PRACTICE!

I don’t understand!  What’s all the fuss about? People seems to be worried about the Covid vaccine immunization schedule.  One of the major complaints I hear frequently has to do with the number of shots required to get good immunity.  Would it surprise you if I told you that most of my vaccines started off as one shot/series and, in time, ended up as multiple shots or series of shots?

You probably don’t remember but your childhood vaccines were given on a schedule.  The DPT (diptheria, pertussis and tetanus) vaccine was given at 2, 4,6, and 18 months.  A booster was then given at 5 years of age and was supposed to confer permanent immunity.  Some years ago, the pertussis component began to fail, and a booster was added in high school. 

I “practiced” medicine for close to 40 years.  All physicians “practice” medicine!  Medical knowledge is constantly changing.  Research brings us new medicines and therapeutic interventions that offer the promise of improved performance over older treatments.  Physicians learn about and subsequently institute those new interventions and medications which promise to improve care without adding significant risk.  New treatments are followed closely once they are introduced to the public and, if problems are discovered, might be removed from the market (Vioxx) or their usage modified to account for added risk (Accutane).

Yep, as physicians, we practice with new meds and therapies; and we learn from using them.  Vioxx was an incredible pain reliever.  It was a non-steroidal, non-narcotic, anti-inflammatory medication that helped many of my patients.  It also supposedly caused significant heart disease and was subsequently removed from the market.  

Accutane is an excellent medication for the control of acne.  It causes birth defects and an assortment of other bothersome side-effects.  Due to these problems, its use has been restricted.  Women on Accutane are required to use at least two forms of birth control.  The last time I prescribed it, the patient was required to sign multiple legal documents acknowledging that he/she received and understood the informed consent documents provide to him/her.

My point is that, in both the above examples, physicians practiced with and learned from the use of new medications.  Yes, there are significant risks involved in practicing medicine.  There are also significant benefits that far outweigh the risks.  Many years ago, I was called to the ER to see a middle aged man who had been diagnosed as brain dead following a cardiac event.  I had read about a new device called an Artic Blanket and was elated to find that the ER had a brand-new Artic Blanket that had yet been used.  After discussing the diagnosis, we unwrapped the blanket, applied the new technology and said a few prayers.  Yes, this was a practice run which offered some hope.  The patient woke up the next day, went home and still is alive.

Practicing physicians should always share the risks and benefits of any treatment with you.  The process is called “informed consent.”  While I fervently believe in the process of informed consent, I hated doing it.  Why?  Informed consent often scares the patient out of doing the proposed procedure or taking my medications.  Everything carries risk!  When reviewing the risks of my upcoming DBS surgery, the surgeon discusses risks that include stroke, central nervous system infection and even death.  Without the surgery, my condition will continue to worsen.  With the surgery, my condition hopefully will improve for a while and the progression of PARKINSON’S be slowed.

Will the Covid vaccines prove to be as good as the Artic Blanket or as problematic as Vioxx.  Only time will tell.  The bulk of evidence today is strongly in favor of a 3 shot regimen and that is what Renee and I have done.

One last historical note.  Vioxx was so good at relieving pain that, despite the risk of heart disease, many of my patients would gladly buy it today, at any cost and despite any risk.

Here’s today’s joke: A man sends his wife to pick up his erectile dysfunction medication.

She gets back and they get undressed and get down to business.

The wife stops and says, “Our new pharmacist is a very nice Chinese man but talks too much politics; but don’t worry, I made sure your pills aren’t made in Russia.”

“Why would it matter if the Russians made my pills?” asked the husband.

The wife responded, Well, the pharmacist told me Russia was meddling in U.S erections.”

LIVING WILL

Wow!  This is harder than I expected.  Let me explain.  It’s time to write a living will.  I am 70 years old and live with Parkinson’s, a disease that will progressively attack my nervous system.  As Parkinson’s attacks, my abilities to walk, talk and even think will diminish.  Along with the loss of function comes a progressive loss of the quality of life.

There are treatments for Parkinson’s but all current day treatments, while restoring some abilities and quality of life, are only temporary.  In March, I am going to have a deep brain stimulator placed deep within my brain.  The surgeon will bore a whole in my skull and thread an electrode into the area that Parkinson’s affects.  The hope is that the procedure will improve the quality of my life by restoring functions previously lost.  Hopefully, I’ll be able to reduce or come off of some of my meds as well.

As with all surgical procedures, there are risks. While the risks are fairly rare, they can be devastating and include stroke, infections, bleeding and even death.  Being a physician, I fully understand the risks and consequences should something go wrong.  I also understand that, in the real world, the risk of anything going wrong is 50%.  The surgeon may tell you that statistically the procedure has a 2% chance of causing injury in the general population. However, in the individual’s case, it either will happen or will not happen (50-50).

My “why” for writing this article should now be readily apparent.  I thought that the hard part of creating a living will was already done.  I was wrong.  While I have had multiple conversations with my wife and children regarding letting me go if something adverse happens during surgery or from any other event, putting my wishes in writing is extremely difficult.  This morning I searched the internet for living wills written by physicians.  I found one helpful article. “ We should strive for a good death that occurs at the proper time and place,” by ALLEN FRANCES, MD and published on KevinMD on April 27, 2015, is worth reading.

While a document that tries to anticipate future problems and leaving instructions for each scenario is impossible, setting a goal of a “good death that occurs at the proper time and place.”   A good death occurs at home with family and friends, not in a hospital or nursing home. A good death recognizes the importance of quality of life and that death is a natural occurrence.  Fighting death is often associated with pain and suffering (tubes in every hole, respirators, nursing homes).

Families want everything possible done to salvage their loved one.  Often, the one thing loving families could but don’t do is let their loved one die a good death.  Likewise, physicians see death as an enemy to be defeated, without recognizing the damage caused by defeating their foe.

I will leave the decision making up to my wife, my children and my physicians with the understanding that, if I cannot reasonably expect to regain my independence, enjoy my family, joke about sex and cruise the back roads of North Carolina with the top down, then I want a good death.

OUR CHANGING WORLD

The world I’ve lived in for 68 years has been changed by Covid and not for the better.  Fear and anxiety have become prevalent among a large segment of our population, leading to poor sleep, agitation, and, in some cases, poor decision making.  While fear and anxiety often are negative emotions, they do confer a certain benefit on the person suffering from them.  The individual that reacts to the growling dog by becoming anxious and slowly backing away from it is more likely to survive than the individual who ignores the threat and further invades the animal’s space.

On a daily basis, I get bombarded with opinions about the Covid vaccines and treatments whether I’m interested in the conversation or not.  The avalanche of opinions come from doctors, scientists, journalists, Google (internet), neighbors, friends, and former patients, as well as from those that have become overnight experts by reading a few articles on Covid found in today’s email or CNN newsflashes.

My purpose in writing this article is not to validate any opinions on Covid and the treatment of Covid, but instead to point out one simple truth. Covid, and the subsequent fear and anxiety induced by Covid, has become the number one excuse for everything that goes wrong.

I used to tell my patients that when their doctors think they know more than the medical authorities, it’s time to find a new doc!  Well, the authorities are telling us to get immunized against Covid ASAP, to wear masks and wash your hands frequently.  While I read everything I can find on Covid, I am not an expert in infectious diseases.  After 40 years of practice, I am qualified to interpret the data and I chose to believe the authorities and follow their recommendations.

Those who fear Covid, the medical authorities and the government steadfastly refuse the vaccine, fearing its possible long-term effects.  While I believe the vaccines are safe and fairly effective, I can understand their fears.  I can’t understand their stubborn insistence on not wearing a mask.

Last week I was listening to a 50-year-old lawyer list his reasons for not getting immunized.  He stated that vaccines were often not effective and carried substantial risk. Rather than getting into a debate I couldn’t win as he was so sure of his beliefs, I simply pointed out to him that he looked awfully good for someone that had polio; he was quick to deny ever having polio.  I asked him if he remembered having mumps or measles and he emphatically denied having had both.  I quickly added that he was lucky not to have been scarred for life from having smallpox and again he stated that he was healthy with a strong immune system and never had any of the childhood illnesses that were so common in years past.

I set the trap and he fell right in!  He had avoided all the childhood illnesses that once upon a time killed and scarred children because he was immunized at a very early age.  Yes, vaccines carry some minimal risks, but those risk are overshadowed by the risk of the disease and the risk of Covid is death. 

Life is dangerous whether you live it to its fullest or hide from it, waiting until the storm passes. I suggest that you live life to its fullest while heeding the warnings and Covid protocols put forth by the world’s medical authorities.  Isolating yourself and family at home carries its own risks, both short and long-term.

I have had two primary shots of PZIZER’S vaccine as well as a booster.  I wear a mask in public even though I hate wearing it. I avoid anyone who has not been immunized.  I avoid crowds! 

I wish you all a happy and healthy New Year, free from Covid.

Here’s today’s joke.

Two octogenarians are sitting at a table having lunch.  They have lunched together fo50 years:

Mrs. A – I’ve known you forever, so I hope you won’t be upset but I’m dying to ask you a question.  I’m so very embarrassed.   

Mrs. B- Don’t be silly.  You can ask me anything!

Mrs. A- What’s your name

Mrs. B- Oh, honey, don’t be embarrassed.  Can you give me a few days to think about it

DBS

DEEP BRAIN STIMULATION

It’s a new year and it’s time to start writing again. The following article was written sometime ago and will serve my purposes well.  I’m scheduled for DBS.  If you are interested, you can see a video of the surgery on YouTube. My Parkinson’s is worsening but still tenable.

Losing your motor skills is not so bad as long as you still have your brains.  It’s your brain that makes you who you are!  I watched too many patients vacate their bodies due to the onslaught of Alzheimer’s.  The big “A” leaves behind an empty shell that only serves to torture its loved ones with memories of who once inhabited it. 

One of the things Parkinson’s can do to its victims is steal their brains.  I’ve been joking a lot about CRS (can’t remember shit).  In your 70s, CRS is prevalent.  It’s also relatively harmless.  So how do you know if you have CRS or another form of dementia?  Most of the time, you wait and see.

Neuropsych testing can uncover early dementia.  In order to be assessed for DBS (deep brain stimulation), an advanced form of treatment for Parkinson’s, you need to have a complete battery of neuropsych testing.  I’m being tested this am.  The problem is that I don’t want to know if I’m losing it!

I’ve been planning on eventually developing dementia.  I’ve been recording on paper who I am so that, one day, my grandchildren and their kids can get to know me.  I need to put it on paper now before it disappears.  Hope for the best but plan for the worst is my motto.

Dementia is the worst!  Unfortunately, our society thinks keeping an empty shell alive long after its brain is gone is the right thing to do.  I don’t!  I witnessed what appears to be a never-ending death as patient after patient gets shipped to the memory unit of a local nursing home.  The patient is not allowed to finish dying and the family can’t finish mourning for their loved one. 

Sometimes I think we are in heaven and there is a hell.  I think the memory unit and hell are the same place.  I watched my father sit at the kitchen table looking through a phone book for his parents’ phone number.  If you asked him what he was doing, he said he was calling his parents, he wanted them to pick him up and take him home!  My mother meant well!  She kept his shell alive, blocking every attempt he made to go home (die).

I want to die before the only part left of me is a gargantuan shell.  So, am I afraid of DBS?  You can be damn sure I am.! Do you have to worry that I may take my own life if the results are bad?  Absolutely not!  I’ve got more to write and things to do.  Just promise me that, when its’s time, you’ll let me go home to a place where I can be whole again.  By the way, I don’t want 40 virgins to greet me at heaven’s gate.  I prefer 40 very experienced versions of Renee!

Now you could use a joke (or is it?). 

An elderly couple had dinner at another couple’s house, and after eating, the wives left the table and went into the kitchen.

The two gentlemen were talking, and one said, ‘Last night we went out to a new restaurant and it was really great.  I would recommend it very highly.”

The other man said, ‘What is the name of the restaurant?’

The first man thought and thought and finally said, ‘What is the name of that flower you give to someone you love?

You know…. The one that’s red and has thorns.’

‘Do you mean a rose?’

‘Yes, that’s the one,’ replied the man. He then turned towards the kitchen and yelled, ‘Rose, what’s the name of that restaurant we went to last night?’