Category: Uncategorized

Today marks the beginning of the Jewish New Year. New Year’s is a time of reflection; and, in the past, a time for taking inventory of my life.  Up until 2019, I was a practicing physician and taking inventory was a daunting task.  Since retirement and the devastation caused by of Parkinson’s Disease, my life’s inventory has shortened considerably.

Sleep, eat, nap, pee, and repeat are the activities that define my life nicely.  After years of giving weigh loss counseling to my patients, I’m a massive 250 pounds.  Having counseled the elderly on the risk of driving, I no longer drive (yet I still hassle Renee about it).  My wife is afraid to leave me alone for fearing an inevitable fall.  One thing I hit perfectly on the nose is my description of home health care: there are bad and worse agencies and aides with few exceptions.  I could go on forever but, so as not to depress my readers, I’ll quit here.

I have to be careful as when my writing gets too dark, it has a negative effect on my readers. Having completed my physical inventory, I’ve come to the conclusion that there is not much of me left.  So, where did I go wrong? I gave good solid advice to my patients.  One of my patients took my Wellthy Plan to heart and came in yearly with his inventories and game plan for the new year.  He did exceptionally well.  I, on the other hand, worked 24/7, ignoring my own advice and am paying for it now.

So, don’t do as I did!  Do as I advised in Diets and Other Unnatural Acts.  Yes, the book was a monumental failure with few exceptions.  The ideas and general advice are solid; unfortunately, it was too simple and therefore not taken seriously.  Exercise and diet may delay Parkinson’s significantly.  Taking time on a regular basis to enjoy life, family and friends is essential.  You never know what tomorrow holds, so don’t put happiness off until you reach your financial goals (or your childrens’).  As for spirituality in your life, believe me, the more you invest in it when you’re well, the easier it will be to fight off depression when you are sick.

Diets and Other Unnatural Acts is free on Kindle and still available in print at Amazon.

Here’s your joke for the day:

An elderly couple, who were both widowed, had been going out with each other for a long time. Urged on by their friends, they decided it was finally time to get married. Before the wedding, they went out to dinner and had a long conversation regarding how their marriage might work. They discussed finances, living arrangements, and so on.

Finally, the old gentleman decided it was time to broach the subject of their physical relationship.

“How do you feel about sex?” he asked, rather tentatively.

“I would like it infrequently,” she replied.

The old fellow sat quietly for a moment, leaned over towards her and whispered – “Is that one word, or two?”

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 appreciated the care they received. 

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 appreciate 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 cost 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 dog’s 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 insurers 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 stand in a line

The bank robber ask 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 lik…”

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

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

There is a time in everyone’s life when he/she has to give up driving.  Turning over your keys to a loved one is one of the most difficult tasks you’ll ever have to do.  My time has come and I no longer drive.   I promised my family that I wouldn’t be an asshole about it and I kept my promise.  Now I’m sorry I did.

As many of you know, I was looking forward to spending 2 weeks in the Chicago area in September.  I had arranged for a second driver to join Renee in our cross- country trek.  Unfortunately, my second driver is no longer able to make the trip and I’m cancelling my plans.

Eventually, Renee and I will make it to Chicago.  We’ll see old friends, eat at our favorite restaurants and re-live past glories.   I had plans to meet many of my patients and friends at the Score Board in LZ for lunch and to reminisce about the good old days.  In the meantime, if I delivered you or attended to you at the time of your birth, please drop me a note.  If you are not sure, ask your folks or look at the signature on your birth certificate.  If I live long enough, I’ll write a second book, “The General Practitioners, where did they go and why we need to find them.”

Today’s joke: The intern sees a duck, aims his rifle, leads the duck with his first shot, trails it with his next shot and hits with his third. He turns to the group and says, “It was too small for a condor, too big for a sparrow. I think that it was probably a duck.”

The radiologist sees a duck, aims a shotgun, hits the duck, and turns to the group. He states, “I just hit a flying animal. It may be a duck, pheasant, or quail. Possible flying squirrel. Cannot exclude a pterodactyl at this point. I think I should shoot it again, but with a scoped rifle next time.”

The emergency physician spots a duck flying above the marsh and aims a huge, automatic combat shotgun, unloading two full magazines into the air, as the other physicians take cover behind him. After the tremendous noise ceases, the intern uncovers his ears and shouts, “What the hell was that?” The emergency physician turns around and says, “I have no idea, but I’m pretty sure that I hit it.”

“Ready or not, here I come!”  I have vivid memories of playing Hide and Seek for hours every day.  It was a simple game, requiring nothing more than a player’s imagination.   Do children still play Hide and Seek?  Truthfully, I don’t know. 

What I know is that at 72 years old, I play Hide and Seek every minute of every day.  In my version of the game, my body hides its (previously taken for granted) skills from me and I have to find them.  For instance, tonight I had Italian Wedding Soup for dinner. The skill I needed to win was the one that allows my hand to get a spoonful of soup to my mouth without spilling it.  I lost tonight and currently I’m wearing half of my soup.

Every time I start any motor activity, I have to verify whether I can currently perform it safely or if Parkinson’s has hidden the skill necessary to perform the task. Over time, Parkinson’s has gotten better at hiding my essential skills, leaving me a long list of abilities I no longer have.

Frankly, I decided to quit the game and accept my losses.  I decided there would be no more trips to Mexico.  I cancelled my trip to Ireland.  I rarely went out.  I was miserable!  Then I remembered “Ready or not, here I come” and how much fun playing was. I decided I would never be ready again, but I would play, nonetheless.

I’ve put together monthly challenges. Having completed Challenge number one, 5 days in Atlanta, I’m on to Challenge number two, flying to Vancouver and boarding a cruise ship for a seven-day Alaskan cruise.  If all goes well with the cruise, then it’s on to Chicago; and, if I can find the skills necessary to enjoy driving to and spending time in Chicago, then Renee and I will return to Mexico in October.

We are never too old to play the game as long as we are willing to accept failure. So, “Ready or not, here I come.” I hope to see many of you in September!

It’s hard to believe that July 4^th has come and gone.  The 4^th has been my favorite holiday ever since we moved to Long Grove.  Our house was the first to be built on a large corn field.  The house sat on a raised parcel of land in the middle of the empty field with 360 degrees of unobstructed views.  Our first 4^th was magnificent.  Wherever you looked were the fireworks of surrounding villages. To our great surprise, there was a loud boom in our back yard followed by our own display.

Across the road from us, a country club was celebrating with a magnificent display of fireworks lighting up the sky. From that 4^th of July until the year we moved, the 4^th was the Segal’s time to party.  Eventually I built a pool, put in a basketball court, bags and volleyball and the 4^th became a 3-4 day party.

Fast forward to 7/4/2023 and Renee and I played Bridge with the neighbors.  We live in a 55+ community; and, as expected, the sky remained black with the occasional pop of firecrackers and bottle top rockets.  I often write about the “Used tos” and certainly celebrating the 4^th is a “Used to.”

So why am I writing about this?  Renee expected the 4^th to be a depressing day.  I did, too.  Surprisingly, it wasn’t!  Remembering the years of celebrations actually felt good.  Writing about the good old days no longer depresses me.  It’s time I live in the present and make peace with my disabilities.

I guess you could say I’ve declared Independence from Parkinson’s.  Parkinson’s will do what it will and I’ll adapt and enjoy what I can until I can’t.  Wish me luck in my new endeavor.

(As any of you know, Renee and I are planning to drive to Chicago in September.  It’s a long drive and we may not be up to it.  I’ll keep you informed as to when we will be there if my fantasy works out.  My plan is to lunch at the Scoreboard with my old friend, Joe, and hope to see many of you there.)

I’ll be 72 in a few weeks.  I wrote the following article on my 69^th birthday.  I thought it would be interesting to look back 3 years and see the effects of the Parkinsonian aging process.

In 2020 I wrote, “I’m 69 years old today.  I graduated from high school in 1969.  The 69 Camaro is my favorite car. Sixty-nine has always been my favorite number.  In previous articles, I’ve talked about the importance of keeping your inner child alive.  It used to be the mere mention of the number 69 that woke up my inner child.  Now, at 69, I’m not sure why that number was so magical.  My inner child died from CRS and/or the reality of aging.  Either way it sucks.  (Nice play on words).” 

At 72, the magic number, 69, makes me smile, and thinking about the 69 Camaro makes me a little sad (my wife drives me around in my used handicapped equipped van.)

As you know, I’m not happy with the aging process. As it turns out, 69 was a good year. Biking was short lived but still possible.   At 72, it’s impossible.  For the 50^thyear in a row, I started to eat better.  That lasted a week, then I reverted to my old fat-ladened diet.  Well, I got back on the wagon and I’m starting to eat better again. I’m down 6 pounds from my all-time high of massive!  I’ve found a job that works for me.  I’m in charge of napping and do so 5 times a day.  I still don’t have the credentials I need as a medical editor for the Sex magazine I talked about earlier.

North Carolina is hot!  Thank God Covid-19 is no longer driving me crazy.  I still want to sit in a restaurant and have a nice meal but getting the wheelchair/walker is hard on Renee.  I want to go swimming but the lift chair at our pool is broken.  I want to go fishing but getting onto the pier is going to be tough.  The reality is I’m stuck indoors most of the time.

Writing about this is like puking: you feel better after the foul stuff comes out.  Maybe I’m wrong.  Maybe 72 will be a better year.  Only time will tell.  It’s 9 am and I have the rest of today to find something to do. Actually, once you are retired, every day becomes the same.  One more piece of advice, don’t retire.  Stay active as long as you can.

Hopefully, a vaccine will be available by January and then we will be able to do more.  We’ll see!  Until then, I’ll just have to come up with something to do each day and so will you.  Renee, this is my 69 year!

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

Whatever you look like, marry a man your own age.  As your beauty fades, so will his eyesight.  Phyllis Diller

In researching for my articles, I often come across valuable sources of material on the internet. Quote Garden is one of those sources. I found many pages of quotes referencing diets. Some of the best are listed below with my thoughts about their significance. Once again, I’m working on losing weight.

“Your stomach shouldn’t be a waist basket” – Author unknown! Not long ago, I saw an overweight patient of mine in the drive-in window of a fast (fat) food establishment. He was putting fried junk into his belly.  He puts premium gas in his car. What’s wrong with this picture?

“Don’t dig your grave with your own knife and fork.” – English Proverb. Raucous Ralph, a character in my book and one of hundreds of patients I have seen over the years, did just that. Who do you love more, your spouse, your family, or your food?

“Inside some of us is a thin person fighting to get out, but they can usually be sedated with a few pieces of chocolate cake.” – Author unknown. Many people use food as a drug/medication. Do you? If you are depressed, see your doc, not the local baker. If your marriage is bad, see a marriage counselor. Don’t have a closet affair with Godiva!

“A diet is a penalty we pay for exceeding the feed limit.” – Author unknown. Yes, diets are penalties; and yes, we pay BIG! It’s time to stop dieting and, instead, learn who you are and what you need to do to get healthy. If you’re healthy, stop fretting over your figure and enjoy life. If you are not healthy, work at getting healthy the right way. Diets and Other Unnatural Acts will help you.

“People are so worried about what they eat between Christmas and New Years but they really should be worried about what they eat between New Years and Christmas.” – Author unknown. I’ll end on this note! A healthy lifestyle has room for holiday treats but no room for holiday cheats!

I’m going to try something new. When I arrived home every evening after a day’s work, I would ask my father-in-law how he was and his answer was always the same.  “It was a good day, I’m alive, aren’t I!”  It never dawned on me that he could have felt miserable or bored or both, or that he could have bitched or responded to the question as I do.  He came from a different generation, lived a different life and had different expectations of retirement than I have.

I find myself wondering whether his attitude actually made him feel better or whether it just made everyone around him feel better while he hid how badly he really felt. In retrospect, either outcome would be welcomed.  So, when asked how my day was, rather than going into my usual truthful complaints, I’m going to say, “It was a good day, I’m alive, aren’t I.”  I’ll let you know if it works (or, perhaps, you’ll let me know.)

You may be asking yourself why I’ve decided to change.  The main reason is I’m making everyone around me miserable. Maybe my father-in-was was onto something.  Maybe if the people around him were less miserable, he would be less miserable as well.  Afterall, every time he responded, “I’m alive, aren’t I?” I smiled and ignored the fact that he might be achy, bored, etc.  He was a bright man who cared for the people around him, never lost his sense of humor and overall enriched our lives.

BY the way.  I think I’ve found my old friend, Will Power. I have written about Will many times. He’s apparently has been hanging out in Chicago and contacted me when I started contemplating visiting Chicago. Visiting Chicago is going to be a daunting trip, 3 days driving there and 3 days back will be hard enough but we’ll be in a hotel for 2 weeks, no lift chair and, at best, so-so handicapped bathrooms.  In my current condition, visiting Chicago would be impossible.  With Renee and my old buddy, Will Power, at our side and an “I’m alive, aren’t I” attitude, maybe I can make it happen.

“Will,” your first assignment is to guard the refrigerator and pantry and keep me out!

Here is today’s joke:

Willpower can make you rich..

..if you get in the right person’s will.

I published the article below 3 years ago.  Covid has now done its damage and is now settling in for the long haul.  Looking back at this article, I realize that 69 was a very good year, as opposed to what I thought then.  Now that I’m seventy-one, it sucks!  In my case, aging is synonymous with rotting.  I’m making the best of it but rotting takes its toll.  The number 69 still makes me smile! Sixty-nine has come and gone.  Seventy-two is right around the corner. I can’t wait to see what it is like!

In the interim between 69 and now, I bought and sold my dream car and now have a handicapped equipped van. It’s pretty cool.  I can drive my wheelchair up the ramp and park it where the passenger seat used to be.   Road trips are now limited to 5 hours a day and the vast majority are to see the various docs I am currently seeing.  I’m still fighting with my weight.  My weight is winning.  The harder I work at losing weight, the heavier I get!  I’ll keep working on it. I suspect that my neighbor (on plant-based diet and doing well) is dumping his weight on my side of the fence.  I step in it and it sticks to me!

I’m exercising again, walking 200 steps a day (from the refrigerator to my chair) and opening and closing the doors. “AI” (artificial intelligence) is coming.  Actually, it’s here in my kitchen.  The LG quick view window lights up as I approach.  My fridge is glad to see me.  The quick view door weighs less so I can get food with minimal effort.  “Hey, Stew, I’ve got goodies for you.  Eat me!”  And I do.  While it’s not as good as 69, it certainly is filling.  See what I’m up against.

Three years ago, my perspective was a tad differen.  Below is the origninal article:

I’m 69 years old today.  I graduated from high school in 1969.  The 69 Camaro is my favorite car. Sixty-nine has always been my favorite number.  In previous articles, I’ve talked about the importance of keeping your inner child alive.  It used to be the mere mention of the number 69 that woke up my inner child.  Now, at 69, I’m not sure why that number was so magical.  My inner child died from CRS and/or the reality of aging.  Either way it sucks.  (Nice play on words).

As you know, I’m not happy with the aging process.  I fear my 69^th year is going to blow (there I go again).   Renee and I are committed to biking daily. I’m starting to eat better although I’m not convinced it will make a difference.  My job search is not going well.  I’m overqualified for most and don’t have the credentials I need as a medical editor for the Sex magazine I talked about earlier. I stopped at the question, “Tell us about your experience.”  There was no way I was answering that other than to state that I was 69.  For a second, I thought that query had resuscitated my inner youth, then it fizzled.

North Carolina is hot!  Covid-19 is driving me crazy.  I want to sit in a restaurant and have a nice meal.  I want to have the neighbors over for a drink and appetizers. I want to go swimming.  I want to go fishing.  The reality is I’m stuck indoors like you and the rest of the world.

Writing about this is like puking; you feel better after the foul stuff comes out.  Maybe I’m wrong.  Maybe 69 will be a good year.  Only time will tell.  It’s 9 am and I have the rest of today to find something to do. Actually, once you are retired, every day becomes the same. 

Hopefully, a vaccine will be available by January and then we will be able to do more.  We’ll see!  Until then, I’ll just have to come up with something to do each day and so will you.  Renee, this is my 69 year!

Here’s your joke:

Whatever you look like, marry a man your own age.  As your beauty fades, so will his eyesight.  Phyllis Diller

I guess three years can make a difference.  Some things stay the same; some things improve; and some things get better or don’t.  Covid now is manageable; it is still hot in North Carolina; and I’m still sharing my experience with you.

Does your doctor ask you random, seemingly ridiculous questions?  Mine does!  Let’s say I’m seeing my doc for an infected toe. The nurse asks:

Nurse: How long has your toe been infected?  Have you been feverish? In the past 2 weeks, have you felt worthless?

Ok, what’s going on?  Toe infections usually don’t cause feelings of worthlessness!

So, why ask that question?  If you are on Medicare, you’re worth a lot of money that is hidden beneath the surface.  Doctors’ offices have learned to mine for that money.  If your staff is savvy, then they will fill out multiple check lists on every visit.  In turn, the billing department will apply the proper codes and collect from Medicare for the codes applicable.

When I was in the final years of practice, Medicare instituted the Annual Wellness Visit for which they reimbursed $140 dollars. In my 35 years of practice, I never had a code I could bill that much for.  What was even more amazing was the fact that the visit was all checklists.  No actual physical exam was required. It was no wonder that many specialists started billing for it also.  Heck, the pharmacies advertised free physical exams causing many patients to use this benefit in the pharmacy, diminishing its value. They also requested regular screening for depression and other illnesses for which they would pay even more money.

The AWV actually has merit, paying your doc to organize your chart, keep problem lists up-to-date, and do a medical review of your care and immunizations.  So, when in the middle of an office visit for a foot injury the nurse asks me about depression, I realize that she is panning for gold and am glad to answer her seemingly inappropriate questions.

Here’s your joke:

They say that during sex you burn off as many calories as running eight miles. Who the hell runs eight miles in 30 seconds?