LIVE THE WELLTHY LIFE

What the hell is wrong with our leadership?  We are being attacked by a new virus.  It’s wreaking havoc worldwide.  The solution, social isolation and shelter in place, is financially destroying the bulk of us.  The news, depending on which station you watch, is doom and gloom.  Anxiety is at an all-time high.

Making everything worse is the inability of our leadership to agree on anything.  Today, the pundits promise that the democrats and republicans are very close to making a deal.  It seems that both sides have lost sight of the trouble this country is in.  We are no longer the United States of America.  We are at war.  It’s the democrats vs. the republicans vs. Trump.

It’s pitiful!  We are all going to suffer if our leadership continues to fight, further splintering an imperfect union.  I can’t imagine how bad it must feel to sit at home, out of work, bills coming in and having these jokers screw around with a relief package.

I know how it feels to have my retirement threatened.  Hell, my very existence is threatened by Washington’s war.  It’s time to call a truce.  It’s time for our leaders to represent the country, not their parties.  It’s also time to vote these people out of office come November.

Believe it or not, I’ve run out of words. On the news this morning, I saw a report about a man making protective face shields on his 3D printer in his basement.  As you know, I’ve been really worried about my fellow docs’ health and this report offered a ray of hope.

I’ve been calling my old patients looking for assess to 3d printers but came up dry.  Actually, one of my patients told me that the schools in the area most likely have 3D printers, but I haven’t been able to find anyone in charge of the local schools.  If you know anyone in the local school districts, please contact them and see if they would consider making protective gear for our local hospitals.  Apparently, the specs for printing a faceguard are open sourced.

So much for the bright side of things.  If there is anything in particular that you would like me to write about, feel free to contact me.  Stay home!  Don’t kill your spouse.  Renee showed me a picture of a woman knitting a noose.  She thought it was funny.  I’m just glad we don’t have any yarn in the house.

Maybe I do have one or two words left.  Humor is a great way to, at least momentarily, relieve pressure.  I appreciate the jokes and videos ya’ll are sending and would share them with you if they weren’t so raunchy.  I never realized how raunchy you guys were.

I will continue to post articles on this blog as often as there is something new for me to address and will resume daily articles when my writer’s block clears or I can be more upbeat.  

The other day I wrote about the roller coaster of emotions I’m experiencing.  Well, I want to get off this roller coaster but can’t.  Every time I turn on the TV, I’m bombard with opinions, facts and outright lies and its pissing me off.

The solution is obvious.  I just shouldn’t turn on the TV.  For some strange reason, I can’t help myself. The thing that’s eating at me is the fact that my friends and colleagues who work at our local hospitals are really in peril.  Without proper personal protection gear, every patient they see may be a suicide bomber, armed with a potentially lethal virus and ready to take the docs, nurses, staff and their families out.

This situation is outrageous.  Why hasn’t the President and national health authorities remedied this situation?  Calling healthcare workers heroes does nothing to protect them and their families.  Promising that masks, gowns and tests are coming just doesn’t cut it!  Yes, while the docs who took the Hippocratic Oath knew what they signed on for, their families did not.  If I was still an ER doc, I’d be afraid to go home.

I’ve talked to some of my colleagues and, in fact, they are afraid to go home.  We are at war and the enemy has broken through the lines and is attacking us from within.  What can we do?  If you know someone in manufacturing, ask them if they can retool and make protective gear for our healthcare providers.  If you are hoarding masks, donate them to your doc and the local ER.  If you are hoarding sanitizers, share them with your neighbors and friends. If you are hoarding toilet paper, I hope you suffer constipation.

Most of all, obey the shelter in place rules.  If we stay away from others, the virus will not be able to spread.  If you are a know-it-all and think that this crisis is being blown out of proportion by the government and press, obey the rules anyway!  It’s ok to be outraged at the situation no matter how you envision it.  It’s not ok to unknowingly pass the virus about your community.  The sooner we shelter in place, the sooner this is over.

Finally, I’m stress eating and that’s not good.  Are you?  Sitting at home 24/7 is maddening and eating relieves some of my anxiety and stress.  Eating too much of the wrong things combined with limited exercise actually weakens you.  It’s time to enroll in boot camp and prepare for a long battle.  Now if I only had a drill instructor to rein me in!  Oh yeah, I do.  Betsy, help!!!!!!! As for exercise, Renee, can you think of a way to get my pulse up for a while?

OMG, I hate rollercoaster rides.  While I can tolerate the majority of coasters, I know they only last minutes and promise to return you to where you got on, safely! The current rollercoaster we are on is miserable and promises to last months.

How any of us are going to stay sane is beyond me.  My emotions are all over the place. Right now, I’m happy and content.  Today is my 42^nd anniversary and I’m home with my bride of many years.  We feasted on steamed Maryland crabs, Facetimed with our children and grandchildren and got literally 100s of good wishes from friends and patients.

In a few minutes, I’ll crash into depression and abject fear.  This virus is blowing my mind.  I worry about my patients and am sad I’m not there to care for them.  I worry about my colleagues: doctors, nurses, clerks, lab techs, x-ray techs, etc.  They are on the front line and, if you believe the news, are running out of protective gear and flying by the seat of their pants.

I’m worried about my children and grandchildren who will inherit the current disaster’s aftermath.  I’m worried about financing my retirement with the market collapse and being stuck with two homes.  OMG, no one is going to tour a stranger’s house with the current virus lurking behind every corner, waiting to get you.

I have mixed feelings about not being able to practice medicine.  If I was physically able, I’d be volunteering my services at the local hospitals.  Working as a doc would put my family and me at risk but it’s what I trained for.  On the other hand, I’m actually glad that I can’t work and therefore will not run into the fire.  

All of this rambling would sound ridiculous to a sane person.  Since most of you are on the same ride I’m on, I’m sure you understand.  How do we survive this upheaval?  One thing is to look at it as being at war.  Isolating ourselves is like going into a bomb shelter and waiting out the bombardment.  To fight off the fear, be assured that the best medical minds in the world are looking for treatment options and vaccines.  They will find them, and the war will end.  Until then, hug your loved ones and keep them close.  If you are hording N95 masks, donate them to the docs in your local hospital.  If you are hording toilet paper, shame on you.  Some of us are running low and that’s just one more “mess” to contend with.

While I’m cycling through emotions, I end up madder than hell.  We’ll find a vaccine and prevent future outbreaks.  Won’t we?  I’m mad because I know the anti-vaccine lobby will fight being vaccinated and serve as fertile ground for this and other diseases, new and old, to attack us.  What a pity!

Time to be happy again.  Renee, let’s play hide and seek.  You go hide and I’ll find you and . . .  Aren’t you glad you are trapped in the house with me? What else can we play?

Wow!  I never would have believed that I, Stewart Segal MD, would endorse the use of Telemed.  Not in a million years could I have imagined telling patients to avoid seeing their docs in person.  Coronavirus has changed everything.

If you are ill, do not go to your doctor’s office, immediate care center or ER.  Call your family doc for instructions.  Expect to wait a long time for a response as most of your docs’ patients will be calling him/her. If you don’t have a family doc, call a hospital-based urgicare center.

The real question is do you have the Coronavirus or not.  Testing for the Coronavirus is not readily available.  If you get sick, assume you have Coronavirus and isolate yourself from the rest of the world as much as possible.  Initial treatment of the Coronavirus is the same as for any other virus.

Rest, lots of fluids, acetaminophen or ibuprofen, combined with prayer are my treatment of choice and is what the phone doc is most likely to prescribe. The real dilemma is discerning when it’s time to go to the ER/hospital.  Shortness of breath and difficulty breathing are your two big indicators that will trigger an urgent call to your doc or a trip to the hospital.

Once you’ve determined that you or a loved one has a worsening respiratory tract infection that is probably Covid-19 and you’ve discussed it with your doc, you are off to the hospital for definitive testing and oxygen.

Yesterday I wrote about the stubborn spouse.  What do you do when your sick spouse is having trouble breathing and refuses to follow the docs instruction and will not go to the ER.  The following conversation is one I’ve had too many times in my life.

ICU Waiting Room

“Mrs. “X,” I’m Dr Segal.  Your husband is on a respirator and stable.  His condition is critical.  If only he would have come in earlier.  What happened?”

Mrs. “X” – “He has been sick for a week.  He started having shortness of breath yesterday.  I knew you were busy, so I called the ER and they told me to bring him in.  He can be a real jerk!  He told me he wasn’t going to the hospital as it was just a bad cold. When I told him he was either going to the hospital or I’d call the paramedics, he told me that “IF YOU CALL THE PARAMEIDCS, I’LL NEVER TALK TO YOU AGAIN!  So, I didn’t call the paramedics until he became so weak, I thought he might die.”

Dr Segal – “Did it dawn on you that if he died, HE WOULD NEVER TALK TO YOU AGAIN? In the future it is better to have a pissed off spouse than a dead one.”

For all of you married to a stubborn spouse, God bless you.  I hold meetings of the Cursed Spouse Married to a Stubborn Person (CSMSP) on the first Thursday of every month.  Stubborn spouses are welcome but will never come.  

In December, KevinMD published “Artificial Intelligence and Angel of Death.”   “AI” sure is spooky.  What’s worse is that we have freely invited “AI” into every aspect of our lives. Science fiction has a funny way of becoming real.  I really don’t want a computer deciding when it is my time to die.  Alexa, kill Siri, then commit suicide!

I’m writing this article in response to a request from one of my oldest patients and friend.  It seems she married a stubborn male who fails to believe that the Coronavirus is as serious as the President and his advisors are saying it is.

My friend’s husband is a delightful individual.  He’s bright, caring and a hard worker.  He wants to go to his office to work even though he can work from home.  Knowing that his wife, child and himself all have risk factors making them susceptible to the worst consequences of a Corona infection has not stopped him from going to work.

Either he truly doesn’t believe that this virus is the monster it is made out to be or being shut in with his family for weeks is a scarier proposition.  Personally, I’m already going crazy.  Social isolation sucks.  I feel sorry for my wife as she locked in with a crazy man.  

Back to the saga of the stubborn spouse.  As I’ve stated before, I’m a pessimist by profession.  I have to assume the worst and protect my patients against it.  I also hate being right when I predict disaster.  I love apologizing to patients when I scared them without apparent reason.  I’d rather tell you your symptoms are consistent with a heart attack and be wrong than miss the diagnosis and have you die from a heart attack.

We know the Coronavirus kills the elderly and those with underlying medical problems.  So why take the chance of bringing the virus home from work?  Sheltering in place makes sense!  It makes lots of sense!  

The optimist says “I’ll go to work and stay 6 feet away from my coworkers. There is no way I’ll catch the virus and I’ll be more efficient working at the office.”  The optimist may be right.  The pessimist says you’d better make sure your life insurance and your wife’s life insurance are paid up.  The realist says that, if you give Coronavirus to your spouse or child, you’ll be out of work and waiting in the ICU waiting room.  Oh yeah, the hospital won’t let you in!

So, damn it, work from home.  Thank God I’m not married to a stubborn woman. LOL!  She wanted to have cataract surgery in the am despite my warnings and having heard me warn of an impending pandemic for years.  I’m happy to report that the hospital cancelled all elective surgery and is taking this seriously.

My major concern is not your stubborn spouse.  It’s your 20 – 40-year-old children.  Getting them to take this seriously is not an easy task.  They need to shelter in place as well.  While they are unlikely to die from this virus, they will pass it on allowing it fertile ground to grow on.  And then it’s your school children who are going to drive you crazy.  It’s no wonder my patient’s husband wants to go to work.  Have him play ball with the kids, ride bikes with the kids or help them with their homework.Stay home, enjoy your family, check on your elderly friends and lock out the rest of the world.  The life you save may be your own or your family’s

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

How old is too old? You tell me!