Fatigue

September 18, 2019

I’m tired.  I’m tired of hurting.  I’m tired of not being able to do what I want.  I’m tired of taking pills.  I’m tired of fighting and losing the weight battle.  I’m tired of using CPAP.  I’m just tired!

Monday and Tuesday were relatively good days.  I at least had enough energy to go out with Renee, do a little shopping, do a few menial things around the house. Yesterday, I was napping on my daughter’s couch by 2:30 pm.  Yesterday was my granddaughter’s second birthday party.  I was at the party, but I really wasn’t.  As per usual, Renee asked me if everything was OK. She stated, “You’re awfully quiet.”

When I’m out of energy or my legs won’t work, I get quiet.  There really is nothing to say other than, “It is what it is, so just move on.”  It’s hard to move on when those around you tell you how good you look.  I know they are trying to cheer me up or they are blind.  IF they are trying to cheer me up, then be honest.   I look like shit!  If they are blind, get some glasses.

I wonder how many of my patients over the years have felt the same way but not had a way of expressing/venting it.  I wrote an article years ago about fatigue.  I stated that fatigue was my most hated diagnosis because EVERYTHING causes fatigue.

Now I know what fatigue really is!  It is still my most hated diagnosis, but now I hate it because it insinuates itself into every phase of life.  It is relentless and self-perpetuating.  It’s primary treatment, exercise, is thwarted by the fatigue itself.  It’s aftermath, in my case; obesity, leads to more fatigue.  It’s an unhealthy spiral that is hard to stop.

The “retrospectrascope” is a very precise device. You’re always much smarter when you look back in time.  Looking back now, knowing what I now know, I could have done a better job with those of you who are chronically fatiguesdand tired.

“High Jack.  You look like shit.  How do you feel?  Yeah, I know, I look like shit, too.  Yeah, I’m tired.  I worked out this morning.  Did you? Yeah, I hated it, but I have to break the downward spiral of fatigue or it will break me.  My diet is getting better slowly, yours?”

Medical education really starts once you are in practice. That’s why they call it the “Practice of Medicine.”  As for me, my education is continuing despite the fact that my practice has ended. Hopefully, I’ll find a way to make my new found knowledge useful to those I have cared for over the years and those who find this blog.November 29, 2011

An article from November 2011 for you and me:

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 seven pages of quotes referencing diets.  Some of the best are listed below with my thoughts about their significance.

“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!

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The Real Medical Education

September 17, 2019

Before you can practice medicine, you must complete 4 years of undergraduate work, 4 years of medical school and 3-5 years of residency.  Upon successful completion of your prescribed training program, you are a highly trained and, hopefully, skilled DOCTOR OF MEDICINE.

You are ready to setup practice and see patients. You are ready to diagnose and treat a vast array of illnesses.  You have read the most up-to-date journals and practice evidence-based medicine. Really?

While you may think your education has prepared for life and death decisions, it has not.  Realistically, once you start seeing patients, your real training begins. You’ve been taught by a system to prepare you for the routine, everyday patient with textbook perfect complaints and treatments.  

In simple everyday terms, you have been trained to put square pegs in square holes and round pegs in round holes and you’ve gotten quite proficient at your task.  Then, one day, you’re given triangular pegs.  What do you do?

Having practiced medicine close to 40 years, I can attest to the fact that all patients are different and many cannot be successfully diagnosed and treated using the most up-to-date rule books. What do you do?  My answer is easy.  You customize your treatment protocols to fit the individual patient’s needs and wishes. Sometimes, it takes months or even years to find the right treatment regimen for your patient.  Sometimes, if you listen closely to what your patient tells you (and you choose to believe your patient) deciding what to do is a slam dunk!

Why am I writing about this today?  My patients are actively searching for new docs as I am no longer in practice.  Some of the new docs will review the patient’s history, his old charts and his treatment regimen and, despite the fact that the treatment does not stand up to present day standards, will choose to continue it because it works!  It has safely worked for 20 years and survived the test of time.

Other docs will choose to stand by the latest treatment protocols, decide that Dr Segal did not know what he was doing, and change the patient’s treatment plan simply because they don’t understand how it was developed.  Reading 20 years of chart notes just isn’t possible.  For the physician, it’s easier to simply start from scratch.  For the patient, it is not so simple.  Sometimes, it’s like squeezing a square peg into a round hole.

What can you do to make the transition of care easier on you and your new physician?

The solution may be as simple as making a phone call.  While I no longer have access to your chart, I can answer many of your new physician’s questions if he/she will call me.  My number is 847-846-2131and I will be happy to help in your transition of care to a new doc.  Feel free to share this post with your new physician as well.

The solution may not be simple.  It may take several attempts to find a new physician who fits your need.  Trust your gut.  If you don’t feel comfortable with your new physician, move on.

I am truly sorry that I’m no longer here to take care of your needs.  I want to thank all of you for your calls, cards and prayers.

The following article was published on April 27, 2011 and is even more pertinent today then it was then.

No, I haven’t lost it.  Today’s article is all about fitting a round peg into a square whole.  My profession is changing.  “Payers,” those entities that have taken on the responsibility for paying for and ultimately providing healthcare for my patients, want statistics.  They collect data on every visit, every medication ordered and filled, every test ordered and done (or not done).  If you are afraid of what Google and Apple are doing with your geographic data, you should be more afraid of “payers.”  The government, in the guise of Medicare, is the worst.

Protocols, for medical care, are being actively built and implemented on a daily basis.  When the President says that the electronic exchange of medical information will save money, he means it.  Information (data) is being harvested from every patient encounter.  That information is used to create evidence on what the least costly and, therefore, most effective treatment protocols are.  I am forced to follow these protocols every day.

Today, my patient needed a stat CT scan of her lungs to assure she did not have a pulmonary embolism.  Her insurer’s protocol required prior authorization (article 4/15/11) for this potentially lifesaving test.  Failure to follow her insurer’s protocol would result in thousands of out-of-pocket dollars expense to my patient.  Delay in care could result in her life.  What to do? 

Protocols don’t take into effect an individual’s needs; they make an individual fit within the protocol’s needs.  Protocols are in the best interest of the “payer”, not the provider and his patient.  In “Normal,” published 2/28/11, I wrote that I had never met a “normal” or “average” patient.  I see individuals and they come in all sizes and shapes.  Protocols are devised to care for that fictitious, average, normal individual.

In “Are We There Yet?” (4/14/11), I wrote about a fictitious New York city in the year 2020.  There, everyone lived by protocol, from what they ate to when they died, protocol controlled everything.  We aren’t there yet, but I think we are on our way.  Certainly, from a medical point of view, we are being pushed to sacrifice the personal aspects of care for the sake of cost control.

How do you fit a square peg in a round hole?  Try using a hammer, chisel or saw.  I’m afraid that the new world of medicine is going to be uncomfortable for most patients and downright painful for many.

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How much is too much?

September 12, 2019

As I write this article, I realize I’m about to get in trouble.  My editor, also known as my wife, is going to rake me over the coals.  “How much is too much” is a question often answered in retrospect.

Let me give you an example.  My wife is upstairs with my 2-year-old granddaughter who is pitching a fit. My daughter is in her office a few doors down from my wife, working. I’m in the kitchen looking out at my pool which needs vacuuming.  I’m actually feeling pretty good.  My motor skills are as close to normal as they get.

After a careful risk assessment, I decide to do a little work vacuuming the pool.  All is well until it isn’t.  I’m working in a relatively tight area in the low end, surrounded by chairs and rafts when my motor skills fail me.  I go into an “off” cycle and freeze.  Off periods last a variable amount of time and can freak me out.

I’ve learned all kind of triggers to break out of an off episode.  They all fail.  Usually, I just wait them out.  Today, my diuretic kicks in and I have to pee!  Wetting myself on top of being busted for being stupid is out of the question. I force myself and move at the risk of falling into the pool.  Success! I cleared all the obstacles, broke out of the “off” period and made it to the bathroom.

How much is too much?  I’m learning.  The problem that I have is that there is a fine line between too much and too little.  If I restrain from doing things like vacuuming the pool, then I end up sitting in a lift chair all day, playing video games.

I’ll vacuum later when Renee can be outside with me. I’ve learned my lesson for today.

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The Cost of Medication

September 10, 2019

I went to the pharmacy yesterday.  What a horrible experience.  I take all sorts of medications on a four times a day schedule.  I have 12 pills a day designed to treat my Parkinson’s. Then, I have a water pill, a potassium pill to treat the side effect of the water pill, aspirin for arthritis, and two pills to treat the side effects of the aspirin.  Then, there are three more pills designed to assist my aging prostate and Vitamin D, as I am deficient in D.  Now, add in an as needed Tramadol for back pain not controlled with aspirin and taking and arranging to take my pills becomes a part time job. 

Yes, I hate taking all those pills.  Unfortunately, I haven’t been able to eliminate any; and I’m a good patient, taking what my Doc prescribes.  I also hate going to the pharmacy.  

Despite having an Insurance card, a Good Rx Card and a Kroger’s card, my costs are exorbitant. I literally will spend thousands of dollars every year on medication.  My choices are lousy!  

My Parkinson’s meds are the most expensive.  Without them, I’m non-functional.  I can’t buy them at a discount online as online pharmacies can’t be trusted (see article below).  Luckily, I can afford the expense, but it surely will cut a deep furrow through my retirement funds.

What do people who can’t afford it do?  Go bankrupt? (I just read an article about the University of Virginia Hospital system driving patients into bankruptcy over unpaid medical bills.). Most roll the dice and buy online.  

In the past, I have recommended that my patients take a vacation to Canada or Mexico and meet the pharmacist.  I now recognize the problem with my advice.  Traveling abroad is difficult when you are sick, as well as being yet another expense on an already tight budget.

I guess the best thing to do is eat lunch and dinner at Costco. For one buck and a half, you get a giant kosher dog and drink.  On the front end, you save a lot of money.  Of course, the side effects of obesity and high cholesterol will need to be addressed.  You guessed it:  more meds.

September 30, 2012

I’ve been sitting by the phone all morning expecting it to ring.  I’ve been expecting a lot of calls from apologetic patients now that the news about online pharmacies selling bogus medications has hit the airways.  Nobody has called, no apologies have been offered.

Over the past five years, I have warned my patients about the risk of online pharmacies thousands of time.  I have wasted valuable time trying to educate my patients about the risks of counterfeit medications and false promises.  I have been mostly ignored.

Mr. C – “Doc, I get my Viagra from Canada.  I order it online.  My friend has been doing it for years and has never had a problem,” is the common retort I get!  Patients order all sorts of medicines online.  Women are the worst.  They should know better.

“Mrs. B, is that a real “Marc Jacob” purse (sells for $600)?”  

Mrs. B – “No, I got it in Florida for $30 and you can’t tell the difference in it and an original.  DO you want me to pick one up for your wife?”  

Yes, women buy knock-off purses, jeans, and shoes.  Men buy knock-offs, as well.  A $25 dollar knock off of a $5,000 watch tells time.  While everyone is aware knock-offs in the apparel and electronic world, no one believes that they might actually be receiving knock-off pharmaceuticals.

Finally, the FDA has stepped up to the plate and tackled the impending disaster Internet pharmacies represent.  It’s in the news in a big way.  Not only is the FDA warning about knock-offs being expired medications or not containing any medication in the capsule you are sold, they are warning that some of the pills contain poisons (arsenic and rat poison was mentioned in the Daily Herald’s article) and other contaminates.

The FDA now has a website dedicated to helping you find safe and legal pharmacies.  Yes, you will need a prescription from a licensed doctor.  Yes, your prescription should be purchased from a licensed US pharmacy.  And yes, if the price is too good to be true, it’s not true.

I’m still waiting to hear from those of you who doubted and ignored me.  By the way, Mr. C and his friend may yet have problems from taking their bogus medications.  The effects of contaminates and poisons can take years to manifest themselves.

One more word of warning comes from the Daily Herald article today.  “Besides likely getting fake drugs, that includes the risk that they will infect your computer with viruses, will sell your personal and financial information to other rogue websites and Internet scammers, or charge you for products you never ordered or received.”  Infect with virus are three words a doc never wants to hear and that patients should strive to avoid.

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Questions

Questions?

Questions?  I have a lot of them.  I woke up at 4 am, again.  Why can’t I sleep past 4?  I don’t know. My doc has me on a machine for sleep apnea.  Yes, I’ve added sleep apnea to a litany of other problems.  

I think CRS may be the worst of my ailments. Most of my friends have CRS.  Just in case you don’t recognize the name, it stands for “Can’t Remember Shit.”  Yesterday, Renee and I totally blew off some very important people due to our CRS and an assortment of other problems.  No excuses! If you read this, I’m sorry!

If exercise is the fountain of youth, why do I hate doing it?  Why did my brother have a stroke?  He rarely ever missed a day in the gym.  Obviously, my brother’s stroke is foremost on my mind.  Don’t get me wrong.  As a doc, I highly recommend a regular regimen of exercise and healthy eating. Of course, there are those, like my best friend Robert, who believe that humans have a fixed number of heart beats in a lifetime and that when they run out, they die.  Robert thinks its foolhardy to waste heart beats in a gym.

Hallelujah!  Last night on the news, they announced that napping decreases your risk of heart attack and stroke.  Finally, a beneficial side effect from the mass of pills I take.  I am the napping king!  Of course, this may be the notorious fake news we’ve heard so much about.

I really don’t like being a patient.  There are too many docs to see.  Too many pills to take.  Too many side effects.  Too many tests.  Too much money spent.  Oh G-d, I have discovered a new ailment, the “Toos.”  Luckily, I have CRS and will have forgotten all of the above by noon.

One last question.  Is anybody reading this blog?  If you are, let me know.  If you’re not, its ok.  As a retired doc, I highly recommend finding something meaningful to do with all the empty hours you spend waiting to see your next doc or take your next set of pills.

Here’s an interesting view from 2011.

October 24, 2011

Sometimes I amaze myself.  Apparently, there is now a name for what I have been doing for the past year: “Patient Engagement/Activation.”  KevinMd recently published “Physicians should embrace patient engagement” by Dr Ken Bottles (http://www.kevinmd.com/blog/2011/10/physicians-embrace-patient-engagement.html).  

This blog has been my way of engaging/activating patients.  Knowledge is power and providing my patients with the knowledge they need to become active participants in their healthcare has been my goal.  

In Dr. Bottles’ article Jessie Gruman, a cancer survivor is quoted as saying, “As a savvy and confident patient who is flummoxed by so much of what takes place in health care, I am regularly surprised by how little you know about how little we patients know. You are immersed in the health culture. But we don’t live in your world. So we have no idea what you are talking about much of the time. One way to help us feel competent in such unfamiliar environments is to give us some guidance about what this place is and how it works. What are the rules?”

In August, I published, “I Am A Responsible Patient.” (https://livewellthy.org/2011/08/31/i-am-a-responsible-patient.aspx)  The article outlined “the rules” for my patients, as well as for any of my readers who were interested in taking an active role in their health.  I have published multiple articles over the last year designed to help patients “feel competent in such unfamiliar environments is to give us some guidance about what this place is and how it works.” (Bottles)

According to Dr. Bottles’ article, “The ten categories of the Engagement Behavior Framework are:

  1. Find safe, decent care
  2. Communicate with health care professionals
  3. Organize health care
  4. Pay for health care
  5. Make good treatment decisions
  6. Participate in treatment
  7. Promote health
  8. Get preventive health care
  9. Plan for the end of life
  10. Seek healthcare knowledge.

I agree with each of these 10 principles.  It is critical that, as physicians, we engage and activate our patients.  The article goes on to report, “Recently Klick Pharma invited 19 health care activists from a wide variety of disease states to participate in a conversation about an ePatient Bill of Rights that would support patient engagement and activation. After four hours of conversation, this group reached consensus on the following key messages of such a bill of rights:

  1. Shared access to my data
  2. Attitude of collaboration and overall respect
  3. The patient is the largest stakeholder
  4. Transparency and authenticity across all areas
  5. Voice of the patient is a legitimate (clinical) source
  6. The right to efficient communication with providers who utilize the technology we need”

I think the key remark in this entire conversation is number three, “The patient is the largest stakeholder.”  The patient is the largest stakeholder, the one with the most to win or lose.  In this ever-changing world, it is incumbent on the patient to take an ever growing and active role in his/her health.  

Investing the time and effort in “self” is critical.  “Seeking healthcare knowledge” (Bottoms) is time consuming and difficult but well worth the investment. Getting “preventative health care” (Bottoms) is important but practicing “preventative health care” (Bottom) is more important (Segal).  

What is missing from Dr. Bottles’ article is the importance and key role of the concept of “continuity of care.”  Communicating with your healthcare provider and forming a longstanding, health care team is essential in optimizing your health.  Long term patient-physician relationships promote trust and trust is the critical factor that allows for “safe, decent care.” (Bottoms)

Dr. Bottles’ article goes on to state, “Experts in patient activation/engagement suggest that hospitals and medical practices provide each patient with a short guide that explains how best to be a patient in that unique setting.”

A “short guide” on “how best to be a patient in that unique setting” does not exist.  There are now 326 articles on this blog and more to come.  Each article hopefully will enable you to be the best patient you can be.

If only there was a “short guide” to being the best doc you can be!

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Don’t Delay the Happiness

September 9, 2019

As a family doc, I am acutely aware of the stages of life each of us eventually go through.  I counsel young sleep deprived parents of a colicky baby.  I reassure the parents of teens pointing out that their irresponsible child will go to college, go to work and become a success.  I help 50-year olds survive their mid-life crisis.  I also work with the elderly helping them through an assortment of losses and eventually death.

Knowing what’s coming really doesn’t help. I really expected that I would skip this stage of life. Instead, I become more like my father every day.  My dad started life as an optimist and ended life as the world’s greatest pessimist. I think Parkinson’s and the unavoidable, degrading losses of motor function does that to you.  At least I haven’t started reading the obituaries yet.  He started his day looking at who died.  Of course, the internet and Facebook bring that info to your desktop in real time.

Yes, I’m in the “Golden Years.”  I’ll share a little secret with you.  They are golden years because you need gold reserves to pay for your medications, nursing home and funeral.  Are you depressed yet?  Are you ready to exit my blog and do something else?  Read on.  I promise it will be worth it!

Here’s my gift.  I’ve often told my patients that the devil exists, and his greatest accomplishment is the concept of tomorrow.  By giving us tomorrow to worry about, save and plan for, the devil ruins today.  Today is the only thing we really have.  Don’t waste it.

They say, “No one knows what the future holds.”  I do. For most of my patients, it holds regrets.  Most of my patients put off happiness and work their lives away so that “one day” they will be secure and realize their dreams.  Don’t wait for “one day!”  It may not come.

I am amazed at how bright I was in 2011.  It’s as if I could predict the future and left myself notes in the form of my blog to help guide me through rough times.  Below is an article published August 26, 2011.

Last night, I watched “The Big C”, a TV show about a woman diagnosed with an advanced stage of melanoma, a nasty skin cancer.  The show follows Cathy, the main character, through the various stages of dealing with a life-threatening disease.  The show is funny and sad, uplifting and depressing.  Living with and dying from cancer is often a rollercoaster ride.

In last night’s episode, Cathy, while counseling a friend, remarked, “Don’t delay the happiness!”  Too often, we delay the happiness while dealing with today’s stressors and tasks.  We promise to get together with friends and family.  We promise to call mom and dad.  We plan to run away from it all and be selfish.  We will do it all, one day.

Sometimes, there are no more “one days.”  I have seen patients die for no reason.  One day they are here, the next day they are forever gone.  “Don’t delay the happiness” is sagely advice.  One thing is for sure: today is your day to find happiness.  Today is a good day to make that call, see that friend, and make definitive plans for your runaway vacation.

Yes, you have to work, to make a living, and provide for yourself and your family.  Yes, you are a responsible individual who others rely on.  Yes, you have a list of problems a mile long.  You also have time to count your blessings and you need to make time to do something nice for you and your special ones.  Recently, I wrote about regrets.  Don’t set yourself up for regrets.

Most of my patients are so focused on retirement that they forget to live.  Don’t live to work; work to live.  Your job tomorrow, and every day, is to find happiness.  Happiness is best when it happens spontaneously, but life’s complexities means that finding happiness often requires some work.  Work hard to be happy and then share it with others.  “Wellthy” is not just about being physically healthy; it is also about being emotionally happy.

Horace wrote, Carpe diem, quam minimum credula postero – “Seize the Day, putting as little trust as possible in the future.”   Yes, you have to plan for the future, but not at the cost of the here and now.  

I wish you many years of happiness and no regrets. 

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Why Him?

September 8, 2019

I’m at a loss for words.  In August of 2011, I publish “I AM A RESPONSIBLE PATIENT.”  I actually have patients who follow the health contract as closely as possible.  Despite living a “Wellthy” lifestyle, they get sick.  Really sick?  What do you say to them?  To their families?  

“Bad luck dude,” just doesn’t cut it.  “G-d works in mysterious ways,” really doesn’t help either.  Do you tell them how scared you are for them? How sad you are that they are sick? In this circumstance, rather than asking “why me?”  the question is “why them?” So what wise and helpful thing can you say?

My brother is in the hospital.  He’s in trouble.  He’s the Segal that has spent pretty much every day of his adult life in the gym. He’s the one that eats a healthy diet, is happily retired with a thin muscular physique. He’s active; cutting his own lawn and walking the dogs daily.  He skipped the family curse, Parkinson’s.  Yet, he is now in a hospital fighting for his life.

Why him?  I have no answers.  What I do know is that his years of exercise and healthy living hopefully have given him the physical reserves necessary to fully recover and resume a normal life.

As to what you say.  Nothing at first.  At first, just listen.  Then let them know that you are there for them.  Let them guide you.  Sickness takes away your control of your life.  Make sure in your attempt to help your loved one, you grant them as much control as they can handle.  

Many of my patients have reached out to me since my surgery.  Their thoughts and care have been uplifting.  Thanks, guys, for caring.

Below is a copy of my healthcare contract.

Monthly Archives: August 2011

I AM A RESPONSIBLE PATIENT

Posted on August 31, 2011 by Stewart8022

August 31, 2011

I often refer to myself as a fireman pouring water on the flames that are burning my patients.  Often, I view my patients as arsonists, pouring gas on the fire I am working to put out.  Taking personal responsibility is a critical component of success in any of life’s ventures.  While my patients are very responsible business and family men and women, they often take no responsibility for their own health.  This blog has been successful at helping many individuals recover and maintain their health.  It has failed to help those who continue to be irresponsible.

In an effort to clearly define my patients’ role in their healthcare, I have developed the following contract:

I AM A RESPONSIBLE PATIENT

I, ______________, am a responsible patient.  As such, I take full responsibility for my health and my healthcare.  My responsibilities include but are not limited to:

  1. Learning how to promote my own health and wellness.
  2. Learning how to deal with illness, both acute and chronic.
  3. Actively working to eliminate those unhealthy habits I have acquired over my lifetime.
  4. Eating properly, exercising, and striving to eliminate those stressors within my control.
  5. Seeking medical advice when appropriate.
  6. Understanding the medical advice I receive.
  7. Asking questions when I do not understand the advice offered.
  8. Following the medical advice when mutually agreed upon by my doctor and me.
  9. Taking my medications as prescribed.
  10. Notifying my doctor prior to stopping my medication.
  11. Notifying my doctor should I have any adverse reaction from my prescribed treatments.
  12. Keeping a list of all medications, both prescription and non-prescription (including herbals, homeopathic, and nutraceuticals), that I take and who prescribed them.
  13. Bringing my medication list to the office at every visit.
  14. Knowing when I will need refills and not running out of pills.
  15. Completing diagnostic tests (lab, x-ray, EKG, etc.) in a timely fashion.
  16. Keeping my follow up appointments.
  17. Seeing consultants when necessary.
  18. Understanding my diagnosis, learning about its effects on my body and how I can help manage it.
  19. Studying and learning about my diagnosis.
  20. Being an active partner in my medical care.
  21. Notifying my doctor when I have added other professionals to my healthcare team.
  22. Being honest about what I am doing, taking, and who I am seeing.
  23. Paying the bill on time.
  24. Setting up a payment schedule when I cannot pay the bill and following that schedule.
  25. Know the rules of my insurance policy, what benefits are covered and what are not.
  26. Notifying the office if any contact information changes occur.
  27. Having an emergency contact listed should critical information need to be relayed to me.

My health is important to me, my family, and loved ones.  I will work hard to care for myself.  I understand that my doctor cannot help me if I will not help myself.  I expect my doctor to offer me his/her best advice based on his/her medical training.  I understand that, without my active participation, my doctor’s ability to help me is limited.  I understand that my doctor is the consulting partner, I am the working partner.  Working together, we can accomplish great things.

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The start of something new

September 6, 2019

The start of a new stage of life should be exciting.  Today marks the transition from living within a scheduled world to one in which every day is a Sunday. I should be excited.  I’m not!

I should also be excited as one of my mentors and smartest docs I have ever known paid me a high compliment.  In his words, “Jesus Christ, you have become a writer! You have graduated to introspection and clarity.” I’m not!

Retirement is what everyone works for and looks forward to.  Not me! I truly belong in the office, caring for those who put their lives in my hands. Getting up to go to the office was easy. Getting up now requires self-motivation. Frankly, it hurts to get up.  My back is at its worst after lying on it through the night.  My Parkinson’s is at its worst upon awakening as my medications have worn off.  It took 45 minutes to dress today.  Now I’m supposed to follow the exercise routine set up for me by my physical therapist.  My brother loves to go to the gym, I don’t.

I’m not looking for pity.  I’m describing what countless people go through every day. When I first recognized that I had Parkinson’s, I got mad at G-d.  Then I rationalized it, believing it was a gift given to me to help me better understand chronic illness and better care for the chronically ill.  Then I realized that Parkinson’s was going to stop me from caring for others and give me the option of caring for myself or languishing in self-pity.

Languishing in self-pity is not my style.  I can still care for others by writing this blog. Can I care for myself?  Years ago, I wrote an article about my friend, Will. You know him as Will Power. Will Power is a great friend. I need him to stand by my side now more than ever. Will, are you out there?  If you are, join me in the gym.  While I don’t want to stretch and workout, I need to. I need to be healthy enough to put words on the internet that, perhaps, will help someone else who is entering my stage of life. 

Here’s an article from January of 2012 about my friend, Will Power.  It was also about losing weight and following a healthy diet.  Losing weight is just one more thing on my list of things to do. It was also one of my favorites:

January 9, 2012

Have you seen my friend, Will Power?  Will and I have been hanging out together since I published my book(Diets and Other Unnatural Actrs).  Will’s my best friend.  He’s the sensible one, always keeping me out of trouble.  With Will Power at my side, I have flourished.

Today, Will and I walked into the Garden Fresh Super Market together.  Will thought we should stop for lunch first but I was in a hurry to get home and prepare for my mother’s 90th birthday.  On entering the store, I noted an attractive young woman standing at a table selling her goods, so I stopped to see what she was offering.  Will was with me one minute and gone the next.  I figured he wandered off for a moment and would return shortly.  Mr. Will Power is a loyal friend; he wouldn’t abandon me!

Anyway, this young woman was sampling a multitude of cheese spreads on delicious, gluten free, crunchy, whole grain crackers.  Any idiot knows not to walk into a grocery store when he is hungry but I figured I was safe since Will Power was with me.  Unfortunately, with Will missing in action, I was doomed!  They sure were delicious.  All seven varieties!

I quickly gained my composure and started searching for Will.  Searching the aisle at Garden Fresh was like maneuvering through a mine field.  One aisle over was another sampling of cheesy treats.  Two more aisles to the north and I was accosted by samples of fresh baked goods.  

I figured Will Power would be waiting for me in the healthy produce area so I ate my way through the mine field, seeking refuge in the green leafy aisles.  They were waiting for me and Will was nowhere in sight!  Taco, salsa and guacamole dip and chips tripped me as I turned the corner.  They assaulted my mouth with jalapeño peppers.  Over by the celery was another woman, offering tastes of hot dogs and queso blanco.  I searched for Will while working my way towards safety in the fruit aisle and the hope of getting to the checkout counter without any other treats.

I’m home now.  I’m calling everyone, asking for help finding my friend.  I’m not worried about Mr. Will Power.  He’s tough and can handle himself.  I’m worried about me.  Without Will Power, I’m afraid I’ll fall off the wagon.  I know what they say, “If you fall three times, get up four;” but, without Will Power’s help, it’s going to be tough.

When I find Will, I’ll apologize for not listening to him.  I’ll never go grocery shopping when hungry again.  I’ll also walk right by pretty young women peddling their wares.  

If you see my friend Will, tell him I miss him!

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September 6, 2019

September 6, 2019

WOW!  When I decided to write again, I perked up!  I realized that I wasn’t “invalid” after all.  I could make something good come from something bad. I realized I could still help others by sharing my 40 years of experience as a physician with my former patients and those who choose to read this blog.  What I didn’t realize was how much reviewing my prior works would help my current circumstances.

The following article from June 2011 will help make my point.  While it focuses on Attention Deficit Disorder, it is truly pertinent in regard to disabilities in general.  

Today I graduate from an intensive rehabilitation program at the Shirley Ryan Ability Lab, formerly known as The Rehabilitation Institute of Chicago (RIC). I spent 3 weeks in their inpatient program and months in the outpatient program.  The staff has been phenomenal and: while I have improved somewhat, I still have a lot of work to do.

One thing that I didn’t understand until this very moment is why a renowned center of excellence like RIC would change its name and attempt to rebrand itself.  Writing this article has given me the answer.  RIC rehabilitated people with handicaps/disabilities.  Shirley Ryan Ability Lab focuses on peoples’ abilities and how to use those abilities to improve one’s own life.

I’d like to thank the team at the ABILITY LAB for all the hard work they put into improving my life.  I hope you enjoy the article below and share this blog with others. 

June 25, 2011

One of the best lessons I have learned is if you can make something good come from something bad, the bad was not so bad after all!  I have taught that lesson to countless patients over the last 28 years.  Today, I want to share my lesson with those readers who have been branded with “learning disabilities” (LD).

Yes, I said “Branded.”  Like those individuals with attention deficit disorder (ADD), individuals with LD often feel branded, even cursed.  During the formative years of life, patients with LD often struggle in school.  LD students receive “accommodations” in the form of special classes, tutors, and attend special testing centers.  Accommodations can make an adolescent feel inferior and damaged.  

I have a learning disability.  When I went to school, there were no special classes, accommodations; you either survived on your own or you failed.  I have a form of Dyslexia.  Reading has always been agonizing for me.  My disability is not readily apparent;  I can read aloud to an audience and they will not detect a single problem.  I just can’t process what I read!  I always failed standardized tests.  Not because I didn’t know the answers, but because I could not process the questions.

I have the gift of being able to process and retain everything I hear.  Over the years, I have learned many tricks that help me deal with my dyslexia.  Modern technology has been a G-dsend.  My texts and journals are now available in audio format.

One of the most traumatic events in my life was my failure to get into the University of Virginia Medical School.  I was an honors student with a 3.5 something average and medical school was a slam dunk!  I was a cocky young man and only applied to three top East Coast schools.  Unfortunately, I bombed on my MCATs (entrance exam).  Scoring in the 14th percentile in English should not have been a surprise.  I can’t read!  Ultimately, I moved to Mexico and graduated from La Universidad Autonoma de Guadalajara Medical School.

Making something good come from something bad is today’s lesson!  Going to a Mexican medical school was an embarrassment.  It also was one of the best things to ever happen to me.  During my four years in Mexico, I learned a lot about myself and the world I lived in.  I learned to talk and think in a different language.  I learned that what Americans believed was not what the rest of the world believed.  It was a humbling experience and I needed to be humbled.

I also learned that I had a learning disability.  I learned that, if you work hard enough, you can learn to live with LD and you can make LD work for you and others.  This article is proof positive.  I have had a long career helping others and working with many of my patients and their children.  I help remove the stigma of ADD and LD by finding the good in the bad.  

If you have a reading disability, develop your listening skills.  If you have problems with the spoken word, thrive on the written word.  All of us are blessed with being unique individuals.  Within all of us is a gift.  Don’t get bogged down with being labeled LD or ADD.  Find your gift and celebrate it.  Don’t be ashamed of needing accommodations.  Use them as tools the same as I use the CD/DVD player.  Most of all, learn to be happy with yourself.  Yes, it may be harder for you to succeed but success will come.

If you are having problems coping, see your doctor or counselor.  If you are envious of others, recognize that they are unique individuals and have their own problems.  If others mock you, feel sorry for them, not for yourself.  They mock you out of ignorance and you are not ignorant.  

Posted on www.livewellthy.org

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Wellthy

September 5, 2019

After talking to several new readers today, I realized that I had started my new blog at the end of my career, leaving new readers lost in concepts I have taught for many years.  Those of you who have known me for the last 30 years should be comfortable with the term “wellthy” and many of the concepts I will present to you over the next few months. For those of you who are newbies, feel free to contact me with your questions and issues you would like me to address.

“Wellthy” is a concept that I developed over the last 30 years with the help of my patients and staff.  Yes, my patients want to be wealthy.  They work long hours, invest wisely, and often become financially wealthy.  Unfortunately, they often spend all of their health obtaining their wealth and, in the end, are miserable.

To help you understand the concept of “Wellth,” my book, “Diets and Other Unnatural Acts,” presents the case of Workaholic Willy. Willy worked 16 hour days amassing his empire and a personal worth in the millions.  He had no time for exercise.  His meals consisted of fast foods 

at McWhatever. His family time was non-existent, never even vacationing with his wife and kids. 

Willy thought he was working to accumulate wealth so that his wife and kids would live the easy life.  At least, that’s what Willy told himself.  As Willy became wealthier, his health deteriorated, as did his relationship with his family and friends.  In the end, Willy was the poorest wealthy person I had ever met.

Instead of getting wealthy, I want you to get “wellthy.”  A “wellthy” person invests, not only in his/her financial wellbeing, but also in his/her physical, nutritional, emotional and spiritual wellbeing. Hopefully, this blog will help you find the tools you need to live a truly wellthy life.

I will be incorporating articles I published in the past into material more appropriate for present times.  I have spent way too long looking back at how I got to where I am today.  Frankly, it’s depressing.  In some ways I had become Willy.  Today I came across the following article published in 2011.  It’s time for me to look forward.  It’s time to stop asking why and instead, say what are you going to do about.

What I’m going to do is work at getting “wellthy!”

November 2011

Many years ago, I was blessed to receive an invitation to serve on a national advisory board for a pharmaceutical company.  I was privileged to sit in a room with 15 experts in their fields of medicine and share in their knowledge.  Since then, I have been to many such meetings and, each time, I have harvested clinical pearls to be used in my practice of medicine.  At the most recent meeting, a well known family doctor talked about the “look backwards” approach to medicine and contrasted it to the “look forward” approach.  The difference between the two styles is remarkable and I look forward to sharing my newfound pearl with my patients.

The “look backwards” approach is what I have done for 27 years.  Mr. A comes in for his blood pressure, blood sugar and cholesterol check.  I look back over the chart and determine that Mr. A has not done anything we discussed at our last visit.  His numbers are not good and I point out to Mr. A that his behavior is fueling the fire that is going to burn him.  I inform Mr. A that I am going to increase his current medications and add one new one.  Mr. A feels guilty and does not want more medication and says he will do better.  “Doc, give me three months.  I can do better!”   Five months later, Mr. A returns, nothing has changed and we start the cycle over.  

The “look forward” approach identifies the current problem and puts an action plan in place.  Medications are adjusted appropriately.  Plans are made for behavioral and dietary changes when appropriate.  A care team is constructed.  Nursing support is set up with a predefined call back schedule being arranged and the patient knows that, if he experiences any problems, he can call his team nurse for help.  Referrals for nutritional and exercise counseling are arranged.  Deadlines are set.  The patient commits to the team approach and returns in one month for a follow up visit and assessment of the success or short comings of the treatment approach.   At each visit, future treatment objectives and changes in current treatment options are reviewed.  

Most patients mean well.  They are going to work on their diet, but the boss calls them in, gives them a new assignment and their personal plans get pushed back.  They are going to exercise; but they are working 16 hour days and they are exhausted when they get home.   They are going to eat fruits and vegetables and whole foods but they are in a hurry and the drive in window at McWhatever restaurant is more expeditious than parking and running into the grocery store.  

A care team and “look forward” approach is going to solve the harried life of today’s worker.  What it will do is help develop realistic work-arounds to the above problems.  

  1. You need to diet to lose weight.  You stress eat. Your boss stresses you.   Currently, you pledge to work on your weight loss as soon as the stress lets up. Realistically, the stress never lets up.  The answer is better stress management.  One goal of your care team is to find stress relievers other than food. 
  2. You need exercise but your 16 hour day is exhausting.   You promise to exercise as soon as work gets better.  Work doesn’t get better.  Another goal of your care team is to find novel ways to build exercise into your work day.  
  3. You need to eat a healthy diet but your car won’t stop pulling into the drive-in window at McWhatever.  You know you shouldn’t; you feel guilty, but your hunger gets the best of you.  Your care team’s goal is to counsel you on food choices and meal planning.  They advise you to eat healthy snacks more often so your hunger doesn’t get the best of you. 

Looking forward to something is much better than looking back and lamenting.  After the heart attack or stroke, looking back at what was not accomplished is truly miserable. I look forward to shedding the “look back” approach.  I look forward to working with you.  I look forward to helping you improve and maintain your health.  I hope you will look forward to the same.

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