Author: wellthy

Are you a glass half empty person or are you a glass half full person?  Does it really make a difference?  Personally, I see a half a glass of a blended drink.  In my glass, I’ve got the sweetness of my family and friends blended with the bitterness of Parkinson’s and the aging process.

Most people look at life from a more simplistic viewpoint: half empty or half full.  As I drink from my half glass, each gulp provokes a different reaction.  Right now, the drink is bitter.  I’m in one of my off stages, having trouble walking and feeling punk.  I’m sick of this drink but have no choice other than dealing with it.

This am, the crap had settled to the bottom of the glass and the sweet nectar of life was on the top. Renee and I went further and faster on our bike ride.  It felt good.  We went on a healthy walk through the local mall/ghost town and my glasses got fixed.  I even made it back to the car without difficulty.  I was almost normal.  How sweet it is!

Renee and I picked up lunch from a new barbeque restaurant and dined together in our new home.  Unfortunately, something always shakes up the content of the glass and today’s most sour concoction bubbled to the surface.  We had to deal with the damage the movers caused.  If you research movers on the internet, you’ll find horror stories.  Our move does not rise to the level of a horror flick but we lost a refrigerator and one of our favorite pieces of art was damaged.  The mover refuses to take responsibility despite the fact that we bought insurance to cover the move.

Drinking down the mover’s lies left a shitty taste in my mouth.

Before my nap, I called an old friend and enjoyed a lengthy conversation with her.  It was like rinsing out my mouth with strawberry juice. I wish I could fill my glass with people like her but I can’t; I have to share her with others. She lives many miles away.

During my nap, my half a glass, which had emptied a bit since this morning, had filled back up.  I’ve got to find a new Doc and that’s not easy.  My profession has gone to the dogs.  Every doc around here works for a corporation and I really want a private doc who will work for me.  While I was looking for a new doc, a very bitter, bilious fluid flowed into my glass.  I came across an article about Walgreens opening 500 doctors’ offices in their pharmacies. My dislike of Walgreens is well known and this new incestuous relationship between Walgreens and VillageMD makes me want to puke.  The Walgreens of the future will sell you the cigarettes that destroy your lungs in the front of the store, send you to the back to see the doctor whose job is to try to save your lungs by ordering medications which his partner then sells you.  Keeping you alive so you can buy more cigarettes is of paramount importance as is selling you the most profitable prescriptions possible.  But enough of my rant.

No matter what I do, I always seem to have a half glass of a mixture of life’s best and worst nectars.  As I’m wrapping this article up, I get a text message scheduling a showing to sell my house.  My beautiful house that raised my 3 children and many more kids over the years sits empty waiting for a new family to add to its heritage.  My house is full of good memories and sweetness, having been the summer watering hole for many in the neighborhood, no longer is wanted despite all the potential that it still has.

Ultimately, I have to drink down the bitter solution of a lousy real estate market and sell it far below its real value.  So, is my glass half empty or half full?  It’s a quarter full of life’s sweetness and a quarter full of life’s crap and my mood depends on what nectar is sitting on the top at the time I take a drink.  Regardless of how I look at it, I must keep drinking or die, so I’ll drink down whatever I have to in order to live.

My birthday is Sunday.  It seems that the in thing to do this year is to ask your friends to donate to a charity.  Please, assume you are the charity I want you to invest in and buy yourself a present.  Have a good time with your present and think of me while you’re enjoying it.

Here’s your music and jokes for the day.

An old man was wondering if his wife had a hearing problem. So one night, he stood behind her while she was sitting in her lounge chair.

He spoke softly to her, “Honey, can you hear me?” There was no response.

He moved a little closer and said again, “Honey, can you hear me?” Still, there was no response.

Finally he moved right behind her and said, “Honey, can you hear me?”

She replied, “For the third time, Yes!”

I have Parkinson’s.  Everyone knows it.  They can see the steady deterioration in my ability to walk and function. It’s a shitty disease, slowly robbing me of my independence.  Last week’s bad days are this week’s good days.

What I want to know is whose fault is it?  Shit just doesn’t happen in this world.  Someone always has to take the blame!  So, who did this to me? Is it my father’s fault?  Afterall, it’s his gene I inherited.  Should he have carried the guilt of bringing me into this world of Parkinsonism?  No, maybe my grandfather is to blame.  He died from Parkinson’s also.

As late as the early 80s, docs didn’t think you could inherit Parkinson’s.  A world renowned Parkinson’s specialist at Rush reassured me that, since it was not a genetically transmitted disease, I could stop worrying

about it.  So, if my father and his father had no idea they would pass on this  lousy gene that would eventually destroy me, how can they carry any guilt or blame? THEY CAN’T!

If it’s not my ancestors’ fault, who else could have cursed me?  IS IT MY FAULT?  Obviously, I didn’t choose to be part of my parent’s gene pool. If I could have, I would have chosen the same parents.  Sure, they had their flaws, but they gave me a pretty great life. 

Should I have been in the gym everyday of my adult life? Certainly, exercise helps slow the degradation caused by Parkinson’s.  Should I have followed a different diet?  No, definitely not!  Besides, I’ve been on multiple diets, none of which helps.

That only leaves God to blame. Being a tad bit egocentric as are most docs, I blamed God.  Afterall, I must have been worthy of some personal attention for God to decide that I should be stricken with this disease.  I decided that God was rounding out my education as a MD.  That idea didn’t hold water as the disease removed me from direct patient care.

This must be another reason God chose me to carry this gene.  The only thing that makes sense is I that I’m supposed to write this article.  I’m supposed to tell those people who carry the guilt of having a bad gene that SHIT HAPPENS BEYOND YOUR CONTROL. CARRYING SENSELESS GUILT ONLY HURTS YOU AND THOSE WHO LOVE YOU.  YOU DIDN’T KNOW.

At the time I had my kids, I didn’t know, but I was suspicious.  I pray that one day they don’t start asking the question, “whose fault is it?”

By the way, it’s not God’s fault, either.  

Here’s your music for today.  Here’s the 20 things Parkinson’s patient excel at.

Yep, my brain is rotting and most days, I’m bored.  Monday and Tuesday are my best days. Today started at 6:30. Renee and I went for a ride on our new bike. Going downhill was great.  The wind blowing in my face was a new sensation that reminded me of how old I’ve gotten.  I forgot about the joys of riding a bike and gliding effortlessly downhill.

The problem is that, in order to go downhill, you have to first peddle uphill.  My legs started burning almost immediately.  In other words, I’m weak and in shit shape.  With the exception of the time I spent in rehab, it’s been years since I’ve exercised.  Basically, I HATE EXERCISE. I should point out that I live with chronic pain and exercise simply increases it.

Is exercise worth the pain it causes? ABSOLUTELY! So, while my track record is not good, I’m convinced that this time, I’ll stick with it.  First of all, I now have an exercise partner.  Renee is committed and will bike with me daily.  Second is the fact that working to go uphill is rewarded by the thrill of speeding downhill.

It’s going to take weeks to months to build endurance and rehab my leg muscles.  Obviously, I blew it.  Following rehab, I should have exercised regularly and I didn’t.  In the past, I’ve written multiple articles on the “should have, could have, would have” trap that people get stuck in.  I won’t.

Instead, I’ll start from scratch, work through the pain and build my endurance a little at a time.  That still leaves the problem of being bored.  I’ve got 6:30 to 6:45 am covered but what about the rest of the day.  Today was Mackenzie day so the morning was spent playing with Barbie, arts and crafts and blowing bubbles.  While she napped, I went grocery shopping and cleaned the kitchen.  

Mackenzie just left.  Now what? I’ll spend an hour on this article, prepare dinner and then watch bad TV.  Tomorrow is a Hudson day.  At 4 months old, Hudson sleeps, eats and cries.  So, I’ll ride the bike with Renee, write an article and go slowly crazy.

Did I tell you I hate retirement!? Today, I started reading help wanted ads on Indeed.com.  I’ve found the perfect job.  A sex magazine is looking for a writer with a research background (in sex ed, sex meds, sex research).  I have to update my resume and wonder if I can use Renee as a recommendation as she is best acquainted with my expertise in the bedroom.  Unfortunately, I don’t know if her recommendation will suffice but I’m willing to put in some extra time in the sack polishing my credentials. Personally, I think I’m an expert on the topic of sex.  My expert opinion is that frequent sex alleviates boredom.  Now that’s an excellent idea for a research project.  I suspect that I’ll have no problem signing up males but finding female subjects is likely to be impossible. 

Now that I think about it, if I count sex as exercise, I don’t hate all exercise. Renee let’s workout some more!  No, not on the bike, that’s our morning routine.  I’m working on an evening routine.  What? No, I’m not crazy but I am I’m recruiting subjects for a new experiment.  Want to sign up?

Seriously, what I’m looking for is ideas.  Since retirement, how do you fill your days?  I look forward to hearing from you. In the meantime, I think I’ll take a nap, then work on my resume.

Here’s your music and a joke.  

After a long night of making love, the guy notices a photo of another man, on the woman’s nightstand by the bed…

He begins to worry.

“Is this your husband?” he nervously asks.

“No, silly,” she replies, snuggling up to him.

“Your boyfriend, then?” he continues.

“No, not at all,” she says, nibbling away at his ear.

“Is it your dad or your brother?” he inquires, hoping to be reassured.

“No, no, no! You are so hot when you’re jealous!” she answers.

“Well, who in the hell is he, then?” he demands.

She whispers in his ear, “That’s me before the surgery.”

I used to work for Pharma.  As a matter of fact, I was in love with Pharma.  Research on new medications was exciting.  Jack and I participated in close to 30 clinical trials, went to national investigator conferences and met some of the greatest minds in the country.  For many years, being a research site meant staying on the leading edge of medicine.

Then the government upped its game.  Research on patients always meant lots of paperwork and government supervision.  Often, patients had to sign a 50 page legal document prior to starting a study; and then, every 6-12 months, there would be revisions that needed new signatures.  Six to twelve-month revisions started coming every 4-6 months then every 3 months and became longer and more confusing. Eventually my patients and I refused future projects, putting an end to one of the most exciting aspects of practicing medicine.

As a clinical investigator, I often taught physicians and pharmacists about new classes of medications and new treatment protocols.  I loved teaching more than I loved research and I continued to teach for years after giving up on research.  Once again, the government stepped up its game and mandated the content of what I was allowed to teach.  No longer could I interact with my students, sharing my ideas and answering their questions based on my experience. 

Typically, I would be given a slide kit and told to read it verbatim.  The government’s goal was to eliminate bias so I would divide my stage into two sections with red tape and, on one side of the tape I would be Dr Segal representing Pharma and following government rules, and on the other side I’d be Doc Segal, discussing my opinions and experience.  It was actually a great approach; NOT (according to the government)!

Government rules were not taken lightly. Sometimes, the government placed monitors in the classroom.  After my last lecture the monitor approached/attacked me:

Monitor – You failed to read the slides to the docs in the room.  You offered your experience in answering questions instead of referring questions to the company science officer as required by government guidelines.  I’m going to write you up and there may be consequences.

Me- My audience are all senior level physicians.  They know how to read slides and interpret data.  I’m not going to insult them by reading to them.  I’m here to teach, not as a stooge, representing Pharma or the government. 

Monitor – You can’t do that!

Me – I thought FU but instead, quit!  

I miss teaching but, as it turns out, I got out just in time.  The press depicts docs who teach on behalf of Pharma as whores and charlatans. Pharma is no longer your friend or mine.  Pharma is big business and is out of control.  Part of the problem is the expense of dealing with the ever-increasing complexities of government oversight.   Part of the problem is the involvement of third-party pharmacy benefit managers.  I believe part of the problem is also greed.

Being a chronically ill, retired patient on multiple medications has taught me how ungodly expensive medications can be.  I’m on ancient medications that still cost a fortune.  I don’t know what the ultimate solution is, but I know one thing you should always do: use GoodRxbefore you pick your medications up from the pharmacy.

There are several discount/coupon pharmacies online. GoodRX is my favorite.  In Illinois, my Mariano’s pharmacist automatically compared the GoodRx price to the insurance covered price and to the Kroger price.  He always saved me money.  In NC, the pharmacist simply charged me what the insurer said I owed.  When I pointed out that GoodRx was cheaper, he made an adjustment and I saved myself a little money.

While I have no solution to Pharma and our ineffective governmental regulations, at least I have a partial solution to the cost of medication.

The TV is playing in the background as I write this.  Renee is getting her morning dose of news. In the last 45 minutes, I’ve heard 5 commercials for medications.  I’ve cringed five times.  Why not prohibit Pharma’s TV advertisements and reallocate the money saved in order to lessen the cost of their medications?

I hate PHARMA’s commercials. That’s a topic for another day.  

Here’s your music video for the day.

Here’s your joke:

A Pollak was suffering from constipation, so his doctor
prescribed suppositories. A week later the Pole complained to the doctor that they didn’t produce the desired results. 
“Have you been taking them regularly?” the doctor asked. 
“What do you think I’ve been doing,” the Pole said, “Shoving them up my ass?”

Yesterday’s article was written for a dear friend who has a major prick as a neighbor.  I had decided not to publish it after Renee, my wife and editor, told me she thought it was good, but not up to my usual standards.  I thought about what to do with it and realized that what I was really trying to accomplish was teach my friend how to negate her neighbor’s venomous attacks by visualizing him as a sad, deficient, comical a-whole.

In deciding what to do with the article, I realized that many of us either had been plagued by a major prick in our lives or currently were dealing with one.  That thought made me LOL as I thought about Leighton, a major prick I dealt with for 3 years, and visualized him with SDS(I think he had it!).  I wish someone had taught me how visualization could be a powerful, positive force in my life.  That thought reminded me that visualization could not only be a positive force for good, but a negative force as well.

Time for a true story.  Joe was a sixtyish man with a resolving pneumonia. He had been hospitalized for 3 days and, when I saw him in the evening of the 3^rd day, was doing well enough to go home in the morning.  I told him that, if all was well in the am, his wife could pick him up around eleven.  

At 8 am, I received a call from Joe’s nurse telling me that Joe was dying, his vital signs were crashing, and she wanted to move him to the ICU.  I told the nurse that I had seen him the night before, that everything was fine and that I intended to send him home today.  She reassured me that she had the right patient and Joe was transferred to the ICU.

I quickly left the office and was at bedside 20 minutes later.  I reviewed his medical records, history, exam, lab and x-ray all of which were perfectly normal.  Even though Joe had no reason to die, he was actively dying.

Me- “Joe, you are dying, and I can’t find a single problem or reason for what’s going on.  I’m calling in an Intensivist for a second opinion.”

Joe – “Last night you told me I was dying from a cancer and that there was no hope.”

Me- “You’re confused.  I told you everything looked good and you would probably go home in the am.”

Nurse- “In morning report they told me you would be going home today.  I was shocked to see you crashing!”

Joe – “I’m sure you told me I was dying.  I slept poorly all night, thinking about dying.”

Me- “Joe, you must have had a bad dream.  Either you can believe your dream and you’ll be dead this afternoon or you can get out of bed, eat breakfast, walk around and go home in the am!” 

Joe got up and went home the next day.  In Joe’s case, he saw himself dying; and, in response to that visualization, he almost died.  (I know it sounds unbelievable; but, in 40 years of practice, I had a lot of unbelievable things happen to my patients.)

So, practice using visualization as a tool for good.  The next time you hear a journalist preaching doom and gloom on the evening news, visualize a different outcome.  Visualize yourself as living a healthy and happy life.  The next time a prick crosses your path, visualize a poor a-whole with SDS, laugh and walk away.

The one thing you have to promise not to do is visualize a scenario like Joe did, and let your mind kill you.

Here’s your music for today.  Renee and I bought a bicycle built for two yesterday and start our exercise regiment today.  Here’s your joke:

A tandem rider is stopped by a police car.

“What’ve I done, officer?” asks the rider.

“Perhaps you didn’t notice, sir, but your wife fell off your bike half a mile back . . .”

“Oh, thank God for that,” says the rider – “I thought I’d gone deaf!”

Do you know a big prick?  Does he hassle you? Insult you? Harass you?  Does he make you feel bad?  DOES HE MAKE YOU ANGRY?  While I know it’s hard, I want you to forgive him.  He may have a “Small Penis Syndrome” and his nasty behavior may be overcompensating for having been born just a little, or a lot, short down there.  Yes, it’s a real disorder and the hyperlink will take you to an article on SPS.

If you know someone who fits this description, try giving him the following letter.  Of course, you may be poking at a hornet’s nest.  Rather than getting stung or riling up a real psycho, perhaps it’s best just to read this article and laugh a little, lightening your mood.  The next time the schmuck attacks you, understand his affliction and laugh to yourself as you turn and walk away.

CONGRATULATIONS!

You have been nominated to the Little Dick Society of Northern Illinois (LDSNI) by many of your neighbors.  In nominating you for this not so prestigious award, your neighbors unanimously agree that you are a big prick.  One neighbor actually honored you with the title of “Major Schmuck.”

In reviewing your credentials and behavior, the board of directors unanimously agreed to offer you immediate induction into LDSNI.  You should feel truly honored as only the biggest pricks get offered immediate membership in LDSNI.

We, the members of LDSNI, truly realize how difficult it is to live with a tiny dick, assuming it is a penis and not just a very large clitoris.  It is our goal to help all persons born with tiny penises deal with their affliction on an emotional level.  It is not unusual for men, if that truly is what you are, who have tiny dicks, to ridicule others who have scars or afflictions.  By doing so, the little prick elevates his own internal status to that of a big prick and feels better.

In other words, by calling someone ugly, the little prick feels less deformed and therefore takes solace by becoming a really big prick in comparison to the person he is verbally abusing.  Many of our members were first inducted into LDSNI for this very reason.

As President, I want to assure you that having a micropenis is nothing to be ashamed of and, with years of psychologic counseling (or surgery), you can be normal.  I, myself, have not been a prick in 10 hours, which is a record for me.  While your neighbors are aware of your affliction, they really wouldn’t care if you would just stop being nasty to others and get comfortable with the idea that, in being recognized for this award, you no longer need to be a schmuck, ridiculing others.  Rather than yelling “you are ugly,” you can proudly say, “I’m recognized nationally as a major prick.”  Take pride in who you are rather than belittling others.

If I can be of further assistance, feel free to call me at SUC-KMY-DICK.  Of course, we will notify your local news media, informing them of your affliction and your new status as a member of LDSNI.

The President

Little Dick Society

Washington, D.C.

I feel I must reiterate that I do not recommend sharing this article with the prick who is currently bothering you as poking at him could bring out the worst in him.   This article is simply a tool that you can use in answering the question, “Why won’t he leave me alone?”  My hope is that by envisioning his tiny dick, you will be able to ignore whatever is spewing from his mouth and walk away laughing.

Here’s your music for the day.  Here’s your joke.

I was with my blind friend, and he’s telling me “Yeah I can read braille”. So I hand him a Lego brick and ask him to read it. Apparently, Lego has been hiding a dark secret from us for years; as all their bricks read “Screw you, asshole”

I don’t know about you; but, if I was worth $18,000,000 I wouldn’t be whoring on national TV selling garbage to the elderly.  Yep, I’m sick of hearing, “Hi, Joe Namath here.”  Joe, yarding on his fame playing football, goes on to tell you that Medicare has authorized new “free” benefits including phone medicine, home meals, hearing aids and a host of other goodies.  

Ever hear someone say, ” It’s too good to be true?”  First of all, Medicare Advantage is not free.  Even if it was free, I would advise you not to switch to an Advantage policy.  A little story should help clarify why. As a physician, I hate this product (and believe that it is a scam).

In my last years as a physician, I worked for a hospital-owned organization.  As a private practitioner, I refused to participate in Medicare Advantage.  As an employed physician, I participated in whichever policy my employer 

contracted with.  

My first patient with a Medicare Advantage policy was a wreck.  Of interest, she worked in the insurance industry for years.  I was shocked that anyone who worked with insurance companies would have an Advantage policy. As it turned out, my patient needed multiple referrals to specialists for multiple serious medical issues.  Since she was told that everything was covered and free on her new policy, she waited until she reached Medicare age to take care of her medical issues.

Her first big shocker came when I explained that I would write the referrals but that each referral had to be approved by her insurance company and getting approvals was by no means a slam dunk.  On her first visit, I wrote six referrals, two of which were urgent as her delaying being seen was taking a toll on her.

Her second shock came three weeks later when I still hadn’t received approval for five of her referrals and a denial on one.  After fighting with her insurer, I finally got approval for the previous denial but the physician she was authorized to see was 25 miles away.  Needless to say, my patient was unhappy.  Unfortunately, she took it out on my staff and I! 

To make a long, complicated story shorter, I’ll cut to the end.  It took 6 months of paperwork, phone calls and being blamed for my patient’s insurer’s rules to get my patient set up to see the specialist she needed to see.  What a pity!  I don’t know how much her Advantage policy cost her but I do know what it would have cost me had I been a private practice physician (a lot of money and frustration).

Let’s assume that everything Joe says is true.  Let’s even assume it’s free.  Is it worth it?  A six-month delay in care can be critical. Seeing a specialist your insurance company sends you to rather than seeing a specialist that your physician refers to may further compromise you.

So, when good old Joe, a retired quarterback, uses his fame to endorse a product that’s “free” or when Tom Selleck ($45,000,000 net worth) sells you on a reverse mortgage, ask, yourself one question; are they being paid to make a pitch?  Then, listen to what they say.  If you listen closely, what they tell you usually doesn’t make sense.

Tom (he’s so warm and caring in the commercial I feel I know him) states, “This isn’t my first rodeo.”  My first question is what the hell does that have to do with a reverse mortgage?   My second question is does Tom have a reverse mortgage?  

When answering those questions, it dawned on me that, since I’ve never been in a rodeo, I must not need or qualify for a reverse mortgage. Backing up my decision not to get a reverse mortgage, is the fact that I’m not worth $85,000,000 so I won’t worry about getting a reverse mortgage until I am a multimillionaire.  Then maybe I’ll understand how a reverse mortgage is a good deal (there are a lot of horror stories on the internet about reverse mortgages).

OK, my rant is over. I feel better. Oh crap, Joe’s on again.  Renee, turn that crap off. Do you want to play rodeo?  I’ll be the cowboy and you’ll be the wild filly.

Here’s your song and joke for the day.

The Jew boasts about his fertility

“I have 4 sons; one more and I’ll have a basketball team!”

“That’s nothing,” says the Catholic, “I have 10 sons! I almost have a football team!”

The Jew and Catholic looked expectantly at the Mormon. “Well?”

“I have 17 wives. I almost have a golf course!”

I usually agree with Zdogg and enjoy his videos.  On July 4^th, Zdogg posted “Should We Try To Save Everyone.”  In his podcast, he refers to a “Culture of Safetyism” and the consequences of such a culture.  At the beginning of his podcast, he freely admits that the topic is controversial.  He clearly states the obvious: people are going to die!

He goes on to discuss the risks associated with shutting down society and ends by reiterating the need for face masks, social distancing and hand washing.  In my opinion, the gist of this podcast is to do what you can, within reason, and people are going to die.  He uses an iceberg analogy (what you see is the tip of the iceberg, what you can’t see is the bulk of the iceberg which is hidden under water) to illustrate the risk of shutting down the US economy again.

What I disagree with is the general premise that ‘PEOPLE ARE GOING TO DIE.”  I would have worded this differently. I would say, OTHER PEOPLE ARE GOING TO DIE BUT NOT MY FAMILY OR ME.  

I agree, we should not shut down our society again.  It didn’t work the first time and it won’t work this time.  However, just because the US stays open doesn’t mean I have to.  I’m shutting down the Segal Household.  I’m not worried about the risk of alcohol abuse, spousal abuse or child abuse (although I occasionally drive Renee crazy) that Zdogg talks about.  I’m worried about dying alone in an ICU in Carolina.

I think you should be, too.  If you can afford to shelter in place at home, do so!  If you can’t, do whatever you have to do, as cautiously as you can.  Just don’t pretend that this isn’t real.  Don’t pretend that statistically it won’t hurt you or your family.  Don’t pretend that because you are young, you are safe.  YOU MAYBE YOUNG BUT YOUR PARENTS AREN’T.

As to what I think about a culture of safetyism, I’m still trying to figure out what it is!  If it’s founded on the premise of better safe than sorry, I’m onboard.  Are you?

Did I tell you I occasionally drive Renee crazy?  I’m about to do it again.  Renee, I’m bored.  Can we play a game?  I’ll be the doctor (and that’s my joke for today).

Here’s your music for today.  We need a catchy commercial for Covid-19 protection.

I am!  I read spy novels.  In the books I read, the hero is an ex-special forces soldier who saves the world by tracking down the bad guys and foiling their plot!  

The bad guys often plot to destroy the world with biologic or chemical weapons.  Often, the bad guys’ scientist will have figured out how to aerosolize a virus or bacteria and how to deliver it to its target. The authors of these books use the words aerosolize and weaponize interchangeably. 

Yeah, it’s fiction and the good guys almost always win.  Don’t they?  If you are a sci-fi fan, you know that sci-fi of the past often becomes the reality of the future.  Are we living in the real version of the book I’m reading?  It seems that we are actors in a thriller/horror story in which the bad guy is winning!

This am, NBC is reporting that scientists now believe that Covid-19 is aerosolized, meaning that it’s not just transmitted by large droplets alone, but also by tiny droplets.  CNN is reporting that early studies suggest that infection does not necessarily confer immunity.  ABC is reporting that the numbers of hospitalizations are increasing.  CBS reports that Arizona is out of hospital beds.

Scare?  Hell, yeah!  I’ve never seen anything like this before and I spent 40 years treating viruses.  Have we been attacked?  Most definitely!  This virus continues to attack us and it’s winning.  We need to fight back, and the first step is taking this seriously.

In a previous article, I discussed the chances of a lightning strike killing you and raised the question, “Would you stand outside in a lightning storm holding a lightning rod?”  Obviously not!  Ignoring COVID-19 is like standing outside in a lightning storm holding a lightning rod.

I’m coming in and getting out of the storm. LITERALLY!  Renee and I are going to honker down, going out for essential items only.  It’s back to home food delivery and Amazon.  We will carefully assess those people we come in contact with and try to establish a POD of friends with similar health habits.

It’s time to pull out my surgical masks and hunt for N95 masks.  If COVID-19 is truly aerosolized, it should be considered to be weaponized.  While the data looks like cloth masks help, I want the most airway protection I can get.  Of course, if I isolate myself, I don’t need a mask.

There will be those who will call me an alarmist.  I AM!  I’ve saved many lives over the years by being an alarmist.  In the office, “doc, I’ve got chest pain” almost always set off my alarm and the trip from my office to the hospital by ambulance is what saved my patients’ lives.  My patients often were adamant that they were fine and didn’t need an ambulance. Some protested strongly!  Some refused to go.  Those who went lived even if they had a bad heart.

I always told my patients the same thing.  “I’ll be happy to be proven wrong!  I’ll be happy to apologize for making you go to the hospital by ambulance as soon as I know your heart is fine.”  I was funny like that.  I liked being proven wrong because proven right meant you were sick and in trouble!

I really want to be wrong about COVID-19!  Unfortunately, I’m right and it’s back to being shut ins.  It’s going to be boring.  You can only put on a mask and play doctor but so often before your wife quits the game.  Got any ideas about two-person fantasy games that shut ins can play?

Seriously, go home and stay there.  Weigh your contact decisions against the risk of being infected by COVID-19 and passing it on to family, loved ones and friends. 

Here’s your music for today.  Be careful who you let in.  Here’s your joke.

What’s a 6.9?  Another great thing screwed up by a period.  (I know, I’m pushing it but I’ll be 69 in a few weeks.)

I want to tell you a true story but first, a little background.  For the purposes of this article, I want to assume that all cases of dementia, regardless of their cause, eventually end up in the same place.  While there are always outliers and exceptions, the vast majority of the dementia patients I treated over the years could be broken down into two categories; happy dementia and paranoid dementia.

Mrs. “X,” a 78-year-old delightful female I had the pleasure of caring for 20 years, was in the 4 final stages of dementia.  She was in the “happy” stage of dementia and she smiled at everything.  Unfortunately, her dementia continued to worsen and, on this particular visit, she didn’t know me.

Her devoted daughter was with her at every visit and lived to care for her mom.  Mrs. “X” had a cough and fever so her daughter brought her in.  A careful history and exam led to a diagnosis of pneumonia and discussion of her treatment options and long-term prognosis.

Me – “Your mom has pneumonia and we’re going to start her on antibiotics.  If her condition worsens, she’ll need to be hospitalized.  I should see her in 2 days to evaluate how she’s doing.”

Daughter – “Can you call the prescription into Osco?  Can I give her any cough meds?”

Me- “Absolutely, you can give her Tylenol and Mucinex if she needs something.  I’m more concerned about her dementia.  It’s getting worse; and, as we’ve discussed before, at some point you should consider withholding treatment and letting nature takes it course.”  

At this point, let me interject the fact that this is one of the most difficult conversations a physician can have with a patient and their family.  It was particularly difficult in the case of Mrs. “X” as she and her daughter were both delightful individuals who always brighten my day.

Daughter – “She’s so happy!  She’s always smiling!  We need to do everything humanly possible to keep her alive.”

Me – “I know she’s happy.  What scares me is that the vast majority of patients I’ve cared for eventually transition to the paranoid stage of dementia.  If we keep them alive long enough, they no longer know you and your family.  They no longer can be cared for at home and end up in a nursing home, in restraints and on heavy doses of medications.  It’s not fair but it’s reality.”

Daughter – “We’ll deal with it when we get there.  For the time being, I want you to treat whatever you can treat.”

I agreed with reservations.  My number one reservation was that Mrs. “X’s” dementia was progressing and there was nothing that could be done to stop it.  Reservation number two was that Mrs “X’s” daughter had no idea how bad the paranoid stage of dementia could be!

Me – “When she’s better, you should start interviewing memory centers as eventually you won’t be able to manager her at home.”

Daughter – “I’ll think about it.”

Me – “I worry about you as much or more than I worry about your mom.  If I can help you in anyway, let me know.  Aren’t you do for a BP check?”

I hate nursing homes and every time I had to place a patient in a nursing home, it broke my heart.  My family knows never to put me in a nursing home.  If things get bad, I’ve instructed them to withhold treatment, put me in hospice and let me die at home.

Back to Mrs. “X”.  She recovered nicely from her pneumonia.  She developed recurrent pneumonias from aspiration of food particles and an incompetent cough.  She developed recurrent urinary tract infections as well.  Overall, she responded to treatment and remained in her happy state for the next few years.

Then it happened.  Right off the pages of a Steven King novel, she developed paranoia.  She complained bitterly that her daughter never visited her.  She couldn’t understand why her daughter abandoned her.  After all, she was a good mom, wasn’t she?  During this time, she was still living with her daughter.  Her daughter was in the exam room with her at every visit.  When I pointed this out to her and introduced her to her daughter, she became agitated.

Mrs. “X” – I DON’T KNOW WHO THIS LADY IS BUT SHE’S NOT MY DAUGHTER!  SHE’S NOT NICE TO ME!  SHE MAKES ME TAKE PILLS!  I THINK SHE IS TRYING TO POISON ME

We had finally arrived at paranoia.  I never saw Mrs. “X” smile again.  I never saw the happy Mrs. “X” again.  Instead, I cared for a miserable sole locked in the prison of her demented brain.  She was in a living hell.  

Strangely enough, Mrs. “X” stopped getting pneumonia.  She stopped getting urinary tract infections.  She stopped getting sick and lived another 3 years.  It was depressing as hell.

Mrs.” X’s” daughter was caught in this nightmare as well.  Her days were spent trying to care for a hostile woman who did not know her and was afraid of her.  She suffered from the chronic verbal abuse her daughter hammered her with on a daily basis.  Despite everything, her daughter stayed with her till the end.

There are times when you just can’t win!  If her daughter had withheld treatments while her mother was in the happy stages of dementia, she would have felt guilty when her mother died.  Instead, she lived in hell for years and felt “RELIEVED” when her mother died.  She ended up feeling guilty about feeling relieved.

In olden times, we died from pneumonia or other infections.  We died at a younger age.  Now, almost every disease is preventable or treatable and we die at an older age.  The cost of living longer can be devastating as in this case.  If you are suffering from a disabling disease or memory disorder, have an end of life discussion with your doctor and family.

Here’s your music and joke for the day.

Robert Benchley said, “Nothing is more responsible for the good old days than a bad memory.”  (Think about it!)