N95 MASK

As many of you know, Renee and I are moving to Charlotte, North Carolina.  We were in Charlotte last week getting to know our new grandson and checking on the construction of our new house.

Due to the coronavirus crisis, we flew back to Chicago on Sunday.  Both airports were not busy and it was easy to stay at least 6 feet apart from others.  I’m pleased to share with you the fact that United Airlines sat passengers as far away from each other as possible.  I’m also pleased to say that I did not see one person cough!

What I was shocked to see was that ,of 16 individuals wearing masks in the Charlotte airport, 14 had either an inappropriate mask or wore them in such a manner as to negate their benefit.  As a physician, we are fitted for masks on a yearly basis.  There are multiple types and sizes of mask.  Employee health screens you for contraindications to wearing masks then sizes your face and verifies that you know how to put the mask on so that the mask seals properly.

If you have underlying lung disease, an N95 mask could possibly restrict your breathing enough to cause you serious harm.  Before you buy a mask, check with your doctor to make sure using a mask is safe.

Goggle “How to use a N95 mask for instructions on how to use your mask or click on this hyperlink.  Remember, you must have the right size mask.  They are not one size fits all.

Of the individuals I saw wearing masks, the most common mistake was wearing the mask too far down the nose.  The other really ridiculous mistake I witnessed was pressing the cell phone up against the mask while carrying on a conversation.  The phone deforms the mask causing it to leak.

The two passengers on my plane who wore masks pulled the mask up and down on a regular basis.  They contaminated the mask and their hands the first time they pulled it down and they never checked for a seal.

If you are sick, wear a proper mask.  Review the procedure for putting on a mask before you use it.  If you are not sick, you don’t have to have a mask and your using one, leads to shortages depriving those who are ill and those in the work force who also need those masks.  Be safe and well.  The life you save may be your own. 

I WOULD LIKE TO BE YOUR FRIEND

Did you ever tell your kid, “I’d like to be your friend, but my job is to be your parent?”  As parents, we often have to make tough decisions.  Many times, our children are not happy with our decisions and their consequences.  Our job as parents is to care for our children, keep them safe and healthy, whether they like it or not.

My job as your doctor is much the same.  Yes, I’d like to be your friend; but, ultimately, I am responsible for your health and welfare and have to do what’s right.  Sometimes, you don’t like what I have to do to keep you safe.

Mr. A wants an antibiotic.  He’s absolutely positive he needs a Z pack or he’ll perish from his upper respiratory tract infection.  Mr. A has a virus/cold.  I am 98% certain that his two-day old cold is viral.  I am also aware that Mr. A is allergic to multiple antibiotics.  Prescribing an antibiotic for Mr. A borders on malpractice.  Mr. A pleads his case: “Doc, I’ve been coming here for 15 years.  You know I’m just going to get sicker if I don’t get a Z Pack.  I can’t afford to miss work.”  I’d love to be Mr. A’s hero and give him what he wants.  I can’t!  I’m his doc and have to give him the care he needs. I’m worried he will run away from home, seeking what he wants on the corner of health and happiness.  I spend an extra 10 minutes explaining why he doesn’t need an antibiotic.  He is not happy.

Mr. C has hypertension.  He does not want to take any medication.  Mr. C pleads his case: “Doc, I’m getting back into exercise and dieting.  I’ll get it under control.  Medications have side effects and cost too much!  Give me a few months to get my act together.”  Mr. C’s blood pressure is too high and has been elevated too long.  Mr. C needs to be on medication.  I spend an extra 15 minutes explaining why it is crucial to treat his high blood pressure.  He is not happy.

I’d like to be your friend.  I’d like to make you happy.  Sometimes, I can’t do both; I’m your doc and your health comes first.  As you grow older and healthier, I hope you grow to appreciate my care.

HOW OLD IS TOO OLD

Jodi, the daughter of a dear old patient of mine, called to discuss her mother’s misery. Her mother is in her 80s and no longer enjoys life. She has a bad heart, bad lungs and a very bad back. Her back pain keeps her awake at night. She moves from the bed to the chair and back again. She can’t get comfortable doing anything. The surgeons are helpless; she is not a candidate for any procedure. The pain specialists are running out of tricks. How old is too old? Only the patient who has lived too long really knows.

In olden times (the first 10 years of my practice), patients died from natural causes, such as pneumonia, heart attacks or heart failure, kidney disorders and cancer. Over the last 30 years, my profession has gotten much better at rescuing people from death. Death is reversible. Often, the patient who would have died just 20 years ago gets a new lease on life. Others are not so lucky.

Sometimes the cost of rescuing someone from death is tragic. It is as if we are playing tug-of-war, with death gripping one side of you and life and your doctors holding onto the other. Sometimes we only bring back part of you. During a heart attack, heart muscle dies. If enough dies, the quality of your life can be seriously lessened. “Quality of life” is a term doctors often use. Like the question, “How old is too old?”, “quality of life” is in the eyes of the beholder. While one patient is content to lie in a nursing home bed and count ceiling tiles, another is not.

So, what is the answer? How old is too old? What does quality of life mean? Since only you can answer that question, your doctor and family need to know what you want. Just as “Doc, did I kill my father?”, discussed the importance of “advanced directives” and their ability to speak for you when you no longer can, sharing your thoughts about how you want to live your life and how you want to die with your family and physician can help them help you through tough times. As we age, we all come closer to death. An important part of life is facing that prospect, answering the tough questions, knowing when to hold on and knowing when to let go.

If the answer to “How old is too old?” is now, hospice can help. Hospice is not just for cancer patients. Hospice helps people who are dying do so in dignity. If the answer is “not yet”, then make sure your care team knows that they should do everything they can to support you.

How old is too old? You tell me!

I CAN’T SAY IT ENOUGH

I’ve written about it before and I’ll probably write about it again, It’s an emergency until proven otherwise. Chest pain is an emergency until it is resolved and proven to not be of cardiac origin. Abdominal pain is an emergency until it is properly diagnosed and treated. The worst headache you have ever had is an emergency until your brain scan is reported as normal.

Yes, I admit it. I overreact to a lot of things. I am a pessimist by training, always guarding against the unseen enemy. I have to be! If I agree with your husband and treat his chest pain as indigestion, I may treat you for depression after the funeral. If I agree with your insistence that your abdominal pain is just the stomach flu, I may have to teach you to change your colostomy bag. If I underestimate your headache and give you the pain pill you are asking for, I may visit you in the nursing home the rest of your life.

Agreeing with you makes you happy the majority of the time. By the same token, disagreeing with you pisses you off when the tests all come back normal and you have to pay for the workup. You get a big, “I told you so!”

It’s an emergency until proven otherwise, and, when the heart attack is real, I’m a brilliant diagnostician, an excellent doc. I saved your life. When it’s indigestion, I’m that quack who overreacts to everything. So, who am I? Am I a brilliant diagnostician or a quack?

The answer to that is easy. I am your doc, working hard to keep you safe and well. Like every other doc, I use my experience, knowledge, and evidence to create a differential diagnosis  that is appropriate for your symptoms and then I act to protect and heal you as best I can. I don’t have to be brilliant. I just have to care for and about you. While I may be wrong about what ails you or, in retrospect, misspent your money, I am not a quack.

So the next time I ask you go to the ER, please go! The next time I order an MRI, please get it! The next time I ask you to come to be examined, please don’t argue! I can’t exam you over the phone. There are things that can be done in the ER that I cannot do in the office. An MRI can find things that a physical exam cannot uncover.

One last thing. If it makes you feel good to say, “I told you so”, then say it. If not, then I would be grateful for, “Thanks, doc, for looking out for me.”

CRAPPY DAY

Today is one of those crappy days.  As my move to Carolina grows closer, I become more uncertain and fearful.  While Renee and I have always seen ourselves as Virginians who just happen to live in Illinois, it is now certain that we were wrong. Home truly is in Long Grove/Lake Zurich and moving away is really tough.

I will always miss going to the office.  There are days when I just want to drive up to 504 S Rand Rd, let myself into the empty building and just sit and remember all of the great families I was so blessed to care for in my treatment center.  I’ve even talked to the landlord about letting me in one last time.

It seems that, wherever I go, another memory of the past pops up.  Yesterday I drove past Motorwerks.  One of my first patients worked there.  At the end of his office visit, he wanted to show me his new BMW.  I had never driven one even though I had dreamed of owning one.  “Doc, take it home for the night and see how you like it,” led to a 26 year relationship with Motorwerks and a love affair with BMWs.

I’ve been touring my favorite restaurants, eating Kaufman’s corned beef, Lou’s pizza, and everything on Mykonos’ menu one last time.  While southern food is good, I doubt many places can match Chicago’s restaurant scene.  When you are my age, food replaces sex. Moving away from the local culinary scene is like giving up sex.

I’ve been saying good-bye to friends and patients by dining with them at my favorite locations.  I’ve realized that my social life had revolved around my office life and that my patients were really my friends.  It’s no wonder my weight refuses to come down.

I am pissed off at Springfield.  While my house is paid off, I don’t own it.  My taxes are like a lease payment due monthly and the state is my landlord.  I don’t know how anybody retires in Illinois.  The government continues to waste our money, raise our taxes and take no responsibility for their incompetence.  My advice is to stop voting for incumbents!

Leaving my home, Renee’s porch and my pool for a tiny house in a 55 and older community is going to be challenging.  The bright side is that they will have a senior’s recreation center where I can learn to knit and play Mahjong.  LOL!

Writing has been my therapy.  I now have writer’s block. It’s similar to bad constipation, full of gas and seepage.  Today I surfed the internet looking for inspiration.  I found a quote by Michael Pritchard, “You don’t stop laughing because you grow old.  You grow old because you stop laughing.”  He’s right and I’m very old.

I also found the following quote from an unknown source, “Do not regret growing older.  It is a privilege denied to many.”  I do not play “woulda, coulda, shoulda” so I have no regrets. I am thankful for each day I awaken next to Renee.

I woke up next to Renee today so I guess its not such a lousy day.

INFIDELITY

Is your loved one having an affair?  No, not a sexual affair with another human.  I’m referring to an affair with his job!  Yes, some people are bigamists, married to their jobs and their spouses.  Is your spouse married to his work?

A work affair can be worse than a physical entanglement with another human.  It can be harder to break up with work than with a human lover.  An affair with your job can be just as destructive to your marriage and can cost you your life.

Not long ago, I saw a leader of American industry whose job took precedence over all else.  Being responsible for a Fortune 500 company’s success is an awesome responsibility.  The company demands constant attention, nurturing and stroking the company’s growth. Responding to changing needs.  Being a successful corporate leader requires long hours, travel, business meals, and more, leaving no time for self and family.

As in any affair, denial plays a major role.  The unfaithful spouse will deny any impropriety, claiming that his/her long hours at work are spent on behalf of his family!  He/she claims that he/she works long hours in order to provide financial security for his/her family.   He/she claims that, one day, he/she will retire and enjoy his/her family and life.

As a patient, the office bigamist often neglects his health, skipping appointments, running out of medicine, and complaining that there is never time for exercise.  Certainly, business lunches and dinner are not amenable to proper eating habits.

Diets and Other Unnatural Acts was partially inspired by just such a corporate giant.  Being married to your business may provide for financial success and security, but money without health and family is worthless.  Carl was living proof.

Are you married to your work?  Is your work an abusive spouse?  Does it demand so much of you that there is no time to take care of yourself or others?  Or are you a stress junky?  A success junky?  

Sometimes business demands are not the problem.  Sometimes the personal need for success creates stresses that are self-imposed.  I’ve written about the two brothers, one whose has “everything” and the other who has “enough.”  Both brothers have identical assets, the difference is perspective.

Whether you are a work bigamist or a stress/success junky, it’s time to change your perspective!  Money without health is worthless.  Over the last 40 years, I have seen many patients sacrifice their health and family relationships in the name of making a living.  I have seen many spouses cheat on their loved ones by marrying their businesses.  In every case, the only thing the family ever wanted was time with their father/mother/spouse.

Success in your job is important.  Success as a spouse and family man/woman is more important.  They need not be exclusive of one another.  Make your health and your family your primary responsibility.  They will be with you long after your business is gone.  Don’t wait until your health fails or your family is irreversibly estranged.  Remember, the life you save may be your own and that life is important to others. 

GETTING WELL TAKES WORK

One of my more successful patients stated, “The harder you work, the luckier you get.”  Apparently, Gary Player is the originator of this particular quote and my patient and I agree with him.

In the past, I have written about the difference between “trying” to accomplish a task and “working” to accomplish that same task.  The only thing I ask of my patients is that they work at being healthy.   The implications of working on a project are many.

Foremost among the many implications of working on a job is that you go to work every day regardless of whether you want to or not.  I don’t care who you are or how much you love your job, there will be days you just don’t want to work.  The successful person gets his act together and not only goes to work but gives it his all.

Another important aspect of working on a job is the knowledge that you will make mistakes and that you will correct those mistakes as soon as you identify them.  The successful worker goes one step further, he learns from each mistake so as not to repeat it in the future.

Finally, incumbent in every job is the knowledge that your work must be finished within a prescribed length of time.  The successful worker learns how to pace himself so as to complete his task in an efficient and timely manner.  The end result may look like luck to an outsider, but as Gary Player put it, “The harder you work, the luckier you get.”

If you look at managing diabetes, hypertension, or high cholesterol as a job, you will succeed at controlling the underlying disorder with a minimum of medications and interventions.  If you look at getting off of your cigarettes as a full-time occupation, you will succeed.  Hire yourself to work on being healthy.  Health does come at a cost!  The cost is learning good nutritional, exercise, emotional, and spiritual habits.

If you are retired, come out of retirement and work 2 hours a day on maintaining your body in tiptop shape!  If you work long hours and don’t have time for your “self,” learn to “Time Wrap!”

Lastly, if you are having problems finishing your tasks in your everyday job, often turning to a co-worker will help you find the solutions you need to succeed.  If you are having problems maintaining your health, turn to your doc for suggestions and help!  Remember, the life you save may be your own.

STRESS

One of my friends said, “Everyone hands me shit.  It’s my choice whether to smell it or step in it!”

I thought her wisdom should be shared with you, my reader.  It seems everyone I see these days is stressed.  Many feel like my friend, buried in excrement; yet most don’t realize that how you deal with stress is your choice.  She has decided not to step in other’s “shit” and I suggest you do the same.

I have written many articles on stress and stress management.  In “Blessing List,” I suggested looking at your half empty glass as if it were half full. 

  • Your husband is out of work; you are blessed to have a husband. 
  • You have too much on your plate; you have a table to put your plate on and food to put on that plate. 
  • You have a full time job during the day and mom at night; you are lucky to have a job and blessed with children. 
  • Your parents are getting old; your parents are alive. 
  • Your house needs work; you have a roof over your head. 
  • You have too many bills; I can spend less and live with less as long as I have a roof over my head, food on the table to feed the children and husband I love. 
  • My children are too needy; they will learn the difference between wants and needs and learn to be appreciative of what they have. 
  • Whiny kids are healthy enough to whine and they will grow up eventually. 

In “Jugglers,” I described juggling your stressors as if they were brass and glass balls.  I pointed out the fact that brass balls (everyday stressors), when dropped could be recovered relatively undamaged but that glass balls (family, friends, health) often shatter upon hitting the floor causing irreparable damage.

In “Stress,” I wrote “Stress can actually make you sick.”  In an earlier article, “Worried Sick” on December 21st, 2010, I described a patient who literally made herself sick worrying about an illness she did not have.  Pure stress can lead to ulcers, phobias, palpitations, high blood pressure, stroke and more.  I also reminded my readers that stress is a fact of life.  My patients have taught that the best stress managers are often the most successful and happiest individuals.

In “Laughter Is Good Medicine,” I reviewed the positive effects of laughter.  When I heard “Everyone hands me shit.  It’s my choice whether to smell it or step in it,” I laughed out loud.  I needed a good laugh! It was a very stressful day and my friend provided a dose of the medicine I needed!

TRADESMAN

According to Wikipedia, “A tradesman is a skilled manual worker in a particular trade or craft.” Carpenters, electricians, plumbers, and many other tradesmen go to work everyday building and maintaining the structures we live and work in. Without them, we would all be in trouble.

Unfortunately, tradesmen often destroy their own physical beings while servicing and building our abodes. Equally sad is the fact that the tradesman’s main tool is his own body; and when his body can no longer take the abuse of his job, he is out of business, left to retire too soon for his own good.

While treating just such a tradesman, it dawned on me that his job was comparable to that of a professional athlete. His job, much like any contact sport, involved regular collisions of brick and steel against flesh. His lungs were assaulted on a daily basis by concrete dust and various work site debris. Unfortunately for him, a knee injury has terminated his career much before his prime.

What makes my tradesman different from the professional athlete is the thought and care given to maintaining the athlete’s own physical self in order to stay in the game. Professional athletes have trainers who help them develop physically and emotionally to maintain peak performance. Professional athletes have warm up exercises and stretching routines to prepare them for their day’s work. At the end of their workday, they have cool down routines. They have trainers and coaches to review the work they did and help them do it better and safer.

While professional athletes realize that their bodies are their job, tradesmen do not. While athletes know they have a limited time to play the game, tradesman assume they will last forever. Tradesmen train by watching the Bears. Their warmup routine is usually a cup of Java and a donut. Stretching, warm-up; I don’t think so. They jump in and start pulling and pushing and loading and unloading, pounding, sawing, and all kind of other violent acts. Their cool down routine is often a beer at the local pub on the way home.

Don’t get me wrong. I have a few tradesmen who eat right and exercise, taking care to keep their bodies in great shape. Most don’t. Most are also at a loss when their bodies falter, break, and are not repairable. It is sad to see a carpenter’s lungs fail due to years of inhaling dust, especially when a cheap mask could have filtered out 99% of the crap he inhaled.

I admire tradesmen for their hard work and dedication. I work hard to serve as their trainer, teaching them how to avoid injury and disease. Comparing them to pro-athletes sometimes helps them understand how important it is to prepare physically for the demands of their jobs. Unfortunately, many look at me like I’m nuts!

If you work in the trades, realize that, without your body, you are jobless. Warm up in the morning prior to working. Learn to stretch. Ice down at night. Wear a mask when around pollutants. If there is dust on your clothes, it’s in your airway. Most of all, eat right, exercise, and maintain your body as if you were a pro-athlete. You may not make millions but your “Wellth” depends on it!

RELIABLE SOURCES

Mayo Clinic, need I say more?  The site is easy to use and full of valuable information.  Go to www.mayoclinic.org.

Are you diabetic or know a diabetic?  The American Diabetic Association’s site could help you master diabetes.  http://www.diabetes.org/

The Family Doc site covers the entire spectrum of medical care. Go to FamilyDoctor.org

Worried about your heart? Go to: heart.org

Easy to use, WebMD helps set the standard.  http://www.webmd.com/

Believe it or not, the Center for Disease Control is a government agency that actually works well.  A must if you are an international traveler. http://www.cdc.gov/az/

While. ZdoggMD is mainly a physician, I think there is much to be gained by listening to the doc’s opinions.  Warning: He often uses potentially offensive language to make his point.

Another excellent site is KevinMD.

Feel free to respond with your favorite sites.