90 DAY PLAN

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.

VACATION

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!

I THOUGHT I WAS HAVING A STROKE

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!”

HOW MUCH

How much of a financial savings would it take to make you gamble with your health and wellbeing?  Would it surprise you if I told you some of your neighbors would jeopardize their health for a savings of $30 a month?  How about $20?  Or even $10?

It wouldn’t surprise me!  In the past, I’ve watched patients put their health on the line for as little as $10 a month.  Now please understand, these are not patients who are destitute.  They have jobs, homes, and go out to eat and to a movie on weekends.  These are people who have bought into what I call “The Insurance Mentality” or TIM for short.

People suffering from TIM believe that if insurance doesn’t pay for something that it is not worth having.  If their insurer tells them they will not pay for a particular medication, they call the office demanding to be taken off their current medication and switched to the insurer preferred product.  After all, the insurance company has their best interest in mind, right?  Wrong!  Their insurance company’s job is to maximize profits and make their stockholders happy.  My job is to maximize my patients’ health!

Unfortunately, the insurers are winning.  Emboldened by their newfound powers under Obamacare, The United Federation of Insurers of America (FU America) declared war on all expensive medications on January 1, 2014, papering the country with denials of medication orders and demanding that doctors and patients alike conform to the insurers select list of cheap medication.  The war continues today. No matter that a person has been successfully treated with a given medication for 5 years, they must surrender and change.

Those patients suffering from TIM immediately follow the edicts of the FU America movement and called in for their insurer preferred scripts.  Many were aghast to find they had to come in for an office visit but did so as FU America covered that visit.  All wanted to know if the switch was “safe.”

“Mr. X, you’ve done great on your Diovan for 3 years.  You’ll probably be fine on Losartan (the generic FU America prefers) but we won’t know until you try it.  I know that Diovan will cost you more so if you want to switch, we can try.”

Mr. X wanted to try so off he went with his new prescription and his trip to failure.  Yes, he reacted poorly to the meds and came close to staying at Good Shepherd Hospital.  He’s better now and back on his Diovan.  He learned a hard lesson but, in the end, he’ll be ok.  What’s your health worth?  Are you really willing to rock the apple cart to save a little money or would you be better off staying home, preparing your own meals and watching reruns on TV?

YOUR DOC THE FIREMAN

As many of my readers know, I often think of myself as a fireman, working to put out fires before they do serious damage.  My patients come in screaming, “FIRE!  HELP ME!”  Unfortunately, many of my patients are arsonists, actively feeding the fire I am trying to extinguish.  Being a doc/fireman can be awfully frustrating sometimes.

As a doc/fireman, I have a variety of fire extinguishers.  My main extinguishers are medications.  Others include an assortment of therapies (physical, occupational, and psychological).  A three-alarm fire requires not only my full assault with the above therapies but the help of others, my consulting group.

Unfortunately, the arsonists I treat often have their own ideas about how they want to put out their fires; and, many times, their unique demands only serve to fuel the fire that is injuring them.

Some patients refuse medications believing that pills are harmful.  It amazes me when a smoker refuses medicinal help due to an irrational belief that pills are toxic; yet, he voluntarily inhales hundreds of known toxins 20 times a day.

Some patients demand medication and shun therapy, even when therapy is a better alternative.  “Doc, I just want my tranquilizer, it solves all my problems.”  Not really!  In many cases, tranquilizers are firewalls, temporarily protecting my patient from being burned by the raging fire.  In the case of anxiety, the psychologist has a much better chance of eradicating the fire than I do.  In the case of a three-alarm blazing anxiety, my deploying medications along with the psychologist’s therapy is necessary.  “Doc, I ain’t seeing no psychologist!  They can’t help me”, means just “give me my pills”.  

Using the wrong extinguishers may cause as much harm as just allowing the fire to burn on its own.  Years ago, we had a fire alarm go off in my office.  Firemen streamed through the front door with axes in hand.  Luckily, there was no fire and no ax was used.  Those axes could have caused a lot of damage if used inappropriately.  Giving in to the demand for tranquilizers can lead to a lifetime dependency on those very medications.  Being a doc/fireman can be frustrating.

Still other patients come in yelling “FIRE, HELP ME”, then refuse all treatments.  They want something “all natural.”  What’s more natural than sitting with a therapist, talking about what ails you?  “I don’t want to see a therapist.”  “What about valerian, it’s all natural?”  “Pills”, published earlier this year, addressed these totally unnatural, unregulated, non-FDA approved, manufactured pills.  Despite the fact that no one really knows what’s in the capsule, what effects it may have on an individual, how the body processes it, and how it interacts with other substances the patient ingests, people have really bought into this form of witchcraft.  Being a doc/firefighter can be very frustrating!  By the way, I have a bridge for sale.  It’s all natural, made from wood.  It’s located in Long Grove.  Any buyers?

Being a doc/firefighter can be extremely rewarding!  I saw a smoker who was being consumed by a raging fire.  His ears hurt, his throat hurt, his lungs hurt, and he couldn’t stop coughing.  Just as the real firefighters and paramedics have to deal with victims of fires and just as those victims often succumb to smoke inhalation, my patient had succumbed to smoke inhalation.  His was no accidental fire! He actually lit his fire 20 times a day for the last 10 years!  I put out his fire and rescued him from smoke inhalation.  Once his burns are healed, he will never again smoke.  Why?  The answer is easy.  He loves his wife and children.  He would never cheat on his wife or children.  When I pointed out that he was cheating on his family 20 times a day, the expression on his face was one of horror.  He had never looked at it that way.  Sometimes, you win one!

Attention, arsonist!  Help me help you!  Do not feed the fire that is consuming you!  Help me help you by listening to the wisdom of my 30 years as a doc/firefighter.  Use all the tools available to you.  The life you save may be your own.

THEORY VS. REALITY

I recently published “Possible vs. Probable”. The premise of the article was that, while everything is possible, what is truly important is what the probability of an illness or outcome is.  Today, I want to apply the premise of “Possible vs. Probable” to the realities of getting old and being ill.

Mrs. “X” is in her 70s.  She has diabetes, high blood pressure and her kidneys aren’t up to par (renal insufficiency).  Mrs. “X”’s most pressing problem is her arthritis.  Her neck, low back, hips, and knees hurt all day long.  It takes Mrs. “X” “forever” just to get out of bed in the morning.  Mrs. “X” also worries about everything.

Mrs. “X” worries mostly about her kidneys.  Her kidney doc has warned her not to take any NSAIDs (ibuprofen, naproxen, etc.).  Theoretically, NSAIDs can adversely affect kidneys causing a decrease or worsening in kidney function.  Realistically, Mrs. “X” is in pain on a daily basis and NSAIDs are the treatment of choice for her arthritic pain.  Mrs. “X” knows that NSAIDs work as on the days she takes ibuprofen, she feels 10 years younger.

What should Mrs. “X” do?  Should she listen to her kidney doc and live in pain or use NSAIDs and risk further loss of kidney function?  Should she try other treatments?

Mrs. “X” does great on steroids.  She becomes pain free!  Theoretically, steroids can worsen her diabetes and hypertension, cause cataracts, osteoporosis, mood swings and an assortment of other problems.  The reality is that they make her better and without steroids or NSAIDs, she is crippled with pain.

What should she do?  She has tried acetaminophen and it has failed to offer any relief.  Narcotics constipate her and make her unsure on her feet.  Physical therapy did not help.

In my book, reality trumps theory every time.  Is it better to protect your kidneys, avoid possible worsening of your diabetes/hypertension and live longer in pain or is it better to relieve pain and potentially shorten your life?

I often find myself treating Mr. and Mrs. Xs who fit the above scenario.  A day with minimal or no pain is always better than ten days in pain.  Many of my patients go for quality over quantity.  What is remarkable is that most tolerate their NSAIDs or steroids well and do not significantly shorten their life or worsen their bodily functions.  Theory is not reality.

Because doctors believe in informed consent, because doctors are afraid of being sued for caring for their patients, they teach their patients about the theoretical problems a treatment may pose.  Because pharmacists have the same concerns as doctors, they glue and staple warnings all over Mrs. “X”’s prescriptions.  Unfortunately, patients often are scared by the warnings of theoretical doom and refuse treatment, leaving them to suffer day after day.

Remember, theory is not reality!  Remember, each of us is unique and how we respond to a given treatment is not preordained by scientific studies.  Life is about weighing risks and benefits and then hoping the decision you make is the right one.  When making decisions about potential treatments, the reality of today should receive much more weight than the theoretical tomorrow.

If you noted a sense of frustration in this article, you would be correct.  Our system of informed consent often backfires.  Rather than protecting patients from theoretical side effects and risks of treatments, informed consent often harms the patient it is meant to protect.  It’s frustrating to offer a patient relief from suffering and then, doing your duty as a physician, talk that patient out of doing what you feel is best for them.  Sounds schizophrenic? It is and therein lies my frustration!

WHY?

Why?  Why won’t you tell me why?  I need to know!  If I know, I can help!  I’ve been practicing medicine more than half of my life.  You would think I would know why, but I don’t.

I’m frustrated.  I’ve learned so much, studied so hard and worked all my life to provide the best care I can.  No matter!  Unless I can find this last piece of the puzzle, it may all be for naught.  Why?  Tell me why!

Why won’t you take care of yourself?  Is a little exercise too much to ask for?  Is cutting back on bacon and salt so hard that it’s worth cutting your life short?  Life is so precious!

Why must you harm yourself?  Sure, smoking is an addiction.  Shouldn’t living “well” be an addiction?  Isn’t the risk of cancer enough of a threat?  Tell me why you won’t listen to your body.  You cough every morning.  You’ve been coughing for months.  You want a cough medicine.  You’ll take a cough medicine, but you won’t stop smoking.  Why?

I’m frustrated.  I don’t get it!  You’ll take medicine for your diabetes, blood pressure or emphysema but you won’t take care of yourself.  You’ll suffer through surgery and chemotherapy for your cancer, but you won’t take care of yourself.

Proper diet and exercise is the one prescription you won’t follow.  Why?  Why suffer at your own hand?  Why make your family suffer?  Why?  Please tell me why.

DON’T LIST

Surfing the net for knowledge is one of my pastimes and last night I struck gold.

A not-to-do list for those with chronic pain or illness” by Toni Bernhard, JD instantly caught my eye!  Coming off a miserable week of back pain, I could use some advise even if it’s from an attorney!  Here goes(taken from her article):

  • DO NOT say “yes” to an activity if your body is saying “no.” 
  • DO NOT call yourself names or otherwise speak unkindly to yourself.
  • DO NOT try a treatment just because someone said it cured him or her.
  • DO NOT wait until the last minute to get ready for something.
  • DO NOT strive for a spotless living environment.
  • DO NOT “shop ‘til you drop.” 
  • DO NOT wear uncomfortable clothes.
  • DO NOT think about pleasures from your pre-illness life, freeze them in time, and assume they’d be as much fun today.

I want to thank Mrs. Bernhard for her sagely advice and add a few of my own:

  • DO NOT tell someone to take the day off, go home and take it easy when they appear to be in better shape than you are.
  • DO NOT sit too long in any one position and expect to be able to stand up gracefully.
  • DO NOT try to fool your patients.
  • DO NOT fail to thank those who show their concern for your wellbeing.
  • DO NOT get short with your coworkers and spouse.

Chronic pain or illness is no fun but how you choose to live with it can make a world of difference.  Oh yes, there are two more big “DO NOTs” for your list:

  • DO NOT forget to follow you doctor’s instructions.

Last but not least, DO NOT give up hope!  An answer may be right around the corner.

REGRETS

Regret is a harmful emotion. Regrets are best avoided. It’s one thing to regret buying a stock that plummets; it’s another to regret that you ever smoked because your chest x-ray shows a large tumor. 

People often don’t appreciate what they have until they’ve lost it. When you’ve lost your health, you will regret its loss for the rest of your (shortened) life. Not long ago, I wrote about non-compliance. Imagine that you were supposed to take your medication every day. Your doc prescribed the medicine because, without it, you would be at risk of having a heart attack. Imagine you decide that medications are expensive, bad for you, and that you are going to use all “natural” over the counter pills to treat yourself. 

Now, imagine you wake up in the coronary intensive care unit. Your doctor tells you that you suffered a cardiac arrest (died). You try to ask him a question but gibberish comes out. The doc explains that you are stable; but you were without oxygen for too long and you have suffered hypoxic brain damage. You’ve had a stroke. You realize you can’t move your right hand and leg. You’re alive, and, for the first time in your life, you understand what being healthy was all about. 

You understand that you may never walk, work, drive, or even make love again. You understand that you will have to take medications, go to rehab, have full time help, and learn to live a new life. You understand that you should have never stopped your medication. You will regret that decision for a very long time. 

Every day, I plead with patients to take their medications, get their colonoscopies/stress tests/ x-ray, done. I plead with them to stop smoking and drinking. I ask them to give up cholesterol, sugar, and other goodies so that they can be healthier. I write articles (over 625) aimed at helping them understand how important their health is. 

Every day, my patients tell me they are going to try to care for themselves. I hate the word “Try”. To me, try implies failure. I ask them to work at being healthy. I explain that the stakes are high, often to no avail. You don’t know what you have until you lose it. A healthy person cannot imagine what it is like to lose his health. A healthy person cannot imagine how much “regrets” hurt! 

Life is full of regrets. Do everything within your power to be healthy. Live a “wellthy” life by investing in your physical, nutritional, emotional and financial wellbeing with the same fervor as you invest in your financial health. Work with your doctor. Learn all you can learn. Follow your doc’s instructions. Don’t fall for the hype of the “all natural” neutraceutical world. If you don’t believe you need a treatment or a test, discuss it with your doctor. 

Staying out of trouble is much better than getting out of trouble. Remember my favorite blessing, “May you be so blessed as to never know what disease you prevented.” Be “Wellthy” and live a long life without regrets. 

EXPECTATIONS

I just read an article about expectations in medicine.  Expectations can make or break a relationship.  They can be the source of great excitement and joy or of great disappointment and sadness.  Expectations, in medicine need to be clearly defined and, when possible, successfully met.

Several years ago, I did a full physical on a new patient.  Patient “X” had been referred to me by a mutual friend and I did my usual, thorough job.  I was dismayed when my friend called me to report how disappointed patient “X” had been!

I called patient “X” to discuss the results of his exam and why he felt I did a “crappy” job.  Mr. “X” started with, “Doc, I like you, but you did not do/order a stress test, Carotid Doppler, lung function test, PSA or colonoscopy.  I went to Dr. “Y” and he ordered them for me!”  To Mr. “X’s” surprise, I asked him why he thought he needed those tests.  Mr. “X” responded, “My partners’ docs ordered those tests.”

In retrospect, the problem was obvious.  Mr. “X” had expectations I did not meet.  I had expectations, as well.  My expectation was that Mr. “X” wanted a thorough, customized physical.  “Mr. “X”, I’m sorry you were unhappy.  Let me venture a guess:  your partners are all in their mid-sixties.”  His answer was “yes”.  “Mr. “X”, had you been in your sixties, I would have ordered those tests and perhaps more.  You are 41 years old and, with your personal and family history, as well as excellent physical condition, I did not feel you warranted any of those tests.”

Mr. “X” cancelled all of his tests and sees me yearly for his exam.  I learned a valuable lesson.  My patients’ expectations may not match mine.  Setting realistic expectations are an important part of any doctor-patient relationship.  Patients must recognize that doctors have expectations and doctors must realize that patients have their own, distinct expectations.

Expectations can range from fantasy to reality.  In the medical arena, it is crucial that expectations be founded in reality.  As your doc, I expect you to follow my instructions.  I expect that, if you are going to vary from my instructions, you will let me know.  These are realistic expectations.  

An example of false or unrealistic expectations would be if you were 75 pounds overweight, drank a bottle of wine and six cocktails, and smoked two packs a day; and I expected you to lose your excess weight while giving up smoking and alcohol simultaneously within 6 months.  (I would give the above patient at least 6 1/2 months). 

Sometimes I set unrealistic expectations for myself and my patients.  When the stakes are high enough, you do what you have to do in order to survive.  Unrealistic expectations can be met when truly necessary!

Patients often set unrealistic expectations.  The most common example of an unrealistic expectation is when the patient, mentioned above, expects his doc to cure his cough, repair his damaged liver, and save him from the heart attack he is about to have.  Doctors don’t heal patients; they help patients heal themselves.  Expecting your doc to save you from a sinking ship while you are punching holes in the hull is another example of false expectations.

So, what can you do?  Discuss your expectations with your doc.  Let him/her know exactly what you want; what you are thinking.  Be sure of what your doc expects of you.  Expect that your doc will work your expectations.  If he/she falls short, discuss it with him.  Work at meeting your doc’s expectation.  Expect that your doc will confront your shortcomings, as well.  Most of all, be honest with yourself and your doctor.

P.S. – I believe in miracles.  I have been blessed to see many miracles in the last 40 years of practice.  It is ok to have false or “fantasy” expectations, as long as you know that the only way they will come true is to receive a miracle.  It is not OK to sell yourself on false hope as the vast majority of time it will end in disaster.