Prolonging college ball

I went to a college basketball game last night with my family.

It was a Division II game at Rollins College in Winter Park, Florida.

It's interesting looking at the game program and, in particular, at the players date of birth.

Many college "seniors" are 25 years old.

How might you ask?

Many graduate from high school at 19 (were often held back a year to help ensure they would dominate in sports), get red shirted their first year of college and then play for another 4 years (often even at the same school!). Some get a 6th year if they are granted a "medical red shirt" for an injury.

It's got to be an advantage for some who get to play against a 17-21 year old (who graduated high school on time and wants to finish college in 4 years).

The dishwasher

A 56 year old male was on two oral medications for his diabetes.

His wife wanted to know why he had to take two different medications for the same disease.

I started a long discussion on the mechanism of action of the two medications but quickly determined they were not following what I had to say.

I decided to try a different approach.

Me: Do you all have a dishwasher at home?

Wife: Yes.

Me: Does the dishwasher get your dishes clean if you put them directly into the dishwasher?

Wife: No, we always rinse the plates first before we put them into the dishwasher.

Me: So you need to do two things to get your dishes clean, right? Your husband has to take two medications to control his diabetes. They both help, in different ways, to keep the sugars lower.

Wife: Oh, now I see. That explains it, thanks.

I actually have no idea why I used a dishwasher for this analogy. Probably because I've washed a lot of dishes over the years and my wife gets annoyed with me when I try to skip the first step (the rinsing part that is).

For whatever reason, it seemed to work this one time.

Just my elbow!

I had an MRI yesterday of my left elbow (the same elbow that I fractured three years ago).

I'm pretty sure I have radial tunnel syndrome and so is the orthopedic specialist.

The radial nerve gets impinged in the region of the elbow and then sends neuropathic symptoms distally in the forearm.

It's been going on for a few months and it's starting to get old.

The MRI took about 30 minutes (and everyone aware of the claustrophobia and noise will know that's a long time)!

I only got scolded once by the technician when my foot started to slip off the pillow.

When the technician pulled me out of the scanner the only thing I could think of saying was "I just hope I never get something really big wrong with me!"

He laughed.

Our cute starter home...since 1994

We went to a great party recently.

It was given by friends of ours that live in a beautiful new home (3500 square feet with 5 bedrooms and 4.5 baths).

It had all the cool extras (60 inch TVs, high ceilings, spacious kitchen, huge closets, pool/spa, outdoor fireplace, etc.).

As we were leaving, one of the hosts mentioned, "you should see some of the other homes in this neighborhood, they're huge!"

That gave us something to think about as we drove back to our "cute starter home (as a friends wife called our home almost 18 years ago)."

Our home is just right for us, however, and we're mortgage free at a time when our kids are getting ready to head off to college.

The timing couldn't be better to still be in our starter home.

Shocking church services

A 64 year old male had been attending an evangelical church for a number of years but hadn't attended for the last few months.

During two different services, a few months ago, while in the midst of an altar call and some "raise the roof" music, his implanted defibrillator had fired.

On both occasions, he was dropped to the floor by the shock, and the rescue squad took him to the local hospital for an evaluation.

He's not sure what to do.

He's had the implanted defibrillator for the last four years and it had never discharged prior to these occasions.

His cardiologist confirms his defibrillator is working properly and is calibrated perfectly.

He has some options (stay at home, change churches, leave before the altar call) but he (after some more prayer) will need to decide for himself.

It's easy to understand the emotions that he's dealing with after, basically, being hit twice in the chest with a baseball bat during the most inspirational part of the services.

Good advice

It's always great to have family visiting for the holidays.

Often it's also a time to rehash stories.

Somehow, we got on the topic of our trip to Ireland last year.

At one point during our trip we had a choice of taking major roads to our next stop or taking a scenic route over the mountains.

We were at the National Horse Stud Farm and headed to Wiclow, on the east coast.

I asked an older Irish fellow selling ice cream if the roads to Wiclow, via the scenic mountainous route, were well marked.

He replied, "Oh no lad, you know Ireland, not atall (one word), but just take it slow...and hope for the best."

We did just that and have another life long memory.

We are all finally able to laugh while remembering the hair pin turns, narrow roads, near head-on-collisions with oncoming cars, and possible sheep around every turn, in the middle of the road, while driving on the opposite side of the road and operating a manual transmission, with my left hand, for the first time in my life!

Have a wonderful day!

"Maybe Christmas, " he thought, "doesn't come from a store. Maybe Christmas...perhaps...means a little bit more."

     Dr. Seuss from "How the Grinch stole Christmas"

"Unless we make Christmas an occasion to share our blessings, all the snow in Alaska won't make it white."

     Bing Crosby

Merry Christmas everyone!

Open mouth insert foot

I saw a nice man recently who weighed 526 pounds.

He had pictures all over his home of his favorite college football team.

He let me know that he played high school football and was hoping to be recruited to play for his favorite college team but an offer never materialized.

He then enlisted and had a 6 year Navy career.

I don't know why (actually I do know why) but I asked him what position he played on the offensive line for his high school football team.

He went on to let me know that during his senior year of high school he was a safety and weighed 160 pounds.

We all know what happens when you "ASS-U-ME" anything.

Luckily he let me off easy by acknowledging my assumption was understandable given his current size.

Tee time?

My 79 year old mother had cataract surgery yesterday on her right eye.

Everything went fine.

She opted to go for a lens that was covered with a standard co-pay, instead of the more expensive lens that could have possibly lowered her chance of needing corrective glasses (it would have been an additional $1000 out of pocket).

The office staff was putting the hard sell on for going with the more expensive lens.

She's been wearing glasses her whole life, so the thought of having to continue to wear glasses was not a concern.

In the recovery room, the ophthalmologist let her know the operation only took 8 minutes.

8 minutes!

Hopefully everything will continue to go well.

Perhaps the surgeon felt my Mom would be comforted or impressed by the 8 minutes.

On the contrary, you can bet she will only remember him telling her that if anything goes wrong with her vision in the years ahead.

My advice to all ophthalmologists: stop telling your patients about your speed.

Most elderly folks would prefer to think you took your time instead of setting a speed record or rushing through the procedure.

Some might wonder if you're rushing to get somewhere, such as the golf course.

You can continue to do it in 8 minutes...just don't tell them.

Balance alternative, traditional medicine

(Initially published as a "My Word" column for the Orlando Sentinel Feb, 6th, 2003-my views haven't changed much since then)

     
     Most people “into” alternative therapies are not aimlessly looking for the fountain of youth. They’re just investigating ways to enhance their health. As a family physician, I try to do the same with traditional medicine.

     However, many people prefer alternative treatments, and it doesn’t surprise me. Many traditional physicians are not the best of role models in terms of lifestyles, health habits or spirituality. Many of us are so disillusioned with our own career that it’s evident in our communication styles. Most of us don’t take the time needed to ensure that patients feel they have had a quality visit. Most people are not satisfied with a 15 minute visit that may have been made months in advance, and that, on the day of the appointment, may be over booked with additional patients.

     I’m glad when patients of mine feel they obtain benefit from alternative treatments for conditions, such as chronic fatigue syndrome and fibromyalgia, for which traditional medicine has often failed. The alternative treatment community, however, needs to have regulatory guidelines in place that prevent some from making outlandish claims.

     Many physicians look down upon former colleagues who have ventured into alternative therapies. I don’t.

     I haven’t met a person going through chelation therapy who wasn’t intelligent, motivated and committed to a healthy lifestyle.  I often see people on three inhalers for lung disease who still have cigarettes in their top pocket. Gee, I wonder who will do better. Hmm, whom would I rather work with?

     If wearing magnets, drinking Noni juice or getting chiropractic manipulations enhances people’s lives in some way, I’m happy for them. I always ask folks to describe the therapy and to bring in whatever information they have so I can review it.

     For instance, there’s feng shui, the ancient Chinese art of placing things to ensure a harmonious flow. A friend told me about a person who was “cured” of chronic back pain by rearranging her bedroom furniture. Good for her!

     Traditional medicine needs to get its act together and recognize the actual or perceived health enhancing benefits of many alternative health treatments. Some in the alternative health community need to clean up their act and stop acting like snake oil salesmen.

     The two need to stop bad-mouthing each other. There needs to be better balance.

     The new health motto should be “feng shui for everyone.”

A trach and an eraser board

Dr. B., a 67 year old retired anesthesiologist and a patient of mine for many years, presented with shortness of breath and a smothering sensation.

He was found, after an extensive evaluation, to have an inoperable hemangioma that encircled and partially occluded his trachea.

He had a tracheotomy performed and has a trach tube in place to keep (stent) the airway open. There are no other surgical or treatment options. He will need to keep it in for the rest of his life.

He spent a good deal of his adult life intubating patients for operative procedures.

The irony is not lost on him.

He was able to tell me such by writing on the eraser board that he now carries with him everywhere.

"W" cubed

Went to see a nice 68 year old man recently who had undergone a shunt procedure (ventriculoperitoneal) about a year ago for normal pressure hydrocephalus (NPH).

It was a success (his gait significantly improved).

The triad to remember for NPH is urinary incontinence, gait disturbance and cognitive impairment-also known as “wet, wobbly and wacky.”

Pass the tissues?

Remember: during this cold and flu season, don’t blow your nose.

When people sneeze or cough, only trivial amounts of nasal fluid flows into the paranasal sinuses. 

A study (in Clinical Infectious Diseases), using an opaque dye and CT scans showed that blowing your nose significantly reverses the flow of nasal mucous back into the sinuses.

Nose blowing is felt to increase the chance of paranasal sinusitis complicating a common cold.

Just think of every time your Mother handed you a tissue to blow your nose over the years…if she had only known!

If you are going to blow your nose the preferred method (believe it or not) is to blow one nostril at a time.

Even stupider

We all know that texting while driving a car is stupid and dangerous.

I saw something recently that even topped that...I almost had an accident looking at him.

A fellow was texting with one hand while driving his motorcycle with the other hand (of course he wasn't wearing a helmet either).

I'm not kidding!

Third time is the charm

A 103 year old male has been married to his third wife for the last 16 years.

His recently let a group of friends (including a friend of mine) know that his current wife is his "true love, the love of his life...the other two marriages were purely physical."

Time

“ The only real currency in life with which we deal is time, not money. We all have just so much of it, and the way we divide it between work, family, lifetime learning and play ultimately boils down to choice, or choosing to adjust around your choice. But medicine is hard work, and the bottom line is that you can’t go home until the work is finished…but do go home.”

George S. Poehlman MD

Further questions?

A 47 year old female reported a long career in the Army.

Me: What did you do when you left the military?

Patient: I packed up my stuff and left.

Me: Oh...OK, thanks.

I did get a chuckle thinking about what she might have said if I had asked, "what did you do when you got out of bed this morning?"

I suspect she would have said, "I pushed the covers off and stood up."

Easy to remember

I saw a patient recently with Reiter's syndrome.

I've never had trouble remembering the possible symptoms (urethritis, iritis, arthritis) due to a catchy phrase from my medical school days: "Can't pee, can't see, can't climb a tree."

The Anzio Beachhead

Mr. H. is a 91 year old male who has some dementia but still has FULL recall of his 4 months (22 January-24 May 1944), at age 23, serving as a platoon leader in the Allied (British and American) VI Corps, during the Anzio Beachhead (Italian beach) Campaign.

His wife had mentioned he was part the Anzio Beachhead invasion.

I let him know I couldn't recall anything about it.

He gave me a brief history lesson.

"We (The Allied forces) were quickly pinned down and contained within the small beachhead (by the Germans) and rendered almost incapable of conducting any sort of major offensive action for four months before a "breakout" on May 24th to join and become the left flank of the Fifth Army that was moving south.

During the Anzio campaign we (the Allied VI Corps) suffered almost 30,000 combat casualties.

While the campaign was controversial, it did accomplish several goals. The mear presence of the Allied force behind the German main line of resistance, uncomfortably close to Rome, represented a constant threat that the Germans couldn't ignore. The beachhead helped to be a steady drain on scarce German troops, equipment and resources that couldn't be moved to reinforce other locations.

The Normandy invasion, of course, occurred on June 6, 1944."

I let Mr. H. know that I VERY much appreciated the history lesson.

It was an honor to get it from an eye witness.

Dad's in the cradle

I still have time to model good/better/ideal driving techniques for my kids.

I'm going to make every attempt to do just that.

I recently went for a drive with my 17 year old son (he was driving).

The song, "Cat's in the cradle," by Harry Chappin, written in 1974, popped into my head when we finally pulled back into our driveway at home.

I'm using the same tune...I just changed the words.

"I went for a ride just the other day
My son was driving us to and from the "Y"
He rolled through stop signs and went to fast
And I just sat there and held my tongue
And as we got home, it occurred to me
My son drove just like me, yeah
My son drove just like me"

Resiliency

It's been said that "it may not be your fault if you're down, but it is your fault if you at least don't try to get back up."

Always try and get back up!

His real co-pilot

I was honored to meet a  military hero recently. He had a thirty year career in the Air Force and flew over 650 combat missions!

He was stationed, with his wife and children, at multiple locations around the world during his career.

Three walls of his den serve as memory walls with plaques, pictures, awards, ribbons and other accolades honoring his career.

At the far left, on one of the walls, was an 8 & 1/2 X 11 framed Certificate of Appreciation (COA) to his wife.

It really caught my eye, even though it was just a sheet of paper in a simple black frame.

"In recognition of your support and cooperation in furthering the dedication, commitment and career of your spouse with the U.S. Air Force."

She was obviously proud her COA occupied this small spot on the wall and I think she was really happy I stopped to acknowledge it.

At first, for me, it didn't seem that the COA was "adequate" but soon after I could tell that she felt as if all the awards for her husband, on all the walls, were partly hers as well.

Very cool.

What a medical detective!

Well, it's been a week and I'm still not feeling back to normal yet-see last Friday's post.

I hate being ill and not up to par.

I also very rarely take any prescription medication.

Two days ago I was still having nightly temps to 102 degrees.

I started an antibiotic for upper respiratory/sinus bugs.

The fevers have stopped.

Yesterday, I kept hearing a whistling sound in my office and repeatedly looked for a faulty computer fan or monitor.

Finally, I realized that the whistling sound went away whenever I would stop breathing.

I started oral steroids and an inhaler last night.

I'm already feeling a lot better.

My wife, a Pediatric Nurse Practitioner, is not overly impressed with my self diagnosis skills.

Infomercial influence

I met Mr. A. and his wife recently.

He's a 74 year old male who had a stroke years ago and has right sided weakness and a very unsteady gait.

His wife is also fairly frail.

As we talked I couldn't help but notice many exercise products I had briefly seen on infomercials while scanning through channels on my TV at home over the years.

There was also a large unopened box up against the wall.

I asked about it.

The wife let me know it was "The Total Gym" (that Chuck Norris and Christy Brinkley promote on TV).

They were waiting for their daughter to come help set it up for them.

We had a long discussion.

I let them know I would have a therapist come to their home as soon as possible to help devise a home exercise program.

I was certain, from knowing how "The Total Gym" worked, that they would not be able to obtain any meaningful benefit from it.

They asked if I would write a letter for them to help get a refund. I let them know I would.

Unfortunately, I couldn't do the same for the 5-6 other opened, unused, "as seen on TV"  items scattered about the room (all of which I'm sure had "simple" payment plans).

I suspect a lot of other elderly folks have many of these same items.

The Man

"Exercise and recreation are as necessary as reading; I will say rather more necessary, because health is worth more than learning. A strong body makes the mind strong."

Thomas Jefferson

A timely message board

During part of a medical meeting today we had a discussion on patient centered care and, when possible, going above and beyond patient expectations.

It's a cruel world, at times.

We have a harsh healthcare system, at times.

On leaving the meeting, I drove past a church message board with the following message:

"Kindness is the oil that takes the friction out of life."

That sure was a nice coincidence.

Surprise, surprise, surprise!

A recent study published in JAMA (2011; 306:1993-2000) reports that physicians who bill for both technical and professional services with nuclear stress imaging and stress echocardiography order such testing at double the rate of those who do not bill for such services.

All I can think of saying in reply to this study comes from three Gomer Pyle U.S.M.C. quotes (I'm aging myself again):

#1. Golly!

#2. Shazam!

#3. Surprise, surprise, surprise!

The tough

When the going gets tough...

1. Mrs. M.: married for 2 months, (a second marriage for both after knowing each other for a total of 6 months), when 50 year old Mr. M. underwent emergency open heart surgery. The operation was complicated by hypoxia and now Mr. M. is in a persistent vegetative state. Mrs. M. remains completely devoted to him.

2. Mrs H.: a 70 year old woman, married for two years (a second marriage for both), when 78 year old Mr. H. is found to have a relatively rapidly progressing form of dementia. Mrs. H. remains his 24/7 caregiver.

When faced with difficult medical situations, to men they really did not know that long, both of these woman have assumed a role that many others would not have chosen to perform. Many others would have "walked."

...the tough get going.

Couldn't agree more

I saw a recent ad for a medical website that offers easy to obtain, up to date medical information for busy primary care physicians.

The ad stated it's important to have access to such information because in most patient encounters the physician has just minutes to be a "teacher, detective, healer and comedian."

I completely agree.

Better tomorrow?

I was sick today but luckily didn't miss work.

I just kept to myself, did charting and computer work all day and didn't make any home visits.

Sore throat, achy, cough, congestion, fever...the usual stuff.

I'm really not very good at being sick.

It just always really annoys me if I don't get over whatever crud I caught in a day.

I'm getting ready to hit the sack after I take some night time cold capsules.

Maybe I'll get some sleep?

Maybe I'll be back to "normal" when I wake up?

Are you up?

I now work with a Program Support Assistant (PSA).

I've never worked with one before.

I usually check in with her whenever I get back to the office from seeing patients.

Today, on returning, I poked my head into her cubicle and announced, "I'm back."

When I thought about it later, it really was sort of a ridiculous statement.

I wouldn't have been surprised if she said, "you're back?...really, I wouldn't have known...I thought it was just someone who looked and sounded like you."

Later, I couldn't help but reflect on years ago when my grandfather used to call us very early at home on weekends when we were all trying to sleep in.

No matter who answered he would say, "are you up?"

It used to annoy my Dad. Often when he would hang the phone up he would say "of course we're up-he woke us all up by his call."

His angel

Met Mr. M., a 69 year old, recently.

Unfortunately, he has severe end stage multiple sclerosis.

His ex-wife is his 24/7 caregiver.

They were married for 35 years and had two children together.

He left her years ago and got remarried to his high school sweetheart.

His multiple sclerosis was diagnosed and his high school sweetheart left.

They were married for one year.

He was alone and, unfortunately, his disease progressed quickly despite all attempts at inducing remission.

His ex-wife offered to care for him.

He accepted.

She does get some assistance through a home health agency for baths since he is bed bound, but otherwise meets all his caregiving needs.

She sleeps in a recliner next to his specialized hospital bed EVERY night.

She's an amazing, loving, forgiving person.

A short military career, unfortunately

A male always has a high and tight hair cut and always wears a US Marine shirt.

I had known him for a number of years.

Finally, I asked: "when were you in the Marines?"

Patient: In 1977.

Me: How long were you in?

Patient: I was medically discharged.

Me: How did you get hurt?

Patient: I hurt my right shoulder on the 4th day of bootcamp doing physical training. I got medically discharged on the 9th day.

I KNOW he would have loved to have had a much longer career.

A wonderfully odd feeling

     Years ago, when my daughter was finishing elementary school, she pretty much swept the awards assembly. It was a great day for our family but, I guess, not so great for many other families attending.
     This past Saturday, my daughter pretty much swept the end of year awards banquet for her horse riding show circuit. Again, it was an amazing night for my daughter and our family, but, I suspect, not so great for many of the others attending.
     Having your children do well in anything is a wonderful thing. The fleeting moments of feeling bad for all the others (who didn't win) is normal, but still a little odd.

A weird style trend

I recently went to buy some men's dress shoes (you would obviously have some questions if I went to buy some women's dress shoes!).

For some reason, most of the dress shoes now have a significant amount of space in front of the toes ( you've seen them haven't you?...they are real long and narrow at the end).

I have wide feet, and always prefer to have a lot of room in the toe box, but not 4 inches worth of space.

What's up with that?

Why are clown shoes "in style?"

A coaches popularity can change quickly

It's that time of the year again...whenever a college football team has a down year everyone calls for the coach to be fired.

     In 2007, Al Groh won the ACC coach of the year while at Virginia. That season his team won 9 games, 5 of which were won by less than three points. Two years later, he was fired after a "disappointing season."  The University paid him over 2 million a year for the next two years "to not be their coach." He also found employment immediately when he became the defensive coordinator at Georgia Tech.

     Last year the University of Central Florida (UCF) won the Conference USA 2010 title and the Liberty Bowl.  This year UCF has lost 6 games by seven points or less, including a pair of losses by two points or less. The coach still has 4 years left on his most recent contract extension. Everyone is calling for the coach to be fired.

     The difference between a good/great season and a disappointing season is often not much. Injuries, a missed field goal, a lost fumble and sometimes just bad karma can change a team’s fortune quickly.

     Alumni and University Administrators need to accept the good with the bad, as long as you are fielding competitive teams and as long as you are running a "clean program."

     Either that or stop giving the coaches such long term contracts (the golden parachutes). It just gets too expensive to keep giving coaches extensions on their contracts, sometimes after one good season, when the win-loss percentage can change so quickly.

If I only knew then what I know now

An 82 year old man made the following statement:

"I look back on my life and ask what really happened? There are a lot of things I would have done differently, but I'm not sure what I could have changed given all my life circumstances."

I let him know we have all probably had similar thoughts over the years and was then able to re-direct him by letting him talk about all his many successes over his life (being a husband, father, having a successful career, etc.).

I think we BOTH felt better after that.

Thanksgiving Day 2011

I'm thankful for so MANY things.

Because I spend such as great deal of time with patients who are ill emotionally or physically (often both), I'll try to keep it as simple as possible today: I'm thankful for HEALTH of mind and body.

My future?

I spent time with a couple recently who has been married for almost 70 years.

The wife pretty much finishes all her husbands sentences.

Whenever I would him a question he would seemingly take a moment to scan his memory banks prior to answering.

Then, often after he said just a few words, his wife would interrupt to see how much time I had left to spend with him because she knew a particular answer would take some time.

"Doctor, are you sure you have enough time to hear the whole story...I've been hearing the same stories now for almost 70 years...if you let him keep on talkin', he will just go on and on and on.

My wife finishes a lot of my sentences and we've only been married for twenty years.

Is this a glimpse into my future?

A 1943 version of a match service

I met Mr. R. recently.

He's an 88 year old man that lives with his wife of 66 years (she's 84 years old).

His wife was from New Jersey and he was from North Carolina. They have three children.

Me: How did you meet?

Wife: When I was in high school we were all asked to write letters to U.S. service men overseas. I wrote to a fellow who was from my home town in New Jersey. He wrote back thanking me for the letter and let me know one of his buddies was real lonely and could also use a letter. I sent a letter to Elbert (her husband), he wrote back and we just kept on writing each other. We got married when he returned. I ran into the boy from my home town years later and we joked about it. He said, "I told you to write him, not marry him." We've had our ups and downs over the years but in general, have been so blessed.

Now that's an awesome story!

Fill a void

A 71 y/o male: I need you to refill my cholesterol and blood pressure medication and then also throw in a little Viagra as well, will ya?

Me: Have you taken Viagra before?

Patient: No, but I just met a real nice lady whose husband died a few years ago and she says she wants me to fill a void in her life. I'm hoping the Viagra will allow me to do just that (he laughs).

2 chairs separated by a table

Every home I've been to, while making home visits, in which the husband and wife are still living, seems to have a common furniture arrangement, in whatever room they use as a den.

Do you remember the show "All in the Family (the main characters were Archie and Edith)"?

They all have an Archie and an Edith chair (seen below on display at the Smithsonian National Museum of American History) in front of a large TV, separated by a small table that has a potpourri of stuff (opened and unopened mail, magazines, remotes, pill bottles, etc.).


One evening recently I informed my wife about my astute observational skills (in terms of noticing the furniture arrangement).

She walked me out into our living room (that serves as our den) and reminded me of our furniture arrangement.

"Oh, you're right...thanks Edith."

#52

It's my birthday today.

I'm going to try and have a great day.

Actually, everyday is a great day.

Hope yours are as well.

What a surprise

I guess everything needs a formal research study to be done.

A recent study, published in the Annals of Surgery shows that elderly nursing home residents suffer more complications from major operations (abdominal surgery, including removal of the gallbladder, appendix or colon, or surgery for bleeding ulcers) than other people their age, who don't live in nursing homes.

I wonder if someone is also in the midst of studying if folks living in nursing homes are more impaired or physically ill than others their age who still live at home?

A great reminder

I made a home visit to see Mr. I..

He is a very thin 80 year male with end stage Parkinson's disease, a previous stroke, is unable to swallow, has unintelligible speech, multiple joint contractures and pressure areas (early stage decubiti).

His wife and I had a wonderful conversation (she's 78 years old).

Before I left, she asked if she could show me some family pictures. Seeing Mr. I. when he was a distinguished looking, burly, younger family man and full of life was an honor and a privilege...also it's a great reminder of the wonderful times they shared in their life together.

A positive spin...I like it!

An 80 year old male (who had been married for the last 58 years) made the following statement:

"My wife and I haven't had sex for the last 18 years because of her stroke (she still has significant residual disabilities) and because GOD stopped giving me the ability for my penis to get hard at about the same time. We're fine and thankful to be alive and to still have each other."

That sure was a great way to look at an issue that is often so troublesome for SO MANY others I see everyday.

Dr., Dr.

A program support assistant recently made me some business cards.

It was greatly appreciated.

My name was listed as Dr. William T. Sheahan M.D..

I thanked the individual.

I'll wait until a later time to point out that the next time around I don't have to be a Dr., Dr..

Just one Dr. is enough.

For now, however, it will be interesting to see if anyone else notices whenever I hand one out.

A true statement

A fellow at the "Y" recently was wearing a T-shirt with the quote: "Talk is cheap unless you are talking with a Lawyer."

I'm sure anyone who has ever hired an attorney and seen how quickly money can disappear from even just "phone calls" alone would agree.

A snip-snip expert

While driving on the interstate recently I saw a large sign that was an advertisement by a urologist.

It had a picture of the relatively young looking physician.

He was advertising "no needle, no scalpel vasectomies."

It stated that he had performed the procedure over 20,000 times.

It got me thinking.

If he had been in practice for 15 years, and worked 365 days a year, he would have already performed over 3.6 vasectomies a day (I admit that I did use a calculator).

Talk about being able to perform a procedure in your sleep!

However, given the delicate nature of the procedure and the psyche of those undergoing the procedure, I understand why he didn't add this additional information to the advertisement.

Even though I think I would be bored out of my mind, I do have to acknowledge that he must be pretty darn good by now (after performing my second vasectomy in residency training, I felt pretty confident!).

So true

My daughter has competed in a horse show weekly for the last three weekends. Over the last few years, she has usually only done one horse show a month, until recently.

As her skill and riding goals increase, so do the available shows in which to compete.

Riding is her passion and she's an amazing 15 year old.

When I was parking our Van yesterday, at the horse show, I noticed a rear bumper sticker on the Van parked next to us.

It said, "The driver of this vehicle carries no cash. It's all been spent on the horse."

It gave me quite a good bout of laughter.

I'll wait until later to tell my daughter why I was laughing.

A Veterans Day tribute

We have lived next to Louie (and his wife Mary) since 1993.

Louie was born 1/14/1918 and has been an amazing neighbor.

He's also a WWII veteran and was on the 2^nd wave of the Omaha Beach Invasion.

He’s been a hard working man his whole life and has been married to Mary for about 70 years.

He retired from the post office as well.

His daughter, Rosie, literally lives right around the corner.

He has some great stories to tell about WWII, but only when asked.

He was a communication man during the invasion and when the LCVP (Landing Craft, Vehicle, Personnel) opened, Louie (a little over 5 foot tall) jumped into water a depth of 6 feet with a large spool of wire over his shoulder. He was sure he was going to drown.

In fact, Louie has always said to never believe anyone who says they weren't afraid in battle-they’re all lying.

Louie and Mary have always remembered our kids birthdays; Tom and Ellie always know to expect a card, on their birthday, with $1.00 in it.

Louie has ALWAYS tried to prevent me from hiring any help; whenever I've had an electrical or plumbing concern in my house he has always had the necessary tool available to fix it.

He still tries to get out for a ride on his tri-cycle everyday.

Happy Veterans Day Louie, you're the best!

Success

Along the same lines as yesterdays post, I read an article on Ronald Reagan, years ago, in which he stated, "if I only had studied harder in school, maybe I could have made more of myself."

I'm sure he also laughed.

If I only knew...

I had the pleasure of meeting a 92 year old man and his 90 year old wife recently.

They still (with the help of home care agencies) lived in their home.

After reviewing his past medical history he did state "if I knew I was going to live this long I would have taken better care of myself when I was younger."

We ALL laughed.

A simple request

I have many patients who continue to be snow birds (spend the winters down south and the summers up north).

I have a request:

If you are in the middle of a work-up and evaluation for, for example, a possible malignancy, it would be best to delay your return either down south or up north until the work-up and evaluation is complete.

Simple enough, right?

Stuck in the middle

It's pretty common for two specialists to have different opinions, despite thousands of dollars of testing.

I have a patient with neuropathic quality foot pain, for example.

A Podiatrist will not back down in stating the foot pain is referred from the patients back.

A Neurosurgeon will not back down in stating the foot pain is coming from the foot, not the back.

It's not so fun for the patient.

It's not so fun for me either.

Usually don't forget after a reminder

Many urinalyses show microscopic blood.

When I inquire, most folks tell me they just peed into the sample cup.

All are given a towelette (to clean) and instructions (collect a mid stream sample) but most report:

1. The person in the lab said something but I wasn't really listening

2. I wasn't sure I would be able to pee and wanted to make sure I had enough for a sample

3. Oh, now I remember. I forgot. I thought the towelette was to clean my hands after peeing. I do sort of remember being told to use it to clean down there

4. Etc., Etc.

I then always offer, when the urine sample was not properly collected, to repeat the sample.

I let folks know that I would love to spend the rest of my life without having to have a cystoscopy (a fiber optic scope is put up the urethra into the bladder), if possible, and that part of the work-up for microscopic blood is to have a cystoscopy.

Both, especially men for some reason, don't seem to forget the proper instructions for future collections when informed of this possibility.

Strength

Mr. L. is a 33 year old male who, unfortunately, has ALS.

He walked into his home 6 months ago and is now already wheelchair bound.

They (he and his wife) have a 9 year old son and his wife is currently 6 months pregnant.

They were  incredibly strong, hopeful, but also realistic.

They know his chances of living more than another two years are slim.

He openly talked about end of life plans as well as funeral arrangements.

While I know they have had many a sad day individually and as a couple, their strength was amazing.

It was an honor to meet them.

A three color uniform

A 64 year old male, a Vietnam veteran, made the following statement:

"My uniform was green, Army issued green; red, from the red dirt and clay; and brown, from going to the bathroom on myself."

I got the visual.

Glad I'm not a fly on the wall at their house

I can't begin to estimate the number of folks I've seen, over the last twenty years, who decided, on their own, before seeking medical advice, to stick their fingers up their rectum to help relieve a bout of constipation.

In most cases, I'm able to help with the problem and offer advice on how to prevent the need to perform such a maneuver in the future.

Still, I always have a recurring thought (see the title of this post)...

Wants his cake and eat it too

An male reported a recent home fire.

His step daughter (who was an adult) left a stove top cooker (that was on) and a bottle of oil (that was too close to the heat) unattended.

By the time the fire was controlled, the kitchen was a total loss.

He reported that they received a $65,000 settlement from the Insurance company for repairs (it must be quite a kitchen!).

He reported the money received would more than cover the cost of the repair/re-model.

He was still annoyed.

"They are compensating me for our loss, but not for my time and all the phone calls I've had to make."

I decided to just say "yeah, I understand," instead of what I was really thinking.

Nuts

Another interesting thing about driving through some southern, rural areas of Florida (was at a horse show with my daughter this past weekend), are all the road side businesses, set up in the back of, usually, a pick-up truck.

I've asked a bunch of folks, but have never come across anyone who has tried the Boiled Nuts that are often for sale.

This past weekend there was one fellow who had placed hand made signs, every hundred yards or so, about his Nuts for sale:

"Just ahead, Boiled Nuts..Just ahead, Cajun Nuts...Hot Nuts soon...Ready for Nuts?...Nuts in 400 yards...Nuts in 200 yards...Nuts, almost here...STOP FOR NUTS NOW."

I love Nuts but how many Boiled Nuts can one eat?

Can these folks earn a living selling Nuts?

Are the Cajun Hot Nuts more expensive than the Boiled Nuts?

If anyone knows, please let me know.

I decided not to stop, but the unanswered questions are driving me Nuts!

What a bonus!

Happy Halloween!

My daughter had a horse show this past weekend.

It was in a fairly rural area of Florida (you know, it still had a General Store and Deputy Barnie Fife positioned at the speed trap).

Best of all, it still had some of the old fashioned, one story motels that advertised having "clean rooms, phones and TVs."

I couldn't help but reflect how fortunate we are now.

Just think of all the wasted time, in the past, trying to figure out if you wanted to stay at a motel with clean or dirty rooms.

One less thing to worry about now, at least from a macroscopic viewpoint (still no telling from a microscopic viewpoint thanks to all the investigative news reports).

Rudy, part 2

Back to my town house and Rudy (see yesterday's post).

Our complex had a designated trash pick up day (every Tuesday you needed to put your trash can on the curb).

One week, I missed it (had been on call in the hospital and forgot).

We had an office complex adjoining our property with a large dumpster.

I walked a bag of trash over and placed it in the dumpster.

When I got home from work, the next day, the same bag was in front of my door with a note:

"The office complex dumpster is for use by the office complex ONLY. Rudy-homeowners president."

 He must have gone into the dumpster to retrieve it...how did he even know...did he have surveillance camera's?

The next meeting, I decided to join in the vote to remove Rudy from his position.

I felt sort of bad about the coup d' etat (the over throw), but only for a brief moment.

Life lesson from Rudy: never retire without having a WORTHWHILE new hobby or passion to fill your time.

Don't retire unless you have a new passion (that's actually worthwhile)

I lived in a town house for awhile, years ago (I was still a bachelor).

We had a home owners association.

Rudy, a retired elderly man, was the president.

I had an approximate 6 X 6 foot front lawn (as did everyone else) and was responsible for maintaining it.

It was a "homeowners rule" to keep the grass less than 4 inches tall.

The association fees took care of all the common areas.

I didn't own a lawn mower.

I used a weed waker but could have just used a pair of scissors (if I had the time).

At one of the homeowners meetings Rudy handed out photographs.

He had gone around to everyones front lawns (the 6 X 6 lawns), placed a ruler in the ground, and gotten down on the ground to take Polaroids to report (embarrass) on folks whose grass was taller than 4 inches.

I was guilty.

Mine checked in at 4 and 1/4 inches.

Thanks Rudy (part 1).

Flee market weekends

I have a lot of patients who have a spot at a flee market every weekend (often including Friday as well).

Most pay $8-$12/day, depending on the day and the location.

Most, it seems, don't care if they actually make any money (although they do prefer to at least break even).

One nice old man who sells knifes explained the reason. "It gets me out of the house, I've got some good buds there and it gives me and my wife some time away from each other."

Well stated!

Family family where art thou?

I recently made a home visit on Mr. D., a 92 year-old retired car dealer, who is also a WWII Veteran.

I was meeting him for the first time.

In the war he participated in the 1st wave of C-47's that brought the wounded from Omaha beach to the inland hospitals.

He lives alone since his wife of 71 years (his high-school sweetheart) has severe Alzheimer's dementia and has been residing in a Nursing Home for the last year.

He visits her as frequently as possible.

His home was somewhat cluttered but was full of framed and unframed family pictures.

Mr. D.'s health, physically and cognitively, is failing.

He wishes to remain home for as long as possible (he would prefer to stay at his home until his death).

He has all the help that he agrees to accept (and pay for).

I don't know him well and like most families, I'm sure there are many unique family issues/dynamics below the surface.

It was great to spend time with him.

On the drive home, however, I couldn't stop thinking about the song "You don't bring me flowers, anymore."

It would be awesome if, somehow, one of his family members (4 children and 9 grandchildren) could live with him, at his home, during whatever time he has left.

A whole lot of suing going on...

A local malpractice attorney runs an ad on a local radio show everyday.

Unfortunately, I always hear it on my way to work, while trying to listen to sports radio to get an update on all the scores from the day before.

The attorney, in the ad, notes that he believes most doctors are good and states that over 90% of malpractice is committed by less than 10% of physicians.

Recently I read one of my medical newspapers.

The headline stated, "Study: Most Doctors Face A Malpractice Claim by age 65."

In low risk specialties (family medicine, pediatrics, psychiatry), 36% of physicians were projected to face their first claim by age 45 and 75% by age 65.

In high risk specialties (neurosurgery, general surgery, OB/GYN), an estimated 88% were projected to face their first claim by age 45 and 99% by age 65.

A staggering 19% of neurosurgeons face a claim EVERY year!

While most claims do not result in a payment to the patient, they still involve significant monetary costs to both the physician and the insurer and results in loss of productivity because a physician is often unable to see patients as they defend cases.

I haven't mentioned the emotional effect of being named in a suit (all who have been named will know what I'm talking about).

So while I believe the ad that the attorney runs, there's still a whole lot of suing going on.

Gee, maybe we have too many starving attorneys?

Just a thought.

Verbal vs visual

A 39 year old male reported 10/10, chronic pain and to being miserable and unable to work or hold down a job.

He was impeccably dressed and well groomed with perfect hair, eyebrows, no body hair (shaved), polished fingernails and wore an assortment of gold bling (earrings, necklaces, rings and one of those huge watches).

For some reason, I found that to be a little odd.

More youth coaching tips

My kids are grown so I want to make sure I get more youth coaching tips down on paper, in case I have some dementia by the time my grandchildren are playing sports.

In no particular order:

1. Everyone should play at least 1/2 of the game. It's awesome to see some of your least athletically gifted players arriving with enthusiasm because they know they will be an active participant.

2. Rotate positions. For example, every kid, deep down, wants to play quarterback. Let him/her try.

3. Always remain positive, win or lose.

4. Never take a kid out of a game right after he/she has made a mistake (should be part of every coaching 101 course).

5. Let them have fun. Most of the boys loved having a 70's night on our basketball teams every year. They would wear short shorts, high tube socks, chuck taylor sneakers and a few even had Afro wigs.

6. Don't over coach (see blog entry dated 10/16/11).

7. Have a family member videotape you coaching if needed. You will, hopefully, realize how pathetic you look if you are standing up screaming at the refs and your players when the score is 6-4 in the fourth quarter of a youth basketball game.

Semantics

I recently became the supervising physician of four ARNP's (Nurse Practitioners).

They are all quite busy and do a great job.

I've noticed that, at times, the word "deferred" is used when a rectal exam was not done as part of a History and Physical, usually on a very elderly patient.

Most of the time, it's not clinically indicated (a palliative or hospice patient, for example).

The problem with the word deferred, however, is that it implies it will be done at a later date.

This is usually not the case.

I have recommended to use one of the following options for "rectal exam" if excluded from the exam:

Not done.

Not clinically indicated.

Patient declined (after being offered).

Reports was done by another health care provider within the last year (especially for folks being followed by, for example, a urologist).

Similar thoughts and words

An 89 year old male lives in an ACLF (assisted care living facility).

Me: How's the food?

Patient: Great; you know I would never complain about any food made for me, prepared by someones efforts. I'm just real thankful.

Me: You and I think a lot alike (and we even talk alike...see below).


My wife is a great cook and I love to eat. She used to make tuna casserole every so often. I hate tuna casserole, but I never told my wife. I love tuna sandwiches but have always despised tuna casserole (my mother used to make it as well growing up). Finally, one day my wife said, "you don't like tuna casserole, do you?" "Why do you ask?" "Because you never have seconds and you have seconds on everything else I make." "You're right, I hate tuna casserole." "Why didn't you tell me?" "Because I would never complain about any food made for me, prepared by you. I'm just real thankful for everything you do for us (my family)."

I think my wife loves to see me eat. We haven't had tuna casserole since.

A thanks flashback

I recently forgot about a patient in my waiting room.

A staff member let me know, at about 1 PM, that he had come in to pick up his parking disability form I had filled out for him.

I said, "tell him to wait a minute in the waiting room and I'll bring it out shortly."

I was in the middle of doing something else.

I forgot.

At about 5 PM a different staff member let me know the same patient had finally gone up to the desk to inquire about his form.

He had been sitting patiently.

I walked the form to him and apologized for the wait.

Surprisingly, he just said, "thanks."

I had a flashback.

During residency, while doing an ER rotation, a fellow resident, who was going off duty, signed a patient out to me in bed #12 at approximately 11 PM (it was a 25 bed emergency room). A blood test was pending and if his blood count was OK he could be discharged home. The curtain was pulled. It ended up being a typically busy night. I totally forgot about the poor fellow in bed #12. During check out rounds at 7 AM, the attending wanted to know what was going on in bed #12.

Oops.

I let him know I was on top of it.

I reviewed the labs that had returned at 11:20 PM and woke the nice man up and let him know his labs were fine and that he could go home.

Surprisingly he just said, "thanks."

Sure...I'll try to help

A male and his wife came in for an unscheduled visit.

They had a request.

The patient wanted me to write him a letter that stated he moved to Florida for health reasons after a heart bypass and that his wife resigned her job in order to accompany him to Florida. She was trying to claim unemployment benefits from the state they moved from.

When I inquired about having his physician up north write the letter, I was informed that the physician left his previous practice and no one knew how to get in touch with him (maybe he moved to Florida also).

When I inquired what "health reasons" were given for the reason for moving he let me know that he could exercise more due to the warmer weather and avoid the harsh winter climates (I guess I'll buy that).

The wife reported she wasn't going to claim unemployment benefits but she had no idea it would be so tough to find a job down here (I guess they didn't read the newspaper before moving about the record unemployment rates in Florida. Also another good reminder-don't quit/resign a job until you have another already lined up).

They were courteous and not demanding in their demeanor (that was a nice change).

I therefore wrote a very quick note along the lines of:

He was advised to move to Florida, by his former physician, to assist with his rehabilitation after his heart bypass and his wife therefore resigned her job to accompany him. Her presence here is helpful to assist in his emotional well being and with some IADL's (Instrumental activities of daily living).

I'm really not sure the unemployment bureau will accept the note but it was about the best I could do with the information gathered.

They seemingly left happy.

Another success story!

His only assignment

A 26 year old male recently came in for his first visit.

He was 6 foot and weighed exactly 300 pounds.

He was married, had 4 daughters and a fifth (the ultrasound had confirmed another girl) on the way.

He worked and they were living with his in-laws in order to save up some money to try and buy their first home.

He reported that he and his wife had a great relationship and that they got along great with his in-laws.

He medically retired from the military one and 1/2 years ago, when he weighed 223 pounds, due to knee problems.

He had gained 77 pounds in approximately 18 months!

I let him know I would do everything possible to help him.

We talked about many approaches to weight loss, including the obvious; diet and exercise (I never include gastric reduction options initially).

I let him know he had a stressful life and it's great he works hard and is a family man.

I decided to keep things simple to start.

His only assignment until the next appointment was as follows:

#1. Buy a scale

#2. Do NOT gain any more weight.

He agreed.

An impressive specimen

Mr. S. is an amazingly spry 87 year old male.

He's not on medications, is cognitively intact, walks unaided and is still the lead vocalist for an oldies band.

My nurse recently placed a sticky note on his chart for me to see before I went into the exam room.

It stated, "87 y/o, WOW!"

I decided to have some fun with it.

Me (after entering the exam room): My nurse is pretty impressed by you. Look at this note she put on your chart. Before we start, I need to know, did she try and put some moves on you?

Mr. S.: Oh no...I'm still the one who chases the girls...I just can't catch them anymore (he laughed).

Me: Do you have a lady friend currently?

Mr. S.: You bet. I stopped looking for the young women 'cause they're looking for the same thing I'm looking for...money (he laughed again). I have a nice companion for the last few years and she's still a young thing...only 73 years old.

After we had finished I told my nurse about showing him the note.

My Nurse: I did tell him that he was an impressive specimen.

Me: Just how much of a nursing exam did you do?

Youth b-ball coaching tip

Quick tip for coaching youth basketball:

Don't over coach.

Watch teenagers when they play a pick up game.

They set picks for each other, pass the ball to an open man, fast break, and even more importantly, look to shoot and take the ball to "the hole (the basket)."

Watch teenagers when they are over coached, told to run only set plays and pulled out of a game when they make a mistake.

They become robotic, paralyzed by over thinking and even worse, are afraid to shoot and to take the ball to the hole, even when they have an unimpeded path to the basket.

Teach skills, good spacing on the court and some basic plays, for when needed, and then let them scrimmage, scrimmage, scrimmage.

While they are scrimmaging sit back, shut up and watch.

Letting it go

I've been holding on to my YMCA coaching polo shirt.

I couldn't get myself to throw it away.

Years ago, it was white.

Over the years it became sort of a whitish-yellow with many visible stains.

It lasted through coaching multiple baseball, soccer, volleyball, flag football and basketball teams.

My daughter stopped doing "Y" teams a few years ago when she became an equestrian, but my son continued, even while playing for his school and club sport teams.

We had some terrible, mediocre and excellent seasons record wise.

ALL were successful, however,  in terms of skill development, as well as trying to instill a love of sports for the kids on my teams.

My son's last basketball season (that concluded this past August), ended with him scoring a basket with one second left in the championship game to complete an undefeated season.

The oldest "Y" league goes up to age 16.

He just turned 17.

Time to move on.

It was time to let my shirt go.

Don't wait

I'm old enough to have learned a lot of life lessons.

One I keep forgetting, however, because it doesn't happen very often, is to correct folks who call me by an incorrect first name.

I'm called "Will" by the receptionist at the YMCA who greets me every morning.

I'm called "Mike" by another physician who works in my same building.

Both are my fault.

I just keep saying "hi" back every time they address me.

I waited too long to correct them...my bad.

My two favorite stop smoking stories

#1. The pastor of our church let us know he tried to quit smoking while in Seminary school in Ohio. He spent many weekends, while in school, filling in for pastors, in various parts of the state, who were away on vacation. He reports driving down the highway on his way to preach while asking GOD to take away his urge to smoke. He would crumple up the pack in his possession and throw it out the window of the car. A short time later he would stop at a convenience store to buy a new pack. He reports there were partially full cigarette packs all over the highways of Ohio for a couple of years. He finally quit.

#2. My father in law reports that the last time he quit for three weeks he was just looking for an excuse to start again. He was hoping for some sort of tragedy to use as an excuse. Eventually, he started to even hope that an appliance would break, the roof would leak, anything. For three weeks nothing happened. Finally, he and my mother in law were going to go out to dinner together. He wanted to wear his favorite shirt and it was dirty. He got mad and had his excuse to re-start. He still smokes.

No approval granted

A 44 year old women wanted an approval on an herbal supplement that she was interested in taking to improve her "cardiovascular health and energy."

I'm usually open to folks trying supplements as long as I can recognize some of the ingredients.

I didn't recognize any this time.

She repeatedly pointed out the heading at the top that said, "PROVIDED BY NATURE, PROVEN BY SCIENCE."

I repeatedly pointed out the disclaimer at the bottom of the page:

THIS PRODUCT IS NOT INTENDED TO DIAGNOSIS, TREAT, CURE OR PREVENT ANY DISEASE PROCESS.

I didn't give my approval.

I don't think she actually cared.

She let me know she had already purchased it through the mail and was already taking it.

Words of wisdom

A 74 year old male reported some family stress.

A grandson, who was in college, had recently been charged with a DUI and his father (my patients son) was reportedly beside himself and threatening to take his son out of college.

Me: How are you doing with everything?

Patient: Fine. He's a good kid. He's always been a good kid. He's never gotten into trouble before. I told my son that we should be thankful no one got hurt and I reminded him that both of us have driven after drinking in the past and gotten away with it. He did nothing that we didn't do at his age. He just got caught. I'm sure my grandson has learned his lesson. It's a real expensive lesson.

The unabomber

Mr. D. is a very nice 81 year old man.

He's had a nickname, in our office, for the last year however.

He still carries a briefcase with him everywhere he goes.

Instead of wearing a watch he carries an old fashioned alarm clock.

He always arrives very early for his appointments.

Last year he came in for an appointment that was scheduled a few hours after fasting blood work was done.

Because his briefcase is heavy and because he's very trusting, he placed his briefcase, with the alarm clock duct taped to it, in the corner of our waiting room while he went over to the next building to get something to eat.

He didn't tell any staff members that he left it there.

Another patient, in the waiting room, noticed it while reading a magazine.

I wasn't aware of the commotion taking place.

By the time Mr. D. returned to our office, the local police were just about to call in the bomb squad.

Mr. D. felt bad.

Since then he's had his new nickname.

Shucks

My Mom is 79 years old.

I've been meaning, for sometime now, to remind her to get the shingles vaccine.

It's the newest adult vaccine and it's use had not yet been part of my standard recommendations for folks over age 60.

I forgot to tell her.

She is in the midst of a shingles outbreak now.

She's been miserable, and she's a tough cookie (she's also a long term breast cancer survivor).

I feel terrible for her.

Even though it's not nearly as effective as many vaccines, in clinical trials involving thousands of adults 60 years and older, the vaccine reduced the risk of shingles by about half (51%) and the risk of (the dreaded) post-herpetic neuralgia by 67%.

The value of the vaccine now "hits home."

It will now become part of my health maintenance recommendations for older folks.

That's the only good thing that has come from my Mom's misery.

Lets see...ah, no

A 56 year old male requested "a brief minute of time" in the middle of a hectic day.

He didn't have an appointment.

Patient: I just need a quick favor. I need you to write a note that says I was sick last week and that my son stayed home from college for the day to take care of me.

Me: Is everything all right?

Patient: He didn't go in for an exam because he didn't feel he was ready and now the professor is giving him a hard time because it was an unexcused absence. A bad grade would ruin his over all grade for the semester.

Me: Were you sick?

Patient: No, but could you just do this favor for me?

Me: Ah, no. Sorry I can't help your son. I would just tell him to tell the professor the truth and see if there are any extra projects or work he can do to make up for it. Anything else?

Patient: Nope.

As he left I couldn't help but wonder if he had a hidden tape recorder and was trying to catch me in an ethics violation.

My only other thoughts were:

1. My wife (a nurse practitioner) would be so proud of me because she does school based health and deals with school/test avoidance issues all year long.

2.  Are you kidding me!

Frequent flyer

Mr. T., an 81 year old, comes to our office, unannounced, approximately 1-3 times a week.

He navigates the public bus system to get here.

He ambulates with the assist of a cane only.

He has all our contact numbers to call for triage advice but always chooses to just come in.

He does have very mild cognitive impairment and is followed by a memory disorder specialist and a psychologist as well.

He's completely compliant with his medications and lives with his two sons.

He'll come in for colds, transient-fleeting headaches, skin tears, a splinter in his finger, an isolated, slightly elevated home blood pressure reading, etc., etc..

Most recently he came in due to a disturbing dream.

I was able to obtain his records from his previous health care facility and this has been his modus operandi for many years.

He usually just needs a brief physical exam and reassurance and heads home satisfied and thankful.

When my nurse noticed he was in again she said, "Mr. T. hadn't been in for awhile. Where has he been?"

My only reply was, "you missed his last three visits because you were on vacation last week for your son's wedding."

She smiled and so did I.

Mine for 6 months

Mr R., a 74 year old,  comes to Florida, from up north, every October (and stays for about 6 months).

He is a wonderful man (I'm not kidding...once you get to know him).

He's a wonderful man that's also cantankerous (I'm sure he would agree).

I'm his primary care physician while he's here.

He recently called (he'd been back in Florida for three days).

I was out of practice, in terms of how to deal with him, since I hadn't seen him for the previous 6 months.

My Nurse: Mr. R. is on the phone and demands to be seen. He says it's an emergency. He also wants you to know he had a bad summer due to the earthquake and hurricane Irene. He says he should have never left Florida this year.

Me: OK, tell him to come right in. I'll be happy to see him.

A little while later...

My Nurse: He doesn't want to come in now, he wants to come tomorrow.

It obviously wasn't an emergency (now I'm starting to remember).

Me: OK, tell him to get here as early as possible so I can see him before other scheduled patients arrive.

A little later...

My Nurse: He doesn't want to come early in the morning. He says he's not an early morning person and he told you that last year.

He's right, I do remember him telling me that last year.

Me: OK, tell him to come sometime during the day and I'll see him between patients with scheduled appointments.

A little later...

My Nurse: He says he won't come and just wait. He's afraid he'll catch something and get sick from all the other folks in the waiting room.

I'm now at full recall...he wants to be seen only when he wants to be seen...how could I have forgotten?

Me: OK, tell him to come at "lunch" when no other patients are scheduled.

That's what I did last year and it seemed to work.

A little later...

My Nurse: He says OK but feels bad you never get to eat lunch.

Me: Yeah, I'm sure he does.

Let's see, only about 5 and 1/2 more months to go (I'm sure you all know what I'm talking about).

Accidental flatulence (at that time of the day)

I get to the YMCA on most weekdays and exercise from about 5:30 until 6:15 AM.

It's usually an older crowd (at that time of the day).

I wake up to my alarm at 5:15 AM.

I already have a bag packed (from the night before) and the "Y" is only about a mile from our home.

Most of the really elderly folks, who exercise (at that time of the day), report having been up since about 3 to 4 AM.

The cushioned floor mats are used by most for stretching and sit-ups.

Occasionally, someone has some accidental flatulence (farts).

Sometimes, there's only one other person on the mat so I know who it was.

Other times I don't know because there's a small group.

Without fail, no one laughs and no one takes ownership (of course many possibly have hearing loss in the  flatulence frequency range).

I had never been a member of the floor mat flatulence club.

That's no longer the case.

The only other person, in the vicinity, on my memorable morning, had ear phones in place.

Maybe. just maybe, my membership is still a secret because I didn't laugh and I didn't take ownership.

False advertising

My wife asked if I would take my daughter to get a flu shot on the way to her daily horseback ride.

We had received a flu shot ad for the "minute clinic (a Nurse Practitioner run clinic that advertises quick, inexpensive visits for common ailments and concerns)," in a local CVS, that opened at 10 AM on Sunday morning.

We got there at 10:01 AM.

We were the 4th in line.

We left at 11:15 AM (when we were third in line), without having received the flu shot (we got tired of waiting).

I doubt we'll return unless they change their name to the "hour and 15 minute" clinic.

Tr, not Thr

A 68 year old male was annoyed that his blood pressure and cholesterol were above goal.

Mr. M.: I don't understand, I've been exercising 5 to 6 days a week on the threadmill.

Me: It's great you're exercising on the TREADMILL. You should continue.

Mr. M.: I thought exercising on the threadmill would keep me off  blood pressure and cholesterol lowering medications.

Me: Exercising on the TREADMILL is a great thing to do but many folks, like you, that do everything correctly, still need to be on medications to help control both.

Mr. M.: But I've really been pushing it on the threadmill.

Me: And you should continue to exercise on the TREADMILL.

Mr. M.: I was hoping to get better results from the threadmill.

I think you get the picture. We were able to finally move on to a new subject after a few more back and forth threads vs TREAD.

Come to think of it, maybe I should have told him that walking or jogging on a treadmill would give better results than exercising at the mill making thread.

Now I understood

Mr. P., a 77 year old, had always been insistent on having an annual PSA, despite his age and despite previous discussions on PSA testing in the elderly.

The most recent result was slightly high and the biopsy performed (at his insistence) by the urologist showed a "minute focus of adenocarcinoma (not surprising)." The amount was so small that a Gleason score couldn't be determined.

He wanted to undergo radiation therapy.

He was going to see the radiation oncologist the next week for a consultation.

He came to see me prior.

Me: Have you just thought about watchful waiting (I did not think he needed to aggressively treat his microscopic prostate cancer)?

Mr. P.: No, I just want to get rid of it once and for all.

Me: Are you aware that it might be such a small amount of cancer that it won't shorten your life...are you aware it still might come back after radiation...are you aware of the potential complications and adverse side effects of radiation therapy...are you aware that some folks develop colitis from the radiation, have incontinence and erectile dysfunction?

Mr. P.: Yeah, I just want to get rid of it once and for all.

Me: Do you know anyone who has had prostate cancer?

Mr. P.: My best friend, my buddy for over 50 years, died from it. He and I were retired Army and Civil service workers. We were also hunting and fishing partners. He got diagnosed with prostate cancer and decided not to do anything. He went and bought a casket and paid for his funeral. He died 6 weeks later.

Now I understood. I briefly discussed the fact that his friend most certainly had metastatic cancer at the time of diagnosis, not microscopic as was his prostate cancer, but I let him know I hoped everything would go well with the consultation for possible radiation therapy.

Mr. P.: And thanks for talking to me about this. You gave me some things to think about. At least I know some additional questions to ask before I make my final decision.

Cool, he really was listening.

No more fungus among us

I hadn't seen Mr. H., a 63 year old, for about 6 months.

He looked great.

He had lost over 50 pounds and mentioned he had a girlfriend for the first time in over 10 years ago.

Mr. H.: Thanks for helping to get my confidence back.

Me: (I actually had no idea what he was talking about) I'm real happy things are going well with you.

Mr. H.: I'm glad you asked me if I would like to treat the fungus in my fingernails when I saw you last year.

Now I remembered. About a year ago, he had come in for a follow-up on his blood pressure. For the first time, I noticed he was sitting with his fingers, of both hands, curled up in a fist. At first I thought he was just tense, but when I went to check his pulse I noticed most of his fingernails had significant onychomycosis. I asked him if he would like treatment for the fungus. He agreed. On follow-up, 6 weeks later, you could see the demarcation beginning between the normal and the abnormal nails growing out. I hadn't seen him since.

Mr. H.: I didn't want to socialize because of my fingernails. I didn't go the church. I felt embarrassed to shake hands. I didn't want to go on a date. I didn't think anything could be done. I've been exercising, eating better and met a great gal.

Now that sure made my day!

Tell me what you really think?

This is an actual quote from an 83 year old male (yes...an 83 year old) with a thick New York accent (the word "frickin" will be substituted for the actual word used):

"I have a frickin problem. The fricken 60 mg heart pill that I take twice a day has taken away my frickin ability to have sex. I looked it up and it's a blocker (a calcium channel blocker). It's blockin my ability to get one (he then raises his arm with a fist to simulate what he can't get anymore). I'd rather be frickin dead. I basically live for sex and food. I love my gal so much and like to have sex twice a day, everyday. I even took Viagra but all it did was give me a frickin headache. You gotta change that frickin medication. I need to frickin get back in action."

I let him know I would do my frickin best to help (actually, everything except the frickin part).

Both socks before shoes?

A 51 year male was depressed.

He had gone to see a psychologist and declined to ever go back.

He was upset.

He finally filled me in on why he was so upset.

Patient: He (the psychologist) asked the stupidest questions. I went along with him for the most part but finally got up and left when he wanted to know if I put both socks on before I put on my shoes or if I did one side at a time.

His wife confirmed his statement. She was with him at the time.

Patient: What did that have to do with me being depressed?

Me: No clue. I think I would have gotten up and left as well.

Of course, I thought about it for the rest of the day. I'm pretty sure I've done it both ways in the past. I'm sort of afraid to ask a psychology colleague what it means.

I'll pass.

Just fine the way he is

Mr. C., a 62 year old, came in for a physical exam.

When I asked him to drop his underwear so I could finish his exam he stated:

"There ain't much there to check but I've always thought I've had such a good time with what little I've got I don't think I could stand to be any larger."

He laughed and so did I.

Well stated, I thought.

His Vow

I've seen Mr. R., a 51 year old, three times for medical visits.

The first two visits were for acute problems.

The third was for a full history and physical.

He's always worn all white (a white shirt, white pants, white belt, white socks, and white shoes).

Finally, on our third encounter, I had time to ask the obvious:

Me: I've noticed you always wear white (I figured he would be impressed by my astute skills of  observation).

Mr. R.: Almost ten years ago my daughter was diagnosed with leukemia. I prayed and asked GOD to cure her. I also vowed to wear white for the rest of my life, as long as she was still alive. She's still doing well.

Me: That's great news. Thanks for filling me in (I had no idea his reason for wearing white would be so impressive).

Best choice

The single most best choice, I've ever made, was getting married exactly 19 years ago.

I'm a lucky man.

His good name

Darrell P. is 52 year old male who just moved to Florida, from New Jersey, to be closer to his daughter and grandchildren.

He let me know he was going to start a business down here.

He had a heating/air conditioning business up north.

He was studying for the state licensing exam since every state has slightly different rules and regulations.

Me: What are you going to call your company?

Darrell P.: Darrell's Heating and Air Conditioning, just like it was up north.

Me: How did you come up with such an original name?

Darrell P.: Oh, I just (he then saw me smiling)...you're busting my chops aren't you (he then smiled)?

Me: Actually, I can't think of a better name.

Darrell P.: Thanks. You know, I've never had to advertise. I've always had such a good reputation that all my business comes from referrals. I know I'll just need to get my first job down here and then my business will start rolling. My motto has always been "we will make you smile." My customers knew I would always take care of them and always make things right. I'm proud to have my name on my company.

Me: You should be. Thanks.

Spoken (unspoken)

Nurse: Your 8 AM patient is ready to see you now.

Me: That's great (since it's almost 9 AM).

A little later...

Nurse: I just roomed your third 9 AM appointment.

Me: OK (too bad we don't have more folks to put in the same time slot).

A little later...

Nurse: Are you ready to see your 10 AM appointment?

Me: Sure am (especially since it's 10:55 AM).

A little later...

Nurse: Doctor ___ had to leave urgently on a family emergency. Can you see his patients for him?

Me: No problem (just let me check to see if my clone is available to help).

A little later...

Nurse: I need you right away in the treatment room; Mr. ___ is complaining of crushing chest pain. He didn't call 911 as he was advised to when he called from home.

Me: I'm coming (so I can do my best impersonation of an ER doc).

And so starts the beginning of another week seeing patients.

Over the years, I've always just tried to operate under the assumption that most days in the office are going to be controlled chaos.

When it's not, it's a bonus.

No one ever said being a primary care physician would be easy.

Just try to limit your sarcasm (to under your breath, unspoken, comments) and always pack a lunch to eat between seeing scheduled and unscheduled patients.

No matter how crazy things are, it still gives gives me a lot of satisfaction and job security (and also gives me plenty of ideas for this blog).

What's next?

I have an 86 year old patient who is always brought to appointments by his 64 year old daughter.

She's a beautiful women but always seems to have had some more "work" done on herself every time she brings her Dad to see me.

She had a face lift a few years ago.

She has fake eyebrows as a result of the face lift.

She then had her neck done since it looked odd next to her perfectly smooth face.

Her large breast implants are usually accentuated by her choice of shirts.

Recently she came in with new, bright white, perfect teeth.

Even more recently she came in wearing post-op boots on both feet.

She had some of her toes straightened.

She has made comments about not being sure what she is going to have done next.

These comments are usually intermixed amongst statements made about her Dads medications being too expensive.

I usually just nod my head but, honestly, I'm quietly wondering what's going on in her personal life.

I haven't asked her since she isn't my patient.

I haven't told her she was a beautiful women before she started having all her work done since it might be deemed inappropriate.

I'll just wait until she brings her Dad in for his next visit to look for the new bandages.

Guilt free results

A 63 year old male was having a problem.

He met his new girlfriend on the Internet months ago and they had already shared many great weekends.

They hadn't attempted to be intimate until recently.

When they did he wasn't able to perform.

"It" had NEVER happened to him before.

He wanted a prescription for Viagra.

He reported being attracted to her.

He reported respectful communication.

He didn't feel threatened or intimated by her.

I finally asked if he felt guilty about anything (I couldn't think of any other questions to ask).

He said she's 53 years old and she thinks he's 53 years old.

He lied to her the first time they communicated on the Internet and hadn't come clean since.

He actually could have passed for 53 years old.

I told him that.

I let him know he didn't need Viagra.

He just needed to tell her the truth.

He stopped by three weeks later to briefly talk.

He was able to tell her and his apology was graciously accepted.

They were still together.

He also let me know that all was back to "normal."

He did not need Viagra.

An attitude adjustment

Mr. T. is a 65 year old male who seems to really enjoy life.

His hobbie is wood working and he shows his products at a number of different craft shows in our area.

He seemed to be in a particularly good mood when I saw him recently and commented to him about it.


Mr. T.: I just had a great weekend. You should've seen the joy on the face of these two kids when their parents bought a Fort I had made.

Me: How did you make it?

Mr. T.: I had a couple of bags of Popsicle sticks that I wasn't using for anything and decided to try and build a Fort. I didn't have any plans, just started building it. By the time I was finished it was complete with a wall around it, watch towers, walkways and even swinging gates. I went to the dollar store and was able to get some toy soldiers to glue at different spots. It looked great when it was done.

Me: Did you take a picture of it before you sold it?

Mr. T.: No, I should have.

Me: How long did it take to build?

Mr. T.: Just a few days. Almost cut off the end of my fingers a few times with the Exacto knife. It's a lot harder to cut the Popsicle sticks than you would think just looking at them.

Me: How much did you sell it for?

Mr. T.: $20. It was my only sale for the day but it helped to pay for the booth for the weekend.

Me: That's great.


You know, it had been a hectic day and I was in sort of a bad mood before spending time with Mr. T.. Seeing the joy he experienced with his $20 sale sure helped give me an attitude adjustment.

Three balls

It was a lot of fun to meet Dr. R., a 74 year old dentist, who still saw patients three days a week and still had a great sense of humor.

Prior to going into private practice he had a 27 year military career.

During the medical history he noted that his only past injury was when he got kicked in the testicles as a teenager.

Dr. R.: Ever since then I've had three balls (of course one was an organized hematoma). In college my frat brothers always called me quarter dozen (he laughed).

Quick math: A quarter of a dozen is three.

It took me a second to do the math.

Me: How did they find out? What were they doing checking out your scrotum?

Dr. R.: I had a little too much to drink one night and let it slip.

During the review of systems he remarked that he was finally ready to be evaluated for hearing aids.

Me: Is it bothering your wife (often it's the spouse that seems to "encourage" men to get hearing aids)?

Dr. R.: No, she has bad hearing also. We just now think each others name is What.

He laughed.

So did I.

To shave or not to shave, that is the question

Lately, it seems that a lot of the younger men who come in for a physical exam have shaved all their pubic hair.

Initially, it sort of surprised me.

Now, I've sort of come to expect it.

Here's some potential reasons I've come across:

1. Religious reasons: all the male nudes on the ceiling of the Sistine Chapel are hairless below the waist.

2. Aesthetic reasons: a cleaner, more contained aesthetic look is in vogue for pubic hair.

3. Cleanliness reasons: the crotch is a focal point for heat, sweat and bacteria.

4. Health reasons: to make sure you don't have a rash or other unwanted critters and to make testicular self exams easier (yep, most are also shaving their testicles as well).

5. Self esteem reasons: the penis will appear longer due to removing the hair that often goes at least part way up the shaft.

Although I suspect I know the main reason, from the list above, why many choose to shave, I think I'll just continue to be "old fashioned" concerning that aspect of my own body.

Some one liners from the past week of patient care

An 87 year old male: I think I'm still doing quite good; I've still got my teeth, no hearing aids and my mind.

A 53 year old male, when asked if he still smokes: Not no more so much (he finally admitted to smoking less than 5 cigarettes a day).

A 36 year old male, with a BMI of almost 50 (ideal is less than 25), when asked how everything went with his visit to the nutritionist: She basically told me I needed to drink water and eat lettuce and carrots, so I told her this conversation is over because I don't have big ears, a fluffy tail and my name isn't Bugs Bunny.

When I asked a 76 year old widower, who was requesting Viagra, if he had a new girlfriend: No, but I do rent one every once in awhile.

Strong ties

I had a nice visit with my Mom recently.

She will celebrate her 80th birthday this year.

My parents always made sure we (my 2 brothers, sister and I) recognized the importance of our immediate and extended family.

As the youngest child, I had the opportunity to get away with a lot more than my siblings.

Looking back, I was able, for the most part, to make good choices when a lot of other kids did not.

It wasn't that I didn't want to try something that might be illegal or risky.

It was because I always worried that if caught, it would bring shame upon my family.

Having a strong family bond usually allowed me to make good choices.

I hope it will do the same for my kids.

Bet that hurt

A 50 y/o male had a concern about a very sensitive private part of his body.

He was embarrassed to show me and even more embarrassed to let me know how it occurred.

After he confided in me, we did laugh together.

He, in fact, did have a significant superficial abrasion and would benefit from an antibiotic to prevent an infection.

Without revealing too much information, he was advised to encourage his partner to fix the jagged edge of the denture (that had fallen into his lap while they were being intimate) or to just keep it out altogether in the future.

He agreed with my expert medical advice.