YOUR ADVOCATE

I had a lot of fun earlier this week. A neighbor, who was having trouble understanding her surgeon’s explanation of the causes of her symptoms and her options, asked me to accompany her to her visit.  I felt like a racehorse (I’m almost as big as one), who was sent onto the track for one more race before being put out to pasture.  I know what it feels like to be put out to pasture and I don’t like it.

Back to my story, the surgeon was 45 minutes late, as expected.  As a physician, you can either answer your patient’s questions and be late, or you can cut the visit short and be on time.  I always preferred to be late and take care of each patient’s needs while they were in my office.  Obviously, I didn’t complain about waiting.

The surgeon was an older gentleman, probably in his 60s.  He reviewed his findings and all available options.  He was thorough but used a great deal of medical terms and abbreviations.  I understood what he said and what existed “between the lines.”  My friend got the gist of the conversation but missed some of the finer points.  I particularly like when he used the term, “phlegman.”

According to Wikipedia, “A phlegmon is a localized area of acute inflammation of the soft tissues. It is a descriptive term which may be used for inflammation related to a bacterial infection or non-infectious causes. Most commonly, it is used in contradistinction to a “walled-off” pus-filled collection, although a phlegmon may progress to an abscess if untreated. A phlegmon can localize anywhere in the body. The Latin term phlegmōn is from the ancient Greek”.  The word Phlegmon just sounds so exotic and descriptive that only very bright people use it.

Back to the story again, the surgeon hedged his bet discussing the current indications for treatment versus the old protocols for surgery.  I sat silent as I listened to this master surgeon cover all options while giving his patient a complete informed consent and leaving the ultimate opinion in the patient’s hands.

Later, I reviewed what I heard the surgeon say and explained his approach from a physician’s point of view.  I believe the surgeon would have preferred to do surgery despite current guidelines which advised a wait and see approach. 

The surgeon scores a 4 out of 5.  He would have been a 5 of 5 had he used more common/lay words and less abbreviations.  My bet is that he is a 5 of 5 in the operating room (OR).  GOD, forbid, I need a GI surgeon, I’d be happy to have this surgeon care for me.

The lesson for patients is to take an extra set of ears (patient advocate) with you when you are seeing a doc.  Your advocate’s job is to listen intently and then be prepared to discuss what he/she heard while in the exam room.  You’ll be surprised at how much difference exists between what you heard and what your advocate heard.

Here is your joke for today:

A man goes to visit the doctor.

Man: Did the test results come back?

Doc: Yes, and the prognosis isn’t good.

Man: Well, how long do I have?

Doc: About 10.

Man: 10 what? Years? Months?

Doc: 8… 7….

FREE WILL

First, I am not a biblical scholar.  That being said, I wonder if we are entering the “end times.”  If you don’t believe that climate changes are caused by man’s rape of the earth or you believe that Covid really is the government’s attempt to control us, stop reading here. 

In the last few days, I’ve watched a movie in which a Rabbi discusses the negative affects of climate change and man’s role in causing climate change, I’ve listened to another Rabbi discuss the same topic and the urgency of the situation, and I’ve marveled at the fact that despite having an effective vaccine against Covid, 50 percent of the US population have yet to be vaccinated.

Personally, I believe in the concept of free will.  I have to!  Afterall, if everything is preordained, then nothing we do matters, and it looks like we are fucked.  So, assume we have “free will.”  That means we can choose to combat Covid and climate change or we can choose to ignore it.  Right?

Let me tell you why I think we are entering “end times.”  I’ve been expecting a pandemic for years.  Pandemics are cyclical and we’ve been overdue for one.  I also expected that Covid, like other viruses, would mutate and that the war against Covid would be lengthy and hard fought with lots of casualties.  I did not expect that we would have a vaccine in a timely manner.  I also did not expect a significant mutation would occur so quickly.

Here’s where free will enters the game.  The best way to delay or prevent more significant mutations in the virus is to refuse to harbor and nurture the virus.  That means that we need to immunize everyone ASAP and continue to work on new and novel ways to make vaccines.  Unfortunately, a significant percentage of our population have exercised their free wills and decided not to immunize themselves or their families.

If you think Delta is nasty, wait until Delta gives birth to another mutant with an even greater ability to kill humans.  If we wait long enough, our expression of free will may well lead to an untreatable viral enemy that makes Noah’s flood look like child’s play.  Sure, there may be future, unforeseen consequences of the vaccine; but there are unforeseen consequences to everything we consume or do.  The consequences of not taking the vaccine are real and include death. If you die, that’s your choice; but if you turn into a killer and give Covid to a friend who dies from it, that’s unforgiveable.   Remember, your freedom ends at the tip of my nose.

Regrettably, I think climate change is a done deal.  We may be able to rescue our planet but it’s going to take years.

Here’s today’s joke:

The real reason not to do anything against climate change:

Just think how dumb we’d look in front of our children, if twenty years from now we discover climate change was in fact not real. We’d have cleaned the ocean and the cities, preserved the rain forests and millions of species, innovated in multiple industries, made the air breathable again, created a more sustainable lifestyle for the decades to come and a better world for our children, completely for nothing. I’m pretty sure we’d all doom the fool that made us do all that.

MY HERO

Yesterday, my sister-in-law, Martha, and my niece, Alli, posted updates on Facebook, reviewing the progress my brother has made since having a stroke 2 years ago.  Alan has worked hard at recovering the use of his left hand and leg and his continued improvement is miraculous.

Alan is no stranger to work.  He worked out in the gym for most of his life.  As a matter of fact, I can’t remember a time when he didn’t go to the gym.  Martha credits the docs for saving his life and aiding in his recovery.  The years Alan invested in building his body and preparing it for combat have been the foundation upon which his progress continues beyond the original projected prognosis.

I also credit his spirit/attitude.  Unlike me, Alan has refused to give in to depression.  He focuses on what he can do as opposed to what he can’t do.  His sense of humor has flourished.  I look forward to his Australian weather reports and our daily conversations during which he works at lifting my spirits.

My big brother is my hero!  Every time I find myself falling into the pity pit, I think about Alan and what he has accomplished and then I crawl out of the pity pit and count my blessings.  In response to a recent article, Lisa reminded me of how lucky I was to have my family walk me into the ocean and swim with me.  She was surprised that I had not made mention of that.

I have been a swimmer my entire life.  While on land I’m a klutz; in the water, I was always graceful.  Having to have my son, son-in-law, brother-in-law and daughter walk me into the water reminded me of how severe my losses have been.  It should have reminded me of how lucky I am to have a loving, supportive family.

Yep, Alan is my hero and I’ll keep working at being more like him.  It’s the Jewish New Year and I want to wish all of you a happy and healthy year full of love and joy.

Here’s your joke for the day:

What is a New Year’s resolution?  It’s something that goes in one year and out the other.

POLITICS

I had a great afternoon yesterday.  My Rock Steady group had a pizza party celebrating a successful fund-raising campaign.  We are all about the same age and all of us are either dealing with Parkinson’s or the spouses of someone dealing with it.

As usual, when you get a bunch of Medicare patients together, the conversation eventually turns to Covid and vaccines.  Naturally, everyone has a different opinion and quote different sources.  There are few things that everyone agrees on. 

First, everyone agrees that the authorities are constantly sending out mixed messages.  Early in the pandemic, it was easy to understand why the messaging was so confusing.  Covid represented a new disease; and, as in a boxing match, we received a blow by blow description of who was winning the fight (Covid vs. humanity).  As expected, there was a sharp learning curve leading to humanity taking a lead late in the first round.

Unlike prior fights between humanity and viral infections, Covid found itself with a new champion in its corner and its new champions have proven to be more powerful than its ability to mutate and adapt to its environment.  So, who are these champions of Covid that are keeping it firmly in the fight?  Believe it or not, the new champions of Covid are the Democrats and Republicans we elected a few short years ago.

Yes, Covid has become politicized and rather than the CDC, WHO and local health authorities deciding on the best defense against Covid, The Democrats and Republicans have taken opposite sides and fed confusing messages to the public, stifling our ability to fight this enemy.  Compounding the matter even further, the internet has weighed in, mixing facta and physicians into a noxious slurry that too many people have swallowed.

On a daily basis, I receive lots of questions about Covid, vaccines and treatment options.  They are from former patients, and all appear to have consumed the noxious slurry mentioned above.  Many are scared, not knowing what to do.

Until we settle on one set of medical facts and one unified plan to fight Covid, I fear it will continue to plaque us, or worse, end our rein on earth.  In my lifetime, I’ve seen the eradication of Polio, Chickenpox, Measles, Mumps, Tetanus, Diphtheria, Whooping Cough and many others.  We succeeded because we had a unified approach to vaccinations and treatment approaches.  I am not surprised that we need a Covid booster.  None of the vaccines I’ve used over the last 40 years were one and done.  All came with rare risks and all hurt someone.  However, the greater good was accomplished by vaccinating those at risk.  The greater good this time won’t be accomplished until we get politics out of medicine!

Here’s your joke for the day:

A very old man was sitting on his porch when he notices a small boy walking past. “Whatcha got there, sonny?” asks the old man. “Cat wire,” replies the youngster. “Gonna catch me some cats!” The old man starts laughing hysterically.

But sure enough, 3 hours later, the boy walks past the old man’s place with a sack full of cats.

Two days later the old man sees the boy again.

“Whatcha carrying there, boy?” he asks.

“Duct tape. Gonna catch me some ducks!” replies the youngster.

Well, the old man laughs even harder, so hard, he falls out of his chair.

But again, a few hours later, the boy walks past the old man’s house with a sack full of ducks.

Three more days pass and the old man is keeping an eye out for the boy. He finally appears.

“Now what are you carrying?” the old timer inquires.

“Pussy willow,” says the boy. “I’ll get my coat!” the old man snaps bac

PLACEBOS

You’re not as smart as you think you are — and neither is your doctor,” by Claire Unis,MD and published on KevinMD is a must read.  Just click on the hyperlink above.

Here’s today’s joke:

A very successful attorney parked his brand-new Bentley in front of his office, ready to show it off to his colleagues. As he was getting out, a truck came along too closely and completely tore off the driver’s door.

Fortunately, a cop in a police car was close enough to see the accident and pulled up behind the Bentley with his lights flashing.

Before the cop had a chance to ask any questions, the attorney started screaming hysterically about how his Bentley, which he had just purchased the day before, was completely ruined and would never be the same, no matter how any car body shop tried to make it new again.

After the lawyer finally wound down from his rant, the cop shook his head in disbelief. “I can’t believe how materialistic you lawyers are,” he said. “You are so focused on your possessions that you neglect the most important things in life.”

“How can you say such a thing?” asked the lawyer

The cop replied, “Don’t you even realize that your left arm is missing? It was severed when the truck hit you!”

“OH, MY GOD!!!”screamed the lawyer.

“My Rolex!”


UP AND DOWN

Up, down, up, down and on and on. Life appears to be a series of ups and downs and when it stops nobody knows. Ups and downs can be good.  At the heart of everything, ups and downs represent the rhythm of love and leads to procreating in a most enjoyable way.

On the other end of our existence, ups and downs are bad being the rhythm of depression and sadness.  August was a particularly rocky month and a good example of the ups and downs.

My August “Ups” list goes as follows:

August starts with road trip in my convertible.  My first stop is Richmond to see Abe and Linda.  Seeing them is always uplifting. 

From Richmond, we travel to northern Virginia for a Bat Mitzvah and family celebration of life.

Next comes Norfolk and my 90 plus year old uncles, my sister-in-law, and other lifelong friends and cousins.

Returning home is usually in the “Ups” category but this time leads to the “Downs.”

My weight is down14 pounds.  That’s a good down!

My August downs not-so-good list goes like this:

My father died in August.  I try to celebrate his life; but, instead, I’m living it.  Parkinson’s is no party!

I came to the conclusion that I’m not physically comfortable anywhere other than home. Yep, I need my lift chair, zero threshold shower, bars and, of course, my bidet.

While visiting my sister-in-law, Renee and I discovered that she is dying and in horrible pain.

Even though Renee and I are driving in a convertible, the top was up.  It was too hot to put the top down!

My car was rear-ended and no longer drivable.

Shortly after returning home, my sister-in-law died and we returned to Norfolk for a funeral.

My uncle tried to serve us cookies and fell flat on his face, breaking his nose.

I regained 6 pounds eating comfort food.

Yep, life is full of “ups and downs”.  It’s what you do with them that counts. I write and talk about them. Life is like riding a roller coaster; once you are in motion, you must ride it to the end.  You might as well enjoy the ride rather than fretting about what’s around the bend or at the bottom of the next hill. RIP, Chrissie.

Here are a couple of jokes:

I went on a roller coaster and the woman next to me would not stop screaming.

Seriously, it was like she had never seen a penis before.

A man was sitting on the edge of the bed, observing his wife, looking at herself in the mirror. Since her birthday was not far off, he asked what she’d like to have for her birthday.

“I’d like to be six again”, she replied, still looking in the mirror.

On the morning of her birthday, he arose early, made her a nice big bowl of Lucky Charms, and then took her to Six Flags theme park. What a day! He put her on every ride in the park – the Death Slide, Wall of Fear, Screaming Monster Roller Coaster – everything there was.

Five hours later they staggered out of the theme park. Her head was reeling and her stomach felt upside down. He then took her to a McDonald’s where he ordered her a Happy Meal with extra fries and a chocolate shake.

Then it was off to a movie, popcorn, a soda pop, and her favorite candy, M&M’s. What a fabulous adventure! Finally, she wobbled home with her husband and collapsed into bed exhausted.

He leaned over his wife with a big smile and lovingly asked, “Well, Dear, what was it like being six again??”

Her eyes slowly opened and her expression changed, “I meant my dress size, you dumbass!”

PATIENT FIRST!

I went with Renee to the physiatrist today to discuss what we are going to do with Renee’s neck.  Renee and I are competing for the “Who Has the Worse Neck Award.” You might say we are neck and neck coming into the home stretch.  The physiatrist said something that is worth repeating:

“There are two types of docs.  There is the doc that treats the patient with a problem and the doc who treats a problem with a patient attached.” While it may sound like a simple play on words, it is a significant play on words.

Back in the dark ages, when I went to medical school, we were taught to take care of the whole patient.  The doctor-patient relationship was sacred and practicing medicine was a calling.  Unfortunately, everything changed with the onset of the computer age.  The focus shifted to problem management and checking as many boxes as possible became the goal.  The doctor was demoted to the status of provider and the patient was demoted to the person who delivered the problem to the computer.

The story is sad but true. During my tenure as physician, I worked long hours caring for people.  Today’s provider works long hours poring over computer algorithms, assuring that the proper boxes have been checked and coding is completed.  By the way, the doc Renee saw today used two novel tools, paper and pen, to record her history and findings. Rather than looking at the monitor while he talked, he actually looked at us and talked to us.  Being cared for as a human was a pleasurable experience.

I feel sorry for Dr W. as I’m sure he’ll spend his night inputting his notes into NextGen.  Boy, I miss the good old days. I’ve now been on hold for 15 minutes.  I’ve been on the phone for 1 hour and twenty-four minutes with Verizon trying to correct a bill I received after terminating my service.  They claim that, once their compute generates a bill, nothing can be done to correct it.  They want me to pay $81 for zero service or else . . .  The computer, even when wrong, has to be fed. 

What next?

Here’re your jokes of the day:

Verizon made a new minimum-security prison; and, despite what many would believe, it’s very successful. It’s got no bars but you still can’t get out of it for 2 years.

What does Verizon wireless and abortion clinics have in common?  They both have early termination fees.

For more Verizon jokes go to: https://jokojokes.com/verizon-jokes.html

CHRONIC PAIN, END OF LIFE

This August has been quite a month.  Two weeks ago, Renee and I drove to northern Virginia to celebrate my niece’s daughter’s Bat Mitzvah.  On the way there, we stopped in Richmond to see old friends.  On the way back, we stopped in Norfolk to see my 95- and 98-year-old uncles and my sister -in-law.  My sister-in-law did not look good and I suspected that her death was imminent. She was miserable, living with chronic, unrelenting pain. I hate when I’m right!  I also hate to see anyone suffer like Chrissy was suffering.

Shortly after returning to our home in North Carolina, we received the call.  Chrissy had died soon after being admitted to hospice.  So, we packed up our loaner car (mine is in the body shop since Renee was rear-ended) and headed back to Virginia Beach.

So, why was Chrissy suffering with intractable pain?  The diagnosis of intractable pain is easy.  Finding the cause is not so easy.  There are many causes of pain.  Unfortunately, if there is no apparent cause, doctors and family members are quick to assume that the pain is either not real or that the person suffering with the pain is just being dramatic. 

Doctors often take a cynical approach to pain patients, having dealt with drug seekers throughout their careers.  Personally, despite the fact that I had seen a large number of drug seekers throughout my career, I always chose to believe my patients and treat their pain until either the drug seeker slipped up and revealed themselves or I found the underlying cause of the pain.  First, let me explain, psychological pain is just as real as physical pain.  That being said, if you pay careful attention to your patient, the drug seeker will always have a tell.

Patient “X” is a 45-year-old male supposedly hurt on his job.  He walks painfully and slowly to the exam room.  He has pain on all movements of his body, especially worse on taking off his shoes, socks and pants.  Every place I touch him and every time I move his legs and back, he winces in pain.  His reflexes are exaggerated.  I validate his pain and ask him to dress.  I watch as I write my note.  He dresses swiftly without any signs of pain.  He sits with ease and waits for his prescription.  When I tell him to take Tylenol and schedule a plain x-ray of his back, he gets angry and leaves.  I follow him to the front and watch him slide into the driver’s seat of his Camaro.

He is the fourth back pain that week. I look for and find the chalk mark on the front of my office.  While I found four drug seekers, I missed one.  The one I missed marked the wall with chalk alerting his/her friends to the fact that I prescribed a potent pain pill for his/her bogus pain.  Yep, they literally “marked” me if I let one slip through my defenses.

In addition to the curse of drug seekers who fake injury to get narcotics, there is currently a government driven war on docs who prescribed pain pills.  The poor patient with real pain suffers as docs are threatened by their government and challenged by fakers.  Most docs I know refer patients with chronic pain to pain specialist who are often inundated with referrals and take months to get seen.

So, what do you do when you are at the end of your rope, the pain is truly debilitating, and life is slipping away?  One of the tools I used was hospice.  Patients and docs alike often believe that hospice is only for patients dying from cancer and that death is imminent.  I found that hospice was available to anyone with a terminal diagnosis and who was expected to die within 6 months of starting hospice.  Hospice helps make patients comfortable and improves quality of life by offering services not routinely covered by Medicare.  I have had patients on hospice for as long as 2 years. 

Here’s your joke for the day:

A married couple is lying in bed.

The wife leans over and says, “I want you to say dirty things before we start”. So, the man starts to caress her neck and whispers to her, “Living room, Bathroom, Kitchen”.

FALL

With the help of my gardener guru, I planted my fall garden yesterday with mixed emotions.  On the one hand, sewing seeds for fall and winter vegetables signals the end of summer.  Summer has always been my favorite season, allowing me to bask in the sun and swim.  This past summer was highlighted by driving with the top down from doctor’s office to doctor’s office and going to my Rock Steady classes.  Believe it or not, most days it was too hot to swim.

On the other hand, planting a fall/winter garden is a new and exciting experience as it signals the coming of a mild southern winter.  While I loved living in Long Grove, I hated the grey sky of the Midwest fall and the arrival of winter snow.  This winter, I’ll have plenty of sunlight and no snow.  I expect to drive, top down, year-round.

I’m working on maintaining an “attitude of gratitude” despite the fact that I hate retirement.  Yes, I enjoy gardening and driving with the top down, but those activities only take a fraction of the time I have daily.  While seeing my docs takes up a significant amount of time, it is depressing. 

As a practicing doc, I never realized how depressing retirement could be.  I never realized how long a day could be.  I also never realized how hard following my advice could be.  I envisioned retirement as a glorious time when you could do whatever you wanted.  I never envisioned retiring to chronic illness where the only thing I really want to do is walk normally.

Yes, I’m depressed.  I can’t put the top down and go for a ride.  Someone forgot to break and smashed the back of my car.  Renee was driving and she has a mild whiplash.  Hopefully, Renee and the car will return to their pre-accident conditions soon.  While I have resisted taking more pills, I may need an anti-depressant for a while.

Getting my emotions onto paper has been my best therapy in the past, so I expect that I’ll return to daily publications for a while. I’ll work hard on being upbeat and am sure I’ll find my way out of my current state. 

Here’s the joke for today:

I was sitting on my own in a restaurant when I saw a beautiful woman at another table. I sent her a bottle of the most expensive wine on the menu. She sent me a note: “I will not touch a drop of this wine unless you can assure me that you have seven inches in your pants.” So, I wrote back: “Give me the wine. As gorgeous as you are, I’m not cutting off three inches for anyone.”

SEVEN KEYS

My neighbor threw a block party last night and it was great.  Renee and I really lucked out when we moved here.  As we left to go home, one of our hosts, Barbara Peters, offered us copies of her new books.  I started reading “He Said, She Said” this morning; and, while I hate reading, I am enjoying her book.

Barbara’s book is all about relationships and the “seven keys to relationship success”.  Chapter One is about communications; and, as expected, the author is an expert at communicating her ideas in a simple to understand format. If the rest of the book is as good as Chapter One, this book will be a must read.

In Chapter One, the author quotes an unknown source:

“Watch your thoughts, for they become words.

Watch your words, for they become actions.

Watch your actions, for they become habits.

Watch your habits, for they become character.

Watch your character, for it becomes your destiny.”

If these five statements were the only wisdom derived from this book by its reader, the reader would walk away enriched and buying the book would have been well worth the cost. So, I’m going to ignore the rest of the book’s contents for now and focus on the above five lines.

In my day, thoughts became words and words took time to travel.  Because there was a significant time lapse between the formation of words from thoughts and the subsequent dissemination of those words, the action caused by those words took longer to occur. Words could be rethought and deleted or changed, and actions could be tempered or stopped.

In today’s world, thoughts become words which lead to action in the blink of an eye. They travel along the internet at warp speed, perpetuating themselves into habits and forming one’s internet character and, I dare say, destiny.  

When I was in school, there was this theoretical “permanent record” in which everything you did was recorded.  Your permanent record could make or break you.  It was like Santa’s list of who was naughty or nice.  It, like Santa, was not real.

Unfortunately, fiction often becomes reality; and the internet has become your permanent record and realistically can determine your destiny.  It is imperative that we teach our children and grandchildren to watch their thoughts carefully so that, if they become words, they are righteous words, words that they can be proud of. In 2021, words published on the internet are eternal and may lead to harmful, unforeseen actions later in life.

One last thought. In olden times, people judged your character based on your interactions with them.  In 2021, people who don’t know you, have never met you and probably will never interact with you on a personal basis will judge your character based solely on your internet presence.  Like your words, your internet character will be irrefutable, carved in stone.

So, today’s lesson is to carefully watch your thoughts, validate them and then share them in person with those you trust before they turn to words or actions. 

Today’s joke follows:

If I ever win the lottery, I’ll give some of the money to charity.

And, if she isn’t dancing that night, I’ll give some to Destiny.