HOW SHARP ARE YOU?

Renee and I are learning to play bridge and I’ve got to tell you, at 71 years old, it’s no easy task.  While on an everyday basis, I feel mentally sharp, I know I’m not as sharp as I used to be.

Prior to my DBS (deep brain stimulator) implantation, I had to take a battery of tests designed to elucidate just how sharp my brain is and what losses, if any, I’ve suffered. Over the years, I sent hundreds of patients for NeuroPsych testing, oblivious to how anxiety provoking the testing was but fully aware of how depressing the results could be.

Taking the test was certainly accompanied by anxiety. I was used to prepping for a test and then “acing” it.  I couldn’t prep for this test nor did I “ace” it.   I showed subtle cognitive losses consistent with Parkinson’s and my age.  Flash forward to today and the harsh reality of learning bridge.

Bridge has lots of rules, point scales and conventions (made up of predetermined actions) to be remembered and, frankly, I’m having trouble remembering all of them. Sure, I’ll eventually learn to play bridge, but in doing so, I’m forced to face my mental losses and deal with the depression associated with those losses.

Hopefully, by forcing my brain to learn new tasks, I can lower or reverse future losses.  I’ll never get used to making mistakes, but I’ll make them, nonetheless.  At least mistakes in a card game are not lethal. 

Your health tip for today is: Exercise your mind.  Play Bridge, Maj Jong, Wordle Crossword puzzles, etc. If you are not as sharp as you should be, see your doc.  There are treatable forms of dementia.

Here’s today’s joke:  Three old ladies are sitting around a table playing bridge and bragging about their sons…

“My Freddie,” said Margaret, “Everyone should be so lucky to have a son like my Freddie. Once a week he brings me a huge bouquet of flowers, he’s constantly bringing me out to restaurants to eat.  If I so much as hint that I want something the next morning, it’s on my doorstep.”

“That’s very nice about your Freddie”, says Gertrude. “But with all due respect, when I think about the way my Sammy takes care of me, it just can’t compare. Every morning as soon as I wake up, he greets me with bacon and freshly brewed coffee. Every lunch he comes over and cooks me a gourmet lunch, and every supper he brings me to his house for supper, he truly treats me like a queen.”

“WELL!” Says Barbara, “I don’t want to make any of you feel bad or anything, but wait until you hear about my Harry, twice a week he pays someone $200 an hour just so he can lie on their couch and talk to them, and who do you think he speaks about at those prices? asks Barbara with a big excited double chin smile, “I’ll tell you who he speaks about! ALL HE SPEAKS ABOUT IS ME!”

DIGNITY

How much is your dignity worth?  How much money would it take to help you forget a day of abuse and anxiety?  Apparently, United Airlines values my dignity at $100!

Yep, an hour after my blog was posted, a representative of UAL called to discuss my experience and to offer a travel voucher for my troubles.  My initial reaction was to say, “No thanks.”  My curiosity got the better of me and I gave the representative my email address.  The phone call ended with the representative promising to review what happened with the “vendor” and alert the appropriate personnel in Houston and Charlotte.

Shortly thereafter, my $100 voucher arrived by email.  United’s less than generous offer clearly answered my question.  My dignity is devalued at $100 by UAL.  It also raised new questions.  Is UAL going to contact the other members of my party who suffered through a days’ worth of emotional distress with me?  Is UAL going to reimburse my wife for having to wheel me through Charlotte’s airport?  What about those poor souls who sat in the “dumping grounds for the handicapped”?  Did someone eventually help them? Are they still sitting there? Is their dignity also worth $100?

My suggestion is to treat everyone as if they were precious.  They are! Having the appropriate equipment to assist the handicapped should be a priority.  I can’t believe that a company that can fly planes coast to coast can’t have an adequate number of wheelchairs and attendants waiting for arriving planes.  A person’s dignity is priceless.  If you are going to offer travel voucher, perhaps you could offer a round trip voucher on which you intend to highlight the improvements UAL has made in caring for the handicapped.

Meanwhile, your gate agent in Houston and the young lady pushing one of my friend’s wheelchairs deserve recognition for excellence in performing their jobs.  Perhaps you can spend $100 dollars on them as a way of saying thanks.

While being handicapped makes me more fragile and dependent on others, it does not make me any less human!  In the future, handle your handicapped customers with care!

UNITED’S DUMPING GROUND FOR THE DISABLED

Let me start by telling you that I’m angry.  I’m angry because I’m disabled and I’m angry because United Airlines made me realize just how disabled and helpless I truly am.  Before I go any further, I want you to know that there are lots of good people (including some United employees) who stepped in to offer help!  While United was busy destroying my faith in man, others bolstered it.

My story starts in Puerto Vallarta at the international airport.  My Parkinson’s has worsened making walking any distance either difficult or impossible.  On Saturday, I couldn’t walk.  Despite the fact that I had notified United Airlines, they did not have an appropriate wheelchair or the means to move me around the terminal..  Eventually, I forced my body into a child’s wheelchair and was taken to the holding area where I was told to relinquish my wheelchair and wait.  Imagine my surprise when I was told I was told the gate was 50 yards away and that we would be taking a bus to the plane and walking up an old-fashioned set of stairs to board the plane.  Making matters worse, the men’s room was 50 yards in the opposite direction; and being an old man, the men’s room was every bit as important as the gate.

By the grace of God, I made it to the men’s room and onto the plane without a major incidence.  I was exhausted but happy to be on my way home.  The real trouble started in Houston.  We had booked a direct flight to Charlotte but United cancelled it.  We were left with landing in Houston, clearing customs, going through security again for which we had 90 minutes between flights.  On getting off the airplane in Houston, we were shocked to find that there was one wheelchair and about 15 people needing one.  The gate agent assured us that the wheelchairs were coming shortly but he could not say what “shortly” meant.  As it turned out, “shortly” meant 20 minutes, leaving us 70 minutes to clear customs, rebook our luggage, catch the train to terminal C and board the next flight.

Here’s where things get bad.  We, the disabled, were taken to a holding area where about 20 elders sat in chairs along the wall, awaiting help. It was a pitiful. My neighbors and I were told to find a chair and wait.  I refused!  I was not going to give up my seat on the transport vehicle I had eventually been placed in.  Several agents approached me and instructed me to get in a chair and I again refused.  Had I gotten into one of the chairs in the Dumping Area for the Disabled, I might still be in Houston today!

Finally, we started moving towards Customs.  I felt bad for the disabled persons we left behind, but as the say, “The squeaky wheel gets the oil.” Now, my chair is being pushed by a young man who showed all the signs of doing too many drugs.  He would stop, then go, then stop.  He mumbled incessantly about not being stupid despite what his fellow employees said.  He lost the rest of my group and most importantly, my wife.  I’ve never felt so helpless.  Airport wheelchairs are not like regular wheelchairs and cannot be self-propelled.  When my attendant walked away, I was stuck.

We made it through Customs and back into security.  Due to my deep brain simulator, I had to go through a pat down.  Best total body massage I’ve had in a long time! I hope the agent was as embarrassed as I was as he groped my crotch.  I explained to him that my weapon hadn’t been loaded or cocked in years. 

I arrived at the gate and the plane was still there.  My wife showed up shortly afterwards.  United Airlines knew how many wheelchairs they needed.  They just didn’t care.  They knew who had connecting flights, they just didn’t care.  They knew who needed assistance getting on the plane, they just didn’t want to pay for a jetway.  They knew how long it takes to clear customs, go back through security, and catch the train to the next terminal. They didn’t care.

What they need to know and understand is the psychological damage their carelessness causes.  In their hands, the disabled end up dumped in the” dumping area for the disabled”, helpless, and alone. Awaiting help that may or may not come in time to get them home.

United Airlines has come a long way from the days of flying “the friendly skies” to dumping on the disabled.  They should be ashamed and act quickly to improve their treatment of the disabled.

THE END

It’s three am and I’m wide awake. I’ve been napping on and off since first awakening at midnight.  I just watched the end of a movie about a comedy writer who has Creutzfeldt-Jakob disease and is slowly losing his memory.  Billie Crystal’s performance is outstanding.  It’s sad when you live a full and happy life, only to lose your memory of that lifetime at the end.

I am dying a little at a time.  Currently, there is more of me that is gone than there is of me that still exists.  There is very little I can do about it.  Most days consist of napping in my lift chair until it’s time to eat, then repeat.   I can’t remember the last time I made Renee laugh or saw her smile. Her day is spent picking up after me since I drop things and can’t bend over to pick them up.

I work at maintaining a good attitude but fail often. I’ve got a long list of “used to” and it gets longer every day.  I’m fighting to lose some weight yet eating is now one of the few pleasures my body allows me to partake of.  There’s even a drawback to eating.  I bite my lip on at regular intervals.

I’ve become that “train wreck” of a patient that I hated to see because I couldn’t fix him/her.  I see a specialist for every part of my body knowing that there is not much they can do.  I remember the patient who was awake all night and slept all day and the advice I gave him about nocturnal binge eating.  Well now, that’s me.

I remember the counseling I gave the patient about depression and chronic illness.  Now that’s me.  I remember the patient who was bored because he spent almost the entire day in a chair.  Now, that’s me.  I remember all the patients I worked with over the years and all the good advice I handed out, and what bullshit that advice turned out to be.

I’m not giving up but it’s getting harder to be positive. I’m going on a cruise ship for a five-day trip to the Bahamas.  Rather than walk the deck at sun-up and sun-down, I’ll ride a scooter.  Rather than run down the beach and dive into the water, I’ll sit on the beach and look at the water.   The one thing I will do well is eat, being careful not to regain the weight I’ve lost.  Did I tell you I’m massive?  It seems the only thing I excel at is gaining weight.

This blog is coming to an end.  As I no longer practice medicine, there’s not much to write about.  I certainly do not want to publish dark and depressing articles like this one.  There are over 1500 articles on this site, many worth reading over and over again. 

I plan to shut this site down in December so feel free to print copies of any of the articles you’ve found helpful if you want them.  It has been my privilege to have shared my knowledge and thoughts with you through this site.  I wish you all health and wellth.

Here’s your joke for the day:  https://youtu.be/70HToRwzDQ0

DIVIDED WE FALL

At 3 am, I wrote my last blog.  Actually, I thought it was my last blog but I just got sick listening to the news and I’m going to break one of my cardinal rules and comment on politics.  I’ve always thought that my political beliefs should be kept to myself so as not to interfere with my medical judgment and care.  As I’ve stated in earlier articles, times have changed.

The reporter on CNN was reviewing the DOJ’s decision to appeal the recent ruling regarding the appointment of a “Master.”   He showed a chart that broke down the judges the DOJ would be appealing to, Republicans and Democrats, and stated that not only did Republican judges outnumber Democratic judges, but that the majority of the Republican judges were appointed by Trump. He implied that an appeal was jeopardized by the judges appointed by Trump.  It’s as if they had been bought and now would pay off the cost of appointing them.

Now imagine that medical care was delivered by a system similar to the appointing of judges.  Might the doc decide that your condition is hopeless and let you die?   Might he decide that you deserved to live but, because you supported pharma, he would give you obscenely expensive medication.  Or, as a parallel to today’s issues, might he ignore your immediate risk and call for a “Master” to decide whether to resuscitate you, knowing that the “Master” is days or weeks away and likely to arrive too late.

I’m glad I’m on the downside of life.  Our democracy is crumbling. There are fewer Americans, fewer fair judges or politicians.  There are Republicans and Democrats; there are extremists, conspiracy believers, MAGA, LGB …, ETC. Certainly, you can’t trust anybody.  At a time when you can claim innocence and that your accuser is lying (despite being captured on film committing the crime), you can get away with anything.

There has never been a better time for orgies.  Shit, I’m too old for an orgy!

THE GOOD OLD DAYS

The medical world has changed to the extent that I no longer recognize it!  What I used to take for granted, I now question. Did doctors really respond to patient needs after hours?  I remember pulling off the road and putting quarters in a pay phone, returning patient’s or the hospital’s call.  Did I really do that or was I hallucinating?

I remember awakening to the phone ringing, taking a message from the answering service and then calling my patient or the hospital, responding to my patient’s need.  Did I really do that?  Yep, I took call seven days a week for years.

I had an exam room at home and, on weekends, would have patients come to my house to be examined.  During the summer, their doc was often in a wet bathing suit.  And yes, I made house calls when appropriate.  My memories of these events are so complete, it must have been real; yet today’s docs look at me like I’m nuts when I talk about the old days.

I started my day doing hospital rounds.  On occasion, I assisted in surgery and even delivered babies. I did a long list of procedures in my office, negating the need to send my patients to the ER.  Now a shoulder surgeon claims he is not trained in elbows or wrist.  Now a message may go unanswered for over a week if the doc is on vacation.  As many of you know, I spent a few weeks in Mexico every year.  Dr Bell covered my practice and supervised my PAs.  What you didn’t know is that, while on vacation, I woke up at 6 am and reviewed every chart note on every patient seen in my absence.

The world I worked in was certainly different than the world I’m currently living in.  In retrospect, I was so dedicated to my patients’ care that I must have been nuts. Of course, most of the family docs and internists I trained with and called colleagues did the same thing.  The closest I’ve come to finding an old fashioned doc is my Gerontologist.  While she does not go to the hospital or make house calls, she does some procedures in her office and is available on short notice.

There are a few dinosaurs still making hospital rounds in the morning before going to the office.  I check in on Dr Bianchi from time to time.  He still practices as I did 40 years ago.  God bless Dr Bianchi.  Lake Zurich is lucky to have an old fashioned family doc.

The next version of medical care is taking root now.  Telemedicine is here to stay, and, in my opinion, TV driven telemed is horrible.  There are commercials for erectile problems, depression, baldness, birth control and others.  The commercial informs you that you will be assessed by a licensed medical “provider.” A licensed medical “provider” is probably not a medical doc!  When you respond to one of these commercials, you are trusting a stranger who will never meet you with your medical care.  You have no idea what the provider’s training is or what degree he/she holds.  That should scare you!

It certainly scares me!!!

Here is today’s joke:  You don’t appreciate a lot of stuff in school until you get older. Little things like being spanked every day by a middle-aged woman: Stuff you pay good money for in later life.

– Emo Philips

DIFFERENTIAL DIAGNOSIS

Pain is the result of an abnormality or injury.  True or false?

Pain can cause pain. True or false?

It is better to treat the cause of pain. True or false?

It is better to treat pain regardless of cause. True or false?

Doctors worry about treating pain. True or false?

Believe it or not, all of the above statements are true. So, which is more important, the cause of the symptom or the symptom itself? Patients usually focus on the symptom.   “Doc, I’m having terrible spasms in my right forearm causing excruciating pain.  I need something for the pain.”  Something for the pain usually translates to hydrocodone and prescribing hydrocodone makes docs nervous.

The doc’s job is to diagnose the cause for the pain, directing treatment at removing the source.  Using hydrocodone is the equivalent of putting a Band-Aid on a cut.  Finding the cause of the pain/spasm can be difficult and often, in many cases, requires a thorough history, exam and testing.

Take, for example, my forearm pain.  I’ve been getting excruciating right arm muscle spasms causing severe pain and disability. It’s gone on for week;s and, at times, it felt like the spasm would break my bones.  Initially, I thought my deep brain stimulator was causing the spasms as the pain would go away when the stimulator was turned down.  When the pain was severe, I turned off the stimulator. The pain persisted.  Obviously, the DBS was not the cause.  Right?

Wrong.  Remember, spasm can cause spasm and my spasm had gone on for weeks.  One spasm was accompanied by a loud pop in my elbow followed by an inability to fully extend the elbow.

As you can see from my example, the diagnostic process can be difficult.  Before you see your doc for a problem, make a list of your symptoms and any possible causes.  Please do not search the internet!  According to google, everyone has cancer and other rare diseases.  On occasion, all you’ll need is a Band-Aid.  When I practiced medicine, I preferred diagnosing the cause of the pain as opposed to applying a Band-Aid. If I could diagnose and treat the origin of the symptom, then I had a chance at a permanent cure.

The next time you see the doc, remember how complex diagnosis and treatment can be.

Here’s today joke:

My wife yelled from the bedroom asking, “Do you ever get a shooting pain across your body like someone’s got a voodoo doll of you and they’re stabbing it?” I replied, “No.”

She yelled back, “How about now?”

SCARE TACTICS

Scare tactics!  Yep, that’s what the commercial I just watched amounts to.  In response to candidates promising to reign in the cost of medicine, Pharma is threatening to stop research and production of new medications.  All I can say is, “Bull Shit!”

Pharma develops and sells medications on a worldwide basis.  Many of our most popular drugs are produced overseas.  Did you know that in many countries medication cost far less than in the United States?  Everyone knows about   Canada. 

So, if much of the world sells medication for less than we do, how come Parma continues to develop new meds?  The answer is easy.  Pharma has huge profit margins! 

Don’t let them scare you.  Vote for candidates who promise to cut the cost of medication.  Then hold their feet to the fire!  It’s time Congress keeps its promise.

PAY THE DOCTOR CASH

A recent article on KEVINMD.COM entitled, “Keep your medical insurance, but pay the doctor with cash,” was of particular interest to me.  My practice was unique in that I ran a Concierge practice side by side with a typical fee for service practice.  Comparing the two practices is easy.

The Concierge practice was fun.  If I needed a test or procedure, I could order it without many hassles.  Concierge patients bought their freedom by paying cash and were more appreciative of their care then their counterparts. 

Fee for service/insured patients relied on their insurance company and gave up their freedom, trading it for a copay.  Their care carried more overhead than the Concierge patients and they really didn’t understand how much back office work it took just to get them an x-ray.

You may not know it, but your doctor’s office is forced into taking insurance products and putting up with the insurers’ discounts.  Did you ever stop to think that your doctor is your banker, carrying your debt until the insurance company pays him/her?  Did you realize that your $10-$40 copay represented the majority of your family doc’s paycheck?  I bet you didn’t know that it cost me money every time I sent you a bill.

Giving a discount for cash paying patients makes sense.  The only drawback is a theoretical one.  Medicare and your insurance company could look at your doctors’ discounted fee as his/her real fee and claim that your doc over charged them.  Medicare could then claim that your bills were fraudulent and file criminal charges against your doc.  Sound insane? It is!

Insane rules created by your insurer and government guaranteed that your doc and their patients had little recourse when it came to arguing over billing and the cost of medicine.  While I was in private practice, I fought to keep costs down and to get my patients the referrals they needed.  I wonder who is going to fight for your rights in the corporate world of medicine that exists today.

By the way, “Pay the doctor with cash” does not mean hand your doc a credit card.  Credits cards charge your doc a percentage of the amount charged.  For those of you old enough to remember cash, there is no charge for the use of cash.  Every little bit counts.

Here’s a true story to think about.  I was standing in the check-out line at the Vet’s office.  The man in front of me was told his dogs bill was $245 and included the doc’s time and lab work.  His dog had a urinary tract infection.   The man paid his bill.  He did not complain, he did not tell the office to bill his insurance.  In my office, the bill for a UTI would have been $200.  I would have gotten a $20 co-pay, billed insurance, and written off the insurer’s discount, collecting a grand payment of $100.  Many of my patients would have griped about the co-pay despite the savings. 

If you like your doc, pay your doc!  Use your insurance for big ticket items.

Here is today’s joke:

A bank robber gets hold of the cash he needs but before fleeing the scene he demands the regular customers to stand in a line

The bank robber asks the first guy in line: “Did you see what happened here?”

First guy: “I sure did! And I’m gonna tell the police exactly what happened and what you look like…”

The bank robber shoots him in the head and asks the next in line the same question.

Second guy: “I assure you I did not see a thing… but my wife here did”

I THOUGHT I HAD SEEN EVERYTHING

I thought I had seen everything.  I hadn’t!  Tonight, I saw a commercial for pubic hair.  That’s right, the cartoon character sang a song in which she proclaims how proud she was of her pubic hair.  In the next scene, the razor she used to sculpt her pubic hair was featured.  How long before we see actresses singing about their vaginas on commercials.  Perhaps the doc who’s on prime time touting her deodorant for private parts will commission a song about vagina pride.  Personally, I can’t wait till Hallmark has a National Pubic Hair Pride Day.  Perhaps we could have a Pubic Parade and shout, “Show us your pubes!”

The other thing I never thought I would see is mail order antidepressants and erectile meds.  The commercial is very reassuring stating that the meds are prescribed by licensed providers. You can be happy, hard and last longer! Depression can be a serious disorder and is best treated by counseling with appropriate follow-up with a MD.  Did it ever dawn on you that erectile dysfunction may be nature’s way of keeping you from screwing yourself to death?  ED is often related to vascular disease.  Lastly, erectile dysfunction is often the result of other disorders.  Sure, the medications are relatively safe but performing an exam over the phone is impossible.  While the rectum tolerates a finger, a cell phone or computer just won’t fit.  The commercials for ED are more than suggestive.  When I was young, they would have been considered pornographic. They certainly are better then the Playboy that used to hide under my mattress!

 The medical world moved to phone medicine during the pandemic.  It appears that phone medicine is being normalized and is here to stay.   I don’t like it.  Being able to see a patient in person, witness their demeanor, facial expressions, and interaction with others all help in making appropriate diagnosis and monitoring treatment success. 

Here’s today’s joke:

In Australia, a man set his pubic hair on fire;  I guess you could call that an “Australian bush fire.”

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