Tuesday, January 31, 2012

No dye for me

A 60 year old male with multiple medical problems recently had a stroke that rendered him with left sided paralysis.

He also has a head of long, thick and very dark black hair.

After taking the majority of his medical history I asked, "do you dye your hair?"

"You know doc, I've been dealt a lot of bad cards in my life, but I must have some great hair genes. I've never dyed my hair. In fact, I've thought about dying it grey or white so my hair would fit the rest of my body...old and washed up."

We both laughed.

Monday, January 30, 2012

Sticking together

A male was diagnosed with Stage IV Non-Small Cell Lung Cancer (NSCLC) over 9 years ago.

The five year survival rate for Stage IV NSCLC is 1-2% only.

I let him know it was great he had done so well, so far.

He responded, "I stuck with the guy upstairs and he has stuck with me."

Excellent advice for all of us!

Sunday, January 29, 2012

Family time

We are celebrating my Mom's 80th birthday today.

A lot of relatives will be there.

I'm sure we'll all laugh and mainly, tell stories of our past.

Stories that have been told and re-told and that never seem to get old, no matter how many times you hear them.

My kids still won't necessarily appreciate hearing them all over again but will benefit from seeing family members laughing and enjoying each others company.

Family time.

Saturday, January 28, 2012

Small, cluttered and full of love

Mr. and Mrs. C. have lived in a very small 2 bedroom, 1 bath house, in the country, for over 40 years.

The home is clean, cluttered and packed full of memories and photo's.

They legally adopted their grandchild, Jessica, when she was an infant because her father (their only son) and her mother were "too stressed at the time to raise a child."

Mr. C. had a stroke in 2007 and sleeps in one bedroom that's equiped with a hospital bed and other equipment.

Jessica has always had the other bedroom.

"Where do you sleep?" I asked Mrs. C..

"Oh, you're sitting on my bed."

I was sitting on a small sofa  in the common room, the only other room in the house.

Jessica is now 17 years old, a junior in high school, a leader, on the honor role and is an accomplished trumpet player in the school band.

She's planning on going to college. She will be the first, in three generations of her family, to go to college.

I let Mr. and Mrs. C. know how great it was that they raised her.

Mrs. C. just said, "she's been such a blessing to us and we are so blessed that she's a great kid, not wild like so many others these days...we're so proud of her."

They should be proud of themselves because they've made such a great impact, one life at a time.

Jessica's life.

Friday, January 27, 2012

Another dose of empathy

I spent a little over an hour last night in an MRI scanner.

My left arm continues to have bothersome neuropathic symptoms (shooting pains, pins and needles, paresthesias) and the neurologist requested I have an MRI of my head and neck. I already had an MRI of the left elbow, as well as a Nerve Conduction Study and EMG without a clear diagnosis being made.

While I was in the MRI, I couldn't help but think about a lot of things, including wondering if something seriously abnormal would be found on my scans. But, the majority of the time, I was thinking about many of my patients, lying alone in the noisy MRI scanner, often every few months, wondering if the cancer they were being treated for had gotten smaller, enlarged or stayed the same.

I was tempted, more than once, to squeeze the little ball I had in my hand to let the technician know I wanted a break or to stop the procedure all together, especially after being scolded a time or two for accidentally twitching. I can only imagine how tempting it must be for my patients undergoing cancer treatments to say, "no more...thanks but I've had enough."

Thursday, January 26, 2012

A puppy and a home run

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

He's a 69 year old who has advanced metastatic lung cancer.

His wife of over 40 years was there.

They met on the beach in Ft. Lauderdale, Florida.

She was from Sweden and had come over to the "States" for a vacation with a girlfriend. She never left.

Me: What kind of pick-up line did you use on her at the beach?

Patient: Man, I was so out of my league. She was, and still is, so beautiful (a true statement) and I didn't look much different than I do now. I never thought I would even get to first base with her, much less hit a home run. But I didn't need a pick-up line because I had a puppy. She loved my puppy and I'm sure that's the only reason she ever agreed to go out with me.

His wife shook her head "yes" and laughed.

Wednesday, January 25, 2012

A great article by a retired FP Professor

How Doctors Die
          By Ken Murray MD, Clinical Assistant Professor of Family Medicine at USC

     Years ago, Charlie, a highly respected orthopedist and a mentor of mine, found a lump in his stomach. He had a surgeon explore the area, and the diagnosis was pancreatic cancer. This surgeon was one of the best in the country. He had even invented a new procedure for this exact cancer that could triple a patient’s five-year-survival odds — from 5 percent to 15 percent — albeit with a poor quality of life. Charlie was uninterested. He went home the next day, closed his practice, and never set foot in a hospital again. He focused on spending time with family and feeling as good as possible. Several months later, he died at home. He got no chemotherapy, radiation or surgical treatment. Medicare didn’t spend much on him.

     It’s not a frequent topic of discussion, but doctors die, too. And they don’t die like the rest of us. What’s unusual about them is not how much treatment they get compared to most Americans, but how little. For all the time they spend fending off the deaths of others, they tend to be fairly serene when faced with death themselves. They know exactly what is going to happen, they know the choices, and they generally have access to any sort of medical care they could want. But they go gently.
PLEASE take the time to read the full article:


It's well written and will, hopefully, generate much discussion.

Tuesday, January 24, 2012

Paybacks are hell

A 91 year old man, a widower, is perturbed because his 71 year old son moved into the same adult retirement community.

He's annoyed because it's infringing on his privacy and he feels like he's always under the watchful eye of his son.

Funny things happen when a parent and child live in the same retirement community, especially if/when the parent wants to act more like the kid!

Monday, January 23, 2012

No peach for him

An elderly male was annoyed that the wrong "Depends" had been delivered to his home.

He had called in a couple of weeks prior, requesting to have an order, so a medical supply company could send him a three month supply.

He asked for the largest and widest available (he was a big man).

A colleague looked through the list of available offerings and ordered the "XL WMS" for him, thinking it stood for Extra-Large Wide Men's.

The XL was for a 200-300 pound individual with a 48-64 inch waist (he met these measurements).

Unfortunately, the WMS was an abbreviation for "Women's."

Almost 300 Women's Depends were delivered to his home.

He was not pleased.

He declined to even try on a pair to see if they might fit. They were even "maximally absorbent!"

They also had a notice on the front of each package announcing their "soft peach color."

He let me know he had spent the last 72 years wearing only men's garments and was not about to change!

A few calls were made and I assured him the problem would be rectified.

I just hope they're a more manly color (because I suspect otherwise they would be pretty much indistinguishable)!

Sunday, January 22, 2012

No stars there

The entertainer, Andy Williams, tells a great story (my friend Dan relayed the story to me).

He went to see someone at a nursing home who was in a dementia unit.

While waiting for the person he struck up a conversation with an elderly women, in the garden area, who was also a resident of the nursing home dementia unit.

After conversing for awhile, Andy Williams asked the women, "do you know who I am?"

"No," she replied, "you'll need to ask the women at the front desk...she might know."

It's good to know

While driving on the interstate recently, coming back to the office from a patients home, I was passed by a Van.

It was a "Courtesy Transport Vehicle" for a Tattoo parlor.

I couldn't help but laugh to myself.

But, you know, it's sort of comforting to know I'll still have the option of getting a tattoo if/when my car is broken down, I've had too much to alcohol (or other mind altering substance) to drive or my license to has been revoked due to dementia.

One less thing to worry about...I'll sleep better now just knowing the option to get a tattoo (would be my first) will always be there.

Saturday, January 21, 2012

Missing instructions?

I saw a man who had recently been discharged, after finishing rehabilitation, from a local nursing home.

He had also been sent home with the remaining supplies from the nursing home.

One product was a "cleansing foam."

He was hoping to get additional bottles of the same product.

The label on the bottle stated, "A No-Rinse total care foam-may be used as a perineal (the area between the anus and the scrotum) cleanser, total body wash or as hair shampoo."

Wow, now that's an impressive product!

Think of all the water we could save!

No additional instructions were included...It didn't even state to start from the head and work your way down, for those who wanted to use it for all its stated purposes.

Thursday, January 19, 2012

Complete agreement

Our local University (UCF) just hired a new Athletic Director (Todd Stansbury).

In his introductory news conference he stated, "I believe that athletics are a vehicle to push young people to become better than they think is possible."

I completely agree.

The only caveat, I would add, would be to make sure the sports being pursued are the choice of the young person and not the choice of parents.

Wednesday, January 18, 2012

On the positive side

What's one of the best things about having relatively advanced Alzheimer's disease?

You get to meet a bunch of new people everyday!

Tuesday, January 17, 2012

A bedtime tale

A colleague told me about one of her patients.

The patient has advanced physical and cognitive impairments, despite still being relatively young (63 years old).

His wife declined a hospital bed for him.

She stated when she and her husband were in their bed together, with the lights out, that it was the only time things felt "back to normal and the way they used to be, before he got sick."

What an awesome statement!

Later, however, I chuckled thinking about what my wife would say.

I suspect she would love for me to sleep in my own bed and possibly, even in another room.

Many mornings she informs me that my snoring, thrashing about, getting up to go to the bathroom or accidentally whacking her with one of my wrist splints interrupted her sleep.

But maybe, just maybe, she would actually miss all that...probably not!

Monday, January 16, 2012

MLK, Jr. quotes

"The quality, not the longevity, of one's life is what is important"
"Life's most persistent and urgent question is, "What are you doing for others?"

"The function of education is to teach one to think intensively and to think critically. Intelligence plus character - that is the goal of true education."

Sunday, January 15, 2012

An altered sense of time

A 66 year old male returned for a follow-up appointment.

He wanted me to know that, although he was feeling better (with the treatment I began for prostatitis), he was upset it took so long for the urology consult (that he insisted upon). He said the 4 weeks delay was unacceptable.

I saw him on April 4th. He saw the urologist on April 13 (same month, same year...9 days)!

I decided to just quickly acknowledge that I was glad he was feeling better and not make an issue over his exaggeration. I also decided not to remind him the urologist did not add anything to the treatment regimen I had started (I had already received the consult note).

I had other patients to see.

Besides, I'm sure the 9 days felt like 4 weeks.

Feeling poorly can do that.

Saturday, January 14, 2012

Balance in residency (training after medical school) leads to bettter balance in life

"In the old days, anyone who wanted to go into medicine had to be prepared for a life of exhaustion. Before laws and regulations prohibited being on call every other night, we were rapidly conditioned to accept the idea that the life of a doctor was not only one of service, but a kind of servitude. In the first year of residency, the fledging doctor learns never to leave work for anyone else at the end of the day." Dr. James Gordon

"The biggest changes have been driven by the new rules on resident work hours and their rigid enforcement. Every resident now has an invisible but heavy stopwatch sitting on their shoulder, ticking loudly, constantly reminding them that their task list still has many unchecked items as time slips away (so it's often necessary to now sign out work to an on-call colleague)." Dr. Michael B. Edmond

"There are advantages to this new paradigm. It reduces the House of God attitudes I saw in medical school and that will benefit patients. It will also benefit physicians as we balance our professional and personal lives. Personally, I'm comfortable being cared for by a doctor from the older generation, whose commitment was evident in his long hours, as long as those excessive hours haven't spawned burnout, substance abuse, or divorce-all of which could negatively impact my care." Dr. Powell

Friday, January 13, 2012

A better perspective

I've been feeling sorry for myself lately.

I've been having a problem with my left forearm for about 4 months.

It's the same arm I fractured (non-displaced radial head fracture) a few years ago, had carpal tunnel surgery two years ago and recurrent olecranon bursitis for more than the last year.

Now I have a condition called radial tunnel syndrome.

The radial nerve is being compressed and sends shooting pains and an electrical shock sensation from my elbow to my hand, in the distribution of the nerve, FREQUENTLY throughout the day (and night).

I'm 52.

I saw a 50 year old male today who needed emergency cardiac bypass surgery this past July. The post operative course was complicated by a cardiac arrest and brain hypoxia.

Now, almost 6 months after the event, he remains in need of total nursing care. He occasionally grunts, is fed through a gastric tube and has significant upper and lower extremity contractures.

After seeing him I realized that although my left arm is still a problem, I'm not feeling sorry for myself any longer.

Thursday, January 12, 2012

The patch tells all

It's the time of the year in Florida when we start to have a few cold snaps (by the way, who ever came up with the term "cold snap?") and I get to wear my Levi's (when not at work).

Usually (when not at work), I just wear shorts.

As you know, Levi's have a patch on the back that lists the waist size and length.

Mine says, "38 waist, 34 length."

I usually keep my shirt untucked for comfort. It also prevents folks from reading my measurements.

But I'll admit, however, that whenever I'm standing behind a patient listening to his lungs, who happens to be wearing Levi's, I usually check the patch out.

Sometimes it's depressing.

Especially, when the person is fairly obese and his patch reads "38 waist, 34 length."

Wednesday, January 11, 2012

No smidgens

It’s been estimated that when most folks are diagnosed with Type 2 Diabetes that they've ALREADY lost close to 50% of their beta cells (the cells in the pancreas that make insulin).

It’s been estimated that a creatinine (a blood test for kidney function) of 2 (a normal level is about 1.0) means that an individual has ALREADY lost close to 50% of his/her functioning nephrons (the units in the kidney that filter blood).

The above fifty percents confirm that there's no such thing as a “touch of diabetes or a smidgen of renal failure.”

Tuesday, January 10, 2012

Quite a character

Mr. W. died last week.

He was 86 years old and had Alzheimer's disease.

His visits were always a lot of fun.

Despite having moderate to severe dementia, his social graces and long term memory were intact and he loved to re-tell stores of his years traveling around the globe, with his wife Rubie, while selling insurance for Lloyd's of London.

I had a long relationship with him so I was fortunate to reside in his long term memory.

He always let me know it was great to see his "favorite Irish doctor (since my last name is of Irish origins)."

He would then also always remind me that I was the only "Irish doctor" he had ever known-hence making it easy to be his favorite (he would always laugh).

I'll sure miss that.

Monday, January 9, 2012

Mr. C's Canes

Mr. C., a 93 year old, was an amazing woodworker in his younger days.

His home is home, to many of his amazing creations, including a couple hundred hand carved canes.

The canes are everywhere-up on the walls on hooks, in the corners of many rooms, and in large umbrella holders.

The handles are all different!

He hasn't made any for a few years, but the time and precision he put in to each one is very evident.

He plans to donate them to a veteran's organization to give to those in need and/or to use as a fundraiser.

He doesn't talk, or smile, much these days but this small part of his legacy will live on, in the hands of many others, for years to come.

I caught a glimpse of a smile when his wife and son told me about the "cane plan (the plan for the canes)."

Sunday, January 8, 2012

Ah...no thank you

A friend of mine told me about a male who, reportedly, looked incredibly young for his age.

At his 100th year old birthday party everyone was telling him his skin was so smooth and how they couldn't believe he had so few wrinkles.

Finally the fellow announced, "I've got some wrinkled skin, I'll just need to pull down my pants to show you all."

Everyone laughed but passed on his generous offer.

Saturday, January 7, 2012

When in Rome do as the Romans do

We have a section of town, on the outskirts of Orlando, that's called "Little Saigon."

It has businesses owned and operated by former Vietnamese immigrants.

There are health food stores, nail parlors, markets, restaurants, medical offices, chiropractors, gift stores, etc..

Most of the signs are in Vietnamese.

In one 3 block section, there are 4-5 massage parlors.

Without fail, they all advertise "Swedish" massages.

For some reason I find that amusing.

Friday, January 6, 2012

The end of some good 'ol southern names?

Saw a nice man and his wife recently; Buford and Thelma.

He's 88 years old and his wife is 87.

You just don't come across a lot of good 'ol southern names like this anymore.

We'll have a lot of Conner's, Tyler's, and Ashley's in the future (not that there's anything wrong with that), but probably no Buford's or Thelma's.

But speaking as a dude, I still think it would be pretty cool to grow up being a "Bu."

Thursday, January 5, 2012

Do as I say...

A 67 year old smokes 1-2 packs a day (ppd); usually closer to 2 ppd.

Obviously, I informed him that he should stop smoking and that I would be glad to assist in any way.

He proceeded to tell me a story.

Patient:  A few years ago I was in a car accident and had a big laceration on my forehead. My shirt was bloody and the ER folks cut it off. The nurse saw I had cigarettes in my top pocket and scolded me for smoking and said I should quit. The doctor chimed in as well. When I was walking to my car, after the laceration was repaired, I saw the same nurse and doctor outside smoking. I just nodded my head and thanked them for everything. I think they were embarrassed I saw them. I never got my pack back from the shirt they cut off. I've always wondered if they were smoking my cigarettes (he laughs).

Wednesday, January 4, 2012

Something to ponder

A colleague practices Feng Shui in her private life.

Their homes, including their boat, are Feng Shui friendly.

She has three legged toads, with coins in their mouths, facing the right direction to promote prosperity.

I had a simple question: Do the three legged toads on the boat rotate to remain pointing in the right direction?

She let me know that the toads are set as the boat sits in the Marina but that she will need to get back to me regarding if any changes are needed after consulting with her Feng Shui expert.

I await the answer.

Tuesday, January 3, 2012

A lot can change

Mr. O, an 88 year old, and his 90 year old wife have lived in their beautiful home for the last ten years.

They downsized from a 4000 square foot home to a 2500 square foot home, ten years ago, but now it's too much house and they are looking to sell and move to an ALF.

In retrospect, they wish they would have done this ten years ago at age 78 and 80, respectively.

A lot has changed over the last decade.

He is now legally blind.

Her arthritis progressed and she is now quite impaired functionally.

Finally, their oldest daughter, who was living with them, was diagnosed with a brain tumor and died.

They are saddened by the events but remain incredibly resilient.

They wish, but know they can't, turn back the clock of time.

They urge others to do a better job of planning for the future in their latter years.

Monday, January 2, 2012

I'll take it!

We went to a movie last week.

We saw "WARHORSE (it was excellent)."

The morning after I was reviewing the ticket stubs.

We (my wife, kids and I) had been charged for one adult, two students and a senior (60 years and older).

I bought the tickets.

I'm still "only" 52 (but I do have a head full of white hair).

It was a $2.50 savings over the adult ticket price.

Not a bad trade-off for having my feelings hurt.

I'll have to see if I can get the same ticket booth person when we see other movies.

I could use the extra $2.50 ( it's almost one-third the cost of a bag of popcorn)!

Sunday, January 1, 2012

Happy New Year!

Every man should be born again on the first day of January.  Start with a fresh page.  Take up one hole more in the buckle if necessary, or let down one, according to circumstances; but on the first of January let every man gird (fasten or secure with a belt) himself once more, with his face to the front, and take no interest in the things that were and are past.  ~Henry Ward Beecher

We will open the book.  Its pages are blank.  We are going to put words on them ourselves.  The book is called Opportunity and its first chapter is New Year's Day.  ~Edith Lovejoy Pierce