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You can take a southerner out of the south, but you can’t take the south out of the southerner!  I just spent four days in Charlotte visiting with my children and all of my bad southern habits blossomed.

I’m not sure if I would still be alive had I stayed in the south.  Day One started with a seafood Po Boy.  For those of you who haven’t had the pleasure of eating a Po Boy, it’s fried oysters, fried crawfish, fried shrimp and fried sausage, all on a bun slathered in Cajun mayo.  In other words, it’s a heart attack on a bun.  Did I mention that it’s served with fried hush puppies and collards?  

That was one of the healthiest of meals. Dinner on Night One was Southern Fried Chicken doused in peppered honey and more collards followed by chocolate cream pie.

I won’t bore you with the rest of the details.  Suffice it to say that I slid downhill from there into a vat of grease and collards (cooked in bacon fat).  In a previous article, I asked, “Why does bad food have to taste so good?”   I’m still looking for the answer.  After an unbelievably great trip, I have a new question.  Why didn’t I become a cardiologist and practice in Charlotte?  I bet business is good and I would be rich!

Renee, where’s my Crestor and when are we going back?

Ever hear someone describe herself as pre-pregnant? Of course not! You are either pregnant or you are not! When I trained forty years ago, I was taught that the physiologic changes of diabetes started ten years prior to the clinical diagnosis of diabetes. Despite all the advances in our understanding of diabetes in the last forty years, very little has changed.

According to Medpage Today, the incidence of diabetes continues to rise. “An estimated 25.8 million Americans, or 8.3% of the population, have diabetes and almost a third don’t know it, the CDC said.” That is a staggering figure. “Another 79 million people have pre-diabetes, with high fasting glucose or hemoglobin A1c levels but not quite at the frank diabetes level.”

In the midst of an epidemic of diabetes, the medical world continues to be politically correct and it tells patients that they have a precondition entity and they have time to do something. It is my belief that understating the magnitude of the problems associated with diabetes is one of the driving forces behind the rise in the incidence of diabetes.

From my point of view, pre-diabetes is as absurd a diagnosis as is pre-pregnant. So why do physicians soft sell the diagnosis of diabetes? In my opinion, there are several answers:

1. There are insurance implications involved in making any diagnosis. Pre-diabetes does not carry additional risk of being rated by the insurance industry.
2. There is a stigma associated with the diagnosis of diabetes.
3. Diagnosing diabetes means having to teach about diabetes, blood sugar monitoring, medications, diet and lifestyle modification. Education takes time and is rarely paid for by insurance companies.
4. Patients do not want to hear that they have diabetes.

So, what’s the big deal? Knowledge is power! If you know you have diabetes and you know what you need to do to treat diabetes, then you have the power to reverse or control the disease. When you have a “sort of diagnosis” that requires you to change your lifestyle to prevent a disease you don’t really have and may never get, you “sort of” address it and will get around to it in time. Meanwhile, the physiologic changes of diabetes continue to erode your health.

On a daily basis, Docs see and diagnosis some of the 79 million patients who have pre-diabetes, hyperglycemia, elevated blood sugar, abnormal glucose metabolism and other names ascribed over time to this condition. Someone once said, “The devil comes in many disguises.” Undiagnosed diabetes is the devil; and the sooner you recognize the devil, the easier it is to get him out of your life.

The next time your doctor tells you your blood sugar or hemoglobin A1c is slightly elevated, think early diabetes. Regardless of what your doctor calls it, take it seriously. A diabetic diet and diabetic lifestyle are a healthy diet and lifestyle. If we all adopted the diabetic lifestyle, the numbers of patients diagnosed would fall precipitously. It is not as simple as “cutting out sugar”. Sugar is not bad. Nature does not produce “bad” foods; there are just foods that are abused and misused.

In 2013, I wrote, “The problem is that I can’t quit!  Not caring for my patients would be like not breathing!  I’m a doc and I’m old school.  I believe my profession is a calling, not a business to be run by corporate America or the government.  I can’t imagine not taking care of Nolan, or JJ, or Hadley, or 1,000 other souls I am entrusted with.”

Six years later and I’m retired, not by choice, but out of necessity. Nine months into retirement and I still can’t breathe. I wake up every morning wanting to dress and go to the office.  Instead, I go to my computer and write.

This blog is my way of communicating with my patients old and new (readers). It’s also helping me breathe.  In reviewing my old articles, I have a rare opportunity.  I get the benefit of listening to a younger me lecturing the old me on how to live with Parkinsons and recover and maintain as much “Wellth” as possible.

Unfortunately, my blog is poorly organized, making it next to impossible for a new reader to see what’s available.  There are 121 articles published so far.  While they contain 40 years of accumulated knowledge, you have to scroll through a lot of material to find what you are looking for.  If any of you know WordPress and want to pitch in, let me know.  In the meantime, please make sure you are sending links to your friends and family.

I know there are people out there whose lives can be improved by reading my articles and sharing in my legacy. My hope is that, long after I’m gone, people will find answers and solace in my articles.

Baird Brightman, PhD’s article published December 23, 2019 really hits home.  I’ve been trying to deal with the loss of my practice and the systematic destruction of medicine as a whole.  Dr. Brightman’s insightful article has helped me understand what I am dealing with.  By clicking on the title of this article, you will be transported to Dr Brightman’s article.

In the past, I wrote about “AI” and its new place in the medical world.  For those of you that missed the article, “AI” is Artificial Intelligence. For years, doctors have warned the public, government and insurers about an impending shortage of primary care physicians.  That shortage has arrived!  On a daily basis, I hear from patients who can’t find a new doc.

I now believe that the shortage plaguing my patients was no accident.  Many of my colleagues and I spent the last 15 years fighting the insurers, PBMs and government on behalf of our patients.  We did not enjoy the fight.  We did not profit from fighting.  We had a sacred responsibility to care for our patients and put their needs above all else.  That relationship has killed the practice of medicine.

We, as a once powerful group, cost the insurers, PBMs and government a lot of money as we jumped through hoops getting approval for testing, medications and necessary procedures for our patients.  Slowly but surely, our power diminished.  We were demoted from physician to providers.  We were forced to accept treatment guidelines as law.  We were accused by the media and government of “fraud and abuse” which supposedly runs into the hundreds of millions of dollars.  The latest assault on physicians, as a whole, has to do with the “opioid crisis.”  Is it any wonder that people no longer want to go into primary care?

In a recent article on the net, a physician pointed out that, in the future, nurse practitioners (NP) will be referred to as “advanced practice providers.”  Physicians will still be referred to as “providers.”  Doesn’t it sound like an “advanced practice provider” has more training and experience than a lowly “provider”?  

I have trained nurse practitioners and physician assistants for years. I have been impressed with their capabilities and dedication, but they are not physicians.  Their training falls far short of your physician’s training. In the beginning, their licensure required that they be supervised by an M.D.  Those requirements are vanishing.

A recent article noted that 60 physicians employed by a local hospital conglomerate were fired and replaced by NPs.  Why?  The answer is simple.  NPs cost less than MDs!  Are you wondering what my point is? 

“AI” is cheaper than physicians, NPs, and PAs.  “AI” will not form a sacred relationship with patients.  “AI,” at least for a while, will obey the rules. It will not argue over a denial of services.  Google will become your provider and the younger generations will be happy to accept Googles advice[rS1] .

I’m actually scared!  Our upcoming move to North Carolina means that Renee and I need to find new docs.  That’s not going to be easy.  We are on Medicare which pays poorly.  I am sick, requiring multiple referrals which will mean extra hassles and expense for any doc who takes care of me.  I’m on multiple meds further complicating matters.  I also want a physician who will be caring, attentive (listen to me), and available when I need him/her.  My patients are telling me that such a person no longer exists.

If I’m scared despite all my knowledge and experience, I can’t imagine what you are going through!  Again, I’m sorry I had to leave you when I did.

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 [rS1]

In a previous article, “Your Doctor, The Master Chef, I compared the treatment process to the making of a gourmet recipe. I teach by using analogies and “The Chef” is one of my favorites. CSI is another of my favorites.  A large part of being a Doc is teaching.  Over the years, I’ve found that the use of analogies as a teaching technique helps my patients understand what they need to learn by presenting the information in a format that conforms to their life experience.  Thus, a foodie will relate to a master chef, a car buff will relate to an analogy of a mechanic and a fan of night police stories to a CSI.

There are three basic parts to your visit to the doc. Part one is the “listening,” where facts are gathered and pertinent history is recorded.  Step two is the “touch” stage, where you are examined. The exam may include physical, chemical, electrical and radiological probing of your physical being. Step three is the “cooking” stage, where your recipe for health is concocted and begun.

As a CSI (Crime Scene Investigator), most docs will combine steps one and two, collecting evidence from the minute they walk into the room. Not long ago, patient “X” saw me for “anxiety.” She was worried that something was wrong; she just couldn’t explain what she felt was wrong. We talked for 15 minutes, followed by a brief review of her vital signs and a very cursory exam. As I started into part three, formulating a treatment plan, Mrs. “X” quipped, “Aren’t you going to examine me.  You haven’t even listened to my lungs and heart!”

Mrs. “X” is not the first patient to complain about not having a stethoscope placed on their chests. Most patients are oblivious to the techniques of an expert CSI tech. I explained to Mrs. “X” that I had actually begun my exam before she had even gotten into the exam room. To illustrate my point, let me digress.

I was walking out of my office as the nurse was weighing Mrs. “X” on the hall scale. Mrs. “X”, a woman in her 30s, stepped easily on the scale and looked away as the nurse weighed her. While she is relatively thin, she was uncomfortable with her weight. I greeted her and she returned the greeting less than enthusiastically. Mrs. “X” is usually gregarious and warm. Again, she appeared uncomfortable.

On entering the exam room, Mrs. “X” appeared nervous, agitated and somewhat aloof, all very unusual for Mrs. “X”.  I asked how her family was, she said “fine”.  She avoided eye contact. Her complaints were vague, and she seemed to be worried about a problem in her genitourinary track. She had seen her gynecologist twice in the past two weeks and reported that both exams were “thorough and normal.” She complained of being anxious but appeared nervous and somewhat defensive. When I checked her pulse, her skin was moist. She was sweating. Her pulse was minimally elevated. I checked her neck for an enlarged thyroid, finding a normal gland.

As I started to tell her what I wanted to do, she erupted in anger that I had not adequately examined her. I had made the mistake of not putting my stethoscope on her chest. I was going to order some labs, order a mild anti-anxiety medication, and set her up for a follow-up visit. I didn’t need to do a more thorough exam today; my preliminary exam had revealed many clues and I was pretty sure I knew what was going on. I’ve been a CSI tech for 30 years — I’ve seen this before.

Mrs. “X” pressed for an answer, again atypical behavior for this patient. I asked her my favorite question, “What do you think is wrong? Is there anything else I should know?” Mrs. “X” came back at me with the usual, “I’m not a doc, what’s wrong with me? I’m not crazy! Tell me what’s wrong!”

When pressed for an answer, I always go over the differential diagnosis in my head and then share it with my patient. 

1. Anxiety Disorder — possible 
2. Thyroid Malfunction — unlikely 
3. Occult Infection — unlikely 
4. Guilt — very likely 
5. Other

Gently, I say “Mrs. ‘X’, I agree you are not crazy. I don’t think this is anxiety or thyroid disease. If I had to make a guess today, I’d guess you were having an affair. Am I right?” The last clue I needed to know I had correctly read the signs were the tears. Mrs. “X” won’t feel better for a while. Step three, the recipe for health is on the cooker. Not bad for never having put a stethoscope on her chest!

Your doc, like the CSI techs on TV, starts collecting clues (examining you) the minute they greet you. There are all kinds of exams, all kinds of tests. What’s important is discovering which villain is attacking you so a treatment plan can be made, and balance restored. 

The next time you think, “But he didn’t even examine me,” think again!

All patients are fictitious. They represent many patient interactions over the last 34 years.

We all know those dreaded four letter words that, as children, we dared not say on penalty of having our mouths washed out with soap. Today, I diagnosed a friend with a viral upper respiratory tract infection. Upon hearing the word “viral,” my wife remarked, “viral has one letter more than a four-letter word yet it’s just as nasty.”

My family always hated it when I pronounced that the cause of their illness was viral. It was not uncommon to hear my wife say, “I don’t care if it’s viral, I want an antibiotic!” My family is no different than the rest of the world. When they are sick, they want pills.

I hate viral infections. It takes me three minutes to prescribe an antibiotic; and, in the eyes of my patient, I am a hero. It takes me ten minutes to explain why I’m not giving my patients an antibiotic, and they walk out angry! Antibiotics do not kill viruses.

“Dr. Segal didn’t even listen to me. He spent 30 seconds in the room, told me I had a virus, and sent me home to die from this horrible sore throat!” The patient did not hear anything I said after “antibiotics won’t help.” I wish I had a prescription placebo!

I have written multiple articles explaining how docs make diagnoses and treat illness. Unfortunately, most people are too busy making a living to take the time to read about healthcare.

When you are infected (sick), you need to know two things:

1. Where is the infection? 

•  What organism is causing the infection?

In the real estate business, it’s location, location, location! It’s the same in illness. When your doc uses words like pharyngitis (infection in throat), bronchitis (bronchi), gastritis (stomach), and pneumonia (lungs), he is defining the location where the illness resides. Think of infection as a crime. Location tells you how potentially serious the crime may be. (Generally, infections in the throat are less threatening than infections in the lungs.)

My brother has been in law enforcement for many years. His job often entailed identifying which criminal(s) perpetrated the crime. He had thousands of potential suspects. I have it relatively easy. My criminals fall into three classes: viral, bacterial, and fungal. Fungal infections are relatively rare so my job boils down to differentiating between bacterial and viral perpetrators. Bacteria respond to antibiotics; viruses do not! Your body has to kill viruses. (Your body can kill bacteria, as well; but antibiotics can help.)

After 30 years as a doc, I can tell you that deciding between viral and bacterial causes of infection is often difficult. I would like nothing more than to prescribe a harmless antibiotic to every patient who comes to see me with an infection. The problem is that I don’t have a harmless antibiotic.

Antibiotics come with risks. Antibiotics can cause allergic reactions, nausea, diarrhea (sometimes potentially life threatening), yeast infections, and something docs worry about called bacterial resistance. Treating patients always involve a risk-benefit ratio. Treating a virus with an antibiotic has no benefit, leaving only risks. 

So, to my patients and family I’d like to say, “I’m sorry you have a virus! The good news is you should be better in a week or two. The bad news is that antibiotics can’t help you.” Eat well, rest when you can, and drink plenty of fluids. See your doc if you get worse as he/she could be wrong about the diagnosis or you might develop a secondary infection.

Yes, “virus” is worse than a four-letter word. Unfortunately, it’s a word we can’t avoid!

Do you love your perfume/cologne/after shave?  It smells great, doesn’t it?  While your favorite perfume/cologne/aftershave smells fantastic to you, it may not smell good to someone else.  Your pleasure may be someone else’s poison!

Yes, I have patients who are allergic to your indulgence.  They see me on a regular basis to refill their antihistamine, nasal steroids and leucotriene blocking agents.  Without their medications, they are in trouble.

I have other patients who suffer from migraine headaches.  Sometimes aromatics, such as perfumes, colognes and aftershave lotions trigger their migraines.  They come in to see me on a regular basis to get their pain pills and controllers.

Are you coughing?  Is your nose running?  The other day I saw a patient who was complaining of a horrible cough, runny nose and irritated eye.  I started coughing as soon as I approached her.  Her perfume irritated my airway.  If you are sick, putting on perfume, cologne or other aromatic products may be adding to your misery and you may not know it!

Your docs’ office should be a safe zone for patients who are allergic to or have other reasons to avoid inhaled irritants. Please take that into consideration before you come to see me or your doc and abstain from wearing anything that others can smell.My patients and I thank you for your consideration

My patients often question whether stress is the cause of whatever is ailing them.  Stress has been linked to many diseases and certainly is a factor underlying most of what ails us.  The only problem with stress is that it is unstoppable.  Of all the successful men and women I see over my lifetime, not a single one has successfully avoided stress.

Since stress is unavoidable, then proper stress management is the key to a happier and healthier lifestyle.  There are thousands of books written on stress management.  There are college level courses, seminars and stress management coaches available to help you.  Drs Wright and Lapporte are psychologistS who worked out of my office. They can teach you how to better manage your stress.  It would be great if stress management was taught in elementary and high school but, for some strange reason, it isn’t.

In keeping with my theme of investing in your health the same way you invest in your financial wealth, I want you to think about your emotional health as if it, too, existed in a retirement fund.  My patients have long term emotional goals (dreams).    “One day” we’ll get a cabin in Wisconsin; travel to Europe; get a boat; sky dive, but today we need to work to save money.  We need to save money so “one day” we can be happy, stress free.

The problem with the one-day scenario is that we really don’t know how many days we, or our significant others, have.  I have lots of patients who have only regrets as their “one day” came one day too late.  I advise my patients to set 90-day mental health goals.  Every 90 days you should take a three-day weekend and do something you’ve always wanted to do.  Whether you take three days to yourself or spend them with loved ones, make sure they are memorable.  If you follow the 90-day rule, then you are never more than 90 days away from a break.  The 30 days prior to your three-day weekend, you can get excited about the time off.  The 30 days after the weekend you can glory over what you did.  The middle 30 days you can plan your next escape.

The 90 day rule is one of my stress management techniques.  It fills my life with lots of good memories.  It helps me stay healthy.  Try it, I think you’ll like it so much that you may even decide to take four or more days at a time.  Americans live to work.  Europeans work to live.  Live now while you are healthy.  Be wellthy with memories and your stress level will diminish.

I’m glad to report that I’m back from “Failure,” and I’m working hard on losing my holiday weight addition and enjoying the “Wellthy” life.  I hope you’ll appreciate this article, first published last January, 2018.

Winter Break brings vacations, Christmas and New Year.  As usual, many of my patients have returned from their vacations and resumed their usual routines.  Some of my patients are having trouble getting back into their routine.

Where did you go on vacation?   A few of my patients went to Australia.  People who travel to Australia have such a great time that they don’t want to come back.  Another favorite destination is “Failure.”  Yes, too many of my patients take a vacation from healthy living during Winter Break.   They eat the wrong things, stop exercising, and, in general, over-indulge in excess. (Yes, that’s a redundancy.)

Like those who travel to Australia, those individuals who travel to “Failure” have a lot of trouble returning to their routine, healthy lives.  While living in “Failure” may be enticing, ultimately there is a price to be paid.  Sometimes that price is a financial one and sometimes it is a physical one.

While visiting “Failure,” my patients gain weight.  With weight gain, many will experience increases in their blood pressure, cholesterol, and blood sugars.  Some will experience back problems.  Others will notice that they get short of breath going up stairs.

The longer you stay in “Failure,” the costlier it gets.  As your blood pressure rises, you’ll need more medication.  Vacation in “Failure” long enough and you may even get a bonus stay in the Intensive Care Unit at your local hospital.  “Failure” must be a marvelous resort.   People whose vacation unexpectedly takes them to “Failure” have lots of trouble returning to normal life.

Well, Winter Break is over and no matter how much you enjoyed vacation; it’s time to get back to work.  If you are wallowing in “Failure,” find your willpower and work on losing that extra weight, eating appropriately and exercising.  Work on lowering your blood pressure/sugar/cholesterol.  Work on refining yourself and becoming truly Wellthy.

If you are having trouble returning to a healthy lifestyle, see your doc, join a gym, or read a book.  “Diets and Other Unnatural Acts” is highly recommended.  Search through this blog for success stories and read them.  Then work at writing your own success story.  I’ll be glad to publish it!

Doc, last week, I thought I was having a stroke.  My vision went from wavy to black then came back slowly.  I just thought I would mention it while I’m here.”

“Doc, last Sunday I had severe chest pain.  I thought I was having a heart attack.  It lasted 2 hours and then went away.  I’ve been achy and have not felt right since.”

“Doc, for the last few months I’ve noticed blood in my stool.  Sometimes it turns the water red.  Should I be worried?”

I hear some form of the above statements on a regular basis and I am always amazed that my patients respond to such potentially life-threatening symptoms in so nonchalant a manner.  While they obviously survived to tell their story, many don’t.

Unfortunately, people die at home while pondering the question, “Am I having a stroke, heart attack or gastrointestinal bleed.”  Their loved ones find them slumped over the kitchen table or lying on the floor.  Others are found in time, only to end up in a nursing home or as a cardiac cripple.  It’s the sad truth.

There is a golden period in which to salvage heart and brain from the ravages of stroke and heart attack, a time to stop the bleeding before you exsanguinate.  Why do people wait at home, pondering such an important question?  Sometimes, it’s simply denial.  “I exercise every day.  It can’t be my heart!  No one in my family has ever had a heart attack.”  Sometimes patients tell me, “I didn’t call because I didn’t want to bother you,” or “I felt foolish.  I was just being a nervous ninny.”  There are dozens of excuses for not acting on their concerns.

“I figured I would wait a while and see what happened,” is my favorite.  I want to respond with, “That’s a great idea!  Wait to see if you can lose your ability to speak, start dropping things or simply die with extreme chest pain.”  Yes, waiting to see what happens is a gamble.  It’s like rolling the dice.  Sooner or later, you crap out!

By the way, if you are alone and think you are having a heart attack, stroke, or start to hemorrhage, dial 911 while you can.  If you wait too long, dialing the phone may become an impossibility.  What have you got to lose?  Afraid you’ll look foolish by calling 911 when it’s really nothing?  Don’t be!  Be happy you are alive!

By the way, in my experience, 7 out of 10 times your intuition is accurate.  If you think you could be in trouble, you are!  As I always like to say, the life you save may be your own.  Be happy and “Wellthy!”