Author: wellthy

A friend asked me what I thought was the best treatment for prostate cancer.  He had researched all of the available options on the internet and was confused.  I told him that, several years ago, I went through a prostate cancer scare.  I, too, was confused!

The treatment for prostate cancer varies depending on the type of prostate cancer present, the physicians treating you, and your own personal needs and wishes.  For many men, the fear of the potential aftermath of treating prostate cancer is greater than the fear of the cancer itself.  The options available at the time I retired ranged from a “watchful waiting” approach to radical prostatectomy and hormonal therapy.  Options also included laparoscopic surgery and radiation treatment.

I used to give my patients four referrals: one to a University of Chicago professor who was famous for open, radical prostatectomy; one for a local urologist who had done more laparoscopic surgeries than anyone else in the area; one to meet a radiation oncologist; and lastly, one to a prostate cancer support group.  Armed with firsthand knowledge of their options, most patients were able to find a treatment option that satisfied their need.

While most patients were able to decide on an approach to treating their cancer, almost all remained highly anxious about the possible aftermath.  Tell a man that you are going to cut out his prostate and he’ll schedule the surgery.  Tell him that he may not be able to get an erection or that he may be incontinent and he will leave your office as fast as he can and put off whichever treatment he had decided on.

The reality is that most men do well with whichever approach they take. Post treatment physical therapy and the Viagra class meds have been very successful in treating the aftermath.

So, how did I help the patient who couldn’t make a decision?  I asked him which specialist did he like/trust the best.  Once he identified the physician he felt safest with, then the decision became a slam dunk.  Simply follow your physician’s advice and let him/her care for you with the approach he/she gets

the best outcome from.

Here’s your joke for the day and a song.

When I was a teen, my dad showed me a 30 minute PowerPoint presentation on why one should always wear a condom during sex.

All the slides were just pictures of me.

I know I’ve mentioned how much I miss living in Long Grove; but, after looking at the weather report, I’ve changed my mind.  It’s 3 degrees in Chicago and 39 degrees here.  There is snow on the ground in Chicago.  There is grass on the ground here.  On a day like today, I’m glad I moved.

Realistically, it matters not where I live as Covid 19 has limited my excursions.  Indoors in Indian Trail, NC is the same as indoors in Long Grove.  Yes, I miss my former neighbors, my favorite restaurants and stores; but, in my new abode, I have new neighbors to get to know.  My Covid-19 weight gain of 40 pounds turns the loss of my favorite grocers and restaurants into a blessing.

I’m working hard on finding the positives in life, pushing the negatives away.  Three nights ago, one of my dearest friends, Susan, was texting with me.  Susan is like a sister, having grown up with me in Norfolk.  My earliest memories include Susan.  Anyway, I was in a dark mood having had a very bad day (trouble walking) when Susan asked me if I was suicidal.  Truthfully, I was not!  Her question shocked me and made me assess the effect my foul mood has on others.

Everyone I know is dealing with depression.  Many will not admit it, most try to hide it.  Hiding depression and negative thoughts is the worst thing you can do.  That’s why I write.  Sharing depression with others can be almost as bad.  That’s why I’m writing this article.  Writing is my therapy.  I have to be very careful that my therapy doesn’t negatively impact you, the reader.  If it does, please drop me a note or call.

By the way, it has been my experience that patients, intent on committing suicide, will not admit to it.  Pay attention to your “gut”.  If your “gut” is telling you that a friend or family member is at risk of committing suicide even though they deny it, be vigilant, caring and do whatever you can to protect and support them.  At the same time, recognize that, no matter what you do, you can not stop them from killing themselves if they are determined to do so.

Here’s your song and joke of the day.

What’s the difference between a G-spot and a golf ball?

A man will actually search for a golf ball.

What is 6 inches long 2 inches wide and makes everyone go crazy?

$100 bill.

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

It’s not hard.

Apparently, I was pretty bright at one time.  Last night, I was talking to one of my former patients when she reminded me of some of the advice I had given her over the last 36 years.  At the top of the list of advice that had served her well over the years was my offering to teach her enough about her body so that she would be comfortable knowing whether she should be seen by me or not.

It was my belief that a portion of every visit to my office should be an educational event. I believe that the more patients know about themselves, the healthier they would be.  One of my favorite lessons was teaching patients to trust their “gut” feelings.  “Gut” feelings are really based on a person’s inherent knowledge of themselves. 

You’ve lived a lifetime in your body.  Even if you are a typical male and ignore your body, subconsciously you learn how it feels and, if prompted by your doctor or wife, can recognize imbalances and abnormalities.  Over the years, I’ve made multiple brilliant, sometimes life-saving diagnoses, by believing my patients “gut” feelings.  My best was a young lady whose complaint was vague, “something is not right in my head.” She had no physical findings and no real symptoms of disease other than just not feeling normal.

Her “gut” was telling her something bad was happening to her.  I told her I could not find anything wrong but I pay attention to the “gut” so I would get a CT of her brain.  In the early years of my practice, I could actually order a test and have it done without talking to the insurance company. The aneurysm was found in time and surgically repaired.  She is still alive and kicking.

In today’s medical world, in order to get any test done, you must justify it to the insurance company.  “The patient’s gut is telling him/her that something is wrong” just doesn’t cut it. Nonetheless, follow your “gut” and tell your doc what’s going on.  Understand that your doc has limits to what he/she can do without sufficient findings but that, if necessary, you always have the choice of paying cash for non-covered tests.

I know that CTs can be expensive and money is always tight.  Insurance companies never say “no” to a test, they simply say they are not going to pay for it.  When it comes to a bad, leaky roof, most people will find the money necessary for a new roof or repairs even if they have to borrow it.  When it comes to their body, most patients will not do necessary tests or repairs on their bodies if the insurance company refuses to pay.  I’ve got to admit, I’m “most people” some of the time.  I’ll assess what the value of the intervention is, the risk of not doing it and the cost and,  on occasion, skip the intervention and save the money. 

Inbrija is an inhaled levodopa used by patients with Parkinson’s for its rapid onset of action and its ability to quickly relieve symptoms.  Levodopa is a very old medicine (fairly cheap); but because Inbrija is a modern remake of levodopa, its manufacturer charges a fortune for it.  My co-pay is $16,000 a year.  LOL! On average, for $16,000 a year, Imbrija will improve my motor function 15 minutes quicker than the pills I’m currently taking, which cost $240 a year.  I’ll just have to wait for my old medicine to kick in.

Here’s today’s joke.

A cop parks at the bottom of a bridge, waiting for a speeder. He pulls a man over for doing 40 over the speed limit, and says, “Son, I’ve been waiting for you all day.”

The man quickly responds, “Well, I got here as fast as I could!”

Here’s today’s music.

👍🏼

Every once in a while, someone posts a significant article or letter on Facebook that seems to disappear after you’ve read it.  This am I read a letter about aging, the losses one experiences and the time we have left.  The letter was right on the spot and reinforced that, rather than getting bogged down in the losses, we should concentrate on enjoying the time left.  When I find it, I’ll share it with you.

I am trying to let go of the losses and follow the author’s advice.  I’m focusing on making the most out of whatever time I have left.  First and foremost, optimizing the time I have left means shedding 40 pounds.  For those of you who haven’t seen me lately, I’ve become a blimp.  Functioning with worsening Parkinson’s is hard enough.  Dragging an extra 40 pounds of lard around is insane as it adds a significant burden to everything I do.

It’s time to go back to the beginning.  Twenty years ago I created my “Wellthy Plan” and successfully got to my healthy/wellthy, losing 30 pounds and improving every part of my life.  Since moving to NC, I’ve done everything I’ve always told my patients not to do.  It’s no wonder that I’ve failed at every diet and lifestyle change I’ve made.  Time to get “Wellthy” nutritionally, physically, emotionally and spiritually.

I’ve started the process to get cleared for DBS (Deep Brain Stimulation) and hope to have surgery in April.  DBS is fascinating but carries some risk.  Everything carries risk.  I had decided against DBS as I was so lost in dealing with my losses (my wife has become my nurse and caregiver) that I lost sight of the fact that I have a loving wife and family, all reasons to concentrate on improving the future rather than awaiting the end. 

My Covid test is finally negative again.  I survived Covid as did my family and friends.  With the new vaccines, I hope it will become safe to travel again.  I really don’t want to use a seatbelt extender.  Losing 40 pounds will ensure that I’ll fit on the plane in a normal seatbelt.  Again, it’s time to get “Wellthy!”

It’s time to find the author of this morning’s inspirational piece.  I owe him/her a big thanks. I also owe a big thanks to all of my former patients who have prayed for me and supported me through my journey since leaving practice.  I recently wrote about Humpty Dumpty and his great fall.  As you know, all the king’s horses and all the king’s men couldn’t put Humpty back together again.  Like Humpty, I can’t wait for the king’s men, I have to put myself back together again.  I’ll keep at it until I succeed!

Here’s your joke for the day:

A large Humpback whale is lazily enjoying a beautiful day when he sees a female Humpback whale just a little ways off, and he thinks to himself that he’s going to try to impress her…

He swims over to her, and breeches the surface, showing off the large hump on his back.

She looked unimpressed as she breached and showed a larger more well formed hump herself.

Now, a little embarrassed, he tries again to impress her by taking a breath and blowing a huge cloud of mist and water with a really nice rainbow in it.

Once again she looked unimpressed and she blew a larger cloud of mist, with a more beautiful rainbow.

Now clearly agitated, the Male sees a Naval vessel in the distance and races off toward it. Just before he collides with the ship, he dives, jumps out of the water and, as he sails over the bow of the ship, he plucks a sailor off the deck and in one gulp swallows him whole!

He swam back to her very proud of himself, only to find the female object of his attentions with a disgusted look on her face…

As she swam off she said…”I’ll Hump, I’ll Blow, BUT I WON’T SWALLOW SEAMEN!

And here is your music for the day. RIP Mary.

Once upon a time I was a technophile.  I had all the newest gadgets.  I built and programed computers.  I was blessed to have patients who brought me the newest cell phones.  I even had a prototype of a smart phone before most people knew of its existence.  Technology blossomed and I rode the wave.  It was an exciting time.

Two things happened that changed everything.  First, I grew old and content with the technology I had; therefore, I no longer needed to learn new tricks. Second, the company that was feeding me the latest and greatest toys downsized and I lost my access to its future of innovations.

Life became boring.  It became cheaper to buy a new computer than to build one.  My IPhone became so smart that future innovations offered little benefit.  OLED TV’s resolution became so good that I didn’t want to leave the couch (except to raid the fridge).

This morning everything changed.  Sitting on the throne, reviewing my medical journals, I came across the coolest new medical technology I’ve seen in decades.  I WANT ONE NOW! Even though I don’t need one and I’m retired and no longer practice medicine, I want one.

What I discovered is going to change the practice of medicine!  It will replace my stethoscope and much of what I did in the office.  It will increase a physician’s diagnostic capabilities tenfold.  The device I’m referring to is a pocket ultrasound machine that interfaces with the I Phone and delivers pictures of a patient’s organs, joints and vascular system instantaneously.  NO MORE GOING TO THE HOSPITAL FOR TESTS AND THEN WAITING WEEKS TO GET RESULTS.

DID I TELL YOU I WANT ONE! I DO! Sure, I’d have to take some courses to become proficient at reading ultrasounds.  It would be worth it.  I could quickly scan your heart, carotids or even your gallbladder.  It seems the future uses are almost limitless. 

It’s also affordable.  While thinking about what I could have done with a pocket sized ultrasound has pumped me up, the fact that I’ll never use one on a patient is a bit of a downer.  The saving grace is that eventually one of my docs will be using it on me and I’ll get to play with it.

So, no matter how bad the Covid news is, here’s something that promises to radically improve your doc’s diagnostic skills and, therefore, your health.

Here’s your joke for the day:

My doc told me to start killing people.  Well, not exactly in those words. He said I had to reduce the stress in my life.  Same thing!

Here’s your music for the day.

It has been a longtime since I’ve sat down to write anything.  I’ve had a writer’s block compounded by boredom and mild depression.  I’m sure Covid is wreaking havoc on your life, as well.

In all my years in medicine, I’ve never witnessed anything like this.  As soon as things start calming down and the news improves, there is a new twist and we start down the rabbit hole all over again.  If it seems like no one truly knows what’s going on, it’s because no one knows what is going on/right.

Whether Renee and I should be vaccinated is a good example of how screwed up everything is.  Most authorities proclaim that if you have had the experimental antibody titer, you should wait 90 days before being vaccinated.  However, some authorities say one should wait 30 days and others will tell you there is no reason to wait.  Confused?  I am.

Part of the problem is that the new vaccine is unlike any of its predecessors.  There is no/minimal data on the effects of the experimental antibody cocktail or the vaccine, or its long term effects on Renee and me.

Part of the problem is that the Covid virus is mutating at what, to me, appears to be an unusually rapid rate.  It appears to be misbehaving on multiple levels.  The new strains sound horrible and, according to the authorities, it does not appear that a prior infection with Covid gives immunity against subsequent infection by mutant stains.

So, what’s a fellow to do?  First, get vaccinated as soon as possible.  Second, get used to your mask and buy N95 when possible. We are going to be wearing masks for a long time to come. Third, isolate yourself as much as possible.  Fourth, help your elderly relatives by teaching them to use their computers to order food and supplies without going out into the public.  Fifth, forgive your elders if they appear a little nuts.  Personally, I’m going crazy!

Every morning when I get up, I regret leaving my home in Long Grove.  Then I open Facebook and see the Chicago weather report and pictures of snow, and I’m glad to be in NC.  Tuesdays and Thursdays, we baby sit.  The kids put a smile on my face and again, I’m glad to be here.

The 3^rd of March the gardener will be here installing my elevated garden and fig trees.  It’s going to be a handicapped accessible garden as my Parkinson’s continues to worsen. Gardening will be good for my soul.  It will also cut down on the need to go to the grocers. 

I’ve gotten many calls and emails from my readers, encouraging me to resume writing.  I thank each and everyone of you for your concern and encouragement.  Please send topics you’d like me to address.

Here is your joke for today and a little music to help you smile.

Two grandmothers were bragging about their precious darlings. One of them says to the other, “Mine are so good at social distancing, they won’t even call me.”

Do you ever feel lost?  I do! I lost my identity when my health forced me to retire.  The literature warns about retirement causing a loss of identity in physicians but there really was no way to prepare for it as my retirement was unplanned and sudden.

For years, I warned my patients about the losses of retirement and the need to plan for a life of retirement.  I told them they have to retire to a second life structured to keep them active, happy and alive.  It was good advice.  Unfortunately, I did not follow my own teaching.  I thought I would have more time to prepare.

I lost my identity at the same time I lost my health.  I’ve preached “Living Wellthy” for 40 years.  That, too, was good advice.  Unfortunately, my genetic heritage piggy backed on my bad back precluded living a “Wellthy Life.”

Nonetheless, I have tried to stay positive, to concentrate on my blessings list and not my losses.  Again, keeping a “Blessings List” is a great idea.  Again, I’ve got good advice for others but find I can’t manage to heed my own advice.  Covid 19 has really screwed with me, as it has for hundreds of thousands of people.  Yes, I’m blessed that my family and friends have survived its initial attack, but I’m afraid it has cost me one of my most precious of blessings.

In medicine, there is a fascinating occurrence we refer to as a cascade.  Typically, a severe illness causes damage that then progresses and causes further damage, all of which cascades into misery beyond compare and eventually death.  Our society appears to be in a cascade of biblical proportions. Between the political turmoil of the past months and 400,000 deaths from Covid, it’s hard to maintain a good attitude.

I’m in a cascade.  My physical abilities are diminishing rapidly.  I venture to say that my readers wouldn’t recognize me as I’ve gained 40 pounds and move like an old man.  Thank God for Renee.  She now helps dress me and wash me.  There was a time when that would have been fun.  Unfortunately, it’s not. 

I’m seeing a therapist.  I’m trying to focus on my blessings.  Some days are easier than others.  Some days the losses just can’t be ignored.  This is one of those days.

“The whole problem with the world is that fools and fanatics are always so certain of themselves, and wiser people so full of doubts.” – Bertrand Russell

The older I get, the more Mr. Russell’s statement makes sense.  Certainly, Mr. Russell describes the political climate in our country.  My patients have been sending me articles and videos substantiating their beliefs as Trumpers or Anti-Trumpers.  Turn on the TV and flip between so called “news” programs and you’ll get different interpretations of the same facts.  Of course, CNN will tell you that FOX journalists are fools and fanatics and FOX will tell you the opposite.

Finding the truth is no easy feat.  I’m a doctor, not a politician or political commentator so I’ve stayed out of the fray.  I guess I am Mr. Russell’s wiser person because I’m full of doubts.  So, what does this have to do with yesterday’s article and the art of practicing medicine.

A wise doctor always maintains some level of doubt no matter how certain the medical experts are regarding any issue.  At this time, organized medicine will tell you there is no place for hydroxychloroquine in the treatment of Covid.  One of my docs is a big fan of hydroxychloroquine.  He has treated multiple patients with hydroxychloroquine with good results and has not seen any side effects or adverse effects from its use.  My other doc, the one I see in North Carolina, quotes the authorities and refuses to prescribe it.  What’s a patient to do?  In this case, I chose my NC doc.  She is on the ground here and will be my treating doc if I get in trouble.  Luckily, Renee and I are recovering nicely.

When your doc is certain, when he/she anchors to a single diagnosis, he/she is probably right.  The problem is that, if your doctor doesn’t maintain some level of doubt, he/she has blinders on and is more likely to miss a less common or evident diagnosis.  I once saw a family of six for food poisoning.  They were miserable.  Their youngest son was the most miserable.  By keeping an open mind, I was able to diagnose his appendicitis.  Five out of six had food poisoning.  What are the odds that the sixth would have an appendicitis?  Pretty low, but possible.

Your job is to ask a simple question: “Doc, what else could it be?”  I’ve written about the “differential diagnosis” in the past; and any time I diagnosed a patient I was always aware of the differential diagnosis (the other less likely causes).  Not having a differential diagnosis would be incredibly rare.  By asking “what else could it be,” you’ll force your doc to think outside of the box.

Here’s your joke today:  Whenever I start doubting my ability to finish all the icing…

… I remember it comes in a CAN, not a CAN’T.

My brother said something brilliant yesterday and I want to share it with you. “Nothing is so uncertain as a sure thing.” Think about it for a minute. How many times have you been sure about something, only to be proven wrong, later?

This morning I realized that my training and practice of medicine was, in many aspects, tied to this statement.  As a physician, being sure of yourself can be a dangerous thing.  Being sure that your patient has a stomach virus causes you to miss the underlying appendicitis.  Being sure the resident’s assessment is accurate causes you to miss the one thing the patient forgot to tell the resident:  that thing being the piece of information necessary to make the proper diagnosis.

When I used to make rounds at the local hospital, patients would complain that everyone asked them the same questions over and over again.  “Doc, don’t you read the chart?  The cardiologist just asked me those questions.” One of the worst mistakes I made was during my second year of residency.  The patient came to the floor at 3 a.m.  I had been on shift for 32 hours and after examining the patient, I copied the cardiologist’s interpretation of the EKG into my note and moved on to my next patient.  I knew the cardiologist was one of the best and he had seen the patient in the ER; so copying his findings was no big deal, right?  Wrong!  Had I read the EKG myself, I would have found his error. ”Nothing is so unsure as a sure thing.”

Fortunately, the patient did fine and the erroneous reading of the EKG had no effect on her outcome. It did have a tremendous effect on my outcome.  It taught me the importance of doing my own history and evaluation no matter how many other physicians had evaluated the patient before me.

The moral of the story is simple.  When you are sick and seeing multiple healthcare providers, don’t complain if they ask you the same questions over and over again.  Complain if they don’t.  And remember, no matter how certain your doc is, he/she may be wrong.  There are no sure things in practice of medicine!

By the way, you can help your docs be more efficient by keeping a detailed personal history and medication list up to date and bringing it with you at each visit.

Tomorrow, I’ll address: “The whole problem with the world is that fools and fanatics are always so certain of themselves, and wiser people so full of doubts.” – Bertrand Russell

Here’s your joke for the day:  The owner of a sex shop hires a new clerk.

After the owner taught him the basics of running the store, he has to run an errand.

‘Could you run the store on your own for a couple of hours, Jeremy?’ he asks.

‘Sure thing, boss!’ Jeremy replied, ‘don’t you worry, I’ve got this.’

So the boss leaves for his errands, leaving young Jeremy in charge of the store.

Some time later, a woman walks in. She’s in search of a mechanized equivalent of the male boomstick of glory. Jeremy shows her the so-called model ‘Hercules’; huge, veiny and with a firm grip. The woman is very intrigued and leaves the store thrilled to bits.

Several other women pass by as well and Jeremy proves himself to be a keen salesman of battery-powered penises. All women leave the store satisfied with their purchase.

Then an elderly lady walks in the store in search of some private pleasure. Jeremy shows her the top of the stock, but the lady seems dearly unimpressed. Then, a spectacular model catches her eye. ‘What about that red one?’ she asks. ‘Oh, I see, my lady is a connoisseur!’ Jeremy replies. He shows her the model and with a light step and a big grin, the lady leaves the store.

Later that afternoon, the boss returns and asks how business has been.

Beaming with pride, Jeremy replies: ‘It was great! I sold quite a lot!’

‘Oh really?’ the boss asks, impressed, ‘what models did you sell?’

‘Well sir, 1 model Hercules, 1 model King Kong, 2 LongSchlong21’s and the fire-extinguiser.’

My brother introduced me to a new word yesterday, “Optirectimitis.”  Simply put, optirectimitis is a connection between your eyes and your butt and accounts for a shitty outlook.  Right off the bat, I fell in love with the word.

I’ve been fighting my shitty outlook and having survived Covid should be winning.  I’m not!  One of the benefits of my Covid infection was the effect of the steroids my doctors put me on.  For 1 week, my back felt great, my legs fatigued less, my joints moved with relative ease, my trigger finger stopped triggering and my energy level increased considerably.    

Unfortunately, I cannot take steroids long term.  Long term steroids are fraught with problems including diabetes, osteoporosis, and hypertension amongst others.  This is one of those times when life is just not fair.  Steroids giveth and taketh away.  Coming off steroids has given me optirectimitis, causing my newly minted shitty attitude.

So, what’s a guy supposed to do?  Medical marijuana seems to help both the pain of arthritis, symptoms of Parkinson’s and shitty attitudes but is illegal in North Carolina. It also seems to adversely affect memory.  Again, marijuana giveth and taketh away.

Non-steroidal anti-inflammatories, like Aleve, help some but give me indigestion.  Exercise helps some but it is hard to get motivated to exercise due to pain.  Narcotic pain medications are completely out of the question. While they are addictive, living with chronic pain and disability is no way to live.  So, being addicted to pain relieving meds can’t be all bad, can it?  In the eyes of the law, it is bad.  Over the last few years, there has been a war on narcotics and most physicians I know are hesitant to prescribe them. Regardless, narcotics don’t agree with me, worsening my constipation and fuzzing my brain.

As you can see, there is no good solution.  So I’ll count my blessings and concentrate on what doesn’t hurt (my right big toe), watch a comedian or two and eat some junk.

Here’s your joke for the day:

A wife sent her husband a romantic text message… 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.”