more mobile life.  Age has a lot to do with the decision.  At my age, I’m looking for quality, not quantity.

Too often, having heard the risks of a medicine on televised advertisements and on the internet, patients refused appropriate treatments out of fear.  They chose to live in misery now for fear of theoretical future problems.  What a pity!

Here’re a few jokes for today:

A mother complained to her consultant about her daughter’s strange eating habits.

–”All day long she lies in bed and eats yeast and car wax. What will happen to her?”

–”Eventually,” said the consultant, “she will rise and shine.”

Docs often write funny things in charts by mistake.  The following is one of my favorites: While in ER, Eva was examined, x-rated and sent home.

DEPERSSION

Well, depression finally has joined my 5 thousand other diagnoses.  If it wasn’t bad enough that Parkinson’s makes me feel like I’m drowning in quicksand, depression has just about immobilized me.  My most recent fall did more than just break my toe and bruise my elbows, it smashed my ego.  In 30 seconds, I went from feeling great on my steroids to feeling 100 years old.

Yep, I’m limping, and my body hurts everywhere.  I’m used to pain having coexisted with it for years, but the added immobility associated with the damage from the fall has been too much. Renee had been managing my depression by keeping me busy.  She’s transitioned from lover to caregiver and lover.  Unfortunately, she’s broken as well.  Her back is now as bad as mine. Getting rear ended didn’t help.

I had been managing my depression by driving around North Carolina’s country roads with the top down; but, unfortunately, someone rear-ended Renee and the car has been in the shop for months.  Damn Covid has put everything on back order and there’s no telling when I’ll get my car back.

Yesterday, Renee and I saw our family doc and I finally agreed to go on an antidepressant.  I’m on a ton of medications and hate the idea of taking yet another pill but it’s time.  The hardest part of transitioning from doctor to patient is the realization that “do as I say, not as I do” is a fool’s errand.  I spent 35 years tending to others, dolling out wisdom and secretly believing that because I was a doctor, I could ignore the rules.  What a fool I was.

If you’re depressed, get help! No one likes to admit to having depression. Depression is a normal human response to a multitude of things and we really need to get out of the Dark Ages and remove its stigma. If your doctor wants you on an antidepressant, take it.  If your doctor wants you to see a counselor, see one; and, if you are a doctor, realize you have to play by the same rule book your patients have. (Unfortunately, some state medical boards will suspend a doctor’s license if he/she has a diagnosis of depression).

By the way, I’m on a new type of “See Food Diet,” and its successful.  When I “See Food,” I run away.  I’m down 10 pounds.  I’m still as big as Jabba the Hut, who I’ll be for Halloween.

Here’s your joke for the day:

The IRS suspected a fishing boat owner wasn’t paying proper wages to his deckhand and sent an agent to investigate him.

IRS AUDITOR: “I need a list of your employees and how much you pay them”.

Boat Owner: “Well, there’s Clarence, my Deckhand. He’s been with me for 3 years. I pay him $1,000 a week plus free room and board. Then there’s the mentally challenged guy. He works about 18 hours every day and does about 90% of the work around here. He makes about $10 per week, pays his own room and board, and I buy him a bottle of Bacardi Rum and a dozen Budweisers every Saturday night so he can cope with life. He also gets to sleep with my wife occasionally.”

IRS AUDITOR: “That’s the guy I want to talk to – “The Mentally Challenged One”.

Boat Owner: “That would be me. What would you like to know”?