Wednesday, February 29, 2012

A real life Energizer bunny

I had the pleasure of seeing Mr. S. today in his home.

He was born October 17, 1915 and is 96 years old.

When I asked," how do you feel," he replied (with a smile and a glint in his eye), "I'm here, I exist day to day."

My reply, "Yes you are, and yes you do!"

By my quick calculations (actually it wasn't quick), he has "existed" for approximately 35,175days!

Tuesday, February 28, 2012

You know you've had a bad day when...

My daughter was riding in a van recently when the driver (her friends mother) accidentally hit a fellow driving a scooter.

My daughter reports the driver of the scooter was not seriously injured and he kept saying he didn't want the police to be called.

The police were called by a bystander and arrived quickly.

Soon after, the driver of the scooter was handcuffed and taken away in the police car.

We later found out that there was a warrant out for his arrest and the scooter was also stolen.

The driver of the van was not charged with anything although all passengers were pretty shook-up over the incident.

The fellow who was hit sure had a bad day.

It's probably pretty rare to be the one taken to jail, when you were the one hit by a car, while out for a leisurely ride on your scooter!

Monday, February 27, 2012

A bit of TB history

I saw an 88 year woman last week who had a history of undergoing a thoracoplasty in approximately 1946 for TB. She served in the Hospital Corp during WWII. I could not remember  the “why and how” of a thoracoplasty. Here are a few things I came across:

The first successful treatments for tuberculosis were all surgical. The initial procedures were all used in the pre-antibiotic era (the first antibiotic for TB was streptomycin-developed in 1946). The interventions were based on the observation that healed tuberculosis cavities were all closed. Surgical management was therefore directed at closing open cavities in order to promote healing.

When the tuberculosis cavity was located in the apex of the lung, a thoracoplasty could be performed. Six to eight ribs were broken (or removed) and pushed into the thoracic cavity to collapse the lung beneath. It was obviously a disfiguring operation.

Although thoracoplasty for TB is considered an obsolete procedure (and was largely discontinued by the 1950s), many underdeveloped parts of the world, where tuberculosis remained rampant, continued the procedure up until the late 1990s.

Sunday, February 26, 2012

B&B since 1946

Bob and Betty have known each other since being kids, growing up in a small town in Ohio.

Their parents were good friends.

They both served in the Navy during WWII.

Bob was a Seabee (see yesterdays post) and Betty was in the Hospital Corp.

They got married shortly after the War, in 1946, raised three children and also have 4 grandchildren.

Bob worked for a metal production company throughout his career.

Betty, in addition to being a homemaker, served as a local hospital volunteer and was the choir director at church.

"She really had an amazing voice," Bob lets me know, "I always sang in her choir...but the only reason I was able too was because she was my wife!"

I'm sure Betty would have never excluded him; they've been partners for 66 years.

Bob's in much better health these days than Betty, but "team B&B" still remains strong.

Saturday, February 25, 2012

He found a way to serve

Mr. G. is an 89 year old who, like so many others, desperately wanted to join the Navy as a young man after Pearl Harbor was bombed on December 7th 1941.

He was turned down initially due to being colorblind.

Finally, a friend told him about a new division of the Navy, the Naval Construction Battalions, that had become operational in June 1942.

He was accepted as a Construction Mechanic and after training at Camp Endicott in Rhode Island, spent close to the next 4 years building bridges, roads and Quonset huts (used for warehouses, hospitals and housing) throughout Europe.

He was a Seabee (came from the initials of Construction Battalion (CB)).

"The earliest Seabees were recruited from the civilian construction trades. Because of the emphasis on experience and skill, rather than physical standards, the average age of Seabees during the early days of the war was 37 ("

The Seabee logo, designed in 1942, by Frank J. Iafrate, has remained in use unchanged ("Fighting Bee").

It was an honor to meet him; another American hero.

Friday, February 24, 2012

Junior's a senior

Mr. H., an 90 year old, could not stop talking about what a great son he has.

He sounded so great I wanted to know more about him.

Mr. H.: Junior has just always been a great son. He's always looked out for his mother and me over the years and I know I couldn't still be living in my home without all the help he has given me...but I also have to remember, he's no spring chicken anymore...he just turned 70 last month.

We both laughed (and I thought of the title for this post while still laughing).

Thursday, February 23, 2012

Too cluttered vs too clean

I saw Mr. H. today.

He's an 90 year old widower, who has lived in the same comfortable home for many years. It's very cluttered (some might even say dirty) and is also home to his MANY cherished memories and photographs from over the years.

He's in poor health but appears to be in great spirits.

With the help of his son, who lives nearby, a home health aid 5 days/week and amazingly helpful/friendly neighbors, he remains at home and hopes to die there.

I met Mr. S. yesterday.

He's an 87 year old widower, who has lived in an efficiency apartment at an Assisted Living Facility (ALF) for the last year. It's a beautiful facility. His one room is VERY clean and uncluttered and is also home to just two pictures-one of his son/granddaughter and one of his deceased wife.

He's in poor health and appears to be depressed.

His only son and granddaughter visit very rarely since they dropped him off at the ALF. He's sure he will die in his room.

Would you prefer your final days to be like Mr. H. or like Mr. S.?

I would prefer the clutter!

Wednesday, February 22, 2012

Dying at home

A wife, of one of our patients, informed me that a marketing person for a Hospice company told her if she doesn’t sign up (with them), her husband’s eventual death at home would be considered an “unattended death” and that their home would be turned into a “crime scene.” She was visibly upset. I tried to reassure her. I also decided to check some references. Here’s what I could re-confirm:

A death is considered “unattended” only if/when it occurs in the absence of a doctor/patient relationship at the time of death.

The physical presence of the attending physician is NOT necessary at the time of death.

A death may be considered unattended if it occurs more than 30 days after the decedent was last treated by a physician, EXCEPT where death was medically expected and is certified as such, by the attending physician.

The medical examiner will be notified when a person dies by accident or in any suspicious or unusual circumstance.

The medical examiner is also notified when a body is to be cremated, dissected, or buried at sea. There's no exemption from this requirement, regardless of the circumstances of the death (I was a community medical examiner in Virginia from 1986-1993. I have some great stories...maybe a blog entry for another day).

To summarize: a person who dies at home, who has a doctor/patient relationship at the time of the death and who did not die by accident or suspicious/unusual circumstances will NOT have their home turned into a "crime scene."

Tuesday, February 21, 2012

A lot of families need one

A lot of families need a Mrs. T..

She raised her 5 kids alone (her husband left soon after their 5th child was born) and then raised three grandchildren (when her daughter dropped them off for a visit (when they were ages 1,2 and 3), and never returned to pick them up).

All 8 children were raised in her small three bedroom, one bathroom home in the country.

She's most proud of her youngest child who is 30, working full time at Home Depot and is close to finishing up her college degree in night school.

She will be the first in many generations to get a college degree.

Her grandchildren and great grandchild also remain the light of her life.

The 9 year old great grandson sleeps over every Friday night and it's Mrs. T.'s favorite day of the week knowing he'll be there.

Like so many other unsung heroes, she makes the world a better place with her unselfish love.

Monday, February 20, 2012

My son's world

It was Sunday morning.

My wife and daughter were away at a horse show all weekend.

I got up at about 6:00 AM and had already done two loads of laundry, paid bills, cleaned the kitchen, unloaded the dishwasher, straightened up the garage and then sat down at the computer to work on our end of the year taxes, when my 17 year old son got up at about 10:00 AM.

I was feeling like it had been a real productive morning.

He said "morning" as he walked past to the kitchen to read the sports section in the newspaper and eat a little breakfast.

About a half-hour later, when he saw me still sitting at the computer, asked when I was going to "start my day."

Truthfully, I was a little irritated.

He couldn't understand why.

Sunday, February 19, 2012

Lucky number 11

I met an amazing 69 year old woman, Mrs. T..

She has lived in the same small three bedroom, 1 bath home for almost 50 years.

She raised 8 children there, 5 of her own and three grandchildren.

Her husband left shortly after the 5th child was born, for another woman, never returned and never assisted financially.

He didn't file divorce papers for a few years, so officially they were married for 11 years.

She worked multiple jobs over the years to survive and provide for her family.

Her ex-husband re-married three additional times, all relatively short marriages (each less than ten years) and died from lung cancer about 4 years ago.

Mrs. T. never re-married.

After her husband died, she was informed by Social Security that she would receive her ex-husbands benefits because they were married for over ten years.

Her monthly benefit increased from approx $600/month to almost $1600/month.

"Waiting as long as he did to file divorce papers was the best thing he ever did for me. I'm sure he had no idea. It's the first time in many years that I don't have financial worries. I laugh about it every time I think about it."

Saturday, February 18, 2012

One smart rooster

I made a home visit recently in the country.

I noticed a large rooster, sitting out front, that gave me the "once over" as I walked by, but just stayed put.

The yard was surrounded by a very low fence.

I asked the owner, Mrs. T., if the rooster had ever tried to "escape."

Mrs. T.: He ventured off once, about two years ago, and got the crap beat out of him by one of the neighbors roosters. He came back all bloodied up. He hasn't left the yard since.

Thursday, February 16, 2012

One man who had a very bad day!

"Man Suffers Severe Injuries After E-Cigarette Explodes In His Mouth. Burn Victim Is Vet Who Served In Vietnam. On its website, ABC News (2/16, Conley) notes that 57-year-old Vietnam vet Tom Holloway is recovering at a burn center in Florida, "after suffering severe injuries from an electric cigarette that exploded in his mouth." Chief Butch Parker of the North Bay Fire District "said the explosion knocked out all Holloway's teeth and part of his tongue." ABC News adds, "E-cigarettes are currently not regulated by the FDA." 

It will be easy to remember this potentially significant adverse effect when I advise patients..."E" for explosion.

Poor guy!

Wednesday, February 15, 2012

Measurements coming and going?

A wonderful co-worker just gave birth to her first child, a daughter.

Of course, an e-mail went out announcing the birth, followed by, as usual, the measurements:

6 pounds, 1 ounce, and 19 inches long.

Why is this information always included with a birth announcement?

Shouldn't or couldn't we just say "a healthy girl was born!"

As a medical professional, I know that the average full term newborn is between 6 pounds, 2 ounces and 9 pounds, 2 ounces, and is between 19-21 inches long, but does every one else know this?

Maybe this is where our fixation with body weight and size gets its start?

Statements such as the following almost always occur (after reading the measurements):

"My o my, what a heavy, tall (or a light/short or any other combination) baby!"

"Wow, I can't believe that such a large baby came out of her!"

It made me think...maybe we should include our measurements when we die.

Of course, statements such as the following might occur:

"My o my, what a heavy, tall (or a light/short or any other combination) person who died"

"Wow, I can't believe that such a large body went into the coffin"

Tuesday, February 14, 2012

He speaks!

Mr. R. has been interesting to follow over the last few months.

He stopped talking some time ago.

The mental health folks have called it selective mutism.

He really hasn't been selective...he hasn't spoken with ANYONE!

Most recently, we decided to have him undergo a comprehensive medical evaluation in an evaluatory unit to make sure we weren't missing something.

During the first week he had a day where he voided (urinated) very little. A bedside bladder scan revealed an over distended bladder.

When he saw the catheter that was about to be inserted to drain the urine he yelled, "YOU ARE NOT GOING TO PUT THAT SH-T INTO ME!"

It was a miracle!

He spoke!

He also proceeded to urinate on his own.

Sunday, February 12, 2012

Just making an ash of himself

I was driving behind a Chevy Cavalier recently that had the sun roof opened.

Every once in a while, the drivers right arm would twitch upward, toward the sun roof.

I was curious.

Maybe he had a nervous tic or a rare movement disorder called hemiballismus (spasms in one side of the body)?

I decided to pull up along side the driver in the other lane.

Nothing exciting was seen...just the driver periodically thrusting his right arm upward and out the sun roof to flick the ash off his cigarette!

Friday, February 10, 2012

Don't tell my wife

Mr. H. is a 90 year old male who had a cervical spine procedure years ago.

He was having increased neck pain and luckily I was able to compare new x-rays to others that had been done over the last ten years or so.

In all the x-rays, a screw was missing on the right side at cervical level 7.

Obviously, at the time of the initial surgery, it wasn't needed.

Me: Has any one ever told you that you only have 5 screws, instead of 6, in the stabilization plate (and I showed him the x-rays at the same time)?

Mr. H.: No, I've never been told that...but do me a favor and don't tell my wife. She's said I've had a screw loose for years and I wouldn't want her to know she was right!

We laughed.

I was pretty impressed with his quick wit!

Thursday, February 9, 2012

Men of few woods

Some specialists have the reputation of not having the best communication skills.

I had carpal tunnel surgery on my left hand two years ago.

When I returned for the post op check, the orthopedic surgeon asked how everything was going.

Me: My hand is still numb.

Surgeon: The incision looks fine.

Me: It does look fine but my fingers are still numb.

Surgeon: The incision is healing fine, thanks for coming in (as he shook my hand and walked out of the room).

When I got home my wife asked: Did you tell him your fingers were still numb?

Me: Yes.

Wife: What did he say?

Me: He said the incision looked fine.

About a year later I went to see the same surgeon, due to a new problem with my elbow.

When we were finishing up the visit, I let him know my left hand was doing a lot better, but that it took almost 6 months for the numbness to go away.

Surgeon: Good to hear, just like I told you (as he shook my hand and walked out of the room).

Jelly donut anyone?

I've used a jelly donut, to help folks visualize a herniated or an extruded disc, for many years.

If you press down on a jelly donut, the jelly starts to poke out of the weak part of the donut wall where the jelly was inserted.

In much the same way, a herniated disc pokes out a weak part of the annulus and can press against nerve roots.

If you remove the pressure from the donut, sometimes the donut will assume its original shape and the jelly will move back inward (recoil).

With a herniated disc, when the pressure is removed, often within 4-6 weeks, the disc material will also move back in, and the pressure on the nerve roots will be relieved.

In contrast, if you smash a jelly donut, part of the jelly will separate from the donut.

This is similar to what happens to an extruded disc.

Obviously, the jelly nor the disc will ever be able to recoil back inward.

It's a simple analogy, but has usually worked for me.

Wednesday, February 8, 2012

No more questions

I've known Mr. S. for some time now.

He's a very ill 67 year old with multiple serious medical concerns.

I've always, inwardly, questioned how he has such a strong will to live. He's just been so sick for so long.

I recently made a home visit, for the first time.

He was sitting comfortably in his favorite recliner in his beautiful, relaxed home, surrounded by his wife, dogs and pictures of his children and grandchildren everywhere you could look.

I no longer have questions.

Tuesday, February 7, 2012

More than just semantics

I overheard a colleague telling a staff member that a patient in our practice had "expired."

It made me think, Why do our patients "expire," but our family and friends get to "die?"


* Expire: to end or to be no longer valid

* Die: to cease to live, to cease to exist, to cease to function, to lose force, strength or active qualities

I prefer to die, instead of expire, when the time comes, and for now on, none of my patients will "expire" either.

The many life lessons I have gleaned from my patients who have died, over the years, are still incredibly appreciated, remembered and valid.

Monday, February 6, 2012

4th time was the charm-at least for now

A 66 year old male "found" another neurosurgeon who offered to "try" a 4th operation for chronic low back pain.

I see a lot of patients with failed back syndromes who never seem to improve despite therapy, multiple operations and epidural injections.

I tried, as diplomatically as possible, to dissuade him from undergoing a 4th operation.

He went through with it anyway.

Surprisingly, post operatively, he's been greatly improved.

Maybe he wanted to prove me wrong.

Regardless, I couldn't be happier for him.

I hope it lasts!

Sunday, February 5, 2012

What would you want?

I came across an "old" article recently, written way back in 1999!

The title was "What do seriously ill patients want?"

It surveyed patients with terminal illnesses. The highest rated "wants" were as follows:

* Pain and symptom control

* Avoid inappropriate prolongation of the dying process

* Achieve a sense of control

* Relieve burdens on family

* Strengthen relationships with loved ones

Despite all the many advances in treatments over the last 13 years, I suspect a new survey would yield similar results.

Saturday, February 4, 2012

Turning a Rock into a pebble

Mr. R. is a 72 year male who owned the Bar and Billiards Hall at the end of his street, for almost twenty years.

It was called Rock's Bar and Billiards

His nickname is "Rock."

I saw pictures of him posing, with a son, at his establishment.

He was the picture of health at age 68, muscular, and weighed over 200 pounds.

About 4 years ago, he was diagnosed with laryngeal cancer and had surgery and extensive radiation therapy.

He was a heavy smoker.

He sold the Bar shortly after being diagnosed.

He's considered cured at this time.

Unfortunately, he was left with the inability to swallow and has been fed through a gastric tube since.

He's had many complications due to aspiration pneumonia, skin breakdown and wounds.

He's now frail, chronically ill appearing and weighs about 120 pounds.

The Rock now feels like a pebble.

Cancer, and the treatment, can often do just that.

Friday, February 3, 2012

An extreme penny pincher

An 87 year old man let me know his wife has always been excellent at "squeezing all the cooper out of a penny over the years," in describing her frugality. He went on to say "she would sometimes squeeze so hard that Lincoln would start to cry!"

Honestly, I had never heard that before!

He was laughing so hard I decided to join him.

Thursday, February 2, 2012

Two memorable quotes for the day

Mr. J. is an independent 90 year old, who will keep you engaged for as long as you are able to stay.

We spent almost an hour together recently.

He continued to talk throughout the entire physical exam, offering words of wisdom whenever possible.

I left with two memorable pearls:

#1. In discussing women (and he has been with quite a few over the years): I've been married three times. All three times I've been in love. To love someone there needs to be lust and respect. I've been with many women I lusted for but didn't respect and I've been with many women I respected but didn't lust for. I never married any of them.

#2. For success in the business world: you need to be nice and sweet on the outside, but sneaky on the inside.

Wednesday, February 1, 2012

A lifetime memory

A 90 year old male:

"Before I went off to the war, my girlfriend said, lets spend a night together that we will remember for the rest of our lives. Well, we did just that, she got pregnant with my oldest son and he's been a pain in the a-- ever I haven't been able to forget about that night...whenever I have to look at or speak to my son (who's 72 years old now)."