FOLLOW UP

I have a new job!  Yep, my new full-time job is seeing my assortment of docs and following up on their orders.  I just saw my urologist who prescribed a new medication and a lab test to be done in 2 weeks to monitor the new medication.  I’ve already made an appointment to have blood drawn and will follow up as directed.  Don’t worry, I’m ok.  I’m just an old man who stops at every bathroom he walks by.

Below is an article I wrote about this subject:

Please, don’t get mad at me! When I last examined you, I gave you instructions on when to follow up with me. I gave you prescriptions for enough pills to last you until our next visit. I told you to see me before you ran out. Now you are running out and being seen in the office doesn’t fit with your schedule.

Medications are prescribed for very specific reasons. Each medication comes with its own benefits and its own risks. Monitoring your medications for both effectiveness and harmful side effects is my responsibility. You are supposed to be my partner in this endeavor. I need your help!

Making me the bad guy is not in anyone’s best interest. I don’t like holding your refills as hostage to your next visit; but, over the last many years, I have come to the conclusion that putting off your doctor’s visit is a universal human trait. Everything is more important than following up with your doctor!

After all, you feel fine. I’m happy you feel fine. My job is to keep you feeling fine. If the medicine I prescribed for you is injuring your liver, there are two ways of finding the problem. My preferred method is to monitor you for liver injury on an appropriate schedule. The second way is to wait for you to turn yellow. Appropriate follow up and monitoring of potential side effects makes more sense than treating rare but serious side effects, doesn’t it?

Unfortunately, the electronic medical record and the “portal” make it too easy to dodge your follow up visit. Sending me an electronic request for a refill or having the pharmacy contact my office for a refill means never having to talk to my staff or your doc. In the end, you get mad at me. Your expectation is I will refill your medication without question and you will eventually see me.

While I’d like to be your friend and play the role of the good guy, I have to be your doc. I have to make sure any treatment I give you is as safe and effective as I can make it and that means seeing you for appropriate follow up.

My recommendation is that you take an empty bottle of your medication and put 2 weeks worth of pills in the bottle and put it in your medicine cabinet. When you are down to your last 2 weeks of pills, it’s time to come in. Pretty simple, huh? Help me help you. The life we save may be your own!

10 GIFTS

With the holidays coming up soon, Sara Debbie Gutfreund’s article on Aish.com entitled the “Top 10 Gifts Every Wife Wants,” is excellent and very thought provoking. The ten items she listed are:

  • Appreciation
  • Compliments
  • Empathy
  • Kindness
  • Friendship
  • Affection
  • Respect
  • Acceptance
  • Authenticity
  • Laughter

At first glance, I thought this was an excellent article and should be shared with my patients. As my readers know, I have written about the surge in divorce I was seeing in my practice. Gutfreund’s article might be an antidote to the sickness afflicting my patients’ marriages.

Then it dawned on me. Should this not be a two-way street? Gutfreund’s article should have been entitled “Top 10 Gifts Every Spouse Wants.” Then I realized that the husband’s list needs to have an eleventh item listed: sex. Now where do you think that goes on the above list?

While we are on the topic, I’m sure you’ve heard the saying, “If momma’s not happy, ain’t nobody happy.” Why haven’t you heard, “If daddy’s not happy, ain’t nobody happy?” I suspect that the answer is that momma controls the eleventh item on the list.

MY FAVORITE BLESSING

There are some things in life that, at first glance, you fall in love with. Once On Saint Patrick’s Day, one of my specialists sent a greetings card that said:

“May your troubles be Less, Your Blessings be More and nothing but Happiness Come through your Door.”

This Irish blessing will join the following blessing on my all-time greatest blessings list:

“May you be so blessed as to never know what disease you prevented.”

And so, to each and every one of you, have a blessed day and be happy and healthy.

I JUST DON’T GET IT

Sometimes, I just don’t get it! Let me give you an example. My patient is 60 years old. He lives in an older section of Lake Zurich in a house that is 50 years old. His lawn is beautifully manicured and landscaped. His house is freshly painted. The roof has recently been upgraded; the windows caulked.

The inside of his house is immaculate. Anything that breaks gets immediately repaired or replaced. The 50+ year-old kitchen functions just as good today as it did when it was new. The plumbing was updated two years ago.

In his two-car garage sits two beautiful cars. The 1998 Oldsmobile is in pristine shape. The 2006 Ford still purrs. Oil changes are done on a regular basis. Brakes and tires are checked on a schedule. As you can see, my patient believes in keeping his belongings in tip top shape.

So why am I confused? What’s not to understand? Let me share some more facts with you. My patient is in lousy shape! His frame has spread in all directions and he weighs in at 240 pounds. His chassis (back) is full of arthritis and the muscles that are supposed to support it have been neglected for decades.

He has heart disease (plumbing), diabetes, high blood pressure and high cholesterol. He has an irregular heart rate called atrial fibrillation (electrical system) caused by his alcohol intake. While he puts only the best gas in his cars, he puts fast food crap in his belly.

I get that it is important to take good care of your house. You live in it! I get that it makes good sense to take care of your car. You drive around in it. What I don’t get is how you can totally ignore and abuse your body. After all, your soul lives in it!

Unfortunately, my patients don’t get it. One day, my patient’s beautiful home will have a hospital bed in it. One day his family will wheel him in a wheelchair to the kitchen to eat. One day, his family will mourn his loss in an immaculate, well kept, old house.

Take better care of yourself than you take of your property or pay the price! By the way, this patient profile is all too common in my practice!

ARTHUR ITIS

One of my octogenarians stated that the “Itis” family was a problematic bunch and Arthur Itis (arthritis) was the worst of the bunch. After I stopped laughing and regained my composure, I realized that he was right and that I should share her wisdom with you.

The Itises are many. This time of year we see rhinitis, sinusitis, and bronchitis just to name a few. Of course, my patient’s arthritis is seen year-round and tends to become more problematic with age.  Frankly, all of the Itis family can be nasty and most need to be dealt with sooner rather than later.

Unfortunately, most of my patients put up with the Itises too long and allow them to entrench themselves in the body where many of them proceed in wreaking havoc. If you are plagued by Arthur or any of his extended family, see your doc and learn how to get rid of them and stop them from coming back. Arthur Itis indeed may be the nastiest of the bunch, and, while we may not be able remove him, at least we can contain him and limit the damage he is likely to cause.

Out of the mouth of octogenarians comes great wisdom.

STOP TRYING

In November of 2010, I published “Try.”  Over the years, not much has changed.  Many of my patients are still “trying” to get healthy and failing.  The following article is being re-published in its entirety in hopes of convincing people to stop “trying” and go to work at being healthy and “Wellthy.”

Sometimes I wish my patients would stop trying.  They try to stop smoking.  They try to lose weight.  They try to take charge of their medical issues and get healthier.  The problem is that something always stops them from succeeding.  Today’s patients were stymied by work stresses, college weekend with the children, an anniversary celebration and depression over a lost marriage.   The problem lies in the fact that today’s patients got sicker despite being warned about the consequences of not taking care of themselves. 


The remarkable thing about today’s patients is that they are all hard working, successful people.  Despite the stresses of work, the celebrating and the grief, each of these patients went to work every day since I last saw them.  Each of these patients was successful at work despite their other problems.  

The difference in the word “work” versus the word “try” is the difference between failure and success.  When you work at a job, you go to work day after day regardless of whether you want to.  When you work and make a mistake, you correct that mistake and learn not to make it again.  When you work at a job, you resolve to finish it no matter how long you have to work to accomplish your task.  Sure, jobs are stressful; but going to work provides for your daily needs.

When you” try”, you give yourself an out.  In my experience, “try” is always followed by “but” and implies failure.  “Doc, I tried, but my cat ate your instructions. I’ll try again.”  What that really means is it’s not my fault.  Can you imagine going to your boss and saying, “I tried to finish the project but failed?  I’ll try harder next time.”  I think you’d be fired.  When your heart fires you by failing or your feet fire you by going numb from diabetes, you’re plain out of luck.

So, this New Years when you make those famous resolutions, resolve to work on your health care issues.  Hire yourself to lose weight, or stop smoking, or start exercising.  Actually schedule that colonoscopy, that physical exam or the appointment with the counselor.  While you are at it, use the same work ethic and skills that have made you successful to accomplish your health care goals.  Then revel in your new found health and live long and healthy.

MEDICINE IS A WEIRD BUSINESS

Despite the authority’s warning about the rapidly approaching flu season and their encouraging docs to immunize their patients, many people still refuse to get immunized.  

What was truly frustrating was that I would spend 5 minutes teaching each patient about the importance of the flu shot despite the fact that I made my living treating the flu!  Yes, while I made a few bucks off the vaccine, I would make a lot of bucks treating an individual with the flu.  If my patients listened to my advice, I would not see them very often.  Medicine is a weird business!

Like it or not, my job was to prevent disease and injury when possible, even if it put me out of business.  Today I want to share another valuable health fact with you in hopes of saving you pain and suffering.

Four decades ago, in a place far, far away (Arlington Heights), a much younger version of me worked as an ER doc.  Practicing Emergency Medicine was thrilling.  You almost never knew what was coming through doors and had to be ready to treat any and everything!  There were times when you could anticipate what you would see and one of those times was the first snowfall of the season.

The first snowfall always brought “ATTACKS!”  Take your choice, heart or back, the attacks poured through the door and were bad.  Snow removal is hard on the body even if you have a snow blower.  Think about it.  Do you train for the heavy work of snow removal?  Do you stretch prior to going to work at heaving shovels full of snow?  DO you cold acclimate?  Of course not!

You are superman or woman.  Despite your sedentary lifestyle, you get into your winter gear and start shoveling.  You start to sweat.  Your pulse rises.  You get short of breath.  An elephant sits down on your chest.  Two hundred thousand dollars later, you have a triple bypass.  Now, you exercise at the hospital (cardiac rehab).  Eventually, you go back to work.  

For $200,000 dollars, you can have a professional plow your driveway for the next 75 years!  Yes, you could have gone to work, collected your salary, and saved yourself the scar that you now wear down the middle of your chest if only you had treated yourself to a snow removal service.

You say your heart is fine?  How’s your back?  Shoveling snow is definitely hard on your back.  Heave, hoe and feel the zinger in your back that takes you to your knees.  The damn pain shoots right down your leg!  If you are unlucky, it also shoots into your groin.  Certainly, the back attack is preferable to the heart attack, but not by much.  I know, my back is a chronic source of problems.

As your doc, I strongly advise you to hire out your snow removal and go to work at whatever job you have.  Pay a professional and avoid seeing me.  Do it yourself and you’ll still pay a professional, only that professional will be me and my colleagues.  Your choice!

Selling health is what I do best.  Treating you when you ignore my warnings is what pays the bills!

PLEASE DON’T

PLEASE DON’T

Hey you!  Yeah, you know who you are.  Your wife wants you to stop.  So do I.  You’re going to hurt yourself.  I know you’re bright.  I know you’ve mastered the internet.  

Let me share a secret with you.  Your internet searches don’t trump my 40 years practicing medicine and my M.D. degree.  It also doesn’t trump the pharmacist’s training and knowledge.

Adjusting your medications by yourself and adding in handfuls of nutraceuticals is downright dangerous, bordering on suicidal.  Let me give you some examples.

Patient number one came into the ER at our local hospital bleeding severely from multiple sites.  He was on coumadin for a cardiac problem and the ER doc followed protocol administering Vitamin K to reverse the effects of the coumadin.  It should have been a slam dunk, but it wasn’t.  Patient number one spent a week in the ICU.  Unbeknown to his doc (me), he had started himself on multiple herbals for an assortment of complaints.

While his internet searches promised him enhanced health, vitality and a never-ending erection, he failed to appreciate the interactions between his miracle herbs and coumadin. 

Patient number two has an assortment of medical problems and medications, some prescribed and some self-prescribed.   So far, he’s been lucky.  Yes, lucky!  He has yet to have any serious side effects, but 40 years of experience has taught me that just because you’ve never experienced a problem doesn’t mean you won’t.  Actually, the longer you screw around with your meds, the more likely you are to have a problem.  Like Patient number three.

Patient number three stopped taking a critical medication because Dr Google told him his medication was a poison.  Patient number three will never recover from his fooling with his meds.  So as not to break HIPAA, I will not share any details but, trust me, fooling with his meds ruined his life.

SO, PLEASE DON’T SELF MEDICATE, CHANGE YOUR MEDICATIONS OR ADD NEUTRECEUTICALS WITHOUT YOUR DOCTORS PERMISSION AND/OR KNOWLEDGE.  THE LIFE YOU SAVE WILL BE YOUR OWN.

Go to Zdogg Pharmacist for an excellent description of your local pharmacists’ job and why you should include them on your team.

COULD THIS ARTICLE HELP YOU?

“Could” is a word I would do without if I had my way!  Unfortunately, my patients love it! 

“Doc, could my headache be from stress?”

“Doc, could my husband be suffering from depression?”

“Doc, could my son have ADD?”

“Doc, could …?”  is a question I hear multiple times a day.  The funny thing is the answer is always the same.  Realistically, anything “could” be true.  So every time a patient asks the question, “could,” the answer is yes. 

“Yes, your headache could be from stress.”

“Yes, your husband could be suffering from depression.”

“Yes, your son could have ADD.”

Unfortunately, the “could” question often mislead my patients.  While the answer to a problem could be stress, depression, or ADD, often those are unlikely sources of the problem at hand.  Explaining why they could, but are unlikely, is time consuming and stressful for the patient and the doctor.  I particularly hate when a parent asks the “could” question in front of their child.  It is not uncommon to see fear immediately consume the patient’s face.

The question my patients should be asking is, “Doc, what is the probability that stress, depression, or ADD is the problem?”  Differential diagnoses are based on probabilities.  A differential diagnosis is a list of the probable causes for an illness ranked from most likely to least likely or most dangerous to least dangerous.

Knowing what my patients’ concerns are is critical.  Cyberchondria is real and the internet stirs up trouble on a regular basis.  Learning to avoid the word “could,” and using “probable” instead, helps allay a lot of fears!

Could this article help you find the answer to what’s bothering you?  I hope so!

I HAVE A MIGRAINE

“Doc, I’ve got a migraine.  Can you help me?”  

In February of 2011, I published “Migraine, Its Not Just a Migraine.”  In that article, I advised that patients “Don’t underestimate your headache. Don’t put off seeing your doctor. Please don’t learn to live with it or let it control your life. We have excellent treatments for all types of headaches. When you see your doctor, he will want to know the following things in order to help classify your headache and provide proper treatment options.

Today’s article covers all those other types of headaches.  Patients tend to refer to any bad headache as a “migraine.”  A migraine is one specific type of headache.  According to Wikipedia, the International Classification of Headaches delineates 13 headache groups divided into primary and secondary headaches.  Today’s article will focus on headaches in the primary group:  migraines, tension-type headaches, cluster headaches, and trigeminal automomic headaches. Headaches caused by cough, exertion and sexual activity, daily-persistent hypnic and thunderclap headaches also fall into this group.

“Doc, I’ve got a migraine” often leads to a wrong diagnosis.  The patient’s self- diagnosis is often quoted in the nurse’s intake note as the patient’s chief complaint.  When the busy doc enters the room, he is likely to review the nurse’s note and then begin taking his history.

“John, I see you’ve got a migraine.  How long have you had the headache?”

“It started yesterday!  My whole head hurts.”

At this point, an experienced doc who has time on his hands would take a full headache history and discover that the patient does not have a migraine.  A busy doc who has patients waiting to be seen, patients waiting to be called, rounds to make at the hospital, and a family he would like to have dinner with might make the mistake of accepting the patient’s diagnosis, coding the visit as a migraine, and then treating the patient’s “migraine.”

Fortunately, the patient’s headache is likely to get better.  Unfortunately, the patient now has a misdiagnosis of migraine which he will carry from doc to doc until someone finally diagnoses his headache appropriately.

Headaches are often complex.  Many patients have several types of headaches lumped into one complaint.  Proper diagnosis of a headache disorder requires a careful history, both taken by the doctor and given by the patient.  Prior to going to your doctor, ask yourself the following questions:

  1. How severe are your headaches on a 1 to 10 scale?
  • How frequent are your headaches?
  • Do you have visual changes?  Do lights or sounds bother you? 
  • Where in your head are your headaches? 
  • What is the quality of the pain? Piercing? Stabbing? Throbbing? 
  • Describe the onset. Does it build in intensity? Is it sudden and severe? 
  • What makes your headache worse? 
  • What makes it better? 
  • Are there associated changes in your ability to think, speak, feel or move parts of your body? 
  1. What have you taken for your headache? 

Share your answers, along with your thoughts, about your headaches with your doc but resist calling it a migraine headache.  It may not be a migraine even if you have a long history of migraine headaches.  In August of 2011, I published “Your Doctor, the CSI Tech.”  Like a good CSI (Crime Scene Investigator), keep an open mind and investigate your headache carefully.  

If you have headaches, keep a headache diary. Learn everything you can about your headache by collecting clues. Read about headaches on WebMD and other reliable sources. Once you have collected as much knowledge as you can, see your family doctor. Let your doctor verify the type of headache and discuss treatment options, both for rescue and control. Certain types of migraines may require consultation with a specialist and your family doc will help you find the right consultant.  

The resource page at www.lzftc.com has lots of helpful links to reliable medical information.  Be happy and live “Wellthy” by conquering your headaches.