Author: wellthy

The AMA has consistently advised against treating friends and family.  A good summary of their rules and the thought process behind their rules can be found on Google.  As a family physician, I treated multigenerational families.  In a sense, I became part of those families, at first caring for a young couple’s babies, then their toddlers, progressing to the point of caring for the babies of the infant I cared for 25 years prior.  In the 34 years I practiced medicine, I cared for families that included great grandparents, grandparents, their sons and daughters and their grandchildren.

Notice the word “caring” in the sentence above.  Caring is what it is all about; and, if you genuinely care for your patients, then eventually they become friends or even family by choice.  So, do you fire your patient because he/she has melded you into their family?  Of course not! 

Surely, knowing the entire family history and how injury or disease affects not only the patient but his/her significant others gives the family physician a distinct advantage over other specialists.  In turn, the family knowing their physician through multiple interactions gives the family and its individual members the trust they need to respond in dire times and difficulty situations.

Don’t get me wrong.  Treating family and friends does pose special problems but a well-trained physician should be able to deal with those instances.  A few examples will help you understand my stance on the AMA’s position.

I’ve known family “A” for years.  I care for their parents and their children.  I bump into the wife (”W”) at Costco and we spend a few minutes catching up on life.  I haven’t seen “W” as a patient in 6 months but she has been in multiple times with the children.  I note that “W” is not herself.  She seems a bit anxious and guarded which is distinctly different from her usual affable demeanor.

Me – “W,” what’s wrong?

W –  Nothing.

Me – You don’t seem yourself today.  Is everything at home ok?

W – Everything is fine.

Me – I’m glad everything is fine.  You know you can talk to me about anything if you need to.

I got a call that afternoon.  She thought about it and decided to share what was happening.  She did not want any information shared with her husband and I assured her it would not be.  She had a sexual problem and felt her gyne was ignoring it.  She wanted an internal exam; and, since we were kinda friends/family, she didn’t want to put me in an awkward position.  I reassured her and she came in for an exam.  Problem solved.

The husband called me that afternoon to pump me for information.  He called me “Stu” which was a tipoff that he was going to play the friend/family card.  He was upset that I would not divulge any information but quieted when I reminded him that I held my patient’s information to be every bit as sacred as a priest did in the confessional.  I knew he was a devote Catholic and that the comparison to a priest’s responsibilities would win the day.

Had I not known her well enough to pick up on the subtle changes associated with her fear of illness, her diagnosis and treatment would have been delayed.  Had she not felt comfortable with me in my physician role, she would have gone untreated.  One of her concerns was the fact that she needed an internal and how that would affect our friendship/family relationship.

In life, each of us wears many hats.  When I put on my doctor’s hat, I go into doctor mode.  In doctor’s mode, an internal is no different than a throat swab.  The trick is getting the patient to understand that fact.  When patients become friends/family, they get to see the transition from Stewart the jokester, foodie, family man to Doc, the caring, serious diagnostician. 

Story number two involves a 60 some year-old female in for her pap smear.  Her doc had just retired and she was looking for a new doc.  I had been taught to talk my way through an internal; and, before doing her rectal exam I asked, “have you ever had a problem with the rectal part of the exam?”  Her answer was an emphatic NO and that no one had ever done a rectal on her and no one ever would. 

I was blown away!  Her lifelong gynecologist was one of my best teachers and Dr. “K” taught his students to do rectal exams on all patients who were in for their annuals.  I talked with Dr. “K” a few weeks later and he reassured me that his notes were accurate and rectals had been done but never discussed.  The difference was obvious: “K” had a long-term trusted relationship that allowed him to do what he needed to do without informed consent and I didn’t.

What has being retired due to illness taught me about treating family and friends?  Story number three:

On the day I was discharged from inpatient PT, a longtime patient (I’ll call him LTP) called asking if there was anything Renee or I needed.  My usual request is for a 40-year old red headed nurse and he said he would find one.  I was joking; he was not.  He called several times over the next week and we finally decided that he would pick me up at rehab (giving Renee an afternoon off) and we would go to lunch.  We had a blast.  Turns out that he was funny as could be; and, if not for the AMA rules, we would have been lifelong social friends.  I have thanked God for LTP on a regular basis.

While I treated friends, I rarely socialized with them.  I often ducked dinner invites and other offers including a villa in Greece.  I shouldn’t have!  My life would have been richer had I socialized with my patients.  I should have taken Renee to Greece when I was whole.

My advice to future physicians is to ”care” for and about their patients; and, if that caring relationship leads to friendship, then accept it as long as you can maintain appropriate barriers when needed.  As far as treating immediate family, who better to know their history, personalities, strengths, and weaknesses.  Make sure they know who to see if they are uncomfortable seeing you and that you have adequate referral sources should you be uncomfortable seeing them. 

For those of you who believe that you will not treat family, wait for that 3 am fever and abdominal pain and see how strong your convictions really are!   I bet you’ll treat them rather than awaken the doc  on call.

Here’s your joke:

A woman playing Golf hit a man nearby. He put his hands together between his legs, fell on the ground & rolled around in pain. She rushed to him & offered to relieve his pain as she was a Doctor.

Reluctantly, he agreed. She gently took his hands away. Unzipped his pants & put her hands inside. She massaged him tenderly for a few minutes & asked: “How does it feel?” He replied: “Feels great but I still think my thumb is broken.”

And my favorite:

I went to the doctor and he said, “Don’t eat anything fatty.”

I asked, ” No bacon? No burgers?!”

To which he replied, “No, Fatty, just don’t eat anything! “

Yesterday, I learned a valuable lesson.  I should have learned it in medical school.  Since they never teach you how it feels to be a patient, you would think that I would have learned it from observing my patients during the 34 years I practiced medicine.  I didn’t!

In medical school and in practice, we learned that treating patients with medications carried significant risk.  We were taught that it was our duty to review those risks with the patient prior to giving them the medication.  We were taught the risks of surgery and other interventions as well.  We were taught to discuss benefits and risks of almost everything we do.  We should have been taught that everything we do has an impact.

We learned that tests had consequences and to look for false positives and false negatives.  Shoot, just coming to my office carried risk (I might uncover something you didn’t want known).  So, what am I talking about?

When my mother came to live with us, it became apparent that her memory was failing.  I shared my concerns with her and sent her for Neuropsych testing.  I explained that Neuropsych testing was a 4hour exam (quoting google) “to understand cognitive strengths and weaknesses, neuropsychological testing (further) evaluates:

Attention and concentration

Verbal and visual memory

Auditory and visual processing

Visual spatial functioning

Language and reading skills

Sensory development and sensory integration

Gross and fine motor development

Social skill development

Executive functioning

Emotional and personality development”

What I didn’t take into account in my ordering the test was the amount of anxiety such an awesome test could provoke.  I didn’t take into account how worried a patient might be coming out of the test and waiting for the results.  I didn’t know because, despite having ordered hundreds of Neuropsych evals, I had never had one.  She had to wait 3 weeks for her results!  Knowing her the way a son knows his mother, those must have been horrible weeks.

I had forgotten how bad test anxiety could be!  I rediscovered that anxiety over the last few weeks.   I was going to take a test that would compare me to my peers and uncover my weaknesses.  Had I known what I now know, I would have done a better job at preparing my mother and my patients for what was to come.  At the very least, I would have asked my patients how they felt about taking such a test.

The doc responsible for interpreting my test did an excellent job at describing the test and how it is graded.  She explained that the test was meant to establish a baseline on which any future changes could be evaluated.  She explained that nobody gets 100% right.  She explained that my results would be compared to the results of my peer group and she would review them with me in 1 week.

If my peer group is comprised of chimpanzees, I did great!  Seriously, I came out of that test feeling like I was an idiot. The examiner said, “I’m going to give you a list of numbers and I want you to repeat them in reverse order.  Ready?  Six, nine, seven, eight, one, four, nine, seven, five, six, one, one, two.  Now repeat those number in reverse order.”  I’m sure someone can remember all those numbers and reverse them, but I can’t.  The more tasks I couldn’t complete the more my testing anxiety increased.  Eventually, my mouth went dry, my brain froze and my performance worsened.

I’m sure my peer group went through the same phenomena.  I’m sure my mother did as well.  I bet she came out of the test thinking she had Alzheimer’s.  I did, at least, until my memory came back online and I remembered all the times as a youth when I came out of an exam thinking I had failed it and instead aced it.

The moral of the story is simple.  Doctors are taught to think as doctors.  What if doctors were taught to think as patients as well? I think they would be much better as doctors if they understood the effects they and their tests had on patients.  I know I would have been.  I know that, having been through this experience and the myriad of experiences I’ve had since becoming a chronically ill patient, I would have spent far more time preparing my patients for this test and its aftermath.  Oops, I’m playing “woulda, coulda shoulda” game (click on the underlined words) again.

In this case, the “woulda, coulda shoulda” game that I have cautioned some many mothers against has a purpose.  I think that an integral part of a doctor’s education should involve learning the patients’ point of view.  This blog will eventually become a book designed to give doctors and patients alike1 a unique view of chronic illness, a view born from my long tenure as a doctor and my newfound view as a patient with an ongoing, neurodegenerative disease.

Now for my daily joke:

I’m not saying my ex is fat…

But my memory foam mattress took a year to forget her.

I’m including the following joke because, just the mention of sex, increases my readership:

Did you know too much sex can cause memory loss?

I read that in a medical journal on page 34 at 3:23 pm last year on Wednesday November the 7th.

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 today’s test?  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?’

Is it a blessing or is it a curse?  I truthfully don’t know.  I was talking to my brother tonight and he commented that everyday was the same as the day before.  He’s retired and recovering from a stroke.  He’s also got a great attitude. He wakes up every day, tells Martha that he’s still there and is happy with his new daily routine.  Like Renee, Martha has taken on most of Alan’s former responsibilities.  He married well.

If Alan can be happy with his new life and deficits, why can’t I?  Like Alan, I wake up every morning blessed to have Renee and the children, yet that doesn’t seem to be enough.  Happiness is a choice.  Obviously, my brother chooses to be happy.  As hard as I try to choose happy, I can’t get comfortable with my deficits.

I discovered part of the problem today.  Channel 3 News filmed my Rock Steady session today.  I realized that, of the 12 Parkinsonian participants working out in the gym, I was the last to complete every task.  I’m used to excelling and can’t stand lagging behind the group.  Still, Alan rose to the top of his profession and was a perfectionist much of his life.  Why can’t I be like him?  I don’t know.

I tell myself that I know where my Parkinson’s is going to take me.  Maybe that’s why I can’t stay happy for long.  I also know that no one knows what tomorrow holds for them.  I know that trying to live in the future is fruitless and causes anxiety so why do I waste time thinking about the future?  Again, I don’t know.  I know I should be happy.  I have great new friends in my sunny new neighborhood and live in a comfortable new handicapped equipped house.  So why can’t I choose happy?

I’m blessed with best friends from childhood.  I’ve got you guys, my readers.  Why aren’t I happy?  Is it the loss of my practice of medicine?  I think perhaps that’s the answer.  If it is, I’ve got to get over it!  While I idealized the medical world I lived in, I knew that it was changing; and I hated the changes.  I was not a “provider” and did not want to become one. I was a doctor (also known as a dinosaur).  I would have hated the Telemed that has become prevalent since the onset of Covid.

For sure, the fact that I’m Renee’s burden plays a role.  We pledged to be there for each other “in sickness and in health.”  Boy, did she get a bum deal.  When you are young and in love, you really can’t imagine what sickness really is.  If I can choose happy and maintain it, it will lessen her burden.  I choose happy.

So, my full-time job now is to work on my Blessings List and be like my big brother.  I choose happiness!  Now all I have to do is keep my head out of future thought and live as best I can in the present!  And follow my brother’s example.

My daily jokes start the day off with a laugh.  Here’s today’s.

What do you do if your wife starts smoking? “Slow down and possibly use some lubricant.”

How do you find a blind man on a nude beach?

. . .it’s not hard.

My Parkinson’s patients have raved about it.  The literature verifies its ability to stabilize and improve Parkinson’s.  I’ve participated in 3 classes over the last week.  Yesterday’s class wiped me out!

Rock Steady is built around boxing.  We train for 75 minutes, 15 of which involves boxing.  We are learning about the boxer’s stance, hooks, jabs and undercuts.  We box with a dummy, a heavy bag and a speed bag.  I actually like hitting the dummy!  I’ve never been a violent person but find great pleasure in hitting the CEO of a major insurance company that for years has given me the blues.

We do laps in the gym.  We do stretch and balance exercises.  We do some endurance training.  The group is highly supportive of each other.  Yesterday, my legs wouldn’t work.  They gave out on the first lap.  I almost fell twice.  Two of the guys walked me out to the car. 

I have avoided going to any group activity involving Parkinson’s and Rock Steady is such a group.   Whenever I was around a person with Parkinson’s, I wanted to cry.  I saw myself in him/her and knew that one day I would be as bad as that person was.  I was foolish.  Now I’m the second worse in the group and vying for the honor of being the worst. 

I’ve written about denial before.  When in my doctor’s outfit, I was Superman.  Denial stopped me from recognizing how bad I had gotten.  While skeptical of its ability to improve my life, I know that doing what exercise I can tolerate will be good for me even if it doesn’t slow my progression.  Being in this group and being able to compare myself with others afflicted with Parkinson’s will, at least, keep me out of denial.

As a physician, husband, parent and friend, my job is and was to help my patients, relatives and friends who are in denial see the light of day.  Think of a person who is in denial as a person who has blinders on.  Taking those blinders off may be difficult and may even damage your relationship with your loved one; but, in the end, it will be worth it.

Denial is particularly bad in heart disease, lung disease and colon cancer.  I had a 48-year-old male who had a complaint of severe indigestion.  He had taken all of the over-the-counter meds to no avail.  I told him that one of the possible causes for his symptoms was heart disease.  He told me he walked 3 miles a day, followed a healthy diet and recently had a normal EKG.  I told him that a normal EKG was meaningless. I explained that, even though he exercised and ate appropriately, his family history (father and uncle with coronary artery disease) and symptoms required a more extensive workup.  He accused me of driving up the cost of medical care by doing “unnecessary tests.”

He sought a second opinion from a gastroenterologist who scoped him and put him on more meds to no avail.  His symptoms remained the same and he had a large MI shortly after starting on his new medications.  Remember the statement I posted the other day, “Uncertainty is the only certainty there is and knowing how to live with insecurity is the only security.”

When you’re deep in denial, there is no room for uncertainty and insecurity as you are certain and secure in the belief that you are right.  I don’t care how unlikely the diagnosis of heart disease was, the risk of missing the diagnosis of heart disease is too great and the penalty too grave not to do a further assessment. 

In other terms, when making a list of possible causes for an illness, if there is anything potentially life threatening on the list, it should go straight to the top of the list even if it is highly unlikely.  I would rather waste money than waste a life!

Here’s your joke for today:

A woman puts an ad in the paper looking for a man who wouldn’t run away at the sight of commitment, who wouldn’t hit her, and could fulfill her sex life.

Two weeks go by and nothing. Finally, one day the doorbell rings. She opens the door and sees a no-armed, no-legged man.

She looks at him and asks, “How do you expect to fulfill my wishes?”

He explains, “I have no arms to hit you with and no legs to run away.”

Then she says, “And the sex life?”

He looks at her and says, “I rang the doorbell, didn’t I?”

Posted on the kitchen wall in my office, I had a picture of footprints on a beach showing two sets of prints leading into one set of footprints.  The poem that went with the picture was:

One night I dreamed a dream.

As I was walking along the beach with my Lord.

Across the dark sky flashed scenes from my life.

For each scene, I noticed two sets of footprints in the sand,

One belonging to me and one to my Lord.

After the last scene of my life flashed before me,

I looked back at the footprints in the sand.

I noticed that at many times along the path of my life,

especially at the very lowest and saddest times,

there was only one set of footprints.

This really troubled me, so I asked the Lord about it.

“Lord, you said once I decided to follow you,

You’d walk with me all the way.

But I noticed that during the saddest and most troublesome times of my life,

there was only one set of footprints.

I don’t understand why, when I needed You the most, You would leave me.”

He whispered, “My precious child, I love you and will never leave you

Never, ever, during your trials and testings.

When you saw only one set of footprints,

It was then that I carried you.”

I don’t know who wrote it, but the poem is truly beautiful.  Over the years I was in practice, I was lucky enough to see evidence of God’s interventions in my patients’s lives.  On several instances, I felt the hand of God guiding my care and therapies.

About 10 years ago, God’s presence seemed to vanish.  I tried, in vain, to figure out what happened but never could.  I finally decided that God went on vacation and didn’t tell anyone.  When I look at the world we live in, I have trouble with the fact that bad things happen to good people and that good things happen to bad ones.

I read multiple books on the subject and talked to the clergy about it and have yet to hear an explanation I can get comfortable with.  My trip through the past reminded me of how many of my mentors have died and, once again, has brought my questions to the surface. 

I know people are born to die but many of my mentors left our world while still young.  Add to that the half million people who have perished from Covid and I think you can see my point.  Is God a vengeful deity who happens to be pissed off at the low attendance in his/her churches, synagogues and mosques?  Is he/she on vacation?  What’s up?

There is, of course, one more very important question:  Why me?  When I first got Parkinson’s, I assumed that God had enrolled me in a course on handling chronic illness as part of my ongoing education.  That assumption led to this thread on my blog.  I was at peace with that idea.

Then, Parkinson’s, along with my back problem, took my practice away.  I didn’t have a good explanation for that.  That pissed me off and I spent a lot of energy on being angry with God.  I asked lots of questions and got no answers.  Today, someone sent me the poem I copied above.  I remembered the picture on the wall in my old office and my anger dissipated.

If there is an afterlife, I assume I’ll get answers to my questions then.  It is said that the pathologist knows everything, just a few moments too late. Will my answers come too late?  I’ll add that question to my afterlife list.

Meanwhile, I’ll try to connect with God and continue to communicate with my former patients and teach through this blog.  I know that some of what I write will offend a few of my readers but I believe that striving to be politically correct stifles original thought and education.

I use vulgarity on occasion.  There are just some sentiments that are best described by vulgar words.  I apologize in advance if I offend you in anyway. 

Here’s your joke for the day:

God said “Adam, I want you to do something for Me”. Adam said “Gladly, Lord, what do You want me to do?”

God said, “Go down into that valley”. Adam said, “What’s a valley?”

God explained it to him.

Then God said, “Cross the river”. Adam said, “What’s a river?”

God explained that to him.

And then He said, “Go over to the hill…” Adam said, “What is a hill?”

So, God explained to Adam what a hill was.

He told Adam, “On the other side of the hill you will find a cave”. Adam said, “What’s a cave?”

After God explained, He said, “In the cave you will find a woman”. Adam said, “What’s a woman?’

So God explained that to him, too.

Then, God said, “I want you to reproduce”. Adam said, “How do I do that?”

God first said (under His breath) “Geez…”

And then, just like everything else, God explained that to Adam, as well.

So, Adam goes down into the valley, across the river, and over the hill, into the cave, and finds the woman. Then, in about five minutes, he was back…

God, His patience wearing thin, said angrily, “What is it now?” And Adam said, “What’s a headache?”

Spring is here!  It’s my favorite time of the year.  Kenzie, my 3 year old granddaughter, has started in soccer and RJ, my 6 year old grandson, in baseball.  Kenzie lives here so I get to see a lot of her “games.”  Once our vaccines are done, we’ll be on our way to baseball in Georgia.

Thanks to the magic of the internet, we get to see Jackson play baseball and Hannah play volleyball in Virginia.  Sooner or later, we’ll work our way up to Virginia.  I have two elderly uncles in the Norfolk area.  One turns 99 soon and I really want to celebrate his birthday with him this year.

The builders are here this am putting in my raised garden.  I love growing fresh veggies.  I love tending to and nourishing my garden, watching it bear fruit.  In Illinois, LZFTC was my garden; and the infants, children, and adults I cared for over 34 years were my precious fruits. 

I watched my families grow into second and third generations.  I’ve lost track of most of them but am secure that they are doing well.  The kids of the kids I took care of when I first opened LZFTC are graduating from college, getting married and having babies.

Now, my children and grandchildren are my main focus and Renee and I will tend to them and nourish them for as long as we can.  I’ve complained bitterly that there is not much I can do.  In reality, I have my family to tend to and, by the end of the day, my garden.

I’ve had two really bad days in a row.  This morning it took me 10 minutes to move from one end of the house to the other to get to this laptop so that I could write this article.  The journey from my room to the kitchen has left me wondering, “Will I be able to tend to my garden?”  We shall see. The journey from the kitchen to the garden is about the same distance as from my bedroom to the kitchen. 

They say, “Where there is a will, there is a way.”  My will is strong. I’m going to pick fresh greens spring and fall.  I’m going to have gazpachos and cold cucumber soup made from fresh tomatoes and cucumbers picked fresh every morning. 

When I say “I,” I really mean Renee and me.  She has become my hands and feet and has taken on a huge amount of what I used to do.  I need to buy her a cap and vest for when she is the chauffeur, a chef’s hat and apron for when she’s cooking and a skimpy, lacey outfit for when she’s dressing me or . . .

Spring is a time to renew and grow.  My recent articles have been a form of spring cleaning. I’m ready to plant seeds in the garden, ideas in those who read this blog.

Today’s seed to plant and nourish:  be happy with what you have, enjoy it while you can as you never know what tomorrow holds.  Don’t put off the happy!

Here’s your joke for the day:

Two boys were walking in the forest…

… and they came across the most beautiful women taking a bath in a hot spring. Upon seeing this, one boy took off running, and the other went after him. When he caught up to the other, he asked “Why did you run off?” To this the other replied, “Well, my mom told me that if I ever saw a naked woman I would turn to stone, and I felt something getting hard!”

Another?

John Snow was at a bar outside the great wall drinking. A beautiful girl comes inside and her eyes meet his. She likes him, so she goes and introduces herself.

-Hello, handsome. My name is Jenny Spring. What’s yours?

John laughs and continues with his drink.

-Why is this funny?

John Snow responds,

-Nothing. I just imagined how rare it would be to have 7 inches of Snow in Spring…

I just realized that I have a job.  Yep, I’m not really retired, instead I’m working for the department of water works.  My full-time job is making sure that I know where the nearest urinal is and that I can get there in time.  Turns out a lot of people my age work at the same job!  I was in Costco’s bathroom the other day and it was packed with old men.  It helps that big box stores put their bathrooms in the same place at every location.  How many of you know where the bathroom in Bed, Bath and Beyond is?  My second full time job is working on my mining for poop.

Constipation, what an exciting topic to write about.  I find it interesting that, at the age of 69, poop talk still makes me want to laugh.  Poop talk leads to all kind of jokes.  My opening line could have been, “Constipation, a shitty topic to write about.”  I had another opening line.  It’s on the tip of my tongue and I can’t quite put it on paper.

Seriously, the older you get the more important and difficult your bowels and bladder become.  For many, their golden years revolve around both poop and pee.  Time for a joke now:

Three old guys sitting at the breakfast table:

Guy 1 – Oy, it’s terrible.  I get up in the morning and sit for an hour straining to take a dump. I push and I push and all I get are little rabbit turds.  I’m miserable!

Guy 2 – I can poop just fine.  I can’t pee.  I get up in the morning and try to pee.  I get tiny drops that go everywhere except where I want them.  I strain and I strain and eventually I pee.  Then 15 minutes later, it starts again. It’s terrible!

Guy 3 – I don’t have a problem pooping or peeing.  The only problem I have is I do both an hour before I wake up!

The best humor comes from reality.  The reality is that I can fix the urinary problem with surgery.  The problem is I like my prostate just as much as I like the rest of my body parts and I’m not in any hurry to get rid of it.  I’ve had enough surgery.

The constipation is a different subject.  There are many causes for constipation.   Mine include my age (if I stop aging it resolves), Parkinson’s (same caveat) and my medications.  My choices appear to be either stop aging or deal with it.  I’ve decided to live so I’ll just have to deal with it.

True story – My fellow residents used to sit together at the 3 am free breakfast that Lutheran General Hospital provided.  We’d talk shop, review cases, and slam the attending physicians prescribing habits.  On one such occasion, I presented a case where the patient was on 13 different medications.  Half of the meds were given to treat the side effects of the other half.  We took an oath: we would never do that!

Fools that we were, we believed it.  Flash forward 30 years and I had patients on 13 meds, half treating side effects of the other half.  Flash forward 10 years more and I’m on 13 meds.  And I’m fricken constipated. 

I’ve seen my doc who told me my protuberant belly was from constipation.  I didn’t believe her.  I got a second opinion from a gastroenterologist.  He told me I was fat and constipated.  His answer, take more Miralax and start on Dulcolax.  Oh yeah, he told me to lose weight and then explained why I wouldn’t lose weight due to the myriad of problems and meds I had.

I’m losing weight and am down 1 ½ pounds in a week.  If Miralax wasn’t available as a generic, I’d buy stock.  I can’t get enough of it.  Same for Dulcolax.  I think today’s the day I get lucky and have a movement.  In the meantime, if you see me out and about, you’ll notice that I’m always scanning for the location of the nearest bathroom.  (I wish Yelp would rate public bathrooms.)

I almost forgot.  I stopped at a Harris Teeter to get some last minute supplies.  On entering the store, I headed directly to the bathroom.  The problem was the store design I was in was different from what I was used to.  I found the bathroom just in the nick of time. 

Next week, I’ll write about designer Depends.  If you are having problems with poop or pee, be sure to review them with your doctor.  Meanwhile, hydrate. 

Here’s some jokes:

At age 4, success means not peeing in your pants

At age 12, success means having friends

At age 17, success means having a driver’s license

At age 25, success means having sex

At age 35, success means having money

At age 45, success means having money

At age 55, success means having sex

At age 65, success means having a driver’s license

At age 75, success means having friends

At age 85, success means not peeing in your pants.

A wife sent a romantic text to her husband. She wrote: “If you are sleeping, send me your dreams. If you are laughing, send me your smile. If you are eating, send me a bite. If you are drinking, send me a sip. If you are crying, send me your tears. I love you.”

Her husband texted back: “I’m on the toilet, please advise.”

👍🏼

Yes, I’ve admitted that I didn’t follow my own advice.  I’ve also admitted that not following my advice was stupid.  I’ve got a little more crow to eat.  It seems that, even though I’ve warned literally thousands of patients against it, I’m playing the “would have, could have, should have game.” 

Males usually play, “It is what it is, move on!”  I’ve said that thousands of times yet, in retrospect, find that it’s a form of denial.  The purpose of my review of the past is to look for situations where I could have improved my life, my family’s life and patient care and then teach others how to avoid/react to those situations.

I’ve often said that of all the personal, carefully thought out and studied decisions I’ve ever made, fifty percent turned out to be right and fifty percent were wrong.  I might as well have been a weatherman!  There must have been a better way.

John Allen Paulos said, “Uncertainty is the only certainty there is, and knowing how to live with insecurity is the only security.”  People expect their doctors to be certain about their diagnoses and treatment options.  Children, while challenging their parents, really expect their parents to be certain about their decisions and keep them secure.

Paulos was right.  In the case of medical care, all diagnoses are provisional and as secure as possible given that doctors are human and science is fallible.  Everyone is asking me for my opinion regarding the Covid vaccines.  My provisional advice is based on existing research.  Current data strongly suggests that vaccines for Covid are as safe as other vaccines as far as immediate risks are concerned.  The provisional portion is that we have no idea what future problems might arise over the next 5-10 years.

I’m getting my vaccine on April 7^th.  I am secure in the belief that, other than an unforeseen allergic reaction, the vaccine will help prevent my chances of reinfection with Covid at extremely little or no risk.  I am fairly secure that there will be no future problems associated with the vaccine.

The takeaway message for patients is that your doctors are human and therefore, imperfect.  Science is constantly evolving, and therefore imperfect as well. Today’s best medical care will be replaced by tomorrow’s discoveries.

 When we emptied out the old office, I came across my rigid sigmoidoscope (a chrome pipe 60 cm long).  My first thought was that I really couldn’t have put that pipe in patients’ rectums!  Then I remembered that, when I started in medicine, the rigid scope was state of the art and I scoped people by putting them on an inversion table, flipping them on their head and ….. So, listen to your doctor, study your options, and then make the best decision you can.  If you are uncertain as to the veracity of your doc’s advice, get a second opinion from a doctor, not the internet, google or your neighbor.

My advice for docs is to never forget Paulos’ statement, “Uncertainty is the only certainty there is, and knowing how to live with insecurity is the only security.”  As long as you temper your certainty with the possibility that you could be wrong, and the security provided by the title of medical doctor with the insecurity of being human, then in retirement you probably won’t need to play the “would have, could have, should have game.” 

Remember the house call I wrote about previously. The whole family was vomiting and had diarrhea.  They had all eaten the same food.  They all appeared to have the same symptoms.  It was a certainty that they all had food poisoning, wasn’t it?  In fact, it was a trap.  Four out of five members of the family had food poisoning.  The fifth member had an acute appendicitis and I made by that diagnosis at my first visit.  My colleagues, upon learning of my diagnosis, wanted to know how I made that diagnosis when the symptoms and clinical findings were essentially the same as the rest of his family.

One of my mentors had taught me about Paulos and the value of his statement, “Uncertainty is the only certainty there is, and knowing how to live with insecurity is the only security,” creating enough insecurity and uncertainty in me to keep me on high alert.

Mentors are invaluable and the wisdom they shared with me has saved a lot of lives!

Here’s your joke:

A woman goes to the doctors with a piece of lettuce sticking out the top of her underwear.

The doctor says “that looks nasty”, the woman replies “that’s just the tip of the iceberg”

One more: What did the cannibal do after he dumped his girlfriend?

Wiped his butt.

First a story.  During a physical exam on a 67-year-old male, I asked him what his plans for retirement were.  He stated that he was going to retire in 6 months and had plenty to do around the house.  I explained that when you have 24 hours a day, seven days a week that whatever needed to be done around the house would be done in 3 months and that he needed to know what to do then.  We kicked around a few ideas and he decided he would go back to school and study history.  He loved history.  Years later, I saw him again.  He had gone back to school, met a young woman, left his wife and married his newfound love.  I learned that interventions, no matter how benign they maybe, have potential consequences.  He was happy; his x-wife was not.

According to feedback from my patients, I gave great advice.  Unfortunately, I rarely followed my own advice.  Part of my yearly physical involved asking my older patients what they planned to do after retirement.  Over the many years I practiced medicine, I had discovered that retirees who had no advanced planning became overweight sloths.  They tended to eat, sleep and watch TV while waiting for something to miraculously fill the long days and nights of retirement.

I found that those who planned their retirement activities in advance did well.  Golfers, tennis players and pickle ball enthusiasts did the best.  Women did better than men.  Even those women who had no plans found something constructive to do.  Women’s superiority over men is a topic for another article.

I truthfully didn’t expect that I would ever retire.  I told my patients that I would die in the office seeing patients and I meant it.  My only real outside interest was cooking.  I talked about working with wood; but, after building my family room furniture with a good friend, I realized that what I needed was missing.  I had no talent for woodwork; and, if I did, my bad back would get in the way.

When I opened the office, I installed double doors at the entrance.  I jestingly told patients that I had double doors as, on the inside, I was a fat man waiting patiently to escape from Dr Segal’s demands that I eat a healthy diet.  Well, the fat man finally won. 

Having no plans to retire or anything to retire to, my actual retirement was exactly as I had described it to my patients.  I became a sloth, eating, sleeping and occasionally pooping (constipation is another topic for future discussion).  If only I had listened to my own advice.

I’ve learned a valuable lesson.  Hippocrates said, “Physician, Heal thyself.”  That statement should be part of the Hippocratic Oath.  In order to care for others, you have to care for yourself.  There should be a firm rule.  What you tell your patients to do should be what you do!

So, what am I going to do with my free time?  One of my patients/friends suggested that I volunteer at the local dog rescue playing with dogs that need a kind human touch.  What a great idea!  I’m working on it but currently am hampered by Covid precautions.  I’m writing a book even though it may never be published.  I’m going to the gym and think I’m going to like boxing.  I’m chasing Renee around the house. We have a catch and release policy.  (If only I could remember what to do when I catch her).

I’m working at staying oriented.  When every day is the same as the one before and the one after, getting disoriented is easy!  I did not really understand the disorientation of retirement when I was well and practicing medicine.  I probably diagnosed a memory loss in too many patients and sent a lot of patients for neuropsych testing (documents cognitive disorders).  I’m going for neuropsych testing next week in preparation for deep brain stimulation.

I’m really nervous!  I don’t want to know what I’m missing/losing.  Am I in denial? Maybe!  I’m about to find out.  What I’ve learned is that a simple 4 hour memory test, that I routinely ordered, can be extremely anxiety producing.  Not recognizing the effects of ordering neuropsych testing meant I couldn’t prepare my patients for the anxiety that I’m currently experiencing.   

Being chronically ill is, indeed, an education.  The question remains, how to teach the lessons I’m learning to a healthy medical student or resident.

Here’s your joke for the day:

A man and a woman had a quarrel:

Woman: If I had known that my life would become like this, I should have just married the devil himself.

Man: But getting married with your relatives is a taboo, isn’t it?