Author: wellthy

Published on February 28, 2011, this article is even more pertinent today. I just got my lab results back.  All but two results are within normal range.  The two that are abnormal are just a little abnormal, hard to interpret and probably significant.  I think my physician is stumped.  I know I am!

Normal is a word I love. It’s great to call a patient and tell him his lab is normal, his chest x-ray is normal, his exam is normal. It feels good to reward someone for being healthy by telling him he is “normal.” 

Normal is a word I hate. It is the spawn of the devil. It makes people feel bad because they aren’t normal. It scares people. It makes people do stupid things trying to be “normal.” 

Last week I treated a perfectly healthy, delightful, intelligent and, quite literally, beautiful female patient who felt bad because her BMI (body mass index) was in the abnormal range. Her BMI, a measurement calculated from her weight and height, was in the obese range (according to recognized medical normalcy charts). She was not obese. She was not overweight. Her “normal” was simply different than the recognized norm. She was healthy until she found out what her BMI was and what it implied.

“Normal” is one of those concepts that can be hard get a handle on. In the laboratory, normal values are set by international organizations that set standards, by the laboratory equipment itself and by the population you are studying. If normal range is 80 –100 units and your value is 101, are you normal? It depends on whom you ask. When your doctor orders an EKG, there are excepted normal wave forms. If your EKG has an abnormal waveform, are you normal? Maybe! If you were born with it, it may be normal for you.

Tonight, I received a phone call from an anxious patient. Her MRI of her brain was interpreted by the radiologist as being abnormal. Her neurologist told her it was normal for her age. Who is right?

Normalcy is subjective. I have spent a great deal of time on this site discussing how remarkably different and unique my patients are. Because people are so individually distinct, each defines normal in a different way. Work at being happy within your own norm. As long as you are healthy and happy, try not to get overly invested in being like others. 

When it comes to medical issues, work with your doctor to understand what each individual test means and how the results pertain to your health. Define how important it is to “normalize” your results. Set realistic goals. When it comes to a disease like diabetes, the closer you are to having normal blood sugars, the better off you will be. When dealing with your BMI, if you are healthy and have no weight related medical problems, relax!

Concentrate more on being healthy and less on being “normal.”

To educate or to medicate, that is the question!  Education takes time and time is something most physicians are short on.   Education takes a commitment from both physician and patient.  The physician must commit to keeping up on the most modern treatment options and providing the patient with fair balance.  The patient must commit to acting on what he/she learns in a positive manner.  Let me give you an example.

Patient A has diabetes in its earliest stage.  His physician gives him a choice of either starting on medication or changing his lifestyle.  His physician gives him an overview of diabetes and the diabetic lifestyle along with a referral to a nutritionist as well as reputable internet sites to help him on his journey.  Patient A chooses to take the education route and does a great job!  Patient A tonight is to be congratulated.  His most recent blood panel was excellent.

Unfortunately, Patients B-Z also chose the education route but failed to follow through.  After a while, physicians get tired of wasting their breath tying to educate patients.  For every Patient A, there are 25 patients who fail to take their lessons to heart.  There are 25 patients who don’t have time to do their homework.  Twenty-five who promise to do better in the future.  “Doc, give me 3 more months and I’ll show you I can do it.”

Unfortunately, medicating a patient is easier than educating a patient.  It takes less time.  It is more likely to work, rewarding the patient and his physician with a modicum of success.  It is less likely to end in disaster and is more defensible in court.  So why not medicate everyone?

It’s a slippery slope.  Your doc starts you on medication and asks you to start working on changing your lifestyle.  Your blood sugar improves a little.  You want to celebrate with a banana split.  Why not?   You can take a little more of your medication.  Five years later, you are on lots of medications.  Rather than lose 20 pounds, you’ve gained thirty.  The dire effects of the diabetes and medication have snowballed.  You would change your lifestyle and start exercising but your back is bad and the incision in your chest from bypass surgery hurts like hell!

To educate or to medicate, is there really any question which one you should choose?  Help your doc by following his instructions, taking your medication as directed and following up when requested.  Make educating easy and successful.

Here is your daily joke:

For all those men who say, “Why buy the cow when you can get the milk for free?”

Here’s an update for you:

Nowadays, 80% of women are against marriage.

Why?

Because women realize it’s not worth buying an entire pig, just to get a little sausage…

It’s been a long time since I’ve awakened with a song in my head. In the past, awakening with a song playing over and over again in my head corelated with an important life event; and today’s song by CSNY correlates well with Parkinson’s Awareness Month.  Below are the lyrics to “Teach Your Children.”   For those of you who are too young to know the song, I’ve included a hyperlink.

You who are on the road

Must have a code that you can live by

And so become yourself

Because the past is just a good-bye.

Teach your children well,

Their father’s hell did slowly go by,

And feed them on your dreams

The one they pick, the one you’ll know by.

Don’t you ever ask them why, if they told you, you will cry,

So just look at them and sigh

And know they love you.

And you, of tender years,

Can’t know the fears that your elders grew by,

And so please help them with your youth,

They seek the truth before they can die.

Teach your parents well,

Their children’s hell will slowly go by,

And feed them on your dreams

The one they pick, the one you’ll know by.

Don’t you ever ask them why, if they told you, you will cry,

So just look at them and sigh and know they love you.

Here’s my take on this song.  We are all on the road of life and many of us experience our own personal hell while taking our journey from birth to death.  My personal hell is Parkinson’s.  As their father and teacher, my job is to teach them how to avoid the dreams that I let haunt me throughout my life and give them reasons to have better dreams, dreams of being healthy and happy.

Currently, there are no proven preventative measures that can be taken but many physicians believe that exercise and leading a healthy lifestyle combined with a diet high in anti-oxidants may prove helpful in delaying or even lessening the impact of the disease.

Certainly, had I been healthier at the time of diagnosis, I would be better now.  My dream is that research will ultimately come up with a cure and that’s the dream I want my children to focus on.  In the meantime, I am happy to say that they have been exercising regularly, have improved their diets and are living healthier lifestyles.

Whether you have Parkinson’s or not, a healthier lifestyle, diet and exercise will surely improve your physical and emotional being.  Work at being “Wellthy.”  (“Diets and Other Unnatural Acts” is now free on Kindle).  The life you save may be your own.

Here’s today’s jokes:

If a man talks dirty to a woman, that’s sexual harassment. If a woman talks dirty to a man, that’ll be $6.50 a minute.

If a midget tells you your hair smells nice… “…is that sexual harassment?”

As many of you know, May is Parkinson’s Awareness month.  I want to thank you all for your support over the years and give a special thanks to those who have contributed to the Parkinson’s Foundation Move It Walk on May 22 in Charlotte, NC. 

You would think that I, above all people, would be fully aware of Parkinson’s and all of its aspects.  Afterall, both my father and his father had Parkinson’s.  I’m embarrassed to say that I have spent a lifetime avoiding anything to do with Parkinson’s.  As a physician, I actively referred Parkinson’s patients to specialists, transferring their care away as caring for them meant facing the disease that has overshadowed much of my life.

Over the years, those very patients have tried on multiple occasions to get me involved in the Parkinson’s community and Rock Steady.  Each attempt to pull me in was met with a cold shoulder.  I owe those caring souls an apology.

As my readers know, retiring and moving to Charlotte left me with no place to hide and I went through a period where I simply gave up on life.  My view of Parkinson’s was so dismal that, as far as I was concerned, the end could not come fast enough.  During that period, my articles were pretty dark; and, in response, my readers showered me with love.  So did my children and grandchildren.

As I was emerging from those dark days, I found a Rock Steady group at the Charlotte Jewish Community Center and, to please Renee, signed up.  I was welcomed into the group with open arms.  It was to be a monumental moment in my life.  I found myself surrounded by Parkinson’s but not the Parkinson’s I had hidden from all my life.  Instead, I found a group of individuals who were living with their Parkinson’s rather than dying with it as I was.

I saw, firsthand, individuals who literally fell down only to get up and move on. I’ve written on many occasions about Mr. Wonderful whose mantra was, “If you fall down 6 times, get up 7 times.” Here I found people who followed the mantra.  I also found individuals who were quick to come to my aid if I needed it.

While I try not to play the “Would have, could have” game, I should have listened to my patients and gotten involved with the Parkinson’s Community sooner.  I’ve wasted a lot of time and have some catching up to do.  Now that I’m finally involved, it’s my job to make sure that others learn from my mistake.  Parkinson’s Awareness month needs to be Parkinson’s Awareness Decade and that takes money.

Renee and I will be walking with my newfound community on May 22^nd.  My goal is to raise as much money as possible so please contribute what you can.  The newest research is promising.  I will see the neurosurgeon this month and am planning on having the DBS (deep brain stimulation) procedure and will keep you informed.

To make a contribution supporting my efforts go to: stewart Segal’s fundraising page for Parkinson Association of the Carolinas  (https://give.parkinsonassociation.org/fundraiser/3206084) do a control/click on the underlined text or copy and paste the address into your web browser and it should take you to my page.  If you have problems, please let me know.

I like a good challenge but this one has bested me.  My neighbor taught me a saying I’ve never heard.  It goes like this, “Hooray, hooray, it’s the first of May, Outdoor sex starts today.”   I like the concept but can’t quite figure out how to write an article about outdoor sex.  As a matter of fact, I can’t remember having outdoor sex!

I remember making out on the beach and getting sand into places it didn’t belong.  I remember fooling around in the mountains of Virginia and being assaulted by rocks and sticks poking up through the blanket we placed on the ground.

Now that I think about it, sex on the balcony of the Holland America cruise ship was outdoors, romantic and downright fantastic.  The moon shining on the ocean, the sound of the waves and the sway of the boat all augmented the experience. Renee, let’s take a cruise!

Outdoor sex sounded good but was uncomfortable unless you were in a tent with a plush sleeping bag or on a cruise ship.  Then, again, that really wasn’t outdoor sex. While my general rule of thumb is any sex is good sex, I guess I’m a prima donna. My definition of roughing it was going to a Holiday Inn.

Well, it’s not much of an article; but this new May First ditty just got me to thinking. Do you remember sex?  Do you remember outdoor sex?  Are they fond memories or things you’d rather forget?  Frankly, I rather forget where the sand went! 

So, what’s this article really about?  My daughter just called to warn me not to see “The Father.” She said it is about dementia from the patient’s point of view.  She said it was very depressing. Dementia is one of the most depressing diseases you can get.  Parkinson’s patients are at increased risk of dementia.  So far, I’m ok.  Hopefully, I’ll dodge that bullet.  In the meantime, dredging up old memories and memorializing them by writing about them is like making deposits in the bank for future use.

It’s also fun.  I imagine my kids are cringing about now; so I’ll quit at this point.

Here’s your joke for the day:

Ever had sex while camping? It’s fucking in-tents.

Is medicine a profession or is it a business?  To us old timers, medicine is first and foremost a profession, a calling.  As such, the business of medicine has always come second.  Unfortunately, neglecting the business side of medicine has led to my profession’s downfall.

Fast forward to current times.  Medicine has become big business.  Companies such as Walgreens have led the charge. The creation of Accredited Care Organizations is just one of the many vehicles created and owned by corporate entities to suck every available penny out of my once proud profession.  Physicians, Nurse Practitioners and Physician Assistants have become corporate America’s service technicians and patients have become cost centers to be controlled and serviced in mass.

What’s behind the changes in medicine?  Profits!  America’s leading healthcare companies have figured out the business end of medicine and are going at the business full gun.  Pharmacies are now doing acute and chronic care in their Quickie Clinics.  Does anyone see a problem here?  I certainly do!

In past articles, I have written about the ethics of selling cigarettes in a facility that administers care and medication to sick smokers.  Corporate America had taken greed to a whole new level.  Due to public outcry, the practice of selling cigarettes in pharmacies finally stopped in 2020.  Unfortunately, it will take more than a public outcry to heal our current healthcare system.

The treatment of chronic diseases entails more than just writing a prescription. It entails helping the patient develop healthy lifestyles.  Will the store front practitioner who is treating a patient for diabetes walk her through the store and show her everything she shouldn’t buy or will the sale on large bags of Reese’s Pieces catch the patient’s eye and will he/she end up with several bags of the sugary delight in his/her cart?   Will the three 12 packs of Coke for $12 sale be the diabetic shopper’s reward for purchasing his/her healthcare at such a convenient location?

Will the store front practitioner walk the hypertensive safely out of the store avoiding the racks of salt-laden chips and pretzels?  I think not!  Instead, the store designers will continue to set up food gauntlets designed to lead the customer to the most profitable products and fill the corporation’s coffers.

The business of medicine is the end of medicine as us old timers know it.  Ethics and morals are changing and it has become completely ethical to sell an obese individual a diet pill, a six pack of Millers, chips, pretzels and candy.  Afterall, corporate America pays its administrators well; and, while the number of docs seems to be decreasing, the number of administrators is on the rise.

Read, “Executive compensation, 2019 Novant Health Form 990”.  It will blow you away.

Here’s today’s joke,

An elderly man is stopped by the police around 2 a.m. and is asked where he is going at this time of night.

The man replies, “I am on my way to a lecture about alcohol abuse and the effects it has on the human body, as well as smoking and staying out late.” The officer then asks, “Really? Who is giving that lecture at this time of night?”

The man replies, “That would be my wife.”

According to an article published in “The Journal Of The American College of Cardiology,” a meta-analysis (scientific review) of 50 studies including 535,000 patients showed major health benefits from being on a “Mediterranean Diet.”  Among the benefits of this diet are:

• Improved systolic and diastolic blood pressure
• Improved levels of HDL cholesterol
• Improved triglyceride counts
• Lower blood sugar levels
• Improved waist circumference.

The “Mediterranean Diet” is rich in vegetables, fruits, whole grains and healthy oils, such as olive oil.  A handful of nuts daily are an added bonus.  Red meats are limited to a few servings a month.  Eating fish and poultry at least twice weekly is advised.  Another bonus is the diet allows for the ingestion of moderate amounts of red wine.

I have addressed diets in numerous previous articles and will continue to do so as an appropriate diet is a mainstay of “Living Wellthy.”  The foundation of the “Living Wellthy” lifestyle encourages you to invest in your physical, nutritional, emotional and spiritual health retirement funds with the same fervor that you invest in your financial retirement fund.  You should set a long-term goal for your nutritional account and that goal should be the healthiest diet that you can maintain long-term. 

The “Mediterranean Diet” and others that I will write about in the weeks to come should be viewed as potential goals that can be realized by careful planning and sculpting of your current dietary habits.  Remember, your diet is based on your family’s dietary habits, your national and religious heritage and your personal likes and dislikes.  Your diet has been around for a long time and is, essentially, encased in concrete!  Rather than trying to radically change it overnight, slowly chip away at it and mold it into something much healthier.  Remember, the life you save may be your own. 

Have you ever called someone a DORK?  I have!  Do you know what a dork is?  According to the Collins English Dictionary, “If you say that someone is a dork, you think they dress badly in old-fashioned clothes and behave very awkwardly in social situations.”  Further, Collins states a dork is “a dull, slow-witted, or socially inept person.”  As of today, there is a new definition of DORK.  According to the Segal Dictionary, I’m a DORK.

Let me explain.  Between my massive belly, quadruple chin and beige grandma support hose, I’ve been approaching dorkdom.  Today, Amazon delivered my protective shorts.  Last week, I watched one of the members of my Rock Steady group fall.  I’ve fallen several times as well.  Despite my CRS, I remembered seeing a study showing that protective shorts were padded over the hips, back and buttocks and prevented breaks associated with falls.  I ordered a pair.  With my natural abdominal padding (fat) and bulges over my hips, buttock and thighs, I’ve crossed the line into the land of dorkdom. Add the support hose and I’m the king of dorkdom.   

Now that you have the picture I’ve described above, add one more item.  Occasionally, I have to swat at the fly-like floater that races across my visual field.  That action makes me look like a dangerous dork.  On days I go to Rock Steady and wear my protective shorts, I assume anyone who sees me will turn and walk in the opposite direction.

Of course, there is a silver lining in any cloud and my protective shorts make me look like I have a big package.  Now that I’ve completed painting a picture of what I look like, you can take a minute to puke and then I’ll get to my point.  The point of my self-deprecating article is that falls are common, as are fractures associated with falls and nobody except dorks where padded pants. I would rather look like a dork than have a broken hip.

If someone in your family is at risk of falls, buy them a pair of padded pants or shorts.  If they balk, have their doc review the care of a broken hip or wrist, etc. with them.  Hip fractures don’t just hurt, they can kill.

Now for a joke or two:

My wife told me she’ll slam my head on the keyboard if I don’t get off the computer. I’m not too worried, I think she’s jokinlkjhfakljn m,.nbziyoao78yv87dfaoyuofaytdf

My wife and I have reached the difficult decision that we do not want children. If anybody does, please just send me your contact details and we can drop them off tomorrow.

It turns out a major new study recently found that humans eat more bananas than monkeys. It’s true. I can’t remember the last time I ate a monkey.

Yesterday, one of my neighbors and his wife stopped by to say hello and invite Renee over for tea with the girls.  This was the first time we had gotten together with this couple and it was a delightful experience.  For the purpose of this article, I’ll call him Mr. G for genius (and because I can’t remember his name right now).

In a short time, I discovered that G is a teacher, author and musician.  As is the usual for older people, the conversation drifted toward the medical field and G talked about the importance of having a physician for a partner in the management of his health.  I want to thank G for coming up with the idea for this article.

In past articles, I’ve discussed the doctor-patient relationship.  In my mind, the doctor-patient relationship was a sacred bond, every bit as sacred as that of a holy man and his congregants.  At least, that was the way I used to look at it.  Having transitioned from a doctor to a chronically ill patient, my new viewpoint has shifted (with the help of my new neighbor) and I’ve discovered a new truth.

I now believe that the doctor-patient relationship needs to be redesigned and called the Patient-Doctor Relationship.  Changing the order of those two words makes a huge difference.  In both versions, there is a partnership formed between doc and patient.  The difference is who is the managing partner.  From where I stand today, I can tell you that the patient should be and should have been the managing partner.

Yes, my role should have been strictly as a consultant, advising my patient in all medical options and consequences of those options (informed consent).  Therefore, the patient’s role should be to make the ultimate decision of what he/she was going to do.

One of the great mysteries of medical practice has always been the patients who both sought my advice and then ignored it.  Perhaps, had I given them the role of managing partner, they would have chosen differently. I know that, in my new role of patient, I am more likely to listen and follow my doc’s advice if I am in control, as opposed to if it is an edict from on high.

Being in control of yourself is extremely important on multiple levels.  My most feared consequence of Parkinson’s is loss of control over myself and my affairs.  Doctors beware, do everything possible to leave your patients in control for as long as possible!  Patients beware!  If you have a disease that will ultimately steal your ability to control your own life, make sure that, while you are in control, you leave detailed instructions for who is going to take control of you and how you want them to proceed.

Personally, if Parkinson’s dementia or some other disease takes away my ability to control my own life, my orders will be to let me die a natural death.  In the old days, we died from natural causes as we had no treatment for much of what ails us.  Accordingly, a natural death means that all treatments/medications are stopped.  In modern times, we treat everything and keep patients alive at all costs, moving them into long term care facilities where they languish, awaiting their death which we hold at bay.

Now, we really need a joke to get the foul taste this morbid paragraph leaves behind out of your mouth.

“He’s so old that when he orders a three-minute egg, they ask for the money up front.”—MILTON BERLE

A worried father calls the family doctor because he thinks his teen son has caught a venereal disease.

“I think he got it from the maid,” says the concerned dad, “and I’ve also been sleeping with the maid.”

“Okay,” the doctor replies calmly. “Well, when you bring him into the office we’ll take a look at you as well.”

“And that’s not all,” the father continues. “I think I might have given it to his mother.”

“Oh, no!” cries the doctor. “Well, now we might all have it!”

“Everything that used to be a sin is now a disease.”—BILL MAHER

I’ve heard about floaters my entire life.  My parents had floaters, as did many of my patients.  My brother describes his as a fly that constantly crosses his visual field.  Having never had one, I could not appreciate the amount of distress a floater could cause.

I have written about my imaginary wheel of medical misfortune (wmm) before.  It seems that my wmm has various body parts on it; and every morning the wheel spins and whichever body part it lands on is the thing that is going to bother me the most that day.  Last week my wmm landed on my right eye and I got to experience my first floater.  It freaked me out!  A thin twisted worm started crawling across my visual field and it’s driving me insane.

Lucky for me, I already had an appointment on the books to see an ophthalmologist this week.  Unfortunately, yesterday I got more floaters and some bright flashes of light.  The two findings together represent a major threat to my vision.  I talked with the ophthalmologist on call and he is going to see me this am.  I’m on my way out the door now and I’m scared.  The lesson today is that you only have two eyes and if one or both malfunctions, be seen immediately. While common, floaters may represent trouble.  Bright flashes can be a real threat.  A curtain over your visual field or loss of vision is an emergency. 

I’m back. The eye doc did a thorough exam and my retina and pressures are fine.  I just have a maddening floater that may or not go away. Most floaters are benign, as is this one.  That damn wmm is going to be the end of me.  Meanwhile, I’m so fat that my fat has fat.  The technician could not get the equipment close enough to me to measure my intraocular pressures.  My belly was in the way.

As Mr. Wonderful likes to say, “If you fall down ten times, get up eleven times.”  I’m up again!  Part of my weight is definitely fluid retention.  I’ll start  a fluid retention study tomorrow.  I’ll record intake and output as well as salt consumption and see my gerontologist for further testing next week.  I’ll persist demanding an answer and most probably we will find one.  If not, then it’s back to Illinois to see my former docs.

Here’s your joke for the day:

After lunch today, Renee said, “Hey, you have something on your chin… no, the 3rd one down.  I found it but it was on the fourth chin.