LIVE THE WELLTHY LIFE

Yesterday, I published “Truth.”  Today, I question if truth really exists.  EVERYONE THINKS THEY KNOW THE TRUTH; BUT, IF EVERYONE’S TRUTH IS DIFFERENT, CAN TRUTH REALLY EXIST?

Are you following me?  At 5 am, being bored out of my wits, I started channel surfing looking for the truth.  I failed miserably.  These days, the truth seems to depend on which news journalist you are currently listening to.

If you listen to FOX, my article yesterday was BS. The doc being interviewed talked about using medication off label.  I’ve done that many times in my career and, after listening to her, I would have to agree that using hydroxychloroquine in the face of Covid-19 makes sense.  To further make their point, FOX interviewed a woman who claims that hydroxychloroquine saved her life.  Again, I have no reason to doubt her statement.

Switch to CNN and you get a different story.  They are on the attack, interviewing one expert after another indicting President Trump for everything that is wrong in the world.  Their doctors tow the official line requiring firm and irrefutable evidence that hydroxychloroquine works and is safe.  (After putting forth the company line, they all admit that the use of hydroxy is up to the doctor and his/her patient.)

Switch, again to MSNBC and you get a less vigorous attack dog.  So, who is telling the truth?  I don’t know.  When it comes to hydroxychloroquine there is one truth I know.  By recommending this medicine on TV, Trump has lumped it in with the toilet paper dilemma. People will search the world to buy up as much as they can.  Hoarding medication, food, masks, gloves and toilet paper has left us in deeper shit with nothing to wipe up the mess!

There is one more truth I’ve discovered.  Half of my readership disappeared yesterday.  The world is sick and highly polarized.  Half of my readership disappeared yesterday as they felt I was attacking Trump.  I was.  When I quoted Trump saying “I’m not a doctor” it was the truth.  Please, leave the doctoring to my colleagues.

I’m not a politician.  If you’ll leave the doctoring to my colleagues, I’ll leave politics to you!

I have maintained an apolitical stance on purpose.  The purpose of this blog is and has been to teach my readers how to become Wellthy.  The blog also serves to keep me sane in my retirement by allowing me to share my 40 years of medical knowledge with my former patients and new readers.

Today, I’m going to break with my apolitical rules and defend President Trump.  Trump is often criticized for exaggerating, lying, being vengeful and a host of other outlandish traits.  I’m not judging him nor agreeing or disagreeing with anyone so don’t bother attacking me.  I just want to defend ONE thing Trump said yesterday.

President Trump clearly stated, “I am not a doctor.”  That statement is 100% correct and truthful. The President has NO MEDICAL KNOWLEDGE AND SHOULD NOT USE HIS BULLY PULPIT TO RECOMMEND ANY MEDICAL TREATMENT.  Last night, Trump was practicing medicine without a license.

Hydroxychloroquine and azithromycin, like all medications, come with an assortment of unknown benefits and risk. I am glad I no longer have a practice.  If I did, my patients would be calling for prescriptions, based on Trumps recommendation, for both medications. 

I would spend time listing the possible and probable side effects of hydroxychloroquine and azithromycin.  Despite the unknown benefits and the known side effects, my patients would demand I roll the dice and give them what they want.

What my patients want is peace of mind. They are scared out of their wits as am I.  Snake oil fueled by the internet and our President is not the answer.  I have had patients on both of these medications for years and have grown to respect both their ability to help specific patients and their ability to do great harm.

For sure, if you were on death’s bed, I’d have you on everything and anything that had one iota of a chance to save you.  But to say a medicine is safe because it has been used for years is foolhardy.  To say that using hydroxychloroquine and azithromycin won’t kill you is foolhardy.

To rightly proclaim, “I am not a doctor” and then recommend a medical treatment despite what your own, hand selected medical authorities have to say, simply makes you a fool.

Please, President Trump, stop being foolish.  Stop sending people to their doctors requesting medications that may or may not help them.  Instead, recommend that people follow the guidelines, stay at home and let the virus die out by denying it any place to go.  Your scientist and medical experts will find the truth about hydroxychloroquine and azithromycin in short order.  Let them prescribe medications when appropriate.To learn about vaccine development, listen to Zdogg’s interview with Dr Offit. Again, this interview is highly technical but interesting and informative.  For sure, after listening to 10 minutes, you’ll understand how complex vaccine development is and you’ll turn off the interview

And I thought having to retire was bad!  I didn’t know the half of it!  I’ve been sad, mad and a little bit crazy.  I’ve written about the emotional roller-coaster I’m on and I’d really like to get off. Unfortunately, I can’t and the rise and fall of the coaster continues to get steeper and more perilous.

Writing has kept me sane, but writing is getting more difficult.  My last article dredged up some of my humor.  It felt good to write a humorous article, especially since one of my readers mentioned that my articles made her cry. 

I awoke at 4 a.m. as usual.  I don’t want to be late getting to my family room.  Brewed coffee and sat down to catch up on my reading.  I’m so busy doing nothing that I get behind on my studies.  This am I read a great article entitled “THE NEXT PANDEMIC WILL BE IN MENTAL HEALTH,” by Dr Najma Hamdani on KevinMD.

Dr Hamdani’s message is worth reading.  We are all on this roller-coaster and, those of us who stay home, will eventually get off together.  Let’s hope sanity prevails and the ride ends in a happier place.

Meanwhile, I’ll dream of being well enough to give telemedicine a trial.  Time to divorce Fridge, and get this weigh off and train for the day I can return to my beloved profession.  Maybe miracles do exist.

Renee. Get the handcuffs.  I know what you’re thinking, but that’s not it.  Get your mind out of the gutter and into the kitchen.  No, we aren’t getting kinky in the kitchen.

Actually, I’m getting kinky in the kitchen.  I’m having a love affair with the refrigerator.  I’ve got it filled with all kinds of delicious food. I loaded it with things I would never buy.  Afterall, if we are going to be stuck at home for a long while, we might as well eat.

Fridge loves me.  She calls to me constantly.  “Oh Stewart, I’m waiting for you.” She longs for TV commercials, knowing that I’ll come to her and empty her of her contents.  My new favorite is Hawaiian rolls covered in cream cheese and smeared with olive bruschetta.  

Nightly, I go to her and she spews her contents into my pots and pans as I cook masterful, unhealthy, calorie and fat ladened dinners. I’m the author of a healthy lifestyle book, yet I can’t get my act together.  I’m on the “I’m bored, I don’t give a crap” wagon.  It would be a great diet to write a book about.  I think I’ll call it “Eat Yourself to Death “or “Fridge Loves Me and I Love Her.”

Seriously, I have two choices.  The first is to buy new clothes.  MTailor can measure me from home and ship me new pants (it’s pretty cool).  I already bought suspenders.  I’ll also need a forklift to get around.  The second choice is to have Renee handcuff me to the bed.

Choice number 2 wins!  Renee, get the handcuffs.  And while you’re at it. Let’s figure out how, cuffed to the bed, I can burn calories.  

For 34 years I was privileged to take care of some of the most incredible individuals in the country.  As Trump would say, my patients were the greatest, the most creative, smartest people, like no one has ever seen.  In this case, he would be right.

We are in deep poop.  Our healthcare professionals go to work every day knowing that today is the day they may contract a fatal disease.  Despite knowing that, they go anyway.

They come home at the end of the day knowing that they may inadvertently kill their family by passing on this hidden enemy.  At the end of the day, some change in the garage before entering their house.  Some don’t come home.  All live in fear.

Make no mistake. We are at war.  Our soldiers are, for the most part, unarmed.  We, sitting at home, are the partisans.  It’s time for us to band together and fight back as best we can.

If you were in manufacturing, figure out how to retool and make face mask.  Invent protective gear for our troops.  If you can sew, make masks.  If you are in the business world, figure out how you can procure the gear the government and local hospitals can’t.  Use your God given talents to save lives.  

If you can’t figure out how to help, then be content to stay home.  Staying away from others will stifle this virus.  If the economy has not crippled you, send a meal to the emergency room.  Ordering from local restaurants will help keep them in business and I can tell you from experience, having food in the breakroom reenergizes the hospital staff.

Recognize that your neighbors may be in trouble.  If you have a paycheck coming in on a regular basis and they don’t, see if you can help them.  This is going to be a long battle.  Viruses have a tendency to come back on a yearly basis.  If we band together, we have a better chance of surviving this then if we turn inwards and become hoarders, competing for toilet paper and sanitizers.

Support your local hospitals and neighbors anyway you can.  There will be a vaccine, it just takes time.  So, get off the couch and figure out how you can help.

Are you anxious?  Depressed?  Scared? Bored?  Angry?  If you are not, you’re probably insane.  The world has changed, and no one can tell you if it will be normal ever again.  

If you can work from home, you are one of the lucky ones.  If the shelter in place order has shut down your business, if you’ve been fired/laid off, then you are scrambling to figure out how to pay your bills and put food on the table.  

In a way, my illness shut down my office and sent me home permanently.  I can’t even pitch in to help my former colleagues during this crisis.  I understand, firsthand, how threatening a sudden disruption in your income stream is.

Luckily, Renee and I are not at each other’s throats. Trapped in the house on an emotional rollercoaster can wreak havoc on a marriage.  Cabin fever, the above listed emotions and those that I’ve failed to list can add up to divorce or worse.  There is a great picture on Facebook of a woman knitting a noose. 

So, what do you do?  Obviously, you now have time for lots of sex.  That’s probably why the above-mentioned woman was knitting a noose.  I know what I’m doing.  I’m relearning how to meditate.  To help, I use Dr. Ruth Naperstak’s Guided Imagery program and have just started to work with a program made by Balance and found in the App Store on your phone.

Meditation can be a very useful tool.  Today, on www.ZdoggMF.com, I listened to a 1 hour Podcast on dealing with anxiety. While it was rather long and somewhat technical, it was excellent. 

My patients never seemed to have time to learn to meditate.  Unfortunately, the only thing that most of us still have is time.  It’s time to learn to meditate.  

Renee, I’ve done my meditation, it’s time for more ……

As I promised yesterday, today deals with a similar but, in many ways, worse scenario.  Assume that you have had extensive end of life discussions with your spouse.  Your spouse agrees to honor your wishes not to be placed on a ventilator and knows when to invoke your DNR orders.  Also imagine that you have not discussed any of this with your children.

Afterall, discussing end of life issues with your children would be awkward and upset them.  Right?  WRONG!

Your 26-year daughter, Amanda, and your spouse come to see me the week after you are buried.

Spouse – “Doc, Amanda won’t talk to me.  She thinks I killed her mother.  I tried to explain to her . . .”

Amanda – “You did kill her.  Had you let the docs intubate her and breath for her she might be alive today.  I can’t stand being in the same room with you.  I thought you loved her.”

Spouse (crying) – “If you won’t listen to me, listen to Dr. Segal.”

Doc – “I know losing your mom came as a surprise.  Covid-19 hit her hard.  Her cancer treatments were also taking a toll on her.  Your mother, father and I had multiple, lengthy conversations about your mother’s wishes.  She did not want to be intubated under any circumstances, She signed DNR papers at her last office visit.  That was before Covid-19.”

Doc – “She also did not want to discuss any of this with you or your brother.”

Amanda – “My brother is furious.  He wouldn’t come today.  He can’t understand why you and dad did not fight harder to prolong mom’s life.  To give her a chance to beat the virus.”

Doc – “Your father and I honored your mother’s wishes.  Your father didn’t want to but had promised her he would not keep her alive mechanically.  She was very sick.  The cancer treatments were horrible.  She told me the only reason she didn’t go on hospice is that you and your brother were not ready to let her go.  The Covid-19 pneumonia made everything 10 times worse.  Your father did what she wanted.  He did not kill your mother.  He loved her enough to let her go.”

Unfortunately, the above conversation is not fictional.  I’ve heard it too many times in the past.  It is far better to have end of life conversations with your children (if they are mature enough) than to leave it to the surviving spouse.

The father depicted above just lost his wife.  He came close to losing his children.  Had they not openly discussed their feelings, the belief that he took away the only chance their mother had to survive Covid-19 would have destroyed their family.

Make sure your children know what you want if catastrophe strikes you.  Every few years, reaffirm your beliefs and wishes.  Should your spouse or children ever have to take you off of life support they will know what you want. They will be able to console each other and give the acceptance and loving support each survivor will need. 

Losing one’s parent or spouse is hard enough.  Losing ones loved one and then forever questioning if you could have saved them is a type of living hell.  As a doctor, I preached preventative medicine.  Everyone agrees, it is better to prevent illness than to treat it.

Mr. “P’ is the perfect example of a spouse suffering intense emotional pain that could been prevented.  The following is a real conversation that was all too common in my practice.

Mr. “P” – “Doc, did I kill my wife?  I think I killed her.  I can’t sleep.  I cry all the time.”

Doc –” P” you know you didn’t kill her.  The cancer took her from us.  She fought hard and, in the end, went peacefully.”

“P”- “I can’t help but wonder if I should have kept her on the ventilator another week or two.  She might have gotten better.  I shouldn’t have turned it off.”

At this point, the conversation goes one of two ways.  The first way is if his wife had advanced directives and she had discussed her wishes with him.  The second, and more common way is when the two of them never had discussed her wishes.

Response to option one:

Doc- “”P”, you didn’t turn the respirator off.  Despite your wanting to keep her alive, you did the hardest thing you could do.  You honored her wishes!  She made her wishes perfectly clear.  She did not want to be on a ventilator.  You did not kill your wife!  You honored her wishes!”

Responding to option number two is not as easy.  No matter what I say, Mr. “P” questions whether he should have kept her alive and hoped for a miracle for the rest of his life.

With thousands of people dying from Covid-19, it’s time to make your wishes known to your family and your doc!  Tomorrow, I’ll address a similar but more complex problem.

My doctor called me yesterday seeking my opinion on a new hospital policy.  We have worked together for over 20 years, so I was not surprised when he called.  I was shocked, dumbfounded, enraged and saddened by what he told me.  I slept poorly last night.  It’s like we are all trapped in the same nightmare, and it keeps getting worse.

First, you need a little background information to fully understand my flood of emotions.  One of the hardest decisions I ever had to make was when I realized that I’d have to give up inpatient hospital care.

When you are hospitalized is when you need your doctor the most.  You need to know that your caregiver knows you, cares about you and that, in turn, you know him/her.  Unfortunately, as I aged, seeing patients in the hospital and office (working 14-16 hours a day) became too much.  Rounding at 6 am and 7:30 pm was difficult.  Being awakened at all hours of the night by nurses seeking orders for sleep aids, indigestion, labs, IV solutions, etc. became impossible.

My solution was to start using the hospitalist as my in-house resident and follow my patients by phone and computer.  I got to sleep through the night and my patients were, whether they knew it or not, remotely supervised by me.  If there were any problems, I would show up at the hospital.

Flash forward to today.  Apparently, the new hospital policy is to admit all Covid-19 positive patients to one of three hospitalist who work for a large group of hospitalists.  At a time when your life is threatened by an unseen terrorist, you no longer will be under the care of the doctor you know and trust.  You will be isolated, in the hospital, ALONE since family and friends will not be allowed to visit.  Yes, your worst possible nightmare is now real.

To make matters even worse.  Your family will be communicating, over the phone or by text, with a total stranger.  As an adult patient, you will have to cope with seeing a stranger, being without family, friends and your doctor.  When I try to imagine how a five-year-old patient is supposed to cope with this, all I can do is cry!

Covid-19 has brought madness into our world!  So, what can we do?  SHELTER IN PLACE!  IF YOU FEEL SICK, CALL YOUR DOC.  HELP YOUR ELDERS.  

If you are admitted to the hospital, demand to see your own doc (assuming that he is on staff and still cares for inpatients).  If hospital regulations preclude you from seeing your own doc, hire him/her as a consultant.  Share this blog with friends and family.

Once upon a time, my opinion not only mattered, but helped to form hospital policy.  Now, the Press Ganey report on patient satisfaction drives hospital policy.  Let your local hospital administrator know that you want your private doc to care for you if you are hospitalized, especially if you have a life-threatening disease. I certainly would want Dr Bianchi at my bedside if I was admitted with Covid-19.

While you are sharing my nightmare, there is one more task you should do.  Make sure your family knows how aggressive you want your doc to be if you should need to be placed on a ventilator or resuscitated.  Your spouse and children should have a clear picture of what you want.

Tomorrow, I’ll explain why your children should be in the know!

Thanks, Jack!  I was out of things to say until I read “It seems we are fighting two pandemics: Covid 19 and Stupidity.”  Whoever said that is right on.  It also seems there is no cure for stupidity either.

Lynn shared the following:  “You thought dogs were hard to train.  Look at all the humans that can’t even sit and stay.”  Damn it, I sit and stay!  If you sit and stay, you’ll get a treat.  You’ll get to live. If you’re really good at obeying the shelter in place order, you’ll have time for other treats.  RENEE, I’ve been really good!

On the lighter side is: “Dear single friends, Stay positive and optimistic.  After 3 weeks of lockdown there will be plenty of divorces and new opportunities.  Unfortunately, many of the females will be newly pregnant.  Top names for the newborns will be Charmin, Angel and Scott.”

Last and the most important is: “The virus doesn’t move, people move it.  We stop moving, the virus stops moving, the virus dies.  It’s that simple.”  Conversely, we keep moving and socializing and perhaps we give the virus to a few grandparents and their children and friends.  Perhaps we get away with murder!  Perhaps you actually kill the doc and nurses taking care of grandma to.

Not only do we need to find a cure for Covid 19, but we need to find a cure for stupidity and selfishness.