I'll be back

I'm going to take a short break-the first since June. We're going to go on a college fact finding journey for my son. Hopefully, things will go well. Be back soon!

Get MET

The metabolic equivalent of task (MET) is a physiological measure expressing the energy cost of physical activities. MET is a way of comparing the level of exertion and the energy spent when people of different weights perform the same physical activity. The published MET values for specific activities are derived from a sample and indicate averages only. You may find the chart below helpful:

Physical Activity	MET
Light Intensity Activities	< 3
sleeping	0.9
watching television	1.0
writing, desk work, typing	1.8
walking, 1.7 mph (2.7 km/h), level ground, strolling, very slow	2.3
walking, 2.5 mph (4 km/h)	2.9
Moderate Intensity Activities	3 to 6
bicycling, stationary, 50 watts, very light effort	3.0
walking 3.0 mph (4.8 km/h)	3.3
calisthenics, home exercise, light or moderate effort, general	3.5
walking 3.4 mph (5.5 km/h)	3.6
bicycling, <10 mph (16 km/h), leisure, to work or for pleasure	4.0
bicycling, stationary, 100 watts, light effort	5.5
Vigorous Intensity Activities	> 6
jogging, general	7.0
calisthenics (e.g. pushups, sit-ups, pull-ups, jumping jacks), heavy, vigorous effort	8.0
running jogging, in place	8.0
rope jumping	10.0

The METS required for sexual activity has been found, in multiple studies, to be in the 2-3 range for the pre-orgasm period and in the 3-4 range during orgasm. This is good information for post heart attack patients who years ago were often told to “go home and take it easy.” Post MI exercise programs often allow the patient and his/her sexual partner to feel more confident in issues dealing with intimacy with knowledge of this information.

Lost in translation

I needed a translator today for an 83 year old male.

It always amazes me when the following occurs:

Me (to the translator): ask him how he is feeling today.

Translator (to the patient): heijsd ekjkslsk the idjssn eoiroed a hs dshasjhksa the shasjkasl it.

Patient (to the translator): it hdgsf eyht ahjhrrbvgee ushsbertsnd a the fdrendghsrt the jkrpsoxzui a hrteerwvs lmidys a the hdjeya st.

Translator (to Me): fine.

Clearly, something is getting lost in the translation. I so wish I was more motivated to learn other languages when I was younger!

I know...it's never too late.

Mufasa would not be pleased

A 91 year old male and female, husband and wife for 70 years, live in an assisted living facility (ALF).

Their son, who is in his mid 60's, doesn't visit very often because he "doesn't like seeing his folks in their current condition."

I so wanted to strongly disagree with his sentiments but decided it wasn't the right time.

I know he has also been under a lot of personal and financial stress of late.

I do know where he lives, however.

Maybe I'll just sneak a DVD of the Lion King into his mailbox so that he can re-learn "the circle of life" concept again.

Two J's secret

James, a 78 year old male, had a stroke when he was only 52 years old.

He has been paralyzed on the left side since.

He loves to get outside and explore and for the last ten years has always had his small dog, Jose, in the basket of the scooter.

His wife always felt comfortable letting them go and explore.

Occasionally, she would hear Jose wildly barking, from a distance, but was never concerned.

James and Jose would often be gone for hours but would ALWAYS return home safely.

One day, she decided to go for a long walk while they rode along side in the scooter.

They were a few of miles from their home when they ran into a couple walking to their car.

"Hi, James, Hi Jose," the couple said, "oh, are you his wife?"

"Yes, I am," she said, "it's nice to meet you."

"Your husband sure has a great dog," one said, "it's great the way Jose will always bark nonstop, whenever James has fallen, until someone hears and is able to help him back into his scooter."

"Oh, he's never told me he's been falling...thanks for the information."

She looked at James and Jose and had never seen such guilty expressions.

Fool me once...

Mr. V. is 88 years old and raised two daughters on his own.

His wife left when they were very young and never returned.

She went on the "collect 5 more ex-husbands" as Mr. V. noted.

"Why didn't you ever re-marry," I asked.

"My first wife was too wild and too expensive, " he said, "I decided, she was enough wife for one lifetime."

Less feely

My wife and I had "take out" recently for dinner.

One of the fortune cookies had the following quote: Life is a tragedy for those who feel and a comedy for those who think.

I guess I'm becoming more of a thinker the older I get.

What about you?

Jill of all trades

Mr. D., a 62 year old, had a stroke almost one year ago.

He has significant residual deficits but has made amazing progress.

His girlfriend for the last 6 years is Donna (she's about his same age).

She has stuck with him despite his health and impairments.

She moved in with him, into his single wide mobile home, to be his caregiver.

While Donna was showing me the book of vital signs she keeps on Mr. D., she let me know she was a Nurse when she was younger.

When we found out we had grown up in a similar area of New York, she let me know she had been a live-in housekeeper for an elderly woman for a few years, before she went to nursing school.

When I asked how she and Mr D. got together, she let me know they met while she was working as a cook at his favorite restaurant (it was her job after she retired from nursing).

I left their home feeling as if Mr. D. was in great hands.

He is loved unconditionally by a woman who has an impressive resume to excel in her current "job" as a caregiver.

He's a lucky man and it was clear to me that he was well aware, and very appreciative, of that fact.

Studying Medicine

Mr. K., a 63 year old, introduced me to his daughter-in-law.

Mr. K.: She's in Medical School.

Me: That's great.

Daughter-in law (wearing scrubs): It's hard but I'm really enjoying it.

Me: Where do you go?

She told me.

It was a local Nursing Assistant School.

Me: That's great, congratulations, I hope everything will continue to go well.

Mr. K. was correct...she was in a School, studying Medicine.

He's obviously very proud of her.

There was absolutely no reason or need to correct his usage of the term "Medical School."

Another casualty of the war

Mr. D. was a relatively young married man when he joined the Air Force during WWII.

His son was 8 months old when he left home to serve.

He was gone for almost three years.

He spent the last part of the war serving as a supply officer on Biak Island.

The Battle of Biak was part of the New Guinea campaign of WWII fought between the United States and the Japanese from May 27th, 1944 (when General MacArthur and U.S. troops landed) until the U.S. victory on June 22nd, 1944.

Biak Island then served as a vital airfield that was used by U.S. planes to attack the Japanese fleet in the Philippines.

When Mr. D. returned home his son was almost 4 years and he and his wife had grown apart.

They got a divorce.

It's evident that Mr. D., at age 91, still feels pain from this loss.

Spiritual osmosis

Mr. and Mrs. S. have a very spiritual home.

The have multiple artists renditions of Jesus hanging on the walls, as well as statues, mounted busts, lamp shades, light switch plates, decorative plates and refrigerator magnets of Jesus.

They are both 96 years old, have been married for 75 years and appear incredibly content.

I felt the same way sitting in their home.

Just three weeks shy

A shell exploded right next to Mr. O., while a commander of a small Army troop that had engaged the Germans, in Czechoslovakia, on 4/16/1945.

He lost his right arm and both lower legs to amputations in a field hospital.

The war with the Germans ended on 5/8/1945.

Mr. O. is now 91 years old.

After rehabilitation, he went to college, law school and then to a long career representing Goodwill Industries all over the United States.

He raised 4 children, all college graduates, and has 13 grandchildren. 

He remains thankful to the doctors, nurses and medics who saved his life on that memorable day, approximately three weeks before the end of the war.

He has accomplished amazing things with his resiliency, drive, motivation and his trusted left arm and hand.

His life is an inspiration.

Collector of mangers+ long life=a lot of mangers

I had the pleasure of seeing Mr. O., a 91 year old, in his home recently.

I did the history and most of the physical exam while we were in his living room.

He maneuvered easily around his home in an electric wheelchair.

Periodically, he would excuse himself to go check on his wife, who was in another room.

Her paid caregiver needed a few hours off to take care of a personal matter.

In his absence, I had the opportunity to look around the room.

The living room had Christmas mangers everywhere.

They had two large glass curio cabinets with 5-6 shelves each filled with mangers.

Manger carvings, manger pictures, manger snow globes, manger picture frames, manger light shades, manger light switch plates, manger figurines, mangers made of wood, glass, and plastic, etc..

When Mr. O. returned to the room I stated, "You all sure have a lot of mangers."

He reported, "we started collecting them years ago and have lived a long time...it's been sort of our thing over the years...I guess we've gone a little overboard."

"No, not at all," I added, "every couple needs a thing. It's really pretty amazing."

7 cents to the mile

I usually try to walk seven laps around my building every day at work during a mid-day break. An employee health staff member put a sign up months ago announcing that seven laps equaled one mile.

Usually, without fail, my cell phone rings or my laboratory beeper goes off or I run into staff or patients and I have to briefly stop.

After the interruption, I would often lose track of what lap I was on.

Finally, I decided on a plan.

I start with 7 pennies in my hand and put one in my pocket after each completed lap.

Odd, yes, but it works just fine for me.

It's cheaper than buying a lap counter and it lets me do something constructive with a denomination of money that is otherwise so hard to use.

50 sonts

I had a discussion with a colleague today.

She pronounced "centimeter" in a way I've heard previously (usually by surgeons, for some reason), but still, nonetheless, odd.

"The patient has a 2 sontimeter abrasion on his face."

"You mean centimeter? " I asked.

"Yes, sontimeter," she replied.

I had one more question.

"If I give you two quarters, will you have 50 cents or 50 sonts?"

She declined to answer but did laugh.

A Silver Alert temptation

While out driving on the Interstate recently, I saw automated signs, every few miles, announcing a Silver Alert. The make of the car, the license plate number and a *three digit number to call was listed.

A Florida Silver Alert was enacted in 2008, which allows the immediate broadcast of information to the public regarding missing senior citizens with dementia, Alzheimer's, or other cognitive impairment. The purpose is to allow a coordinated response between local and state law enforcement to quickly broadcast important information to citizens so they can assist law enforcement in the rescue of the endangered person and/or notify law enforcement with helpful information.

I've already got silver hair so hopefully if/when I get advanced dementia, I'll never get access to the car keys to cause such an alert. On the other hand, if my capture was televised, it could possibly be my 15 minutes of fame...even if I wouldn't remember it!

"Not so elementary, my dear Watson"

In my quest to be time efficient, I often jump to conclusions.

When I smell tobacco smoke on a patient or in their surroundings, I'll often just ask, "so how much do you smoke?"

The patients often seem impressed by my detective skills (and I give myself a pat on the back).

Sometimes, I'm wrong with my assumptions.

While seeing Mr. B. in his apartment (on the 12th floor of a lower income housing tower) recently, I noticed pictures and models of airplanes everywhere, and the Air Force logo on one.

Given my keen sense of observation (and my knowledge that he had been in the military), I asked,"what years were you in the Air Force (I'm quite the sleuth...aren't I?)?"

Much to my surprise he stated, "I wasn't in the Air Force, I was in the Navy."

"Oh," I said, "I just noticed all the airplanes and the Air Force insignia."

"Oh yeah, " said Mr. B., "they're all from another veteran who died in this building a few years ago. He was in the Air Force and his son knew we didn't have any decorations in our apartment, so he gave them to us as a gift."

"Oh...that sure was nice," was all I could add, while envisioning my Sherlock Holmes hat being snatched off my head!

Gloria

Gloria is the wife of a patient of mine.

Her 66 year old husband, Mr. B., is quite ill, and has been for many years.

Gloria did not finish high school, but like so many other caregivers, has more than earned her honorary nursing degree.

Gloria keeps their efficiency apartment as clean as possible, handles all the finances, often down to the penny every month, does all the shopping, meal preparation, and laundry, in addition to doing a great job of caring for her husband.

They never had children and have no living relatives in the area.

She sleeps on a small couch every night, so as not to crowd Mr. B..

When I asked how long she has been sleeping there she replied, "only for a little over 4 years."

With all the problems in our society that we witness, read or hear about about every day, I always leave an encounter like this feeling uplifted by the personal, unselfish, caring acts, of so many individuals like Gloria.

It's a wonderful life!

It's hard to know where to begin to describe my visit with Mr. S..

It's hard to imagine all the things he has seen since being born in 1915.

He grew up in a relatively poor family.

He joined the Navy in 1933 and became a pilot.

He was in Pearl Harbor during the attack.

He flew over 40 missions during WWII.

He met a "cowgirl," a sweetheart  named Jeanne, just before going to Europe and they married on his return  in 1947. His oldest son, Jimmy, was born the same year.

They had a house built  in 1951, one block from the Naval Air Station in Sanford, Florida, just before he left to fight in the Korean War.

He finally retired from the Navy in 1958, after a 25 year career.

He and Jeanne still live in the same home.

They raised their three children there.

Jeanne was a nightclub singer before they got married and the photographs from her performing days hang in the living room, as do many of Mr. S.'s military photo's, along side all the many family photo's.

He got into real estate after he retired and although he wanted to sell homes, just "couldn't stop buying up a lot of places because they were so cheap."

The youngest son, Paul, lives next door in one of the homes Mr. S. bought during the 1960's.

He's physically frail but cognitively, almost intact.

He takes a bunch of herbal supplements every day and has for many years, many of which are of questionable efficacy and safety.

A colleague, who saw him prior, was often upset over this issue.

I offered NO recommendations concerning his supplements.

I did make a note of what he was taking, however, for future reference, if needed...for myself that is.

Mr. S. is a proud American, who had a distinguished military career, has been a faithful husband for 65 years, a loving father/grandfather, and was a successful businessman in the private sector.

It sounds like a pretty great life to me.