Month: December 2022

When I graduated from my Family Practice program, my doctor’s bag was full of tools and hopeful expectations.   It was a rather large black bag that opened from the top and revealed my stethoscope, otoscope, ophthalmoscope, reflex hammer, tuning forks, and spaces for an assortment of injectable medications, gauze, alcohol wipes and needles and syringes.  I carried gloves, lubricant, and suture material as well.

I was equipped to handle a wide assortment of medical problems during a home visit.  Yes, I made home visits.  Home visits were routine.  When I was 10, I realized that if Doc Perlman came to the house, I would get a shot of penicillin in my buns.  I hated being on the receiving end of a home visit.

Over the last 40 years, the doctor’s bag as shrunk to the point that, in short order, it will be gone. Yep, even the stethoscope is vanishing.  Most of my docs use it inappropriately, listening over the clothes and speeding through the exam so fast that I doubt that they can hear anything.  Stethoscopes are being replaced by echocardiograms and CT scans.

The last thing to go is going to be the doc who carried the bag.  Nurse practitioners and physician assistants are performing more and more of the physical exam and almost all of the medical history taking.  They have also taken on diagnosis and treatment of an ever-increasing list of disorders.  In other words, they assume the role of the doctor.

Doctors have become supervisors, watching over the “midlevel” practitioners.  I have written about being demoted to a “provider” before.  We are all providers now and my prediction is that in the next 20 years, there will be no MDs.   I’m happy I won’t be around to see the demise of my calling.

So, what does the patient do?  The patient sees a provider and determines if they trust their provider with their health.  When possible, the patient sees an MD as their training is much more extensive than the non-MD providers.  As with any provider, if you are uncomfortable with your provider’s care, get a second opinion.

One last comment.  The stethoscope has a diaphragm which picks up sound and delivers it to your ears.  The difference between an expensive stethoscope and a cheap one is often the quality of the diaphragm. When someone listens through your clothing, they dampen the diaphragm by inserting a material that will not transmit sound, thus decreasing the ability to hear murmurs or other diagnostic sounds.  My nurses knew that taking a patient’s BP through a sleeve or other clothing was a fireable offense.

Here’s your joke of the day:

Doctor: “You have high blood pressure and amnesia.”

Patient: “Well, at least I don’t have high blood pressure!”

Over the years, I’ve ended most of my blogs with a joke.  After all, laughter is good medicine.  Yesterday, I was tasked with writing an uplifting article by a reader.  Lately, I have not been a very uplifting sort of guy, so I was at a loss for words.  When I’m at a loss for words, I turn to “The Quote Garden!”

If you’ve never used “The Quote Garden”, click on the hyperlink above and enjoy yourself. Yesterday, I advised that a person with an early diagnosis of Parkinson’s retire and clear their bucket list.  George Burns, who lived to be 100 would have scoffed at my suggestion.  Here’s a quote from George:

“Retire? That’s ridiculous. What does it for you is to have something to get up for in the morning. Now, they say, you should retire at 70. When I was 70, I still had pimples. ~George Burns, 1978  [Burns lived to 100 years, and passed away in 1996”. —tg] Quote Garden

In yesterday’s article, I mentioned gratitude.  One of my favorite quotes from Isaac Asimov is: If we were blind for one day each year, how we would enjoy the other three hundred and sixty-four. ~Isaac Asimov Qote Garden

Lastly, I think the following quotes sum up today’s political BS:

The trouble with the laws these days is that criminals know their rights better than their wrongs. ~Author unknown Quote Garden

It’s strange that men should take up crime when there are so many legal ways to be dishonest. ~Author unknown Quote Garden

So, when you have a little free time, explore Quote Garden.  As for humor:

After God created the world, he made man and woman. Then, to keep the whole thing from collapsing, he invented humor. ~Guillermo Mordillo, in Stuttgarter Zeitung, Germany, as quoted by The Reader’s Digest, 1982

Normally, words come easily to me.  I’ve spent a lifetime giving advice; yet when asked what I would say to a person newly diagnosed with Parkinson’s, my mind draws a blank.  When it comes to Parkinson’s, all the rules I lived by and all the advice I’ve given over the years is of limited value.  Parkinson’s is a life changing event that deserves its own set of rules.  It is also variable in its presentation and highly unpredictable.  The one thing you can be confident in is that it will get worse and it will ultimately decrease your ability to enjoy life.

Let’s look at what you should do in the early stages of the disease:

1.  Exercise!  I don’t care if you hate exercise or not, exercise daily.  Box!  Join a Rock Steady group.  Ride a bike.  The more active you are now, the better you’ll be later.
2. Thin out now and maintain a good body weight.  As you age and lose the capacity to exercise, you’ll tend to put on weight.  Weight is your enemy.  There are times when I have trouble walking an carrying an extra 40 pounds does not help.
3. Do as many fun things as you can now.  If possible, retire.  Exercise is a full-time job.  Travel while you can.  Spend quality time with your family and friends.  If you can’t retire, take a 4-day weekend quarterly. Empty your bucket list.
4. Keep an “attitude of gratitude” as long as you can.  Make a “blessings list and read it daily”.
5. Enroll in your local Parkinson’s group and keep up with the latest in research.  There is lots of research going on.  Maybe in your lifetime we will have a cure.
6. If you believe in prayer, pray!
7. Make the most out of every day.  When you lose abilities, concentrate on the abilities you still have, not on your losses.
8. Don’t be afraid of DBS.

Parkinson’s sucks!  Make the most out of it while you can! 

It’s easy to count someone else’s money.  I can guarantee you that the majority of the time, you’ll be wrong.  One of my favorite patients, who in later life became a good friend, likes to say, “Doc, if I had your money, I’d be retired and live the high life.”

Family Practice is a nickel and dime specialty.  No doc gets rich by going into family medicine.  Don’t get me wrong. If I was graduating from a residency program today, I’d still go into family medicine. The only thing I would change is I would spend more time with my own family. 

In essence, Renee was a single mom.  Most days, I was out of the house by 5:30 am and back by 8:00 pm.  The phone rang 2-3 times between 11 pm and 5:30 am.  Calls could be as frustrating as a nurse wanting a sleeping pill for a patient at 4 am and as complex as a call from the ICU informing me that my patient was crashing and that I should get out of bed and come in.

It was not uncommon for me to sleep in a call room at Good Shepherd Hospital or in my Lazy Boy lounger in the x-ray room in my office. In retrospect, I was addicted to family practice and OCD in being “available, whenever you need me.”

Despite what you think, I did not make lots of money!  One patient who was angry that I kept billing him for “just $10” didn’t realize that there were a lot of people who owed, “just $10!” That $10 went towards paying the bills or salaries.  My response to my patient was, “If it’s just $10, then just pay it, please.”

NOW FOR THE POINT OF THIS ARTICLE!

It’s come to my attention that some of my patients are not taking the flu shot this year. Others are not taking the Covid vaccine.  If I was lucky, I made $10 per shot.  I made $10 whether I spent 5 minutes describing the risks and benefits to a vaccine compliant patient or if I spent 15 minutes trying to teach you why you and your family should be vaccinated.  When the anti-vaccer left without being vaccinated, I felt like a fool.

While I made $10 per vaccine given, I made $500 off an ICU admission.  If you had only had your shot I would have gotten home sooner ( I also might have gone out of business).  As a businessman, I wanted to flag your chart so I wouldn’t waste my time trying to teach you in the future.  As a doc, I couldn’t. I was obliged to do everything possible to keep you well. Those readers who were patients will verify that I never gave up.  As a retired physician, my suggestion is that, if you don’t want to get vaccinated, you give your doc a signed document stating that you know more than your doctor as you graduated from the Google School of Medicine and that you will not sue when you spend a week in the ICU or possibly die.  Oh yes, please pay the $10 bill.

Yes, you are right.  Someone may get sick or injured from the vaccine.  But someone may slip down the front stairs of his house and break his neck.  Are you going to make sure your stairs are as safe as possible or are you going to ignore the warning signs listing by the county building inspector? Are you going to go out or are you going to go out? Get my point?

Here’s your joke:

Minnie told Mickie that she wanted a divorce.

Mickie said, ”Are you fucking serious?

Minnie responded, “No, I’m fucking Goofy.” 

I’ve addressed this before it bears a reminder.  Holiday depression is real and potentially dangerous.  Holiday depression hides behind the cheer and laughter that accompanies Christmas and other religious and festive times.

Unfortunately, many of us get lost in holiday cheer and miss the signs of depression in our loved ones and friends.  Some of us catch the signs but write them off stating, “She/he’s always down this time of year and always recovers.”  My experience tells me that people intent on committing suicide rarely talk about their plans, making it difficult to prevent suicide.

According to Mayo Clinic’s web site:

Suicide warning signs or suicidal thoughts include:

Talking about suicide — for example, making statements such as “I’m going to kill myself,” “I wish I were dead” or “I wish I hadn’t been born”

Getting the means to take your own life, such as buying a gun or stockpiling pills

Withdrawing from social contact and wanting to be left alone

Having mood swings, such as being emotionally high one day and deeply discouraged the next

Being preoccupied with death, dying or violence

Feeling trapped or hopeless about a situation

Increasing use of alcohol or drugs

Changing normal routine, including eating or sleeping patterns

Doing risky or self-destructive things, such as using drugs or driving recklessly

Giving away belongings or getting affairs in order when there’s no other logical explanation for doing this

Saying goodbye to people as if they won’t be seen again

Developing personality changes or being severely anxious or agitated, particularly when experiencing some of the warning signs listed above

Many of these symptoms are present in depression as well.  Watch your friends and relatives and if you think they are depressed or suicidal, take it seriously.  Encourage them to see a doctor or counselor. Speak up! The life you save may be the best Christmas present you’ll ever receive.

In the old days, they sold snake oil and people bought it.  Today, they sell Medicare supplements/Advantage programs.  Can someone explain to me how the Advantage companies work?

I barely made a living off of Medicare.  As a matter of fact, I refused to take new Medicare patients for seven years.  In the last years of my practice, if I spent more than 10 minutes with a Medicare patient, I lost money.   How do United Health and the other companies succeed?

First, they advertise hourly on TV and cable.  They hire famous people, like William Shatner, to tell you about the benefits of their Advantage product.  The benefits include free medication, dental and eye care and, if you live in the right location, they’ll even deposit over a thousand dollars a year into your bank account.  By the way, you may get a free membership to the gym as well.

The kicker is that all of the perks are free.  You don’t even have to pay for the policy.  Too good to be true?  Wait!  According to their pitches, your doctors are probably already in plan and will see you promptly.  If that’s not enough, they may even help you make appointments.

Sounds too good to be true, doesn’t it?  If you’re well, it’s true.  Yep, if you rarely see a doc, rarely take medication, and are a “young” 65, you win big time with the Advantage program.  JUST DON’T GET SICK!

One of my last new patients had just retired and was on the Advantage program.  He had 3 major medical problems and 3 minor problems.  He wanted referrals to 5 specialists.  After 6 months, my staff managed to get him 4 of the referrals he requested.  He had to drive 30 miles to see one of the specialists.  He had obtained one half of the tests that I had ordered and had to change the majority of his medications to meet the company’s formulary requirements.  His blood pressure, previously controlled on 1 medication, was finally controlled on 3 medications. He was not a happy camper.

Insurance companies are very clever.  They never refuse care.  They simply tell you what they cover and at what price.  You are always free to buy whatever you want.  He could have seen all five specialists in a matter of weeks; he just would have had to pay them.  He could have stayed on the one medication that controlled his BP as opposed to the three generics which barely controlled his BP. Doing so would have cost him an extra $150 a month.

How do the insurance companies give you so much for free? That’s a question that demands an answer.  Perhaps restricting access to specialty care and high-end medications may be one way.  Before you buy, ask lots of questions!  Just don’t ask the salesman, ask the docs!

Now for a little secret.  There is sound reasoning for delaying your consults and care.  The best medicine is often referred to as “tincture of time.”  Yep, wait 3-6 months and almost everything corrects itself.  Unfortunately, using “tincture of time” can be hazardous.

Here is today’s joke:

4000 YEARS of MEDICINE

2000 BC : Here, eat this root.

1000 AD : That root is heathen! Here, say this prayer.

1865 AD : That prayer is superstition! Here, drink this potion.

1935 AD : That potion is snake oil! Here, swallow this pill.

1975 AD : That pill is ineffective! Here take this antibiotic.

2000 AD : That antibiotic is poison! Here, eat this root.

I love this time of the year.  I love to shop for presents.  I love giving presents away.  Most of all, I love to see the smiles on my grandchildren’s faces when they open their presents.  I hope to score big this year.

The main reason I love the Chanukah/Christmas season is that, most years, people are nice to each other. People hold doors open for you, are much less likely to cut you off in the parking lot or break into line at checkout.  You even catch people whistling to the music playing overhead.  Unfortunately, the joy of the holidays only lasts 3 weeks, then people go back to being grumpy as they return presents that weren’t very exciting.

There is a dark side to the giving season.  As a practicing physician, I treated a fair amount of holiday depression.  While I expected that those individuals living in poverty or from paycheck to paycheck would be more likely to deal with holiday depression, I soon found out that well-to-do individuals were just as likely, if not more likely, to deal with holiday depression.

One of my most interesting cases was a gentleman I saw for depression with suicidal thoughts.  This individual had a 6-figure job, a loving family and lived in a beautiful neighborhood in a high-end community.  Believe or not, his depression was triggered by an advertisement for a car.  My patient felt like a failure because he could not afford to buy his wife a Lexus with a bow on the roof. 

I’ve already explained why I love this time of the year.  Now, let me tell you what I dislike about this time of the year.  Being bombarded by commercials telling you what you should buy your loved ones or what they should buy you is harmful.  I imagine that this year holiday depression will be worse than usual as inflation has impacted so many households.

If you are feeling depressed, talk to your family, your friends or your doctor.  Don’t try to hide it or live with it!  Work on your blessings list and study it daily.  Turn off the TV and don’t read the internet ads that flood your inbox.  If you haven’t noticed, I write about my ups and downs on this blog.     In return, I get a lot of support from friends, former patients and family.  I have a large support group and you can join it at any time.  I think you’ll find that you aren’t alone. 

Let this holiday season be your best.  Be happy and healthy and realize that it’s not what you give that’s important.  Simply put, the act of giving is what counts, even if it’s just a hug, a kiss and a happy Chanukah and a Merry Christmas!

Here’s your joke for today:

I’ve been depressed, lately, because I’m in my sixties and don’t have a girlfriend
My friends have tried to be supportive.
My wife has been a real jerk about the whole thing.

This may not make sense to you, but my article entitled, “The End,” was my saying good-bye to the old me to make room for the new me.  At the time, version Stewart 3.0 was a wreck being able to write about his losses but not accepting them.  My doc wanted to put me on antidepressants, but like most patients I refused.  Having counseled patients for years, I felt seeing a therapist would be a waste as well.

The answer was obvious, withdraw.  So, I said goodbye to my blog and turned to the healing properties of food, gluttony and, of course, sex.  At this point in today’s blog, my children are cringing and resisting the urge to throw up.  No kidding, sex releases endorphins and is a great treatment for whatever ails you.  But that is a topic for a future blog.

Gluttony is not a good solution, leading to a host of other problems. Nonetheless, I excelled and rapidly added weight and three chins.  Luckily, my best friend, my wife, held my hand through version 3.0 and put up with me.  One of the things that helped was the feedback I got from my readers.  One of my former patients and readers, I’ll call him “J,” wrote a very powerful argument outlining why I should still blog.  Thanks, “J”!

It took “J’s” response ,United Airlines and seeing “the dumping grounds for the disabled” to motivate me to start working on version 4.0.  Yes, I’m disabled.  Yes, there is a lot I can’t do.  But there is also a lot I can do.  There is a lot I can do for myself and there is a lot I can do for others. By blogging again, I can call out those who fail to provide for the disabled.  You, my readers, can help as well by adding your voice to my blog.  United is just the beginning!

On a personal note, I’ve started working on the gluttony.  Losing weight without exercising may be one of the hardest things I’ve ever had to do.  It’s going to take a long time to repair my diet and lose 40 pounds.  I’ve gone back to the basics as laid out in “Diets and Other Unnatural Acts.”

What did Adam say to Eve the first time they made love?  Stand back!  There’s no telling how big this thing will get!

Oh yes, I’ve found my sense of humor and the healing power of laughter.  Be sure to let me hear from you!