DOCS HAVE FEELINGS, TOO

“Doc, we’re moving to Schaumburg.  Do you know a good doc near there?  I want to find someone close to home.”  After taking care of Mr. R for 20 years and saving his wife’s life, all I can say is “OW!  That hurts!”

“Here’s my personal phone number.  If you need me this weekend, bypass the on-call doc and call me directly.”  Instead of thanks, I hear, “Are you going to get a female doc to replace Amy?”  “OW!  That hurts!”  Guess I should look into a sex change operation.

My billing manager asked me what to do about the H family.  They are about to go into collection for the third time.  They have been chronically late paying their bill for 20 years.  When I call to talk to Mr. H, he promises to come in and pay his bill for $700 when the family gets back from their spring break vacation.  “We are spending a week in Costa Rica.” “OW!  That hurts!”

Sometimes, I think patients don’t realize that docs have feelings, too.  Caring is a two-way street!  

Yes, Schaumburg is an eighteen-minute ride.  What’s a 20-year relationship worth?  

Yes, I’m a man.  I’ve spent the last 40 years of my life caring for women and hearing them complain about men.  Most of the time, they are right!  When it comes to understanding females, you don’t have to be female.  

Yes, medical care is expensive.  Practicing medicine is expensive and one of the things driving that expense is collecting what is owed.  It’s one thing if you can’t afford to pay your bill.  It’s quite something else when you finance your vacation by not taking care of your financial commitments. 

“OW!  That hurts!”  Practicing medicine is getting harder with ever-increasing regulations, the click of the computer and ever-increasing overhead.  Don’t forget that your doc has feelings.

CORONAVIRUS

Everybody seems to have a different opinion about the Coronavirus and what we should do to prevent its spread and treat it.  My friends and former patients have called looking for my opinion and most have not been happy with my response.

By their vary nature, viruses are unpredictable.  Even the influenza virus, which we have studied for many years, makes us look like fools as it traverses the earth.  Some years our vaccines work well, and some years the expected virus mix changes and all of our preventative measures fail.

Truthfully, I have no real idea how this pandemic infection is going to play out.  Being a pessimist by training, my gut tells me that we are being attacked by a truly dangerous and potentially lethal disease for which, currently, we have very little defense.

So, what should you do to deal with the effects of the coronavirus?  First, don’t panic!  Don’t hoard masks, hand sanitizers, food and water (unless you live alone and don’t have help available).  Hoarding these items is only going to keep them out of the hands of those who truly need them.  Next, WASH YOUR HANDS WITH SOAP AND WATER, FREQUENTLY!  I can’t stress how important proper hand cleaning is.  One of the hardest things I had to learn as a doc was not to touch my face.  KEEP YOUR HANDS OFF OF YOUR FACE!

Third, put an N95 mask on if you are sick and isolate yourself as much as possible.  COVER UP WHEN YOU COUGH EVEN IF YOU ARE WEARING A MASK.  Remember, the sick person wears the mask.

The problem with the coronavirus is that it causes symptoms identical to the common cold and influenza.  The only way to know if you have it is to be tested and getting tested is not going to be an easy task.  Even if you test negative for the coronavirus, you could still have it.  All tests are associated with false negatives and false positives.

If you are sick, call your doc and ask him/her what to do.  In the dark ages (when I started in medicine), if your child had a very infectious disease like measles or chickenpox (vaccines have almost eradicated these diseases), parents knew to call the office before coming in.  My staff would arrange to meet them at the side door and escort them to a secluded exam room.  It’s time to reinstitute that policy.  If you think you could have coronavirus, do not sit down in your doc’s waiting room unannounced.  CALL FIRST!

STAY WELL HYDRATED!  Dehydration is your enemy!  Eat even if you don’t feel like it.  If you have trouble eating, then take tiny amounts of food on a every 15-minute regimen. Vitamins, specifically Vitamin C, may be helpful.  Treat fever only if you are miserable or dehydrated.  I believe that fever is part of the body’s defense system.

If you are old and have other medical problems, seek help early.  Over the years, I’ve often heard my patients say, “Doc, this cough is killing me.”  This time it just might kill you. 

It’s time for our community to rally to the aid of those who need us.  If you are hoarding masks and know a sick neighbor or friend, share a mask with them.  Let your neighbors know that you are available and can shop for them if they get sick.  A bowl of homemade chicken soup is a great way to say, “I care.”  You are not going to get sick by dropping food off at their house.  Make sure you call or text to check on them on a regular basis.

Together, we’ll do fine.

MRS. PERI MENOPAUSE

Mrs. Peri Minipause was in the office. She is 48 years old and having a very rough time. She’s not sure, but she thinks she is going crazy. She complains about wild mood swings, inappropriate crying, and being a “bitch” to her husband and children. She’s sure it is not menopause as she still has her “curse”, and she had her hormones tested at the local lab and they were “normal”. To make matters worse, her curse is now irregular and heavier than usual. She wants her thyroid checked. She is gaining weight and has heard that a poorly functioning thyroid will cause all of her symptoms.

Peri does not want any medication; she just wants answers. If you haven’t figured it out yet, Peri is premenopausal. She is not crazy. I wish she was. Treating a “crazy” woman is much easier than treating a perimenopausal or menopausal woman. First of all, there are no rules. Every woman does menopause differently. The lucky ones don’t even know they are in menopause; life just goes on uninterrupted. The unlucky ones, like Peri, trade one “curse” for another. 

Menopause and its forerunner can be very destructive. Not only is Peri in trouble, but her husband and children are, as well. They can’t do anything right. I’m in trouble, as well. Since she is still menstruating and her hormone tests are normal, Peri is not buying the diagnosis. She wants more tests. The more tests that come back normal, the more frustrated Peri is going to be. When Peri is frustrated, her moods swing; and I’m right in the middle of those swings. I’d rather get hit by a golf club.

I’ve given Peri a reading assignment. I’ve informed her that normal hormonal levels mean nothing. I offered her an assortment of medications, including hormonal support. I need a Staples, “That Was Easy” button. When I mentioned putting her on SSRIs, the tears flowed. “I must be crazy. You want me to take anti-depressants!” I tried to explain that SSRIs are used to relieve symptoms of menopause. She’s not buying.

At this point, I want to refer her to a specialist. When all else fails, a second opinion is helpful and gets me off the hot seat. I’ve taken care of Peri for 27 years, so I don’t refer her. It’s my job to work through her problems with her. I am sure she will survive. I think I will.

We draw her thyroid panel and set up our next visit. We discuss medicinal, as well as bioequivalent, hormones. The all-natural approach is to go through menopause sans medication. Peri needs meds. We discuss nutritional support and exercise. I have requested a family conference so that I can explain things to her husband and children and enlist their aide.

If you are like Peri, rely on what your body and doc are telling you. No tests are perfect; all have false positives and negatives. Everyone will go through menopause in her own, unique way. There is no shame in taking medication or hormones when needed. Medications best known as antidepressants are often useful in menopause, not because your doc thinks you are depressed, but because they influence your neurotransmitters.

Peri, take a deep breath. You will endure, survive, and have a bright future.

VIRAL vs BACTERIAL

Often, the most difficult part of my job is deciding whether my patient has a viral or a bacterial infection. The second most difficult job is explaining to a patient who has a viral infection why an antibiotic will not work. Patients suffering from respiratory tract infections (URI) want me to cure them. They want antibiotics, the supposed cure-all! In my early years in practice, it was impossible to differentiate between a virus and bacteria. Antibiotics were considered relatively harmless and everyone who suffered from a URI received one. Since my patients got well (because of or despite taking an antibiotic), they grew to believe that, without an antibiotic, they would not get well. Over the last decade, antibiotic-resistant bacterial infections have dramatically increased due to the overuse of antibiotics. In the decades to come, appropriate use of antibiotics will be imperative.

In the real estate business, it’s “location, location, location.” I often hear, “Doc, I’ve got a sinus infection and need an antibiotic.” “Doc, I’m coughing up green sputum and need an antibiotic.” Sinusitis, bronchitis, tonsillitis, pharyngitis, gastritis and cystitis are all infections in certain locations within your body. The easy step in diagnosing an illness is determining where the infection is. The hard step is determining what “bug” (virus vs. bacteria) is causing the infection at the given location.

“Bugs” can all cause the same symptoms. A sinus infection, complete with facial pressure, green discharge, fever and chills, can be viral or bacterial. A viral sinus infection is treated with symptomatic measures and eventually goes away by itself. Once your body recognizes the virus, specialized killer cells (lymphocytes) are produced and then hunt and kill the virus. Antibiotics assist your body in getting rid of bacterial infections. Once your body identifies an invading bacterium, it makes specialized killer cells (neutrophils) that eradicate bacteria.

In the early stages of any URI, mucoid secretions are clear. As the infection worsens, they often turn yellow, grey then green. Green is actually good. Green is the color of white cells (lymphocytes or neutrophils) engaging the enemy. Green means your body has found the invader and is attempting to heal you. Mucous, in itself, is a problem. It nurtures and shelters the invading “bug.” Symptomatic treatment is aimed at helping you clear mucous. Mucinex is my favorite agent. My instructions also call for saline nasal sprays and the ingestion of copious amounts of fluids. Please avoid orange juice. While it contains vitamin C, it also contains citric acid. The acid content further irritates the throat and increases mucous production.

So, how do I determine if you have a bacterial or viral? As stated above, it’s not easy. Bacterial infections tend to cause higher fevers and tend to be associated with more severe physical findings. Viral infections tend to cause severe symptoms with milder physical findings. In the early stages of a communal illness, diagnosis tends to rely on highly educated guess work. That may sound shocking, but it’s true. Once I have seen 10 or more cases, it becomes easier. The disease takes on its own personality and becomes predictable. 

I used to rely heavily on the ability to do blood counts in the office as an aid in diagnosing viral vs. bacterial infections. Low white counts are usual for viruses and high white counts are seen in bacterial infections. Normal white counts may indicate an infection with a mycoplasm infection (modified bacterium/bug).

In person, it is difficult to accurately diagnose a URI or any other medical problem. Diagnosing over the phone is often impossible. Sometimes, it takes several visits to solve the mystery of what is infecting you. One reason I keep an open, extended-hour schedule is so that you can easily be seen. Please come in when you are sick. The life you save may be your own!

PREVENTION MAKES SENSE

What’s easier; caulking and painting your house’s exterior or letting it rot and eventually replacing it? The answer is simple, isn’t it?

What’s easier; checking and replacing the brakes on your car when they are worn or dealing with the carnage when the brakes fail? Again, the answer is obvious!

So, what makes sense; taking care of your body by eating the right foods, exercising and seeing your doc for yearly physicals and routine maintenance or letting your body go to fat, your belly sag over your belt and your muscles atrophy from disuse. The answer should be obvious, shouldn’t it? Unfortunately, it’s not!

Many of my patients take their health for granted! They feel well! They’ve never been sick a day of their lives. They work hard at making a living but invest little in staying healthy. Then catastrophe hits and they are sick! Their blood pressure is elevated. They are diabetic or worse; they have a heart attack or stroke. Recovery is a bitch!

It’s no secret. It’s easier to maintain your health than to restore it once you’ve lost it. So, this year, work hard at maintaining your health. Make sure your spring-cleaning list entails cleaning up your diet, tightening up your waistline and exercising. The life you save may be your own.

FIND, FIX, FINISH

I’m reading Brad Thor’s book, Full Black. In the book, a “former Navy SEAL Team 6 member turned covert counterterrorism operative Scot Harvath,” joins an ultra-secretive, counterterrorism group whose motto is, “Find, Fix, Finish.” His job: save the United States from the horrors of a massive terrorist attack.

I instantly liked the motto, “Find, Fix, Finish;” and, while I do not have SEAL training, as your doc, my job is to thwart attacks on your health by a wide variety of terrorists, known as infections, diseases and addictions, or to limit their damage and help you heal. I think I like being a covert operative better than being a chef or CSI technician. It sounds sexier!

The three “f’s” start with “find.”  “Finding” what is going to hurt you or what is currently hurting you is critical. Many of my articles have dealt with the art of diagnosis. Just as Scot Harvath depends on his team to root out the villains, you, your family and your doc need to work together to uncover any hidden villains lurking in your history or actively harming you.

The “fix” is designing an appropriate treatment regimen to protect you from harm and repair any damage already done. Treatment is not synonymous with medication. Treatment starts with appropriate lifestyle changes, diet, exercise and giving up unhealthy habits, to name a few. Lack of compliance with treatment protocols often lead to disaster.

Today’s article is about the “finish.” It’s the “finish” that is often lacking in medicine. While I often write about diagnosis and treatment, Thor’s book has made me focus on the real problem: getting the job done once and for all. Too often patients try to comply and fail to follow through. Many times they stop short of their goals. While “finishing” is not always possible, it is worth making every effort to accomplish the goal. 

When my patients do “finish” their job, it is a sight to behold. Recently, I wrote “Wow.” The two patients depicted in this story “finished” their jobs and shed their medication. Finishing the work you start is an integral part of success! 

The next time you go to your doc, work through the “Find, Fix, Finish” protocol.  Remember, if at all possible, you want to finish the job. “Finishing” means getting your blood pressure into a normal range and then doing whatever is necessary to keep it there. “Finishing” means going on that diabetic diet your doc recommended and make it your own diet, not something you are doing to lower your blood sugar so that you can resume your old bad habits. “Finishing” means never smoking again. “Finishing” means sticking with your new exercise routine.

What job do you want to “finish”? What job needs to be “finished”? Take the first step. Tell your doc it is time to finish the work you need to do to be healthy and ask him for his help.

HOW TO EVALUATE WEB SITES

We’ve all done it.  We’ve all purchased that miracle cure being sold on the internet.  The ad usually starts with “What doctors won’t tell you,” and ends with “You can have this life saving miracle for just 4 payments of $49.95.  Shipping is free.”  How do you know what’s true and what’s bullshit? 

In “How to evaluate health websites,” published in 2013 by Kenneth Lin, M.D., Dr Linn does a nice job discussing the potential problems with biased internet sites.  While this article is somewhat dated and some of his hyperlinks no longer function, it is still worth reading.

Why am I writing this article?  On a daily basis, I saw patients who had been misled by highly polished internet sites selling snake oil.  “Doctors recommend product X,” “Proven in over 100 clinical trials,” “Made from the finest, all natural ingredients and proven to help with . . ,” are all impressive headlines used to gain an individual’s trust.  Unfortunately, the consumer often does not realize that words such as “Doctors,” “Clinical,” and “Natural,” are actually meaningless.

Let’s look at “Doctors recommend product X.”  What kind of doctors are they?  Are they doctors who are shareholders in the company?  How many doctors are “they?”  Do they recommend it because they sell it?  Are they even medical docs?

“Proven in over 100 clinical trials” sounds good but is often meaningless.  Who ran the trials?  How many patients were in the trials?  Were they open label or blinded?  Did the FDA approve the trials and review the results?  

My favorite is, “Made from the finest, all natural ingredients and proven to help with . .”  Imagine I am a soybean farmer.  Do I sell my finest soybeans to a company that is going to encapsulate them, or do I sell it to a high-in grocer who caters to the Japanese community?  So, I sell my finest to the high-in grocer, my next finest goes to the producers of tofu and soymilk.  What do I do with the remainder, the damaged and bruised portion of the crop?  Yep, I can sell it to an industry that pulverizes it and sells it in cans of powdered protein.  Yes, it comes from the finest crop.  It just happens to be the part of the finest crop that I used to discard as waste.

Remember, if it’s too good to be true, it probably isn’t. If you do decide to buy product “X” let your doc know you are taking it.  Better yet, discuss it with your doc before you buy/swallow it.

So, take what you read on the internet with a grain of salt.  One of my favorite sites is from the Mayo Clinic.  Another favorite site is FamilyDoctor.org.  Many of our most reputable medical centers have educational web sites that you can probably trust.

NEVER ASSUME

You know the old saying, “When you assume something, you often make an ass out of you and me? In my world, assumptions are bad. Ever notice that I discuss my findings and plans with you and then give you a written summary of my findings and plans? 

I can’t afford to assume that you understand me. I can’t afford to assume that you will remember what I said. If I assume that you and I are on the same page and we are not, it can lead to catastrophe. If you do not understand what your doctor is telling you, stop him/her and ask more questions. If you do not say anything, the natural assumption is that you’ve got it! If your doctor does not give you a written summary of the visit, ask for one. The written summary of your office visit is one of the few benefits of the electronic medical record.

Ever notice that I repeat what you say to my nurse and to me? Often, I will read my nurse’s note to you and ask if it is accurate. Do not assume that what you say is what your doc heard. Communications between individuals is often lacking. One of my favorite quotes is, “I know that you believe you understand what you think I said, but I’m not sure you realize that what you heard is not what I meant.”

During your visit with the doctor, both parties should take the time to make sure they are on the same page. One way to assure better communications is to plan for your visit in advance. Write down the questions you need answered and the points you want to make in advance. Once you have your list, prioritize your needs as the doc may not have time to address all of your concerns at one visit.

Do not assume that your doctor has all the answers. Your doctor’s job is not to know everything; his/her job is to know what he/she doesn’t know and how to find the answer. Do not assume that there is always an answer to your problem. There are problems that have no answer. There are problems that have no solution. 

The true art of medicine is in listening, communicating, and finding a way to deal with those problems. In today’s world, everyone is in a hurry. No one is willing to pay for time and no one is willing to wait. The number one complaint about my practice is wait time. I’ve always been perplexed by that complaint because the walk-in system means you will be seen on the day you need to be seen, not on the day an appointment is available. Yes, patients often wait an hour or two in my lobby or exam room. It takes time to listen, more time to communicate, and even more time to make sure that everyone is on the same page.

Help me help you! Prepare for your visit in advance. Stop me if you think I’m not getting your meaning. Stop me if you are not getting my meaning. Make sure you get a written visit summary before leaving. Actually, read that summary and make sure you understand it. Read this blog. It is designed to teach you to help take care of yourself. Send this blog to your friends and relatives. You may save a life.

WOW, THEY DID IT

During the last few weeks, I’ve been writing about taking control of your health through knowledge, partnering with me to accomplish a healthy lifestyle.  I’ve written about the doctor-patient relationship and characterized that relationship as often being similar to the fireman-arsonist relationship.  Today, I want to share with you the story of two patients who took charge of their lives and changed their lives for the better.  One willingly, the other after I thoroughly pissed him off.  Today was a great day!

My first patient (Number One) of the day had been given a diagnosis of diabetes, hypertension and elevated cholesterol; and he is on multiple medications including insulin.  He followed my instructions and took command of his health rather than letting his health take command of his life.  Forty-two pounds lighter, he is rewarded for his efforts by feeling younger.  He no longer needs insulin and I suspect most of his medication will eventually be stopped.  I applauded his efforts and sent him on his way feeling like I had succeeded as his doctor and mentor.

As a physician, I love to see my patients flourish.  I think of myself as a benevolent teacher and enjoy seeing my students prosper.  While my first patient took my teaching to heart, my second patient did not.  Patient Number Two was markedly overweight, diabetic, hypertensive with high cholesterol and neuralgia (a painful malfunction of the nervous system).  Number two was on three medications for blood pressure, two for diabetes and two for neuralgia.  My efforts to help number two understand the immensity of his problems included:  I tried education and instruction; fear mongering; and guilt.  I TRIED ANYTHING ELSE I COULD THINK OF IN ORDER TO MOTIVATE MY PATIENT TO TAKE CONTROL OF THE ILLNESSES PLAGUING HIM.   It seemed nothing would work.  At last, I let him have it and royally pissed him off.  That worked!

Patient Number Two proudly came in for a yearly physical today, having lost in excess of 100 pounds.  Medications were no longer necessary.  The diagnosis today was not hypertension, not diabetes, not neuropathy.  Today, the final diagnosis was “HEALTHY”!  

It’s a pity I had to piss him off but it was worth if in the end.

STORM WARNINGS

While I would like to believe that I am better at predicting storms than the weather- man, unfortunately, I am not.  If you are wondering if I’ve lost it, I haven’t.  Once upon a time, my first patient of the morning left the office by ambulance.  After taking a careful history and performing a thorough exam, my assessment was that he was in imminent danger, much the way the weatherman declares a tornado/storm alert.

Yes, a major storm was in the making, one we docs call sepsis.  Calling in the paramedics is the equivalent of calling up the National Guard.  As always, they responded quickly and efficient, securing my patient against what could have proven to be a major tempest.  The next day, my patient is much better.  The storm has blown over and, thanks to G-d, was nowhere near as devastating as I had predicted.

Unfortunately, there are times when medical storms strike fast and appear from nowhere.  No matter how good my patient and I are at practicing preventative care, there are many occasions when medical twisters touchdown in our lives wreaking havoc.

So, what can we do?  In the case of a severe weather alert, most of us get busy securing our homes, checking on our flashlights, making sure we have gas for our generators and snow blowers and fill our pantry.  We check on our loved ones and neighbors and then hunker down for the night.

In the case of a medical alert called by your doc, respond promptly, heeding his advice.  Don’t argue as it wastes time.  If the doc says, “Call 911,” call 911.  Take proper precautions.  If your doc warns of an approaching storm in the form of a future heart attack/stroke/diabetes, take action by improving your lifestyle, complying with medication and seeing the specialist when recommended.

Yes, my predictions are often wrong.  When I warn of impending doom and it fails to develop either due to your precautions or not, I’m one happy camper.  Now, if I can only figure out how to predict those sudden acts of terror that occur when illness is lurking in the wings but invisible to the modern medical eye.