Author: wellthy

Today is a good day to discuss “compliance.”  I saw my doc yesterday and she administered a screener for depression which I failed.  Of course, I’m depressed.  Wouldn’t you be if your motor skills were vanishing in front of your eyes?  Tomorrow, I’m scheduled for a cervical epidural and I may need a multi-level cervical fusion.  That’s depressing, isn’t it?

Of course, it is!  These days there are plenty of reasons to be depressed.  The doc wants to start me on antidepressants and in counseling.  For sure, I don’t want more meds.  I’m already taking pills every 3 hours.  Some of my pills are meant to counter the effects of others.  Adding one more doesn’t make sense.

I’m a strong believer in counseling; but, realistically, how is counseling going to help with Parkinson’s and Degenerative Disc Disease?  I guess the counselor will work on my perceptions of my illness.  Will it help?  Time will tell.

I asked Dr Rosen for her opinion and help with my health issues.  She gave me her opinion.  My choices are to comply with her treatment or ignore it.  Over the years, those patients who complied with my orders did well while many of those who were non-compliant did poorly.  Despite my doubts about counseling and meds, I’m going to choose to comply with her plan and see how I do.  After all, I’m now the patient and asking for the doc’s advice; and ignoring it would be silly.  It would assume that I know more than the doc and you know what they say about assumptions.  To assume often makes an “ass out of u and me.”

We’ve talked about the patient’s role in getting well and maintaining their health and wellth.  Compliance with your doc’s advice is critical.  Almost as important as compliance is making sure your doc knows when you are non-compliant.  Let me give you an example.  Doc S has diagnosed Patient A with hypertension and heart disease.  Doc S prescribed two meds for his elevated pressure, one of which will also protect A’s heart.

On a follow up visit, Patient A fails to tell his doc that he is not taking his meds regularly.  A’s BP is markedly elevated, so Doc S stresses how important controlling A’s BP is and gives A stronger meds.  Meanwhile, A decides to comply and starts on the new meds.  Two days later, he passes out at work, cuts his forehead needing sutures and suffers a mild concussion. The ER documents hypotension (low BP) secondary to his meds and reduces his dosage to his original dose.

Had Patient A been compliant from the onset, he would have skipped the ER and done well.  Had Patient A told his doc that he was non-compliant, the doc could have simply reviewed the importance of taking his meds and kept him on the starting dosage. Either way, A wins if he is upfront and honest.

I’ve sent many patients for counseling and have seen marked improvements in patient wellbeing following counseling.  I’ll start counseling next week and give it a month.  I informed my doc that I would be willing to take an antidepressant if she really felt it would help.  She agreed to put additional meds on hold for the time being.

Here’ your joke for the day:

This is probably one of the most worrisome statistics to emerge in recent years.

25% of the men in this country are on medication for mental illness.

That’s scary.

It means 75% are running around untreated.

There was an old guy who took suppositories as a medication. One time he went to a restaurant with his wife.  She said, “What is a suppository doing in your ear?” The old man says, “Oh! Now I know where my hearing aids are!”

👍🏼

Do you drive a car?  Are you a passenger in a car?  Do you know how many injuries are attributed to driving in a car?  Do you know how many people die in car accidents yearly?

In 2019, there were 36,096 automotive fatalities and 2,740,000 people injured in car accidents.  I’m willing to bet you that you know someone who has been injured in an automobile accident.  Despite millions of injuries a year, we either drive a car or are a passenger in a car on a daily basis.  Sure, we buckle up for safety and follow the rules of the road in an effort to lessen the odds of being involved in or injured in an automotive accident; but no matter how cautious you are, you cannot guarantee that you won’t have an accident.

Do you remember when seatbelts first came out?  I do!  My father refused to wear them.  People feared that seatbelts would actually worsen their chances of injury in an accident.  My father was afraid that he would be trapped in a burning or submerged car due to the seatbelt.  As the years passed, it became more evident that seatbelts saved lives.  Of course, there were those cases where the seatbelt did cause injury; but, overall, buckling up made sense.

So, why am I writing about seatbelts?  The invention and use of seatbelts can be used as an analogy for the development and use of the Covid-19 vaccine. Just as people feared the use of seatbelts, they fear the use of the Covid-19 vaccine.  Driving a car can also serve as an analogy for the Covid vaccine.  A car is a vehicle that gets you from point A to point B relatively safely. Wearing your seatbelt helps diminish the risk of serious injury should you have an accident while driving the car.

The Covid-19 vaccine helps you socialize, shop, return to school and work safely.  Should you get a Covid infection despite being vaccinated, the vaccine lessens your chance of hospitalization and dying from the infection.

So, why aren’t people getting the Covid-19 vaccine?  Fear, fed by the Internet, and looking at the vaccine from the wrong perspective are stopping people from receiving this critical vaccine.  The better perspective is everything we do carries risk of injury or even death!  As in the case of the car, we follow the rules of the road. In the case of the Covid-19 vaccine, if you have concerns, have your doctor address them, not the Internet’s search engines or Facebook.

Anecdotally, I’ve had Covid-19; and, from personal experience, I can tell you it is miserable.  Its effects and damage may well be long term in nature.  This viral curse is not done with us yet as evidenced by the recent increase in cases worldwide.

Here’s your joke for today:

I am a proud anti-vaccine Father of 3.

Edit- Two, Now

2nd Edit- One, Now

3rd Edit- Nevermind

4th Edit- WOW, this really blew up. I would like to dedicate all these wonderful awards to my 3 children:  Byeson, Dieanne, and Ammunity. They would have been so proud. RIP

My brother recommended that I read a book he had just read.  “The Noticer: Sometimes, “All a Person Needs is a Little Perspective” by Andy Andrew.  I don’t read; I listen.  The book is read by the author; and he is an excellent reader, making this book even more enjoyable and educational.

One of the stories he tells is about a young man who is down on his luck. The main character, whose name is Jones, and another young man had lunch together on the beach.  The lunch consisted of Vienna sausage and sardines; and the young man, who lived under the pier, did not like the combo.

The punchline is that, while the young man had a lousy lunch on the sand near the pier where he lived, Jones had surf and turf by the ocean. Simply put, the experience they shared differed based on their individual perspectives.  My brother should have been a psychologist.  He picked up on the change in my mood and, rather than lecturing me, gave me a delightful book to help reorient me.

Whatever life I have left can either be miserable, focusing on my losses and handicaps, or marvelous, focusing on my blessings and remaining abilities.  It’s funny how, despite the years of counseling patients and teaching them about how important perspective is, I could ignore what Dr. Segal knows and get lost in what Stewart thinks. 

In medical school, we learned that we should never treat ourselves or family and friends, as we supposedly lose our objectivity when dealing with loved ones and those close to us.  I always thought that edict was BS.  I’m discovering the truth.  While Dr Segal could look from the outside at a patient’s situation, when dealing with Stewart (myself) and perhaps family, the view is from the inside out and, many times, warped by my perspective.

Let me share a true story with you.  My very first patient with cancer had a particularly nasty type of cancer and her cancer was in a late stage when she was diagnosed.  As most patients with cancer do, she asked me how long she was likely to live.  Not only did I refuse to make a prediction, I begged her not to ask any other docs that question and to stay away from the library (pre-computer source of knowledge).  She followed my instructions.  Regrettably, her family did not.  They discovered that she had, on average, 3 months to live. 

SHE LIVED 8 YEARS!  She had multiple tumors grow and regress.  Her perspective was that she would live until she died and was going to enjoy everyday as much as possible.  She confided in me that what bothered her the most was the look on her family’s faces. They went to the library and walked away with the perspective that their mom was going to die in the near future.  The fear on their faces was harder to deal with then the cancer itself.

My overall take away message is that, when transitioning from doctor to patient, maintaining and following the “doctor’s wisdom” is difficult but necessary.  I’m losing weight because I’ve gone back to the basics I’ve taught others for years.  I’m working on my Blessings List because counting your blessings is better than taking antidepressants.  I’m going to Rock Steady because that’s what I told my Parkinson’s patients to do.  I’m reviewing Mr. Wonderful’s book of positive sayings that I’ve shared with so many patients over the years.

Thanks, bro!

Here’s today’s joke:

One night, the 96-year-old draws a bath, puts his foot in and pauses. He yells down the stairs, “Was I getting in or out of the bath?”

The 94-year-old yells back, “I don’t know, I’ll come up and see.” He starts up the stairs and pauses, then he yells, “Was I going up the stairs or coming down?”

The 92-year-old was sitting at the kitchen table having coffee listening to his brothers. He shakes his head and says, “I sure hope I never get that forgetful.” He knocks on wood for good luck. He then yells, “I’ll come up and help both of you as soon as I see who’s at the door.”

Rock Steady is one of the best things I’ve ever done.  As I’ve said before, one of the dumbest things I’ve ever done is put off joining a Rock Steady until I was in really bad shape.

According to Rock Steady’s website, “The mission of Rock Steady Boxing is to empower people with Parkinson’s disease to fight back.”

Rock Steady Boxing, a 501 (c)(3) nonprofit organization, gives people with Parkinson’s disease hope by improving their quality of life through a non-contact boxing-based fitness curriculum.  It really does work!  I work out with a group of Parkinson’s patients on Monday and Wednesdays.  If you had asked me about Rock Steady 8 weeks ago, I would have told you that, while I would give it a trial, I doubted I would stick with it.  I hated group activities and exercise.

I’ve changed my mind.  Being in a group with other Parkinson’s patients has been eye opening. The group welcomed me with open arms.  Exercising in a boxing-based class is already paying off.  I’m ready to increase my participation in Rock Steady to 3 times a week.  I may even go 4 times a week.

At the onset of a Rock Steady session, the group forms a circle and each member answers the question of the day.  Yesterday’s was to name 4 things you are thankful for. We all have bad days and I was coming off a 3 bad day period.  Answering yesterday’s question forced me to concentrate on my positives and listening to the rest of the group share details of their lives brightened my day.

We then took a few laps around the gym and warmed up with our stretching exercises before donning our boxing gloves.  I was surprised to find that I enjoy boxing and left at the end of the session feeling better than I did when I got there.  By the end of the session, I’m covered in sweat.

Recently, I wrote about arrogance.  I’m guilty!  I was arrogant enough to assume that I did not need Rock Steady.  Afterall, I‘m a doctor, know everything about Parkinson’s and could exercise on my own.

Today’s topic is “the stubborn patient.”  Again, I’m guilty.  Multiple patients and friends recommended I join Rock Steady.  I didn’t.  The medical literature recommended I join Rock Steady and I stubbornly ignored their recommendations.  Over the years, I dealt with stubborn patients on a regular basis.  Most were men.  You’d think I would have learned that stubborn patients often hurt themselves.  I didn’t!

Learn from my mistakes.  Do as I say, not as I did!  If you’re a man, the odds that you will stubbornly refuse good advice is high.  In multiple recent studies, more women than men have received the Covid vaccine.  As of early April, statistics showed the vaccine breakdown between women and men was generally close to 60% and 40% — women made up 58% of those vaccinated in Alabama and 57% in Florida, for example.  Get vaccinated!

I know what you’re thinking.  Women can be stubborn, too.  You’re right, except women tend to be more compliant and less stubborn when it comes to taking care of themselves.  That may be why there are so many more widows than widowers.

Here’s your joke for today:

Husband: You are negative

Wife: And you are stubborn, arrogant, a low life, care about no one but yourself and your friends, all you are interested in is your own self, and in all your life you’ve not fulfilled even one of your promises. I’m the only one that has to put up with such a miserly and insensitive man. You good for nothing, fat, ugly man. Even your hair transplant failed.

Husband: I was just letting you know that your Covid test was negative.

Did you ever find yourself wishing that your life was as good as someone else’s? Ever hear someone say, “The grass is greener on the other side of the fence?”  I think it’s human nature to imagine that others have it better than you and to wish you could trade places.  Would it surprise you if I told you that the neighbor whose fortunate life you covet is looking out his window and wishing he had it as easy as you?

One of the gifts caring for so many families over the years gave me was a real look inside their houses and lives.  What that intimate view taught me is that nobody in his/her right mind would trade their problems for someone else’s.  The grass is definitely not better on the other side of the fence.

Nonetheless, after reviewing the MRI of my neck with the neurosurgeon yesterday, I’m ready to swap problems with anybody crazy enough to swap with me.  I’m also jealous.  I’m struggling to walk due to my Parkinson’s and probably also due to cervical disc disease.  Walking is one of those things that people take for granted.  I did.  When I could have walked with ease on a daily basis, I made excuses for not walking.  I was always either too busy or too tired.  Now that it’s difficult to walk and I’ve got motorized scooters and wheelchairs in my future, I feel like a fool.

WALK WHILE YOU CAN! Don’t be a fool.  Walking is good exercise.  The more you walk, the more you’ll be able to walk.  Walking with others brings you closer to them.  Socialize while you can.  Need some quiet time?  Walk by yourself.  Don’t take walking for granted.

Looking forward to retirement?  I can tell you that retiring due to illness is no fun!  Despite all that practicing medicine taught me, I’m jealous of those who have their health.  I’m using that jealousy to fuel my fight to regain some of my lost health.  I’ll do whatever I have to do to get stronger and healthier.  Sure would have been easier to maintain my health in the past than get it back now.

Here’s the joke for today:

Jealous wife gets call from husband late for supper:

He said, “Baby, I know I’m late, but I had a terrible accident at work. My friend Brenda brought me to the hospital. I lost one arm and I have three hundred staples in my head. I probably won’t live through the night. If I do, they’ll have to amputate both legs and I’ll need around-the-clock care for the rest of my life.”

His wife said, *”Who the hell is Brenda?!?”*

It’s been so long since I’ve been to an actual movie theater that I have no idea whether they still play coming attractions before starting the movie but the coming attractions were often the best part of my theater experience.  In a brief amount of time, the viewer got to experience the most exciting parts of multiple movies.  I remember saying, “I want to see that one as soon as it comes out,” and repeating it multiple times.

July 4^th has always been one of my favorite holidays.  I love fireworks and water so the fourth of July was always a big deal in the Segal household.  There were fireworks over the pool and a great display at my neighbor’s house overlooking the pond.  The party often started at noon and ended the next day.

I was happy to see that my new neighborhood came out in mass to sit at the community pool and enjoy the spectacle of a 360 degree fireworks display.  Unfortunately, my Fourth came with a prolonged viewing of the coming attractions for the movie, “Living with Parkinson’s is Hell!”  I shut down shortly before getting in the car to drive over to the pool.  I stayed shut down for the rest of the evening.  I struggled to get from the car to the pool and did not think I would ever get back to the car again.

It was pretty damn scary!  I knew it was coming but didn’t think it would come on this quickly.  There is no longer any doubt in my mind.  I will have a deep brain stimulator implanted in my brain.  First, I must deal with the herniated disc in my neck, my chronic cough and my enlarged thyroid.  That’s already in progress.  I also need to lose some weight and have shed 4 pounds.

The most important thing I have to do is get in the right mindset.  I can contend with the medical end of Parkinson’s and even with the mechanical failures, what I’m having trouble with is the fact that Renee has chosen to take this journey with me.  Spending her retirement accompanying me through a tour of hell is just not right.  She deserves better!  Unfortunately, this ride may be far from over.

I’ve changed my mind, I no longer like the coming attractions!

Here’re your jokes for the day:

God said: “Let there be Satan, so people don’t blame everything on me. And let there be lawyers, so people don’t blame everything on Satan.” George Burns

The devil went to church one day and upon seeing his red skin, big horns and cloven feet, all of the people ran from the building in terror. All except for one old man near the front. He didn’t even budge. The devil was intrigued by the man’s apparent disinterest in his hideous appearance. So, he strode down the aisle to where the old man sat.

In a loud voice, the devil said, “PUNY HUMAN, DO YOU KNOW WHO I AM?” Without glancing up, the man said, “I’d guess you’d be the devil?”

“I AM LUCIFER, MASTER OF THE SEVEN CIRCLES OF HELL! DO YOU NOT FEAR ME?”

“Nope.”

“DON’T YOU KNOW THAT I COULD FORCE YOU TO ENDURE TORMENT AND AGONY THAT WOULD GO ON FOR YEARS?

“I suppose you could.”

“AND THIS PROSPECT DOESN’T FRIGHTEN YOU?”

“Not really, no.”

The devil was so surprised that, for a moment, he forgot to act scary. “I must admit I’m confused; no one has ever been so calm in the face of such power before. I must know what your secret is!

Finally looking up, the old man looks the devil in the eyes and says, “Well… I’ve been married to your sister for 35 years….”

Yesterday, my neighbor described his doctor as being arrogant.  I’ve heard others refer to their doctors in the same way.  I started to defend his doctor’s right to be arrogant but stopped myself.  You see, my profession has been under attack for as long as I can remember; and I am accustomed to defending it.  In this case, there is no adequate defense.

Even though there is no defense for arrogance, I can understand how it happens.  The dictionary defines arrogant as:

having or revealing an exaggerated sense of one’s own importance or abilities.

“he’s arrogant and opinionated”

synonyms:

haughty · conceited · hubristic · self-important · opinionated · egotistic · full of oneself · superior · overbearing · pompous · high-handed · swaggering · boastful · bumptious · blustering · patronizing · condescending · disdainful · contemptuous · imperious

Doctors spend 4 years in medical school and another 3-5 years in residency training to care for you and your family. Doctors are trained to be opinionated.  Their opinions can be the difference between life and death and they never forget the deaths that they were unable to stop or may even have caused.  When you hold a person’s life in your hand, it’s easy to become conceited, even pompous and patronizing.

By the same token, when you’ve lost a patient, it’s easy to hide from the emotional damage and depression of loss by inflating your sense of self worth and superiority, feeling that no one could have done better.  Over the years, I’ve met multiple physicians who were arrogant and, frankly, had a right to be.  Those physicians were at the top of their fields, recognized world wide for their expertise.  Some of the most arrogant physicians I met were my teachers.

While a certain degree of arrogance is supported by a doctor’s credentials, arrogance in a clinical situation is counterproductive. Arrogance can blind a physician to his/her own short comings.  Arrogance can push a patient away.  In the office, a physician needs to be humble, understanding that no matter his training or credentials, he/she is human and have short comings.

On graduating from the University of Virginia, I was so arrogant that I only applied to the top three medical schools on the East Coast.  When I did not get accepted, I made the mistake of going to graduate school and found that I hated it.  My arrogance led me to being the leader of a rebellious group of graduate students and, subsequently, being asked to leave the program.

Having come down off my high horse, I made one of the best decisions I’ve ever made. I went to Mexico and enrolled in medical school.  Mexico taught me humility and gave me the tools I needed to take care of those individuals who put their families in my hands. 

My advice is to grant the arrogant physician his/her right to be arrogant and then find another physician to care for you.

Here’s your joke for the day:

A DEA officer stopped at a ranch in Texas and talked with an old rancher.

He told the rancher, “I need to inspect your ranch for illegally grown drugs.”

The rancher said, “Okay, but don’t go in that field over there…..”, as he pointed out the location.

The DEA officer verbally exploded saying, ” Mister, I have the authority of the Federal Government with me!”

Reaching into his rear pants pocket, the arrogant officer removed his badge and proudly displayed it to the rancher.

“See this badge?! This badge means I am allowed to go wherever I wish…On any land!

No questions asked or answers given!! Have I made myself clear…do you understand?!”

The rancher nodded politely, apologized, and went about his chores.

A short time later, the old rancher heard loud screams, looked up, and saw the DEA officer running for his life, being chased by the rancher’s big Santa Gertrudis bull.

With every step, the bull was gaining ground on the officer, and it seemed likely that he’d sure enough get gored before he reached safety. The officer was clearly terrified.

The rancher threw down his tools, ran to the fence and yelled at the top of his lungs…

“Your badge, show him your BADGE!!”

I’m turning 70 this month.  Seventy has been an eye opener!  My retirement consists of awakening in the am to look at my schedule, then taking pills, eating and off to the first doctor appointment.  Seeing doctors has become a full-time job.  I take meds every 3 hours.  Taking meds is my secondary job.

On Mondays and Wednesdays, I go to “Rock Steady,” my Parkinson’s exercise class.  Next up is meal planning and grocery shopping.  Thank God for motorized shopping carts.  I’ll tell you a secret.  Motorized shopping carts are a chick magnet.  Everyone offers to help me shop.

My afternoons are spent writing and checking out the blogs I follow.  I’ve given up on ZdoggMD.  He crossed the line last week when he recommended a book that teaches you how to avoid paying your doctor’s bill.  One of the sites I go to is my high school graduating classes’ blog.

I’m sad to say that my HS friends are dying off on a regular basis.  I thought 70 was too young to die.  I thought wrong!  Renee talked to two of her friends today, both of whom are suffering from chronic disorders and are miserable.  Remember when I wrote about my fantastic neighbors and our 5 o’clock cocktails on the driveway?  Twelve out of twelve members of the group are actively seeing doctors for chronic problems.

In her 90s, my mother bemoaned the fact that all of her friends had long since died.  While I’ve seen the elderly become increasingly isolated as their friends die off, I never dreamed it would start in my 70s.  If I don’t want to join my deceased friends, I better get this weight off, exercise and start enjoying life.

So, what are we to do? A quote from Mark Twain sums it up nicely, “Don’t regret growing older.  It’s a privilege denied to many.”  Yep, I’ve wasted too much time regretting my Parkinson’s and the aging process.  It’s time to actively work at getting healthier.  Rock Steady is starting to pay off.  My doc thinks he knows why my legs are weak and how to fix them. Lucky me, more spine surgery.

It’s time to get together with old and new friends.  I won’t miss another reunion whether it be high school, college of fraternity.  Better to see them while they are alive than to wait for their funerals. I’ve resurrected my old patient’s mantra, “I have an attitude of gratitude” for just being alive.

Yes, it’s time to work on the bucket and fuck-it lists as well. 

PS – I’m still coming to Chicago for a few weeks and hope to get together with many of my old friends and patients.  Until then, drop me a note and let me know how you are doing.

Here’re your jokes for the day:

A girl walks into a dry cleaner.

She drops off her dress and turns to leave. The owner says, “Come again!” She says, “No, it was toothpaste this time.”   

Why do Jewish men get circumcised?

Because Jewish women only want things that are 20% off.

A man is involved in a shipwreck and is stranded on an island with nothing but a pig and a dog. After 6 months or so, the guy starts to feel a little “amorous”. So he looks at the pig and says to himself, “What the hell? who’s gonna know.” So he takes off his pants, walks up behind the pig and starts… well.. you know… boinkin the oinker. Suddenly, the dog attacks him and continues to do so until he stops…. Another 6 months go by and the guy is going crazy with need. So, he tries doing the pig again only to be attacked once more by the dog. Yet another several months go by when this BEAUTIFUL woman washes up on shore – naked as the day she was born. One problem, she is not breathing. Quickly the guy gives her mouth to mouth. He nurses her back to health. One day when he is tending her, she looks up at him (STILL NAKED) and says.. in a breathy, sultry voice… “You have saved my life. Anything you want, it is yours. Any desire you   have… ask. Anything… anything at all.” The guy looks at her lustfully and says… “YEAH! Can you hold that damned dog?”

This morning, I was looking for a topic to write about when I came across this article published on KevinMD: “Why do patients hate going to the doctor?”  Dr Maheswari Raja did a great job analyzing and then answering this question and I highly recommend that you read it. 

As you know, I practiced for over 35 years.  My staff and I worked at making Lake Zurich Family Treatment Center into a medical home where you could feel safe and respected.  For the most part, we succeeded.  Like Dr Raja, patients often put me on notice that they hated going to the doctor; and, like Dr. Raja, I took offense.

Since transitioning from doctor to patient, I realize why going to the doctor might be a hateful experience and have actually voiced that sentiment to Renee.  From the time, I’m given a stack of papers to fill out and having my most precious commodities documented (insurance care, Medicare card) to the time the medical office assistant rooms me, the doctor in me is assessing the staff and office protocols.  The patient in me just wants to be seen, be heard, and be cared for!

By the time the doctor (or nurse practitioner/physician assistant) enters the exam room, I’m ready to leave.  The system has gotten on my nerves and often that affects what happens during the remainder of my visit.  Given the fact that your doc’s office has to have your insurance information and a host of legal documents allowing your physician to treat you, changing the registration process is almost impossible.

The vast majority of practices have the ability to register you online, allowing you to fill out their forms in the comfort of your home.  Unfortunately, even I forget to go online prior to an office visit.  Of course, patients forget to do their homework.   After all, they usually go to the doc because they don’t feel good or they worry that they have some dread disease. When you don’t feel good, often you don’t feel like doing anything.

So, what can a doc and his/her office do to make the office experience less hateful?  Dr. Norwicky, my new dermatologist, and his staff have found the answer.  On our very first visit, it felt as if they knew me and we were old friends.  Prior to my coming to the office, the office manager had reviewed my internet profile.  The staff was ready for me, cordially inviting me into their home and treating me as an honored guest.  (In subsequent visits, I have found that everyone receives the red carpet treatment.)

The doc quickly displayed all the characteristics of a great doc that I’ve laid out in prior articles. He listened to me without interrupting.  He answered my questions in a reassuring and caring manner.  His immediate and future plans for my care were explained in detail.  He answered Renee’s concerns as well.  I walked out of his office confident that I was in the right doc’s hands.  Every visit since that first visit has been the same. His office should be the prototype for Healthcare 3.0!

As I’m writing this article, it dawns on me that, while I worked to provide my patients with a medical home they could call their own, the hospitality they would receive on coming to my family home, in many cases, was missing.  Further, what set Dr Norwicky and his staff apart was that, in their office, hospitality was evident from day one.  Congrats, Dr. Norwicky.

Joke of the day:

Doctor: “Nurse, how is that little girl doing who swallowed 10 quarters last night?”

Nurse: “No change yet.”

The on/off phenomenon that Parkinson’s patients can experience is hard to understand.  When I treated Parkinson’s patients, I was aware of the on/off (freezing as in “can’t move”) periods they could have but never really appreciated the cataclysmic effects an off episode could cause.

This morning, I am “off”.  Imagine walking through a muddy bog, the thicker the mud, the harder it is to move your feet.  My feet feel like they glued or cemented to the floor.  Most of the time, if I muster all of my strength, I can move them.  Often, once moving, I’ll freeze again. Episodes can last minutes to hours and occur on a random basis.

When I use the term cataclysmic, I’m not exaggerating.  Imagine you have to urinate.  You head to the bathroom and freeze at the doorway to the toilet room.  (Freezing at portals is common.)  You’ve really got to go, and you can’t move.  Yep, you wet yourself and the floor.  Now, imagine that rather than being home, you are at the grocery store. “Off” periods are horrible and capable of scaring anybody who is around you. 

Imagine seeing me in the local market, standing rock still at the entrance to the bathroom, wetting myself.  Horrifying?  Luckily, it has never happened.  When you have unpredictable off periods, you stop at every bathroom you pass. It’s not uncommon for me to go straight to the bathroom when I enter the store and prior to leaving the store.  When we moved to Carolina, Renee learned the names of the key roads we would need to get around.  I learned where all the clean bathrooms were.

“On” periods can be amazing.  If you see me during an “on” period, you might think I’m normal.  On a rare occasion, an “on” is so good that I almost feel normal.  Other times, I can move but still feel like shit. “Ons” are precious moments in which you can exercise, swim, work on a project or simply enjoy a shower without fear of falling.

So, what can you do to help? The first thing to do is simply ask me if there is anyway you can help.  I’ll tell you to tap on my right shoulder as sometimes that helps.  Most of the time, I do not want to hold on to your arm or hand.  I can’t explain it but holding on to someone seems to make it worst. 

Just as thresholds may provoke an off episode, so might obstacles on the floor.  I might ask you to clear a path for me.  On occasion, I can’t break the “off,” in which case having a chair to sit in is very helpful.  So far, I’m lucky.  My “off” periods are always followed by “on” periods.

If you know someone with Parkinson’s, talk to them about the on/off phenomena and be prepared to assist them if necessary. If you see Renee hitting my left shoulder, I probably pissed her off.  If you see her tapping my right shoulder, I’m frozen and she’s trying to get me moving.

Here’s your joke for the day:

Difficult things to say when Drunk. 1. Innovative 2. Preliminary 3.Cinnamon. Very Difficult things to say when Drunk. 1.Specificity 2.Passive-disorder 3.Transubstantiate

Things that are just down right impossible to say when drunk.

1.No, thanks, I’m married.

2.Nope, no more for me.

3.No, I don’t want to see your tits.