PRAYING HANDS

In order to understand this article, I need you to do the following:  put your hands together, fingers extended as if you were in prayer.  Next, interlace your fingers, making one large clenched fist.  Now imagine that your fingers represent different parts of your life or problems that you are having.

Life is complex and the problems my patients come in with are rarely simple.  On a daily basis, I see patients with the metaphoric clenched fist I described above.  My job is to find the key that will open the clenched fist and relax the fingers into a peaceful, happy set of praying hands.

On July 25th,2011, I wrote about Mrs. “X”, a patient with diabetes, hypertension, kidney problems, and arthritis.  Mrs. “X” is also depressed; wouldn’t you be?  Imagine that each of her problems is represented by a finger on her hand.  The other fingers represent other parts of her life: her relationship with her family, her friends, her finances, the excessively hot weather and her aging eyesight and hearing.  Mrs. “X” is miserable and can’t tell me why.  She is confused about which of her many problems she should address first.  She is frustrated!  Every time she fixes one thing, something else breaks.  Her fingers are interlaced and clenched into a painful death grip of a fist!

Now, interlace your fingers and tighten the grip for as long as you can, until it hurts.  When you open your hands and pull them apart, note that your fingers are tight and sore.  The tighter and longer you keep your fingers locked together, the harder it is to pull them apart.

Mrs. “X” has allowed her multitude of intertwined problems to lock together for so long that she can no longer separate one from the other on her own.  My job is to pry her fingers apart, one by one until each has been addressed and healed.  The process is time consuming and frustrating.  As her doc, I think I know what the primary issue(s) is, but I may be wrong.  I am searching for the key that will more readily unlock her hands and place them in a relaxed, healthy, praying stance.

I start with her index finger, depression.  I have written about depression before.  Depression is a normal state of life but can be severe, affecting everything else in an adverse manner.  Healing depression is often a potent key that allows one to more readily heal everything else.  Mrs. “X” fights the idea of depression; it is a stigma no one wants.  I explain that she can either admit to depression, as a sane person would in her circumstance, or be insane.  I pry her finger open.  I pray that by doing so, I can unlock the rest of her fingers.

Today, I work with her arthritic pain, prying a second finger open.  I work on opening a third, allaying her fears of the theoretical worry about NSAIDS.  Eventually, finger by finger, I will help Mrs. “X” open her hands and live with the burden of age.  I help her recognize her blessings and build her blessing list.

Oh yes, I work on one more finger today.  I talk to her about “An Attitude of Gratitude.”  Now, I’ll place my hands in a praying position and say a prayer that I get this right the first time.

PS – If this article sounds like you, it would not surprise me.  Mrs. “X” represents thousands of people I have seen over the last 28 years.  I have interlaced my fingers into a fist, assigned a multitude of attributes to each finger, and then unfolded my fingers into praying hands every week, painting a picture of the healing process for those in need.  I hope to do so for another 28 years!

THE HAND

My family, my friends and my patients think being selfish is bad!  I bet you do, too.  I used to think so, as well.  Thirty years in practice has taught that being selfish is good.  Actually, selfishness is essential to an individual’s health.

I saw a selfless young woman who was ill.  She had an assortment of complaints.  She had not felt well in months.  If she was the CEO of a Fortune 500 company, she would have been diagnosed with executive burn out and given two months at Canyon Ranch, an executive retreat.   Unfortunately, she is the CEO of a typical American family.  She is married, has five children, a dog and works full time.  She has living parents who are aging and require help.  She is a hard worker, dedicated to caring for her nuclear and extended family, as well as excelling at work.  She has no time for self.  She is one of hundreds of such mothers in my practice.  She is stressed to the max but does not have the luxury of going to Canyon Ranch.

I often tell the story of the hand.  The thumb is you.  When you are young, you are self-centered, egocentric.  The world revolves around you and only you.  One day you realize that you have parents (your index finger), and you are responsible to them, as well as yourself.  As you age, you meet the love of your life (the middle finger) and are responsible to your mate.  In time, children come along (ring finger) and they need lots of your time.  You become very responsible for them.  Then you have your job (little finger).  As you grow in your job, responsibility grows as well.  You are a good person and want to excel at everything.  Your parents are aging and require more attention.  Your children are aging and require more attention.  Your job is growing more complex.  Your mate, who is often responsible like you, is in the same position.  

So, what do you do?  Things are out of control!  You have to take care of your parents, your mate, your children and your job.  The only thing you control is you, so you sacrifice yourself.  Try using your hand without using your thumb.  What you find out is, without the thumb, your hand is useless.  No matter how hard you work to make your four fingers function, without the thumb, the hand falters.

If you are not healthy, you cannot help those who need and depend on you.  If you are not selfish enough to save time to care for and nourish yourself, you will get sick.  Those around you will have to function on their own.  Why wait until you are exhausted, burnt out or sick?  The answer is simple.   Your parents taught you not to be selfish.  They taught you to be a responsible individual.  It is time you teach your loved ones to be responsible to themselves, to set healthy limits, to take time off, to laugh and be happy.  Set a good example: get healthy.  At first, those who are used to getting all of you will rebel.  They may call you selfish.  Teach them that a part of a healthy you is better than part of an unhealthy you.  In the end, by being selfish, everyone will be better off.

A CURSE

For centuries, man has believed in the “evil eye”, curses and spells.  In the movies, an evil being places a “spell” on the heroine who suffers horribly until that spell is broken.  I believe in the “evil eye,” curses and spells.  They actually work!  Let me explain.

In modern times, doctors curse people.  They don’t mean to, but it happens.  It’s not just doctors; there are many offenders.  In medicine, Google may be the worst!  A patient comes to the office with a complaint.  The complaint leads to a diagnosis of cancer.  A diagnosis of cancer leads to testing and specialty care.  In the process of finding out the extent of the cancer and exploring treatment options, the patient is smothered in information.  Doctors, performing their duty to inform the patient, start talking about percentages.  The percentages include calculations regarding the risk and side effects of the treatment and one and three year survival rates.  Patients, trying to figure it all out, turn to the internet, friends and relatives.  They see more doctors.    Ultimately, it all boils down to population statistics and calculation of odds.

My patient, once a unique individual, becomes a statistic.  The system “cursed” him and the curse became real.   I have seen people die because they gave up.  For them, the odds were overwhelming.  One day, not too many years ago, I was making more morning rounds at the hospital when the nurse called and asked me to come to her floor stat.  She told me Mr. A, in room 424, was dying.  I told her that was impossible; he was to be discharged home that morning! He was well!  When I arrived at his room, I was dumbfounded.  Mr. “A” was, in fact, dying.  I examined him, reviewed all of his lab and x-rays and could not find one reason for his failing health.  When I told Mr. A that I could not find the reason for his dying, that he should be going home, he responded stating he was certain that the day before, he had heard the nurse tell his wife that he was going to die.  I explained that there was absolutely no reason for him to die; but that, if he did not get out of bed and decide to live, I was going to lose a healthy patient. 

Mr. A taught me the power of a curse.  Ever since that day I have reminded my patients that they are unique individuals, not “average patients with a disease.”  I have reminded them that they have never been average and pleaded with them not to become a statistically average patient at this stage of their lives.  I have asked them to gather evidence and knowledge so that they can make the best decisions they can for themselves, but not to let the evidence overwhelm and curse them.

Odds are a funny thing.  If the odds of living with a given diagnosis are 1 in 100 or 1 in 100,000 for the general population, are they the same for you?  Not really!  I see it is either you are going to live or not.  That’s 50/50 in my book.  I want my patients to choose to live.

So, if you are given a potentially bad diagnosis, turn it into a potentially good prognosis.  Don’t be suckered by statistics.  Don’t become a statistic.  Become an outlier.  Live long and be happy.

SCI FI

The following article was written when I was healthy.  What I didn’t understand then, I now do.  Once you are obese, out of shape and hurting, dragging your butt to the gym is next to impossible.  When you live in the Midwest, walking outside in the heart of winter is dangerous.  

“Yes, I know.  You’re too busy, too tired, too sore, or too sick to exercise.  You have hundreds of excuses for not exercising; and you promise that, when things are better, you’ll exercise.”  I have lots of excuses, all very real.  Even though I’m retired, I’m still to busy.  I’m too busy napping!  Reading this article was a unique experience.  A younger healthier me lecturing the older sick me right out of a Sci Fi movie.  I’ have to be a fool not to listen to myself.  So, I’ll just have to find the motivation and strength to exercise or stop complaining.

I have addressed the fact that many of my patients paid more attention to what they feed their pets than to what they put into their own bodies.  Today, I want to continue to explore the relationship between man and his pet in order to try and figure out why pets get more attention to nutrients, exercise and healthcare than humans.

“Jack, I really need you to start exercising.  Your blood pressure and cholesterol are both quite elevated, and exercise and weight reduction will help.”

“Doc, I walk my dog every day!  Isn’t that enough?”

If you were to watch Jack walking his dog, you would see Jack walk 50 steps and then wait while Fido takes a leak or just sniffs the bushes.  This process of walk, sniff, pee goes on for 30 minutes or more and Jack feels like he has done a day’s work.  In actuality, neither Jack nor his dog has done any exercise.  If Jack wants to exercise with his dog; then he needs to run alongside of his dog as Fido races across his lawn barking at passing cars.

Exercise is the fountain of youth and most of my patients won’t do it!  Why?  Mr. Wonderful and I often pondered that very question and failed to come up with an answer.  It’s as if my patients are sleeping behind the wheel!  They hate the idea of taking medication; yet, they’d rather take a pill than go to the gym 2-3 days a week.

Yes, I know.  You’re too busy, too tired, too sore, or too sick to exercise.  You have hundreds of excuses for not exercising; and you promise that, when things are better, you’ll exercise.  Unfortunately, until you start to exercise, things will only get worse.  You will get more out of shape, take more medications and get much older.

Like the man who falls asleep behind the wheel of his car, you are heading for an accident.  Wake up.  Walk your dog for your dog’s health.  Walk by yourself or with friends for your health.  You don’t have to join a gym, you can start tonight.  When you get home from work, don’t go into your house.  Instead, explore your neighborhood.  The journey starts with just a few steps in the right direction.

I DON’T WANT TO BE RIGHT

While I wrote this article in 2011, it is still very relevant today.  Last night at my friend’s Christmas Eve celebration, one of his guests and I actually had a conversation about this very topic.  When I got home, I dug this out of my archive.

A lot has changed since 2011. The most important thing is that now I am dealing with a progressive neurological disorder that is slowly stealing my life away.  My own thoughts change on a daily basis, but one thing is for sure; I do not want the government/Medicare to determine how long I live and how I die. Those decisions belong to my family and me.  

The second thing that I know for sure is that life without quality is not really life.  Each of us has to decide what quality of life means and, perhaps, when our lives should end.

July 20, 2011

Sometimes you just don’t want to be right.  Over the past many years, I have seen an alarming pattern arise in my profession.  Many of my patients have heard me talk about “Soylent Green”, an old Charleton Heston movie.  I have even written about it on this blog.  The premise of the movie seems absurd.  Can you imagine the government of the United States providing for all the needs of its people including healthcare, food, clothing, and even death (Food Stamps, Medicaid, Medicare, Social Security)?

David Brooks’ opinion piece in the New York Times on July the 15th (http://www.nytimes.com/2011/07/15/opinion/15brooks.html?_r=1) makes my fear of a “Soylent Green” society frightenly real.  While I recommend you read the entire piece, for the purpose of this blog, I want to highlight the following:  

Mr. Brooks writes, “This fiscal crisis is about many things, but one of them is our inability to face death _ our willingness to spend our nation into bankruptcy to extend life for a few more sickly months.”  He quotes S. Jay Olshansky as saying, “our main achievement today consist of devising ways to marginally extend the lives of the very sick.”    He then closes his piece with “we think the budget mess is a squabble between partisans in Washington.  But in large measure it’s about our inability to face death and our willingness as a nation to spend whatever it takes to push it just slightly over the horizon.”

In “Soylent Green”, the citizens dutifully walked into the death chamber when it was their time.  Mr. Brooks would be proud of how those brave souls faced their demise for the good of society.  Rather than “marginally” live another month or two, costing society a fortune and threatening a budgetary crisis, the citizens of “Soylent Green” did as prescribed, they follow the “protocol” created to save society (prescribed “outcome” equals death).

My question for Mr. Brooks is who defines what “marginally extends the lives of the very sick” is?  Who decides who shall live and who shall die?  I can’t!  Not long ago, I met a “very sick” patient in the emergency room.  He was critically ill having had a catastrophic event.  He was comatose with signs of profound damage.  The neurologist told the family he was “brain dead”.  While Mr. Brooks believes that medical science has made very little progress in extending life, my patient benefited from a remarkable new invention, the “Artic Sun Hypothermic Unit”, and fully recovered.  I spoke to him this a.m.  He was at work! Editor’s Note: He’s still alive today, 15/26/19.

The procedure and hospitalization cost in excess of $300,000.  Saving this one life cost a fortune!  In Mr. Brooks’ world, should we have forgone this patient’s treatment and helped his family “face death”?  Are we “spending our nation into bankruptcy” by working hard to save lives?  Maybe so.  But who are we if we don’t care for our ill?  What do we become when we arbitrarily decide what a life’s value is?  

Mr. Brooks obviously doesn’t practice medicine.  If he did, he would know that an individual life is worth everything to that person and his family.  Mr. Brooks would know that patients survive against all odds and recover to enjoy meaningful lives.  He would know that statistics lie!  A patient with a life ending cancer is told he has three months to live without treatment and 6 months with treatment.  Despite the tremendous expense both financially and physically, he accepts treatment.  Seven years later he is thriving!

Respectfully, Mr. Brooks doesn’t know what he is talking about.  The problem is the policy makers aren’t doctors.  The policy makers are Mr. Brooks’ cronies.  “Soylent Green”, here we come!

QUOTE GARDEN

Quote Garden

In researching for my articles, I often come across valuable sources of material on the internet. Quote Garden is one of those sources. I found many pages of quotes referencing diets. Some of the best are listed below with my thoughts about their significance.

“Your stomach shouldn’t be a waist basket” – Author unknown! Not long ago, I saw an overweight patient of mine in the drive-in window of a fast (fat) food establishment. He was putting fried junk into his belly.  He puts premium gas in his car. What’s wrong with this picture?

“Don’t dig your grave with your own knife and fork.” – English Proverb. Raucous Ralph, a character in my book and one of hundreds of patients I have seen over the years, did just that. Who do you love more, your spouse, your family, or your food?

“Inside some of us is a thin person fighting to get out, but they can usually be sedated with a few pieces of chocolate cake.” – Author unknown. Many people use food as a drug/medication. Do you? If you are depressed, see your doc, not the local baker. If your marriage is bad, see a marriage counselor. Don’t have a closet affair with Godiva!

“A diet is a penalty we pay for exceeding the feed limit.” – Author unknown. Yes, diets are penalties; and yes, we pay BIG! It’s time to stop dieting and, instead, learn who you are and what you need to do to get healthy. If you’re healthy, stop fretting over your figure and enjoy life. If you are not healthy, work at getting healthy the right way. Diets and Other Unnatural Acts will help you.

“People are so worried about what they eat between Christmas and New Years but they really should be worried about what they eat between New Years and Christmas.” – Author unknown. I’ll end on this note! A healthy lifestyle has room for holiday treats but no room for holiday cheats!

LAWSUITS

After spending an entire weekday at home, I am sure of one thing; daytime can rot your brain!  Not only can daytime TV destroy brain cells, it highlights the worst traits of the human race.  Dr Phil, Judge Judy, and multiple other TV personalities parade some of the human race’s most embarrassing individuals in front of their viewing audiences.

If you don’t believe me, channel surf like I did!  It was enlightening and frightening.  This article is all about the frightening side of my day at home.  As I was perusing the channels, I was mesmerized by a commercial segment I happened upon.  During that segment, five different law offices were mining for gold.   

“If you have been injured by the use of surgical mesh, call 1-800-We-Just-Won- The-Lottery!”

“If you experienced a bleed on Pradaxa, call 1-800-You-Can-Get-Rich!”

“If your child was born with a birth defect, call 1-800-Make-A-Fast-Buck”

“If your loved one developed a bed sore or fell in a nursing home, call 1-800-Collect-Millions now!”  

“If you developed a blood clot on birth control pills, call 1-800-Screw-Them-And-Get-Rich.”

Yes, we have a healthcare crisis in the US.  Providing healthcare becomes more difficult and expensive every year.  Doctors are criticized for doing unnecessary tests and practicing defensive medicine.  Defensive medicine and the defense of unfounded lawsuits adds to the cost of care.

Is it any wonder that doctors practice defensive medicine?  Frightening is an understatement when describing these commercials.  To make matters worse, each smiling attorney makes one promise:

“We promise that we won’t charge you anything unless we collect on your claim.”  Yes, you can sue a healthcare professional for free!  You can roll the dice without any financial risk!  You can play the odds.  Just call 1-800-Increase-Everyone’s-Healthcare-Costs and hope your doc’s insurance company settles rather than financing a winning defense.

Why would they settle?  It’s simple math.  Pay out $50,000 to settle an unfounded claim or spend $300,000 to win in court.  Luckily for me, my insurer did not settle cases.  Fortunately, they would rather spend $300,000 and win.  Unfortunately, the cost of malpractice insurance is shared by every patient seen in this country.

Frightening?  You bet!  The sharks are circling and all of us are the food they live on!  And no one is doing anything about it.

CHRISTMAS CHEER

While it may seem strange, I view Christmas Day as I would any loss.  Yes, I love the Christmas Season with its joyful giving, and its promise of peace on earth and goodwill towards man.  For 3 weeks every year, people whistle Christmas carols, wish each other the best, open doors for strangers and other such niceties.  People perform great acts of charity and appreciate the ones they love and strangers alike.  It’s a truly wonderful time of year.

Then it happens!  Christmas day comes and goes. With its passing, the joy of the season vanishes.  People hurry about returning gifts.  They rush to get that close parking space, burst through the doors of the shopping center and line up with the rest as life returns to normal.  It’s sad indeed!

Wouldn’t it be nice if the one thing you didn’t return this year was your portion of the Christmas spirit?  Imagine a year of peace on earth and goodwill towards all men and women.  This year, try allowing that car in the parking lot that really was there before you to pass. Try holding the door open for a complete stranger while whistling an upbeat tune.  Sound corny?  It’s not!

Why not perform random acts of kindness year round?  I guarantee it will be one of the healthiest things you can do.  Perhaps the true gift of Christmas is the 3 weeks of fellowship leading up to it.  If that is the case, why return such a precious gift?  

I know, I’m Jewish and it’s not my holiday.  Actually, it is!  I believe the true gift of all religious holidays is to bring families and friends together and no holiday does it quite like Christmas.  So, for whatever reason you celebrate, let’s declare the 2020 holiday season a yearlong event!

Be happy, live wellthy and be blessed everyday of your life.

IF ONLY

During the next week, many of us will be busy preparing for the holidays, excited to be with family and friends, looking forward to the New Year.  The New Year brings many things, starting with the New Year’s resolutions.  While most of us look forward to a new beginning, hopeful that things will be better, many spend time pondering about the past and saying “what if?” and “if only I had”.

Thirty years in practice has taught me that ruminating on the past and the “what if” question and the “if only I had” reply is detrimental to your health.  After all, you cannot change the past.  While you are busy regretting past errors, you may be missing future opportunity.  Today, a friend told me that one of the most important moments in her life was when I helped her through a moment of self doubt and self recrimination.  She had made a decision many years ago that had long term consequences for her child’s health.  At the time she made that decision, it was the right decision.  Many years later, it was still the right decision, but when viewed through the “retrospectascope”, could be questioned.

All of us are called on to make decisions on a daily basis. As individuals and parents, who do not have a crystal ball with which to look into the future, we make the best decision we can.  All of us, when looking back in time through the “retrospectascope”, realize that some of those decisions turned out to be wrong, some foolish, and some absurd.  What is critical is to remember they were right at the time we made them.  

When you make a decision that affects you or a loved one, take the time to gather as much knowledge as you can.  Follow your heart and your mind!  Give pause, then decide and carry out that decision with great care.  Later, if the decision turns out to be the wrong choice, live with it.  Learn from it.  Do not do the “what ifs”.  “What ifs” serve no purpose.  They lead to self-doubt, anxiety and depression.  They make you less capable and, therefore, more likely to err in the future.  Residing too long in the past steals your future.  Look forward to the future and all of its possibilities.