Saturday, December 31, 2011

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).

Friday, December 30, 2011

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.

Thursday, December 29, 2011

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.

Wednesday, December 28, 2011

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.

Tuesday, December 27, 2011

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.

Monday, December 26, 2011

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!

Sunday, December 25, 2011

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!

Saturday, December 24, 2011

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.

Friday, December 23, 2011

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.

Thursday, December 22, 2011

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.”

Wednesday, December 21, 2011

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.

Tuesday, December 20, 2011

"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.”

Monday, December 19, 2011

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.

Sunday, December 18, 2011

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!

Saturday, December 17, 2011

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."

Friday, December 16, 2011


“ 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

Thursday, December 15, 2011

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."

Wednesday, December 14, 2011

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."

Tuesday, December 13, 2011

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.

Monday, December 12, 2011

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"

Sunday, December 11, 2011


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!

Saturday, December 10, 2011

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.

Friday, December 9, 2011

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.

Thursday, December 8, 2011

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.

Wednesday, December 7, 2011

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

Tuesday, December 6, 2011

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.

Monday, December 5, 2011

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!

Sunday, December 4, 2011

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.

Saturday, December 3, 2011

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.

Friday, December 2, 2011

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?

Thursday, December 1, 2011

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."