WELCOME TO HELL

If you don’t believe in hell, you should!  We are all in a living hell.  All infected by a horrible virus.  Some have respiratory problems, fever and fatigue.  Some require hospitalization.  

Qualifier – I do not believe that all of us have the actual virus.  I do believe that having or not having the virus is a moot point.  The damage that 6 feet of separation does to our souls is real.  Parents and grandparents worry about their progeny.  They see each other on the internet or through their car windows.  There are no actual hugs or kisses.

Under the strain of social isolation, child and spousal abuse increases.  Depression and anxiety worsen or show up for the first time.  Businesses and careers are lost.  The food chain is compromised. The entire fabric of society has started to unravel.

Worst of all, the dying die alone, among strangers.  The strangers who act as stand-ins for your loved ones, have their hearts ripped out as they pronounce their patients dead.  There are no more shiva’s, and wakes. Funerals are held online.  Six feet of separation might as well be a mile.

I can go on and on.  The effect of this virus is to send us all to hell.  Will we ever be rid of this scourge?  Certainly, we will learn to control the virus or kill it.  What is less certain is what the long-term effects of social distancing will have done to the survivors and their progeny.

In a famous song by the Rolling Stones, Sympathy for the Devil, they make a pivotal statement.  “Please to meet you . . .Hope you guess my name.”  Listen to the following if you do/don’t remember the song: https://youtu.be/GgnClrx8N2ken

I’m no biblical scholar but I think the first step to ridding ourselves of this plague is to guess his name. After all these years, I finally know what his name is.  It’s Covid-19.  Now to figure out what the nature of his game is.

The answer we need to fight our way out of hell is embedded in the title of the song.  SYMPATHY  for your fellow beings is key to our survival.  Sympathy will allow you to touch another without breaking the 6 feet of separation rule.  Sympathy will stop you from flaunting the separation rules long enough to rid our society of the virus.  Sympathy will remind you we are all in the same place and need each other to dig out.  Only when we act together will we find the faith necessary to survive this latest attack on our souls.

The song ends with, “tell me baby what’s my name; one time, you’re the blame.”  I know who you are.  You call yourself COVID-19!  Now that you’ve been identified, I refuse to be the blame.  I will alert my brethren and we will dig our way out of hell together.

We will once again feel human touch, hugs and kisses.  We will mourn together and celebrate together but first we will name you and drive you back to the hole you came from.  WE WILL ISOLATE YOU!  ISOLATION IS THE NATURE OF YOUR GAME AND WE WILL PLAY THE GAME LONG ENOUGH TO SEND YOU BACK TO HELL, AND YOU WILL GO ALONE!Where did this article come from? I awoke with it in my head.  It was a gift from GOD.  I’ve found my faith again.  Find yours and we will all be fine!

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AMERICAN INGINUITY

First, a qualifier.  Note that the doctor in the video starts off by warning you that his wife’s design has not been tested.  His faith in the mask produced by his wife is “anecdotal” based on his sniff test and use of the mask.  I think her design is brilliant and, if you are going to use a home-made mask, makes a lot of sense.

THIS VIDEO SHOULD GO VIRAL, IT’S THAT GOOD! https://www.youtube.com/watch?v=W6d3twpHwis

PUTTING ON A MASK AND TAKING IT OFF CORECTLY IS VERY IMPORTANT.  HERE IS A VIDO EXPLAINING HOW TO DON AND TAKE OFF A MASK CORRECTLY. https://www.youtube.com/watch?v=z-5RYKLYvaw

WHILE WE ARE AT IT, LET’S DISCUSS CORRECT REMOVAL OF GLOVES.  WHEN TAKING OFF YOUR GLOVES ALWAYS TREAT THEM AS IF THEY ARE COVERED IN POOP.  WATCH THIS VIDEO PLEASE.

Improper use of mask and gloves puts you and your family at risk.  Please remember to safely dispose of old masks and gloves in the appropriate garbage receptacle.  Do not recycle potentially infectious materials.

One last point.  I do not believe that simply making a mask out of cloth has any real protective properties.  If I were to pass gas, you would smell it!  Assuming I were fully clothed, that gas would pass through underwear and pants.  If gas can pass through, virus probably can as well. The following video is for those who can’t sew.  I would recommend using a HEPA bag as a middle layer in this type of mask, always remembering that none of these designs have been tested and proven helpful. https://www.youtube.com/watch?v=r51YroAFPds

Prior to using any mask, it may be worthwhile to pass smelly gas as your own sniff test.  A healthy serving of corned beef and cabbage should help!

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QUALIFIERS

In my world, recognizing qualifiers is very important.  Qualifiers are words like “could,” “may,” “might,” and on and on. Personally, when I hear a qualifier, I pay attention to how it is used and then put it on the back burner.

Could ultraviolet light help eradicate Covid-19?  The answer to could is always yes.  Anything could happen.  I could get lucky, but that’s another blog for another day.   In science and medicine, qualifiers are good for formulating theories and running research.  What a doc wants to know is how certain are you that UV works. How did you come to that conclusion? Was the study blinded or double blinded and what’s the P value? According to Wikipedia, “In statistical hypothesis testing, the p-value or probability value is the probability of obtaining test results at least as extreme as the results actually observed during the test, assuming that the null hypothesis is correct.[1][2]

I know it sounds complicated, but a practicing physician is taught to analyze P values and a host of other statistical terms so as to be able to evaluate how trustworthy the results of any test are.  I often frustrate my friends when they present with anecdotal stories about the benefits of vitamins, medications, UV light, alkaline water, etc.  It’s not that I don’t believe them.  The heart of the matter is my profession requires proof before we accept any therapy or test.

What qualifiers are good for is avoiding the wrath of the press.  Had President Trump said, “I’ve heard/read that UV light might be beneficial and think that further research might be helpful, no one could have criticized him.  Had he said sanitizers do so well at killing the virus on surface that I wonder if we might be able to find a potentially effective and safe sanitizer to use on humans.  No one would be able to criticize him.

Maybe I’ll hit a hole in one someday.  Anything is possible assuming I start playing golf.  Using qualifiers when you put forth an idea helps in assessing how reliable an idea is.

By the way, when you quote research such as the very small study done in China, be careful not to take it as gospel.  In college, I was in charge of a rat lab and my research was worth 12 credits if done right.  I screwed up!  My results were not good and it looked like I was going to flunk 12 hours of credits.  As a pre-med, it was a disaster.  I spent an entire week in the library studying statistical analysis and came up with a statistical test that gave me a good “P” value.  I got an “A” for those 12 hours.

While I could fool most of you, I did not fool my professor.  Nor was my work ever published.  Dr. Best gave me an “A” for my ingenuity in finding a valid statistical test that turned shit into gold. I learned a valuable lesson and have never screwed up again.  Thank you, Dr Best!  I participated in over 30 clinical trials in my lifetime and enjoy each trial.  Research always kept me on the cutting edge of medicine. 

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FREEDOM

Thank God!  I can finally get a tattoo.  All I have to do is fly to Georgia.  Now to decide what tattoo I want and where to put it.  I thought I’d tattoo instructions on how to intubate me so that when I get a Covid infection, the ER doc would know how hard it is to intubate me and what he should do in order to get it done before I stroke.

Welcome to a world taken over by madness.  Keep us at home, watching bad TV, worrying about the future and we will go mad.  I’ve lost it.  I’ve started surfing between CNN, MSNBC and FOX.  My mood shifts with each channel change. Who do I believe?  I’m really not sure.  What I do know is that there is not a right answer.

If I were about to lose everything (my business, my savings and my home), I would want to open up for business and depend on my customers to be responsible enough to stay 6 feet apart, wear mask and self-quarantine if they were sick.

I’m glad I don’t own a business.  As I am old and frail, I’ll choose to shelter in place until this is over.  As a doctor, I know that opening up business will prolong the misery and lead to a spike in deaths.  I know that many will not take this seriously and will spread the virus.  As a doctor, I am furious that nothing my colleagues need to do their jobs is made in this country.  I’m pissed that supplies of critical protective gear are so deficient that our frontline doc’s are dying in the field.  We knew this was coming.  Knowing and believing are two different things.

As a retiree, I need the economy to grow and flourish.  I need a healthy stock market.  If we stay closed, that will not happen.  The longer we stay closed the longer it will take for the stock market to recover. 

As a human, I need to eat.  I need to be sure our food chain is strong.  I need the government to invest in securing the food chain by encouraging innovative ways to allow workers to safely return to the fields and factories.  Securing the food chain is critical and no one seems to be talking about it.  I need human touch, hugs and kisses.  I need to be with family and friends.

As a parent, I worry about the effects of social isolation, economic distress, home schooling and a host of other problems facing my children and their children.  As a parent, I worry about everything.  Most of all, I worry about how I’m going to get to the east coast and see them.

I’m actually in good enough shape that, barring getting infected. I can weather the storm.  I can’t imagine how my patients, some of whom were living on the edge to begin with, are going to make it through this.  

So, I’m not going to criticize those who push to get back to work.  I’m not going to call them names.  Instead, I’m going to support them.  I’m also going to support those who choose to shelter in place.  As free men and women, it’s time to exercise that freedom.  It also time to become innovative.  If you are going back to work, figure out how to stay safe and keep your customers safe.  If you are going to be a customer/client, don’t let your guard down.  Be responsible whatever your choice.

If you’re going to get a tattoo in the midst of a pandemic, I have nothing more to say.

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COVID CONFUSION

I just viewed a video sent to me by one of my former patients.  IT WAS HYSTERICAL!  The video consists of a young woman standing in front of multiple TV and News microphones as she explains the Covid-109 rules.

She starts off stating that she could not understand why everybody is not following the same rules as they are very clear.

“First, you must not leave the house, for any reason; unless of course you have a reason and then you can leave the house. All stores are closed except those that are opened.  All stores must close unless they have a reason to stay opened.  This virus is deadly, but don’t be afraid of it.  It can only kill people who are vulnerable and also those who are not vulnerable.”

She goes on to say, “We should stay locked down until the virus stops infecting people and it will only stop infecting people if enough of us get infected so that we build immunity, so it is very important that we get infected and also do not get infected.  Also, do not go to the doctors’ office or the hospital unless you have to go there or are too sick to go there.”

The video goes on for another two and a half minutes making statements and then contradicting them.  IT’S HYSTERICAL!  IT’S SAD!!  It represents exactly what you are being told in the news.  Wear a mask.  Don’t wear a mask.  No, I told you to wear a mask.  By the way, a mask won’t protect you.  It protects people from you.  If that’s true and we all wear mask, then no body should be able to infect you.

Along with social isolation and anxiety, we have to deal with mass confusion.  Who do we believe?  Believe me!  The authorities don’t know what they are doing.  The news media doesn’t know what they are doing.  The scientist and doctors know what they are doing.  They are learning on the fly, collecting evidence and designing the kind of research that leads to treatments and vaccine.

Unfortunately, docs are becoming talking heads/celebrities and, rather than treating patients and seeking truth, vomiting suppositions and half formed theories on any reporter that will talk to them.  The reporters air these opinions widely, the internet picks up on it and, in the end, a preposterous idea becomes reality.  Did you hear about the patient who got miraculously well after her nurse spilled a urine sample on her? 

While that would be absurd, if enough of you quote me as reporting that peeing on a Covid-19 patient is harmless and may well help them get better, we’ll see it in the news.  President Trump, not being a doctor, might even suggest that if we pee on each other, we can end the pandemic.  “What have you got to lose.  People are dying. It sounds right to me.  Give it a try”

Of course, Congress has been peeing on us for years (or dumping on us) without any apparent benefit.  Enough said. 

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MY FAVORITE DAY OF THE YEAR

Just as kids get excited Christmas morning, I get excited the day my pool opens.  Yesterday, we opened the pool.  Even though the water is cloudy and I cannot swim yet, I still relish awakening in the morning and looking out on my own private heaven.  I’ve been awakening to the sight of an expanse of clear blue water since I was five years old.

My parents built an inground pool when I turned 5 and most of my fondest memories are of growing up at Camp Segal.  When I moved to Long Grove, I reopened Camp Segal and treated my children to the joys of having a pool, volleyball and basketball court and bags in their back yard.  My memories of summers past in Long Grove are fond ones with many groups of teenagers and adults reveling in the sun and water. 

Whomever said all good things must come to an end knew what he/she was talking about.  We have a “showing” today.  On the one hand, I’m excited about my move to North Carolina and starting my retirement stage of life.  I am sure whoever buys my house will enjoy the screened porch and pool.  Whether it takes on a country club like environment as it did with my family or a peaceful, private escape, I know they will love it.

On the other hand, I want to stay and enjoy one more summer at Camp Segal.  The one place where the Parkinson’s does not bother me is in the water. Lunching on the screened porch and lounging in the pool is my kind of heaven.  Lucky for me that my 55-year-old and older community in North Carolina offers me a similar experience.

There will be one clear difference, the laughter of little kids playing will be replaced by old people complaining or telling jokes.

Paul: “o… o… o… y… y… y, o… y”

John: “I thought we weren’t talking about the kids today!”

Three old men sitting at the breakfast table drinking coffee.  Max complains, “I’m so constipated.  I wake up in the morning and push, push, push.  Eventually, after an hour or so, I have a little B.M.”

His friend Paul says, “I don’t have any problems with BM. My problem is peeing.  I strain and strain for hours.  Finally, I get some relief.”  The third guy says, “I don’t have any problem pooping or peeing, I just do both 1 hour before I get up.”

I’m already boning up on my jokes.  Renee and I are learning to play bridge and Mahjong and settle into old age.  Just as Renee and I are going to settle into a new way of life in NC, so must all of us settle into the new rules of life caused by Covid-19.

The sooner we accept change, whether good or bad, the sooner we can get on with our lives.  The better we comply with the rules of our new way of life the happier and healthier we will be.

Be happy, be healthy and pray for a vaccine or a therapeutic approach that works.

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WHAT DID YOU SAY?

Renee and I have the most fantastic conversations!  The problem is that neither of us can hear the other.  First, a little background.  Renee is a speech pathologist.  When we first got married, she taught me to modulate my voice.

I used to talk very loudly.  In a lecture hall of 500 students, I did not need a mic.  Everyone could hear me.  Ever hear the expression, “Happy, happy life?”  I quickly learned to tone it down and, for many years, my wife was happy.

Flash forward to 4 years ago.  Renee’s hearing got progressively worse.  I had to relearn how to talk loudly.  It was not an easy task, Parkinson’s naturally soften your voice and, to make matters worse, there is a fine line between talking louder and yelling.

Renee admonished me for yelling.  She taught me to look her in the face when I wanted to talk to her.  She taught me that if I was behind her and trying to communicate, she could not hear me.  Eventually she got hearing aids and things got marginally better, but, she began to mumble as her aids amplified her own voice.  The only time I could truly hear her was if she was on the phone.   On the cell phone, she projects her voice over many miles.  The neighbors could hear her.

Flash forward to today.  My hearing is now bad.  Even with hearing aids, I miss much of what she says.  The funny part is that now I’m admonishing her for the same things she accused me of.  Isn’t getting old fun?

Communication between spouses is so very important that we all should take care that we understand what our spouse is saying, and we follow Renee’s rules.  If you or a loved one has hearing problems, talk face to face.  Speak slow and verify that what you said is what they heard.  Be patient with your loved one particularly since one day in the future, your hearing may be just as poor.

One of my favorite sayings is attributed to Alan Greenspan:

“ I know you think you understand what you thought I said but I’m not sure you realize that what you heard is not what I meant”

Think about it!  If you or your spouse or loved ones are hard of hearing, take care that you verify what you think you heard.  Remember, “Happy wife, Happy life!” Hearing what your spouse said and meant will lead to a happy spouse and life.

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RISK TAKING

Bear with me as I tell you a story.  If you read to the end, you’ll understand the point of my story.

When I turned 15, my father taught me how to drive.  When I turned 16, he bought me a car. That car came with a host of rules designed to keep me safe.  My first car was awesome.  It was a 1963 and ½ Ford Falcon Sprint with 4 on the floor and 276 horses under the hood.  It was FAST!   What it wasn’t was safe.  No seatbelts, no airbags and enough of an engine that we had to put sandbags in the trunk to keep the rear wheels on the ground.  I was damned lucky I survived and didn’t kill anyone.

When my children turned 16, I gave them each a car and a set of rules.  I also told them how lucky I was to be alive and that their mother and I would probably spend the rest of our lives worrying about them.  So, why did I give them cars?

Being able to drive gave them a great deal of freedom.  It also taught them how critical it was to drive responsibly and how dangerous a car could be.  I thank God they survived.  Each kid got speeding tickets, each wrecked a care.  All the three survived and thrived.

A car is a very dangerous thing.  If used responsibly, it provides tremendous freedom and potential.  No matter how responsible you are, it can kill you.  Yet, I gave cars to my children as did my folks.

Opening up society in the face of Covid-19 is very much like giving a teenager a car.  Opening up the USA comes with a new set of rules that, in order to survive, need to be followed.  Not following the rules can lead to death and just as is the case with a car, the person or persons who die may not be the driver, but people the driver runs into. 

Nonetheless, as a parent, there comes a time when you have to let your kids leave the nest.  You pray you have taught them well.  You pray they follow the rules.  You suffer along with them if they don’t.

The government and scientist are the parents and we are the children.  It’s time to give us a set of rules, an education and then set us loose.  We are suffocating locked in at home.  We are starving.  The greatest nation on earth is going the way of Rome.  Open up our society and let us prove we can be responsible.  God help us if we can’t. 

!

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STAY THE COURSE?

I wish I knew what to do.  On the one hand, we need to turn the economy back on.  People need to work, get paid, put food on the table and take care of the bills.  The economic downturn is crippling.

On the other hand, If we go back to business as usual, I can almost guarantee you that Covid-19 will return. ICU admissions will increase as will deaths.  A paycheck does not help if you are dead or spend a month intubated in the ICU.

In a perfect world we would have an effective treatment and a vaccine.  We don’t live in a perfect world.  One of my patients says, “Stay safe, stay healthy and stay the course.” I’ve got to agree with him.  As much as I want to get out and see my friends and patients before I move to NC, I’m staying the course.  Of course, Renee and I are in the risk pool.  If I was younger and healthy, I’d be in the office taking care of you.

Those of us who are “staying the course” are starting to suffer from cabin fever.  My patient’s advice for cabin fever is “Keep busy, stay busy and be busy today.”  While that is excellent advice, it’s been a disaster for me.  I’ve kept busy shopping for food on the internet, I’ve stayed busy cooking it and putting it in the fridge and I’m busy today eating the food I bought and prepared yesterday.  At least I walked outside today.

One of my favorite lessons I used to teach my patients is that the 3 keys to health and happiness are:

  1. A good attitude
  2. A good attitude
  3. A good attitude

I’m staying the course.  I’m staying busy. I’m working on my attitude.  Writing these articles and reading your responses help me. I hope they help you. 

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I HATE SLEEPING PILLS

During my early years in practice, I freely prescribed sleeping pills.  The evidence available during the 80s and 90s looked great. Sleeping pills appeared highly effective and safe.  As the years passed, I started to see more and more problems with sleepers.  By 2010, I dreaded using sleepers.  Sleepers can cause drowsiness, lethargy, drugged feelings, depression, memory problems and a multitude of other problems.

During the last decade of my practice, I had large numbers of middle-aged patients who couldn’t sleep without their magic pills.  Despite my admonishments about the risk of sleepers and their addictive potential, patient persisted in requesting/demanding them.  In the last 3 years of my practice, I started getting my patients off of Ambien and other sleepers.

Unfortunately, I still have patients who insist they need Ambien.  I talked to one yesterday.  She’s retired and has trouble staying asleep.  I explained that I can’t stay asleep either.  My sleep cycle is screwy!  I go to bed at 10:30 and sleep until 3 am.  At 3 o’clock in the morning, I go to the computer and write.  I watch a little TV or listen to a book.  By 7 am, my eyes start to close and I nap until Renee comes down at 10:30. I nap again in the afternoon and after dinner.

Since surgery and retirement, the above pattern has become my new normal.  I have two choices.  Choice number one is to ask my doc to prescribe a sleeper.  If I start on a sleeper, I can “normalize” my sleep cycle but will be on a pill the rest of my life.

Choice number two is to accept my new sleep cycle and live with it.  I chose to live with it.  If I had to work at a 9 to 5 job, choice number 2 would not be good, but I don’t have a work schedule.  Anything I can do during the day can be done at night or during the very early morning hours.

After 40 years of practice, I advise that you accept your sleep cycle as normal for you and learn to live with it.  So, what do you do if you have a sleep abnormal sleep cycle and have a fixed schedule that does not work with your sleep cycle?  Meditation is your best bet and while we are all sheltering in place, it’s a good time to learn how to meditate.  

Dr Belle Ruth Naperstak has some excellent material used to teach you to meditate through the use of guided imagery available at Health Journeys.com.  The Center for Sleep Medicine, in Libertyville, has a great program for treating Insomnia through behavior modification.  They can also assess if sleep apnea plays a role in your sleep architecture.  There are several easy screening assessments you can use at home to help diagnose sleep apnea.  Please look under the “For Patient” tab for those screeners.

If you must take a pill, melatonin seems to be the least harmful.  Unfortunately, the nutraceutical market is full of questionable products.  If you can, look for melatonin made by Douglas Labs, Metagenics or OrthoMolecular.

If all else fails, see your MD.  Well, it’s time for my morning nap.  

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