LIVE THE WELLTHY LIFE

I don’t understand!  What’s all the fuss about? People seems to be worried about the Covid vaccine immunization schedule.  One of the major complaints I hear frequently has to do with the number of shots required to get good immunity.  Would it surprise you if I told you that most of my vaccines started off as one shot/series and, in time, ended up as multiple shots or series of shots?

You probably don’t remember but your childhood vaccines were given on a schedule.  The DPT (diptheria, pertussis and tetanus) vaccine was given at 2, 4,6, and 18 months.  A booster was then given at 5 years of age and was supposed to confer permanent immunity.  Some years ago, the pertussis component began to fail, and a booster was added in high school. 

I “practiced” medicine for close to 40 years.  All physicians “practice” medicine!  Medical knowledge is constantly changing.  Research brings us new medicines and therapeutic interventions that offer the promise of improved performance over older treatments.  Physicians learn about and subsequently institute those new interventions and medications which promise to improve care without adding significant risk.  New treatments are followed closely once they are introduced to the public and, if problems are discovered, might be removed from the market (Vioxx) or their usage modified to account for added risk (Accutane).

Yep, as physicians, we practice with new meds and therapies; and we learn from using them.  Vioxx was an incredible pain reliever.  It was a non-steroidal, non-narcotic, anti-inflammatory medication that helped many of my patients.  It also supposedly caused significant heart disease and was subsequently removed from the market.  

Accutane is an excellent medication for the control of acne.  It causes birth defects and an assortment of other bothersome side-effects.  Due to these problems, its use has been restricted.  Women on Accutane are required to use at least two forms of birth control.  The last time I prescribed it, the patient was required to sign multiple legal documents acknowledging that he/she received and understood the informed consent documents provide to him/her.

My point is that, in both the above examples, physicians practiced with and learned from the use of new medications.  Yes, there are significant risks involved in practicing medicine.  There are also significant benefits that far outweigh the risks.  Many years ago, I was called to the ER to see a middle aged man who had been diagnosed as brain dead following a cardiac event.  I had read about a new device called an Artic Blanket and was elated to find that the ER had a brand-new Artic Blanket that had yet been used.  After discussing the diagnosis, we unwrapped the blanket, applied the new technology and said a few prayers.  Yes, this was a practice run which offered some hope.  The patient woke up the next day, went home and still is alive.

Practicing physicians should always share the risks and benefits of any treatment with you.  The process is called “informed consent.”  While I fervently believe in the process of informed consent, I hated doing it.  Why?  Informed consent often scares the patient out of doing the proposed procedure or taking my medications.  Everything carries risk!  When reviewing the risks of my upcoming DBS surgery, the surgeon discusses risks that include stroke, central nervous system infection and even death.  Without the surgery, my condition will continue to worsen.  With the surgery, my condition hopefully will improve for a while and the progression of PARKINSON’S be slowed.

Will the Covid vaccines prove to be as good as the Artic Blanket or as problematic as Vioxx.  Only time will tell.  The bulk of evidence today is strongly in favor of a 3 shot regimen and that is what Renee and I have done.

One last historical note.  Vioxx was so good at relieving pain that, despite the risk of heart disease, many of my patients would gladly buy it today, at any cost and despite any risk.

Here’s today’s joke: A man sends his wife to pick up his erectile dysfunction medication.

She gets back and they get undressed and get down to business.

The wife stops and says, “Our new pharmacist is a very nice Chinese man but talks too much politics; but don’t worry, I made sure your pills aren’t made in Russia.”

“Why would it matter if the Russians made my pills?” asked the husband.

The wife responded, Well, the pharmacist told me Russia was meddling in U.S erections.”

Wow!  This is harder than I expected.  Let me explain.  It’s time to write a living will.  I am 70 years old and live with Parkinson’s, a disease that will progressively attack my nervous system.  As Parkinson’s attacks, my abilities to walk, talk and even think will diminish.  Along with the loss of function comes a progressive loss of the quality of life.

There are treatments for Parkinson’s but all current day treatments, while restoring some abilities and quality of life, are only temporary.  In March, I am going to have a deep brain stimulator placed deep within my brain.  The surgeon will bore a whole in my skull and thread an electrode into the area that Parkinson’s affects.  The hope is that the procedure will improve the quality of my life by restoring functions previously lost.  Hopefully, I’ll be able to reduce or come off of some of my meds as well.

As with all surgical procedures, there are risks. While the risks are fairly rare, they can be devastating and include stroke, infections, bleeding and even death.  Being a physician, I fully understand the risks and consequences should something go wrong.  I also understand that, in the real world, the risk of anything going wrong is 50%.  The surgeon may tell you that statistically the procedure has a 2% chance of causing injury in the general population. However, in the individual’s case, it either will happen or will not happen (50-50).

My “why” for writing this article should now be readily apparent.  I thought that the hard part of creating a living will was already done.  I was wrong.  While I have had multiple conversations with my wife and children regarding letting me go if something adverse happens during surgery or from any other event, putting my wishes in writing is extremely difficult.  This morning I searched the internet for living wills written by physicians.  I found one helpful article. “ We should strive for a good death that occurs at the proper time and place,” by ALLEN FRANCES, MD and published on KevinMD on April 27, 2015, is worth reading.

While a document that tries to anticipate future problems and leaving instructions for each scenario is impossible, setting a goal of a “good death that occurs at the proper time and place.”   A good death occurs at home with family and friends, not in a hospital or nursing home. A good death recognizes the importance of quality of life and that death is a natural occurrence.  Fighting death is often associated with pain and suffering (tubes in every hole, respirators, nursing homes).

Families want everything possible done to salvage their loved one.  Often, the one thing loving families could but don’t do is let their loved one die a good death.  Likewise, physicians see death as an enemy to be defeated, without recognizing the damage caused by defeating their foe.

I will leave the decision making up to my wife, my children and my physicians with the understanding that, if I cannot reasonably expect to regain my independence, enjoy my family, joke about sex and cruise the back roads of North Carolina with the top down, then I want a good death.

The world I’ve lived in for 68 years has been changed by Covid and not for the better.  Fear and anxiety have become prevalent among a large segment of our population, leading to poor sleep, agitation, and, in some cases, poor decision making.  While fear and anxiety often are negative emotions, they do confer a certain benefit on the person suffering from them.  The individual that reacts to the growling dog by becoming anxious and slowly backing away from it is more likely to survive than the individual who ignores the threat and further invades the animal’s space.

On a daily basis, I get bombarded with opinions about the Covid vaccines and treatments whether I’m interested in the conversation or not.  The avalanche of opinions come from doctors, scientists, journalists, Google (internet), neighbors, friends, and former patients, as well as from those that have become overnight experts by reading a few articles on Covid found in today’s email or CNN newsflashes.

My purpose in writing this article is not to validate any opinions on Covid and the treatment of Covid, but instead to point out one simple truth. Covid, and the subsequent fear and anxiety induced by Covid, has become the number one excuse for everything that goes wrong.

I used to tell my patients that when their doctors think they know more than the medical authorities, it’s time to find a new doc!  Well, the authorities are telling us to get immunized against Covid ASAP, to wear masks and wash your hands frequently.  While I read everything I can find on Covid, I am not an expert in infectious diseases.  After 40 years of practice, I am qualified to interpret the data and I chose to believe the authorities and follow their recommendations.

Those who fear Covid, the medical authorities and the government steadfastly refuse the vaccine, fearing its possible long-term effects.  While I believe the vaccines are safe and fairly effective, I can understand their fears.  I can’t understand their stubborn insistence on not wearing a mask.

Last week I was listening to a 50-year-old lawyer list his reasons for not getting immunized.  He stated that vaccines were often not effective and carried substantial risk. Rather than getting into a debate I couldn’t win as he was so sure of his beliefs, I simply pointed out to him that he looked awfully good for someone that had polio; he was quick to deny ever having polio.  I asked him if he remembered having mumps or measles and he emphatically denied having had both.  I quickly added that he was lucky not to have been scarred for life from having smallpox and again he stated that he was healthy with a strong immune system and never had any of the childhood illnesses that were so common in years past.

I set the trap and he fell right in!  He had avoided all the childhood illnesses that once upon a time killed and scarred children because he was immunized at a very early age.  Yes, vaccines carry some minimal risks, but those risk are overshadowed by the risk of the disease and the risk of Covid is death. 

Life is dangerous whether you live it to its fullest or hide from it, waiting until the storm passes. I suggest that you live life to its fullest while heeding the warnings and Covid protocols put forth by the world’s medical authorities.  Isolating yourself and family at home carries its own risks, both short and long-term.

I have had two primary shots of PZIZER’S vaccine as well as a booster.  I wear a mask in public even though I hate wearing it. I avoid anyone who has not been immunized.  I avoid crowds! 

I wish you all a happy and healthy New Year, free from Covid.

Here’s today’s joke.

Two octogenarians are sitting at a table having lunch.  They have lunched together fo50 years:

Mrs. A – I’ve known you forever, so I hope you won’t be upset but I’m dying to ask you a question.  I’m so very embarrassed.   

Mrs. B- Don’t be silly.  You can ask me anything!

Mrs. A- What’s your name

Mrs. B- Oh, honey, don’t be embarrassed.  Can you give me a few days to think about it

DEEP BRAIN STIMULATION

It’s a new year and it’s time to start writing again. The following article was written sometime ago and will serve my purposes well.  I’m scheduled for DBS.  If you are interested, you can see a video of the surgery on YouTube. My Parkinson’s is worsening but still tenable.

Losing your motor skills is not so bad as long as you still have your brains.  It’s your brain that makes you who you are!  I watched too many patients vacate their bodies due to the onslaught of Alzheimer’s.  The big “A” leaves behind an empty shell that only serves to torture its loved ones with memories of who once inhabited it. 

One of the things Parkinson’s can do to its victims is steal their brains.  I’ve been joking a lot about CRS (can’t remember shit).  In your 70s, CRS is prevalent.  It’s also relatively harmless.  So how do you know if you have CRS or another form of dementia?  Most of the time, you wait and see.

Neuropsych testing can uncover early dementia.  In order to be assessed for DBS (deep brain stimulation), an advanced form of treatment for Parkinson’s, you need to have a complete battery of neuropsych testing.  I’m being tested this am.  The problem is that I don’t want to know if I’m losing it!

I’ve been planning on eventually developing dementia.  I’ve been recording on paper who I am so that, one day, my grandchildren and their kids can get to know me.  I need to put it on paper now before it disappears.  Hope for the best but plan for the worst is my motto.

Dementia is the worst!  Unfortunately, our society thinks keeping an empty shell alive long after its brain is gone is the right thing to do.  I don’t!  I witnessed what appears to be a never-ending death as patient after patient gets shipped to the memory unit of a local nursing home.  The patient is not allowed to finish dying and the family can’t finish mourning for their loved one. 

Sometimes I think we are in heaven and there is a hell.  I think the memory unit and hell are the same place.  I watched my father sit at the kitchen table looking through a phone book for his parents’ phone number.  If you asked him what he was doing, he said he was calling his parents, he wanted them to pick him up and take him home!  My mother meant well!  She kept his shell alive, blocking every attempt he made to go home (die).

I want to die before the only part left of me is a gargantuan shell.  So, am I afraid of DBS?  You can be damn sure I am.! Do you have to worry that I may take my own life if the results are bad?  Absolutely not!  I’ve got more to write and things to do.  Just promise me that, when its’s time, you’ll let me go home to a place where I can be whole again.  By the way, I don’t want 40 virgins to greet me at heaven’s gate.  I prefer 40 very experienced versions of Renee!

Now you could use a joke (or is it?). 

An elderly couple had dinner at another couple’s house, and after eating, the wives left the table and went into the kitchen.

The two gentlemen were talking, and one said, ‘Last night we went out to a new restaurant and it was really great.  I would recommend it very highly.”

The other man said, ‘What is the name of the restaurant?’

The first man thought and thought and finally said, ‘What is the name of that flower you give to someone you love?

You know…. The one that’s red and has thorns.’

‘Do you mean a rose?’

‘Yes, that’s the one,’ replied the man. He then turned towards the kitchen and yelled, ‘Rose, what’s the name of that restaurant we went to last night?’

You are going to want to read this if you drive a car.  Have you ever heard of “Diminished Value?”  I hadn’t.  If you have an auto accident that was not your fault and your car has been damaged, then not only did your car suffer damage but your car’s value suffered as well!  That’s right, if prior to your accident your car was worth $25,000, then after the car has been repaired it is worth $25,000 minus a sum of money based on the extent of damage the car suffered.

If you sell your car to a private party and if they fails to look at Carfax, you may get lucky and receive full value for the car.  Unfortunately, most people look at Carfax today and Carfax will report the accident and the extent of damage. Now, to the heart of the matter.  Many states have a “Diminished Value” law that requires that an insurer pay you for the loss in value the car suffers due to your accident (if the accident was not your fault).

What the law does not require is that your insurance company inform you that the law exists and that they owe you money.  If you are lucky enough have read this article, you may collect a substantial amount of money from your insurer.  I was lucky to have been told about “Diminished Value” by a neighbor.

So, share this article with anyone you know who has had an accident.  Your insurance company will not!

Here’s your joke of the day:

This drunk wanders into a hotel lounge where an insurance convention just happens to be taking place. The drunk is hell-bent on causing trouble and he yells, “I think all insurance agents are crooks; and, if anyone doesn’t like it, come up and do something about it.”

Straight away, this guy runs up to him and says angrily, “Hey! You take that back right now!”

The drunk sneers and asks, “Why, are you an agent?” The man replies, “No, I’m a crook.

I’ve written about honesty before, and I will probably write about it again in the future.  Does honesty really exist?  Have we become so used to partial truths and dishonesty that dishonesty in business has become acceptable? Let me explain.  Yesterday, an executive with one of the larger insurance companies said to me, “Let me be completely honest with you.”

“Let me be completely honest with you” has become a common statement in the world we live in.  It joins other statements such as, “I’m going to be totally transparent,” and “the truth is . . .” Have you ever stopped to think about what these statements truly mean?  You should.  What the person who freely uses these statements is telling you is that he/she is a liar.

Yep, when people qualify their statements with, “Let me be completely honest with you,” they are telling you that they have been dishonest in the past.  A person who always tells the truth has no reason to notify you that he/she is going to be honest, this time!  When I hear someone tell me he/she is going to be completely honest, I run from that person.  Unfortunately, there are not many places I can run to.

The executive that I talked with yesterday really did not have to qualify his statement.  The fact that he worked for an insurance company clearly marked him as a liar.  Should I believe that he was going to be completely honest with me because he told me he was?  NO!  Instead, he alerted me to the fact that he was a liar and that what he was telling me was probably B.S.

If you listen to what the person you are conversing with says and then analyze it, you will realize that, in the vast majority of cases, the person’s true self will reveal itself.  When publishing an article such as this, I worry that I’m teaching liars and people of low morals how to lie more efficiently. 

So, take care.  Listen to what people are telling you with an analytic brain, hunting for key phrases that will help you in deciding whether to trust them or not. Monitor what you say to make sure you are sending the right message. 

One last thing.  Recognize that the internet and TV commercials often lie, as well.  Rarely are things free; yet your TV and internet promise “free” with no risk or downside on an hourly basis.  Currently, Medicare Advantage plans are not only promising free everything, including free money, and all you have to do is  make a free call to an 800 number!  Bullshit!

Here’s your joke for the day:

Don’t Bullshit Your Mother

Mrs. Rabin comes to visit her son Bernie for dinner.

He lives with a female roommate, Elaine. During the course of the meal, his mother couldn’t help but notice how pretty Bernie’s roommate is. Over the course of the evening, while watching the two interact, she started to wonder if there was more between Bernie and his roommate than met the eye. Reading his mom’s thoughts, Bernie volunteered, “I know what you must be thinking, but I assure you, Elaine and I are just roommates.”

About a week later, Elaine came to Bernie saying, “Ever since your mother came to dinner, I’ve been unable to find the silver sugar bowl. You don’t suppose she took it, do you?” “Well, I doubt it, but I’ll email her, just to be sure.”

So, he sat down and wrote an email:

Dear Mom,

I’m not saying that you “did” take the sugar bowl from my house; I’m not saying that you “did not” take it. But the fact remains that it has been missing ever since you were here for dinner. Your Loving Son

Bernie.

Several days later, Bernie received a response email from his Mom which read:

Dear Son,

I’m not saying that you “do” sleep with Elaine, and I’m not saying that you “do not” sleep with her. But the fact remains that, if she was sleeping in her OWN bed, she would have found the sugar bowl by now.

Your Loving Mother

I’ve finally figured out what’s happening.  At 3 am this morning, I realized that my nocturnal binge eating was reminiscent of the problem I treated several of my patients for.  My bet is that, if I had access to their charts, I would fit their profiles perfectly.  Not only do I fit their profiles, I, too, have failed to control it!

Upon further analysis, it became apparent that my sleep disorder also fit the profile of many of my patients.  Once again, I failed to alleviate their sleep issues despite multiple treatment interventions, just as I’ve failed to alleviate mine.

The list goes on.  My persistent pain is no different than my chronic pain patients suffered with.  My Parkinson’s is following the same course as my Parkinson’s patients did.  My eating disorder has led to obesity which I am struggling to control.  I counseled and treated large numbers of patients for depression.  Now I’m getting a first-hand view of depression and its effects on all the other problems.

What I have finally realized is I have become a composite of my most difficult patients.  Being a typical male, I asked myself why this has happened to me.  I can hear myself telling countless patients, “It is what it is, now get on with it.”  I’m getting on with it! 

The real question is how to treat the conglomeration of problems I have.  First and foremost is remembering who I used to be and working to hold on to that person.  The only part of Stewart that still exists is his sense of humor (most of the time, at least).  As I read back through this blog, I get a glimpse into the life I lived and the battle to come.

I am at war with the entity that currently inhabits my body.  I look at me in the mirror and don’t recognize myself.  The first thing I have to do is restore my self-image. As those of you who have fought obesity know, losing weight is a bitch.   I know what didn’t work for my patients.  I won’t take pain meds or sleepers as I’ve witnessed their abilities to addict and control my patients.  I won’t go on fad diets.  I will take bupropion, an anti-depressant, that can help with pain. I will follow my doctors’ advice and will keep in mind how frustrating it is to treat a train wreck such as myself.  I will continue to read articles I wrote in the past and absorb as much of my advice as I can.

I want to thank those of you who have called and written.  Your kind words and remembrance of Dr Segal are tremendously helpful.

I’ll be with my Renee, kids and grandchildren for Thanksgiving and I’m going to spend three weeks with my fraternity brothers in Mexico.  I always feel better when I’m with them as they help remind me how blessed I am.

I expect to resume daily articles in January.  Until then, I want to wish you all a healthy and happy holiday season!

Here’s today’s joke:

If I were to die first, would you remarry?” the wife asks.

“Well,” says the husband, “I’m in good health, so why not?”

“Would she live in my house?”

“It’s all paid up, so yes.”

“Would she drive my car?”

“It’s new, so yes.”

“Would she use my golf clubs?”

“No. She’s left-handed.”

I loved being a doctor.  Realistically, I loved it when I was in an exam room with my patient, liked it when I was rounding at the hospital, and hated it when I had to deal with insurance companies and Medicare.  Early on, I learned that insurance companies were in the business of making money and they made their livings by denying patient access to medical care.  As time went on, insurance companies got better at restricting care; and, by the time I retired, the insurance industry had decimated my profession, becoming a de facto government.

Of course, the insurance companies would disagree with my assessment of their role in medicine. As a matter of fact, they flood the airways with commercials portraying them as kindly neighbors, there to take care of your every need 24 hours a day.  Current commercials promise to give you more benefits than ever, with dental care and eye care coverage, while depositing an extra $100 dollars a month in your savings account; and you get it all for free.  Even the plans’ name, “Medicare Advantage,” is designed to give you a sense of being special.

You should ask yourselves how the profit-focused insurance companies manage to pay you $1200 a year while giving you more services?  The answer is that they can’t!  While promising the moon, they take away your right to see the doctor of your choice and make some medical choices you feel you need.  Sure, they tell you that you can see any doc you want.  What they don’t tell you is that many generalists and specialists refuse to accept the limitations the “Advantage” contracts impose on them.  Their reimbursement for services is pitiful.

One of the last patients to join my practice was in an Advantage plan.  Unfortunately, he was sick, having not seen a doc in years.  He had multiple problems requiring specialty care ASAP.  It took 4 months to get his referrals done and appointments scheduled. Had he been on Medicare, he would not have had to get referrals approved by his plan and he could have been seen quickly.  On Medicare, he would have seen a specialist in Barrington.  On his Advantage Plan, he had to travel 40 minutes away to find a doc who accepted his plan.

The long and short of it is that Medicare Advantage saves you money and gives you additional benefits if you stay well.  Medicare Advantage becomes a disadvantage if you get sick.  We are being brainwashed by TV commercials and the internet into believing that we will be in the good hands of our neighbor, Jake, while we are sold inferior products.  If a car salesman told you he could give you an upgraded model, pay you $100 a month, and do it for free, you’d run, not walk, away. 

I could never admit to any of this when I was a practicing physician as many insurance contracts have built-in gag orders.  Years ago, I had a well-read medical blog and kept my patients informed about the transgressions of the insurance companies despite the gag orders.  I was visited by a representative of one of the larger insurers who informed me that, if I didn’t take down my blog, his company would cancel my contracts.  Losing their contracts would have put me out of business.  I took down the blog.

Recently, I’ve learned that my home and auto insurance companies are just as bad, if not worse, than medical insurers I grew to hate.  More about that later.

Here’s today joke:

Larry’s barn burned down and his wife, Susan, called the insurance company. Susan told the insurance company, “We had that barn insured for fifty thousand and I want my money.”

The agent replied, “Whoah there, just a minute, Susan. Insurance doesn’t work quite like that. We will ascertain the value (using our formula) of what was insured and provide you with a new one of comparable worth.”

There was a long pause before Susan replied, “Then I’d like to cancel the policy on my husband.”

I can’t believe:

• I can’t believe how our world has changed since the onset of Covid.
• I can’t believe how many people have died either directly or indirectly from Covid.
• I can’t believe people are still dying from Covid.
• I can’t believe that people still insist that Covid is not real.
• I can’t believe that people still refuse to wear a mask.
• I can’t believe that people still refuse to be vaccinated.
• I can’t believe that people are refusing simple precautions such as wearing masks and hand washing.
• I can’t believe that politicians politicized the pandemic and its treatments to win elections.
• 10.I can’t believe that people I call friends will verbally attack me for writing this article.
• I can’t believe that the cost of everything has skyrocketed.
• I can’t believe that small mom and pop businesses are closing because they can’t find the workers they need to stay open.
• I can’t believe that people believe that what they read on the internet is the gospel.
• I can’t believe that our country is coming apart at the seams.
• I can’t believe that Covid was an act of nature.
• I can’t believe that I don’t have an office to go to in the morning.
• I can’t believe I don’t have patients to care for in their times of need.
• I can’t believe that illness is slowly stripping me of everything I hold dear.
• I can’t believe that there is nothing I can do about anything!
• I can’t believe . . . .

This list can go on forever. 

There is not much I can believe.

I can believe:

• I can believe we need to be vaccinated.
• I can believe that masking may do very little to control this beast but is a fairly harmless intervention.
• I can believe that we can’t give in and let Covid run freely amongst us.
• I can believe that we can get the politics out of disease management by refusing to listen to the politicians.
• I can believe that we can stop the bickering and accusations surrounding vaccines and treatments of Covid by listening to the medical authorities and not the internet.
• I can believe that the designers of the internet use their vast powers to brainwash people.
• I can believe that we are heading for an uncivil war and it may be unstoppable at this point.
• I can believe that the political parties are as guilty as the internet, serving their own interests and not those of the people.
• I do believe that first and foremost I am a person, not a democrat and not republican. 
• We are a republic made up of people wanting to be free and prosper, not red states and blue states.
• Journalists need to report the news, not create it.  They need to pull us together, not fuel the fire.

I HAVE SPENT A LIFETIME BEING A PHYSICIAN AND HEALER.  THE FIRST STEP IN FINDING A CURE FOR WHAT AILS YOU IS TO RECOGNIZE YOU HAVE AN ILLNESS.  WE, AS A SOCIETY, HAVE A LIFE-THREATENING ILLNESS.

THE SECOND STEP IS TO FIND THE CAUSE/CAUSES.  THE ABOVE LISTS ARE ONLY THE TIP OF THE ICEBERG.  FEEL FREE TO ADD TO THIS LIST.

THE THIRD STEP IS TO DESIGN A TREATMENT COURSE.  LOOKING BACK IN HISTORY, YOU’LL FIND THAT ALL GREAT EMPIRES COME TO AN END.  I THINK OUR ILLNESS IS TERMINAL AND THAT WE ARE ON LIFESUPPORT.  I HOPE I’M WRONG.  TREATMENT ENTAILS COMING TOGETHER AS ONE AND FINDING THE TRUTH.

UNFORTUNATELY, IF I’M RIGHT, I’M GOING TO LOSE FRIENDS AND CATCH A LOT OF SHIT FROM A LOT OF PEOPLE FOR PUBLISHING THIS.

There is no joke today.  This is not a laughing matter.

Have you heard the phrase, “Live and learn?”  I’m 70 years old and can personally verify that not only is “Live and learn” true but that another common phrase, “You are never too old to learn” is true, as well.  A few weeks ago, I experienced one of life’s lessons that I wish I could have skipped.

I tore a muscle/tendon in my groin. I spent 35 years asking people to rate their pain on a 1 to 10 scale. I have had multiple docs ask me the same question.  I thought I knew what a 10 was.  I didn’t!  I was getting out of my car when I felt a burning, searing rip in my groin that almost knocked me off my feet.

When my patients complained of pain, I asked them to describe it.  I then offered them some common descriptions of pain by asking, “Is it burning, stabbing, crushing, throbbing, aching, dull, sharp, etc.?”  Once the type of pain was determined, I asked them whether it was continuous or intermittent, what made it better and what made it worse. Patients were usually quick to answer these questions and their answers made sense anatomically.

It’s when I asked them to score their pain on a 1 to 10 scale or some other scale that things got difficult. The problem with scoring your pain is that whatever scale you use, the answer is going to be highly subjective and individualized.  It is also going to be unreliable.  Scoring on a 1 to 10 scale helps the physician gage the success of his/her therapy from visit to visit.

Let me explain. Patient “A” has lower back pain.  He injured his back at work and has been out of work for        a week. He walks hunched over and rates his pain at 11 on a 10 scale. His face showed no signs of pain or distress.  His pulse and BP are normal. When my pain hit 10, my pulse shot up, I started sweating, and I screamed, “F.ck, f.ck, f.ck.”  I certainly was not calm.

So, what is a doctor to do with this patient’s 11 or 10?  Some people exaggerate (I’ve been accused of that).  If he is one who exaggerates, then his 11 will serve as his baseline and will be compared to future values. The patients 1 to 11 scale will be personalized.

Perhaps he has a low pain tolerance.  Often, I would ask the patient to imagine that he was putting up a picture and hit his thumb with the hammer rather than the nail.  I would tell him that the pain from smashing his finger should be a 10 and ask him, given that information, what his number would be.  In this case, he said 11 of 10.  He also asked for Norco.

He didn’t get his Norco and stomped out of the office.  It was interesting to note that his hunched stance disappeared as he left.  I watched him slide into the seat of his Camaro and drive off.

The point is that grading your pain based on a 1 to 10 scale is difficult and of limited value.  Categorizing pain based on the type of pain and what makes it worse or better is much more helpful.  Faking or exaggerating pain to get narcotics is not only hard to do but turns physicians into skeptics and adversely affects the care of other patients.  Abuse and overuse of narcotics has led to the current restrictions on pain management.  Many of my colleagues will no longer prescribe narcotics and many of my chronic pain patients are suffering due to these restrictions.

If you suffer from pain, before seeing your doc, assess your pain, paying attention to location, type of pain, and what improves or worsens it.  In using these descriptors, you are trying to paint a picture of your pain so that your doc can make the correct diagnosis and formulate an appropriate treatment plan.

Here’s your joke for today:

A young woman has been taking golf lessons. She has just started playing her first round of golf when she suffers a bee sting. The pain is so intense she decides to return to the clubhouse.

Her golf pro sees her come into the clubhouse and asks, “Why are you back so early? What’s wrong?”

“I was stung by a bee.”

“Where?” he asks.

“Between the first and second hole,” she replies.

He nods knowingly and says, “Apparently your stance is too wide.”