Thursday, May 31, 2012

Keep laughing

I had the pleasure of spending time with Mrs. R. recently, who's 91 years old and a widow for over 20 years.

She still lives alone but has home health assistance for 4 hours everyday.

Here are just a few of her one liners that made me laugh:

Does talking to your kids (her 54 year old twins) bring you joy? "No, not really, because they still always just want to borrow money (she laughs)."

That's a nice lazy boy chair you have over there (she was sitting in another much smaller recliner). "I call it my bobbie trap chair. Once you get in it, you can't get out. I tried it twice but haven't been in it for the last 7-8 years. Only my company sits in it now (she laughs)."

That's a nice picture of your daughter receiving a diploma up on the wall. "Thank you, I consider it one of my greatest accomplishments. She's deaf and I had to work like hell to make sure she got a normal high school diploma and not a special ed diploma. It's opened up so many doors for her over the years. I was a real pest but kept pestering the school principle and the school board members to the point that they all knew me by my first name and could recognize my voice on the phone (she laughs)."

I know you have a hernia. "Yes I you want to meet George? He was little George at first but has been big George for the last few years (she laughs)."

You seem to have a great sense of humor. "You know I lost it for awhile, but got it back. Things weren't too pleasant for many years of my marriage. My husband smoked and drank too much. We always had an extra bedroom in our home and it got used a lot." Did you sleep there to get away from him? "No, whenever I would kick him out of our room, he would sleep there...I loved my bed too much to ever leave (she laughs again)."

Wednesday, May 30, 2012

Anyone listening?

The often quoted study on how quickly doctors interrupt patients comes from 1999 (JAMA. Jan 20, 1999; 283-287).

On average, doctors interrupted patients for the first time (during a medical interview) after only 23 seconds.

Interestingly, the study also showed that most patients only have 2-3 main concerns to discuss and, if given the chance, will state their concerns in an average of 32 seconds.

A more recent study has been done (March 2007).

It showed that now doctors interrupt their patients within 18 seconds of the start of the medical interview.

It's not all bad news for those glass half-full folks. 44% of physicians who were given training in conducting open interviews were found to allow patients to express all their concerns, compared to only 22% of those without the training.

It's not so good news for the glass half-empty folks...56% of physicians who were given the special training still interrupted.

Tuesday, May 29, 2012

Our dogs re-birth

Everyone in our neighborhood thinks we have a new puppy.

Our Dog, Bailey, is a ten year old beagle.

For the last few years, up until recently, she had been sleeping 21 hours a day, lost all the hair on her tail, had recurrent skin infections and pretty much declined to take any walks (she would just lie down in the yard and refuse to move).

We had an extensive evaluation a few years ago, when these symptoms started, and was given a diagnosis of "lameness."

Recently she was diagnosed with hypothyroidism and started on medication.

A thyroid test had not been done in the past.

Now that she has settled into her dose, she has lost weight, her hair has grown back and she's back running non stop laps around the living room couch.

It's been pretty cool to see.

Maybe we should just tell folks  she's only 7 years old since she spent the last three years in hibernation.

Monday, May 28, 2012

Happy Memorial Day!

My wife was literally "radioactive" for a few days after taking treatment for thyroid cancer (and needed to be quarantined) and my daughter had a horse show up in Gainesville, Florida so I was "on duty."

My daughter has been riding in competitions for a number of years and I've been able to make an appearance at most shows, but have never been the full time parent (my wife has always had that role).

It was a great experience.

My daughter did well but the time spent together during the long weekend was, as they say, priceless.

Thursday, May 24, 2012

She's glowing!

I can honestly say my wife is "HOT" tonight.

Actually, she's hotter than normal and will be that way for the next 48-72 hours.

She took her dose of radioactive iodine (I131) this morning (for thyroid cancer) and needs to be in semi-quarantine for the next 2-3 days.

We can't get within 6 feet of her, she needs to use a separate bathroom (good thing we have two) and double flush, she needs to wash all her clothes and dishes separately and we can't hug, kiss or "trade body fluids (these are the exact instructions given)" for a week.

It's going to be a long 2-3 days for her but at least she's home!

Wednesday, May 23, 2012

Just a temporary fog

My wife had her thyroid out three weeks ago due to cancer.

Although the surgery was curative, its been recommended for her to take a dose of radioactive iodine (I131) to prevent a possible recurrence in the future.

She needed to wait to become very hypothyroid prior to being given the dose.

A TSH is a test that helps to measure thyroid function.

A normal level is up to about 4.5.

The higher the TSH, the greater the level of hypothyroidism.

Her TSH was 64 this past Monday.

It helps to explain her fatigue, feeling like she was walking through a cloud and the difficulty in putting a complete sentence together.

She takes the I131 tomorrow and can then start on thyroid medications.

The clouds should lift quickly.

Just 6 tasty steps

Mr. D. is an amazing 63 year old who had a stroke almost one year ago.

He has made great progress but continues to have trouble swallowing and has had a gastric tube in place for sometime now.

His last swallow study still revealed small amounts of aspiration, so he has been instructed (by a speech therapist) on the Super Supra-Glottic Swallow maneuver to improve airway protection during swallowing.

Here are the 6 steps (I'm not kidding...these are the exact instructions):

1. Take a deep breath and hold it very tightly
2. Take a bite of food or sip of liquid
3. Bear down while continuing to hold your breath
4. Swallow hard with greater effort than usual while continuing to hold your breath and bear down
5. Cough when breathing out
6. Breathe

Believe it or not, its been effective.

I give him all the credit in the world.

I'm fairly certain the same instructions could also constitute a pretty good way to lose weight.

Maybe I should give it a try!

Tuesday, May 22, 2012

Slipping off my soapbox

A 25 year old female with low back pain was INSISTENT on having an MRI done.

She had recently re-started to exercise because she had gained a lot of weight since she left the military a few years ago.

She never previously had trouble with back pain.

I spent a fair amount of time reassuring her (especially after a normal physical exam). She had mechanical low back and did not have any radiating symptoms.

I also spent a fair amount of time talking about the over utilization of x-rays, lifetime radiation exposure, unnecessary MRI's and even threw in some issues such as the cost to society, bankrupting of our health care system, unrealistic expectations of society, etc, etc.

I was on a roll...

After much negotiation, however, we did agree to do plain x-rays, after making sure she wasn't pregnant.

I let her know I would call her with the results (I also let her know that I predicted the x-rays would be normal).

The x-rays revealed a congenital defect of the lower back, degenerative changes and spondylolisthesis.

Although these findings were not the cause of her acute back pain (given the normal physical exam), it was still a call I didn't really enjoy making because she did, in fact, have an abnormal x-ray.

I was really wishing I had not spent so much time on my soapbox!

Monday, May 21, 2012

Fine at attention

A 56 year old male had long standing Erectile Dysfunction (ED).

After multiple other interventions had failed, he finally underwent a surgical procedure by a urologist and had a penile implant placed.

Post-operatively the implant was functioning well but he was not a happy camper.

He felt he had lost some length when erect, compared to "the old days."

"All my life I've been a grower, not a show-er."

He went on to further explain, "I was small when flaccid but looked fine with an erection."

Although I had never heard it put quite that way before, the further details added nothing to his initial description.

I know a lot of men can relate!

Sunday, May 20, 2012

No falling leaves

An assisted living facility has the following information on their website:

"The staff is dedicated to serving residents in the autumn of their lives with dignity and grace."

I wasn't exactly sure what that meant so I investigated a little more.

The Autumn of life is a metaphor which likens ones' life "to the season when the time for planting, growing and flowering is over, when the temperature begins to drop and the days become shorter. The leaves on the trees drop and the natural world edges toward dormancy. It's the time when ones' death is closer than ones' birth."

Now that's an effective metaphor!

It replaces about 50 words with a mere 5.

Since I would like to avoid a long care facility in my later years, when the time comes, I'll need to try and fool those around me that I'm still in the spring of my life, even if it means super-gluing the leaves in place.

Saturday, May 19, 2012

On the brink of insanity

My Brother has decided to have The da Vinci procedure performed for his recently diagnosed prostate cancer.

He's going to come to Orlando to have it done.

A local surgeon, Dr. Vipal Patel has performed more than anyone on record and has an outstanding success rate (he has performed over 5000!).

On his web page there's a chart that compares his statistics vs. "The Average Doctor (and I'm assuming he means The Average Urologist Doctor!)."

He performs the procedure in approximately an hour and 45 minutes.

"The Average Doctor" performs the same procedure in 2 hours and 42 minutes.

That's hour less of anesthesia time is always a good thing!

His average hospital stay is 1.1 days and "The Average Doctor" hospital stay is 1.4 days.

My first thought was big're still going to get charged for 2 hospital days.

On closer analysis, however, it's a difference between 26.4 hours in the hospital vs. 33.6 hours in the hospital.

For anyone who has been a patient in a hospital, I'm sure you are well aware that those 7.2 hours can be the difference between maintaining your sanity or LOSING it.

It's a statistic that's very worthy of bragging rights!

Friday, May 18, 2012

I don't know you?

Last night over dinner my daughter said, "I'm going to go out to dinner tomorrow night with some girlfriends after we finish up at the barn (she rides her horse, Blues, almost every day)."

My son then said, "I'm going to meet some guys for b-ball (basketball) tomorrow night."

He then said, "How come it doesn't sound right for me to say I'm going to meet some boyfriends for basketball."

I couldn't think of anything to say other than "you're right, it doesn't sound right. For some reason, you need to stick with some guys or some dudes."

It just seems to roll off the tongue so much easier and doesn't cause anyone to have any second thoughts along the lines of "what did he just say?"

Thursday, May 17, 2012

Please, pretty please...let me stay home!

I went to a 34-bed Assisted Living Facility (ALF) today to see a patient.

It was clean and the staff were friendly but I had such an odd feeling driving back to the office.

All the patients there were elderly and all looked fairly "lost."

All, during the window of time I was there, were calm and sitting quietly by themselves, watching TV or napping.

While I know many are demented and/or have some other underlying reason for being there (behavioral outbursts, day-night reversal (sun-downing), incontinence, etc.) I just couldn't help but think that many, if not most, also have a family member, somewhere, with a spare bedroom.

It sort of gave me the "heebie-jeebies" and one additional thought: "I DON'T want to end up in a long term care facility when I'm nearing the end of my life on earth."

Wednesday, May 16, 2012

The Big C

My wife had her thyroid removed a week ago for papillary cancer. She's doing great but will need to go through radioactive I131 treatment to help ensure that she will remain cancer free for the years to come.

I just got off the phone with my oldest brother who's 57 years old. He had a prostate biopsy last week and got the results back today. He has cancer and will need to consider all the treatment options available to remain cancer free for the years to come.

Even though it's great to think about the years to come, the Big C also makes me think a lot about the years that have past.

I'm thankful for all the years; past, present and for whatever the future holds.

Tuesday, May 15, 2012

Good till the last breath

Mr. K. is an 88 year old with advanced dementia.

His 83 year old wife is his caregiver.

She's in excellent health for her age.

They've been married for 41 years.

It's a second marriage for both.

She's completely devoted to him and wants him to spend his remaining time, with her, at their home.

She would never dream of or consider nursing home placement (many friends and family have advised her of such).

The things she does for him are amazing. She's amazing. I told her so. I remarked that I didn't know how she did it.

She said, "when you've been married before and been mistreated, and finally end up with a good man, you cherish every moment together. I wouldn't have it any other way. He's just a good man."

I sure hope my wife will be able to say the same about me in my later years...the being a good man part!

Monday, May 14, 2012

Getting a MALS

College graduations are in full swing.

I saw that a friend just graduated with a Masters of Arts in Liberal Studies.

Good for him!

I had no idea what the degree exactly meant, however, so I investigated.

"Typically liberal arts graduate programs are designed to counter the trend in modern education toward specialization and toward a career focus, offering instead the opportunity to explore ideas, to pursue knowledge for the sake of knowledge, and learning for the joy of the intellectual challenge. The Master of Arts in Liberal Studies (MALS) is a graduate degree that aims to provide both depth and breadth of study in the liberal arts. It is by nature an interdisciplinary program, generally pulling together coursework from a number of the humanities and social sciences."

Obviously, the faculty at the colleges/universities offering this masters degree don't think the "trend in modern education toward specialization and toward a career focus" is a good thing.

It seems to me, however, that a high percentage of folks pursuing such a degree must either be independently wealthy, living on a trust fund and/or already have a high paying full time job.

My friend already has a good job.

I think it would be especially hard to be a parent financing your child in getting a MALS "for the sake of knowledge and learning for the joy of the intellectual challenge" without having at least fleeting thoughts as to "why am I paying for this?"

Sunday, May 13, 2012

Happy Mothers Day!

I have a great Mother and my wife is a great Mother to our children.

I know most of you all are able to say the same.

I've come across many men over the years who, for whatever reason, have been estranged from their children, often for decades.

I'm sure there may be some "dead-beat" Mothers out there but I haven't come across many in my life; have you?

Saturday, May 12, 2012

I'm a believer

I've been having neuropathic quality symptoms (burning, pins and needles, shooting pains) in the distribution of the radial nerve in my left arm for MANY months.

I started with an orthopedic consultation.

I then had an emg/nerve conduction test of my left arm and an MRI of my elbow (a common site for the radial nerve to be entrapped).

I then had a neurology consultation.

I was referred for an MRI of my neck and my head.

All the tests were inconclusive and luckily, nothing incidental (an abnormal finding that has nothing to do with what was being looked for) was found.

The orthopedist wanted to operate.

The neurologist wanted me to take medication.

While trying to decide what to do I decided to go to the "Massage Envy" near our home.

After the 1st massage, my arm was at least 50% better.

I've had three additional massages (one a month for the last 4 months) and my arm is now about 80-90% improved.

I'm sold (I even signed up for one massage/month for the next year).

Total charges to date for my medical evaluations: almost $8000.00

Total charges for my 4 massages: $196.00

It might not work for everybody, but it has for me.

Gee...I wonder what I could have done with the extra $7800.00?

Friday, May 11, 2012

That Dang Agent Orange

Between 1962 and 1971, approximately 20,000,000 gallons of chemical herbicides and defoliants were sprayed on South East Asia, predominately Vietnam.

Agent Orange is the code name for one of the herbicides and defoliants used as part of the herbicidal warfare program known as Operation Ranch Hand.

"The goal was to defoliate forested and rural land, depriving the Viet Cong and North Vietnamese Army of cover; another goal was to induce forced draft urbanization, destroying the ability of small farmers to support themselves in the countryside, and forcing them to flee to the cities, thus depriving the north of their rural support base and food supply."

During the Vietnam War, the Da Nang Air Base (south central coast of Vietnam) was a major U.S military base. Agent Orange, and other herbicides were stored and loaded onto airplanes there, as well as at almost 30 other military bases in Vietnam.

Some agencies still report high levels of dioxin in the soil at these former bases, decades later.

The Da Nang Air base is still operational; it's now an International Airport.

I met Mr. R. recently, a 57 year old Vietnam veteran.

He was an airplane mechanic and stationed at Da Nang Air Base, from September 1972, until the US flag was lowered on March 20th, 1973.

He has recently completed treatment for Non-Hodgkins Lymphoma. His treatment was complicated by a stroke and he remains paralyzed on the left side of his body.

Before he got sick he was a welder and a volunteer football and baseball coach for a local high school.

A good site to review on Agent Orange is:

Non-Hodgkins Lymphoma has been linked to Agent Orange exposure.

Thursday, May 10, 2012

Big Boy

I came across an article from a Pediatric Journal.

Parents were asked to rate various terms used by healthcare professionals in discussing their child's "weight problem."

"Chubby," "fat," "extremely obese," and even "obese" were considered unfavorable.

The preferred and most motivating terms (to promote weight loss) were "unhealthy weight" and "overweight."

It pretty much goes without saying that some other descriptive terms including "chunky," "rotund," "pot belly," "hefty," "love handles," "spare tire," "fat boy," or "muffin top" would not be acceptable as well.

The article said nothing about the parents preference for terms to describe themselves because, as is often said, the apple usually doesn't fall far from the tree.

Although a formal study has not been done, I suspect it would still be best to just say "unhealthy weight" and "overweight" for women.

Speaking as an overweight man, however, I take no offense to being called "Husky," "Big Man" or my personal favorite, "Burly."

Go ahead, try it...I'm sure I'll even smile right back at you.

I very motivated to lose weight but I have this one problem...I love to eat and my wife is a great cook!

Wednesday, May 9, 2012

What's so funny? It's just a name!

On the drive back from seeing a patient today in Holly Hills, Florida, I drove past a billboard on I-4 advertising the Emergency Room of Florida Hospital: Fish Memorial.

At the top of the sign was the quote, "Your Emergency is my priority."

It had a picture of a smiling male doctor dressed in a white lab coat and underneath the picture was his name; Dr. Weiner.

Now we all need a name and there's NOTHING wrong with his name, but it's just a little funny.

I couldn't stop laughing (to myself) at the thought of a male coming to the ER for a possible STD and being told, by the triage nurse, that Dr. Weiner will be in to see you shortly.

I checked the hospital web site and sure enough, Dr. Tracy Weiner is on the ER staff at that hospital.

When I relayed the story to my family over dinner (I know...sometimes our dinner conversation might be considered to be a little odd) my son did point out something positive.

"At least his parents didn't name him Harry, Dick or Willy" he said.

I thought, "I wonder if there are any Urologists named Dr. Weiner?"

Sure enough, a quick goggle search confirmed that there were a number throughout the country. I'm sure they've shared a lot of laughs with patients over the years!

Tuesday, May 8, 2012

I hear not'ing (as Sergeant Schultz used to say)

TV advertising obviously helps with pharmaceutical sales.

The advertising executives very effectively use beautiful and happy backgrounds, even while in the midst of discussing many potential serious side effects of the medication, including death.

Listen closely to the commercial for Enbrel for Rheumatoid Arthritis:

While the actors are walking on the beach, fishing, painting and playing with grandchildren, the announcer is talking about the risk for death and/or other medical conditions such as tuberculosis, lymphoma and nervous system disorders.

Maybe it's a good approach for the office...If I smile the whole time I'm talking about all the potential side effects of a new medication,  maybe I won't get asked any additional questions!

Monday, May 7, 2012

Can't judge a book by the cover

There was an editorial in our local paper today due to the recent suicide of, former star NFL linebacker, Junior Seau.

It reminds us that a suicide occurs every 15 minutes-about 34,000 a year.

I'm often reminded about "Richard Cory," a narrative poem written by Edwin Arlington Robinson that was first published in 1897. The speakers are townspeople who admire Richard Cory. It describes a person who is wealthy, well educated, mannerly, and admired by most everyone. Despite all this, he takes his own life.

"Whenever Richard Cory went down town,
We people on the pavement looked at him:
He was a gentleman from sole to crown,
Clean-favored, and imperially slim.

And he was always quietly arrayed,
And he was always human when he talked;
But still he fluttered pulses when he said,
"Good-morning," and he glittered when he walked.

And he was rich-yes, richer than a king,
And Admirably schooled in every grace:
In fine, we thought that he was everything
To make us wish that we were in his place.

So on we worked, and waited for the light,
And went without the meat, and cursed the bread;
And Richard Cory, one calm summer night,
Went home and put a bullet through his head."

Lessons: you can't judge people by their appearance-there's more to a man than what appears on the surface; money can't buy you happiness; we can't always predict or control suicidal behavior; and individuals who we think are at the highest risk are NOT always the ones who actually kill themselves.

And finally, for all who might be considering suicide...It's OK to ask for help. Please ask.

Sunday, May 6, 2012

A good reminder

Memorial Day is this month.

Came across this excellent editorial in The Journal of Family Practice:

It's short but gets an excellent point across: War is an experience that keeps on giving-addiction, divorce and flashbacks.

Saturday, May 5, 2012

No rest here

The more things change, the more things stay the same.

Eleven years ago I wrote an article for Medical Economics on a recent hospital stay:

R&R in a hospital? Surely you jest

After major surgery, the author discovered firsthand why some of his inpatients go downhill.

"Many of my patients over the years have left the hospital in worse condition than when they were admitted. Now I understand much better why they succumbed to the "cascade of deterioration."
Recently I had a total hip replacement due to dysplasia. I was told to arrive at the hospital at 12:01 am on the day of my surgery, to avoid being billed for an additional hospital day. My wife’s parents came to our house to watch our two children, both of whom had the flu. My wife and I got to the hospital at 11:45 pm and were told to sit in the emergency room waiting area until called by the admitting clerk. The ER was packed with people with different ailments, and periodically a rescue squad would pull up outside. At about 1:15, the clerk called us, and I got to my room at approximately 1:45.
A nurse met us on the orthopedic floor. He seemed annoyed that it had taken me almost two hours to get admitted. He completed his paperwork and nursing physical in about 15 minutes and asked me to stay awake because the lab tech would be up soon to draw my blood. After that, he said, I could sleep until 5 am, when it would be time for my shave and body scrub in preparation for surgery at 7:30.
When the lab tech hadn’t arrived by 3:30, I walked to the front nursing desk and was told the tech would be in as soon as possible. At 5:45, I reminded the staff that I hadn’t been given a gown, razor, or scrub brush. I was handed these items and told to take a shower.
At 6:30, the lab tech arrived. She was upset because it was so late and she was going to have to take my blood down to be tested stat. She didn’t wear gloves when she drew my blood, but I decided it wasn’t a good time to remind her about universal precautions.
Minutes later, the OR aide arrived to take me down to pre-op holding. He told me to give my glasses to my wife, even though I protested that I couldn’t see a thing without them. He had forgotten to bring a blanket for the transport stretcher. I was wheeled through the hospital and down the elevator sleep-deprived, cold, and unable to see.
When I squint, I can focus slightly without my glasses. The woman in the pre-op holding slot next to me was yelling, cursing, and being restrained while having an ABG drawn. The man on the other side of me wasn’t responsive and appeared to have an intracranial pressure monitor in place. I could see how frightening this could be to other patients.
The surgery went well. Eyeglasses were allowed in the recovery room, and one of the aides was nice enough to get them for me. I remember how much better I felt when I could see again. I got up to my room about noon. After a while, I told my wife I was fine and suggested that she go home to our kids. The man in the next bed had been operated on the day before. He spent most of the day snoring. I spent most of my time pumping my feet and squeezing my buttock muscles. Despite TEDS and Lovenox injections, I was sure I would develop a DVT without this effort. The same technician as before drew my post-op labs. She didn’t wear gloves this time, either.
My IV alarm periodically sounded throughout the day. Sometimes it would take only 15 minutes for the nurse to reset it so the piercing sound would stop. A nurse came in about 10:30 pm and woke my roommate to see whether he needed anything to help him sleep. He said he hadn’t slept all day, so she gave him a sleeping pill. The snoring restarted. Now he had long apneic episodes. Every time I feared he might be dead, he would let out a loud snort and begin snoring again.
About two hours later, the night shift nurse came by to take vital signs. She turned on all the lights in the room, waking my roommate. She asked whether he needed anything to help him sleep. He said Yes. She gave him another sleeping pill. Shortly after she left, he resumed snoring, with even longer apneic spells.
I was able to catch some short naps, interrupted by the IV alarm. In response to the call button, the nurse would usually yell, "WHAT DO YOU WANT?" She would turn on all the room lights in order to press the alarm reset button. My nearly comatose roommate didn’t notice. An overhead announcement was made at 2 am to let all hospital staff know that the cafeteria would be closing in 15 minutes.
At about 2:30, I was rolled on my side with a foam wedge strapped to my legs. The nurse said she wanted me on my side for about an hour. I didn’t notice that the call button was out of reach. The nurse closed the door as she left. For the next three or four hours, the IV monitor alarm sounded. I couldn’t reach the reset or call button. The staff couldn’t hear the alarm with the door closed. My roommate was unresponsive with his double-dose hypnotics. The room started to seem hot. It was a long night.
At about 6:30 am, the room door opened. The night nurse was getting ready to leave. She was shocked to find that the room temperature was over 100 degrees because the thermostat had malfunctioned. She was also annoyed that my IV had infiltrated. Why hadn’t I called? She didn’t seem concerned that I had spent four hours, instead of one, rolled on my side.
That morning, three air-conditioning troubleshooters weren’t able to fix the thermostat. A single room became available, and I moved in. I saw my previous roommate’s physician making rounds and let him know his patient probably had sleep apnea. I suggested it might be a good idea to discontinue the sleeping pills.
The nurse admitting me to the new room realized that I hadn’t voided since surgery. She said she would be back shortly to in-and-out catheterize me. Motivated by my memories of patients who had had traumatic in-and-out urinary catheterizations, I declined and assured her that I would go on my own. My wife arrived at the same time. After about an hour of concentrating while she made the bathroom faucet drip, I was able to fill the bedside urinal.
My wife stepped out briefly to get some food. Soon afterward, a nursing aide arrived, with a big basin of soapy water and a washcloth. . "Good morning! Time for a bed bath," she chirped, and whipped off my blanket and gown. I told her I could bathe myself, with a little help from my wife, and she left abruptly. When my wife got back to the room, I was still lying in bed naked and uncovered.
The physical therapist came in later. It felt great to get up on the walker. The orthopedic surgeon was making rounds and was happy things were going well. I let him know I was planning to leave the next day. "None of my patients have ever left that soon," he commented. I didn’t tell him I thought I’d feel much safer at home.
That afternoon I started having myalgias, arthralgias, and fever. I was sure I had the same flu my kids did. I was terrified that my surgeon would call in an infectious disease colleague, who would then surely send me for a bunch of X-rays, labs, and cultures. I decided not to let the nursing staff know. My wife gave me a bottle of acetaminophen that I kept handy and out of sight, and I chewed on ice chips before the nurse came to take vitals.
That night was one of my longest ever. The nurse covering my room had never worked on an orthopedic unit. He apologized whenever he turned me in a way that caused pain. He said he’d never had training or instruction on how to do block turns with patients with hip replacements. Through the early morning hours, the smell of everything in my room gave me the sensation that I wanted to throw up. The sheets, towels, soap, and water all had a distinctive objectionable odor.
At 5 am, I called my wife and told her to pick me up when our kids woke. I asked the nurse to call the orthopedic surgeon and tell him that "Dr. Sheahan’s hip is doing great but he has the flu and is going home." When my wife arrived at 8:30, I felt like the cavalry had arrived. Within an hour, I was home in my own bed. One of my partners called in a prescription for antiemetics and analgesics. My rehabilitation went great. At six weeks post-op, my orthopedic surgeon was happy with the results, and so was I.
Hospitals are short-staffed. Nurses seem to spend more time charting than doing patient care. Brief clinical assessments often trigger a series of treatment decisions that may not be in the patient’s best interests. Night shift workers seem to have little regard for the importance of maintaining patients’ circadian rhythms.
My experience has made me an advocate for outpatient treatment whenever appropriate. When hospitalization is necessary, I encourage a family member or friend to stay with the patient as much as possible.
My three-day hospital bill–without the surgeon’s fee–totaled more than $25,000. You would have thought I was staying at the Ritz."

My wife had a thyroidectomy yesterday for papillary cancer. The surgery should be curative but she's sure hoping to come home today. I stayed with her until about 830 PM last night and she sent the following text early this AM: "Someone in here literally every 20 minutes since you left. Room clean at 130 AM, labs at 230 AM, new psycho roomie at 4 AM."

Thursday, May 3, 2012

A "B" to at least the 6th power

I had the immense pleasure of spending time yesterday with a 92 year old male, Mr. C..

His nickname has always been "Buddy Roll."

After serving in WWII, he returned home to Sanford, Florida.

Jobs were very scarce at the time but he persisted until he landed his first job working in a factory that made Brushes.

He married and raised a family and over the ensuing years became a successful Business man, acquired a lot of real estate, was a Builder (built homes, shopping centers and churches) and also enjoyed working as a Barber and school Bus-driver.

He has lived in the same home, that he built, for over 60 years.

All three children graduated from college.

His oldest child, his only son, is still a practicing dentist in Sanford, right next to the shopping plaza that Mr. C. has owned for many decades.

His daughter lives on the same street.

His wife died a few years ago.

He chuckled when I pointed out all the B's in his life ("Buddy," Brush maker, Business man, Builder, Barber, Bus driver).

He reminded me of some other things that didn't begin with a B; Sunday School teacher for 70 years, member of the church choir for the same amount of time, and a church Deacon for over 40 years.

He's pretty much a local legend.

He has a framed picture shaking hands with then Vice-President of the United States, Hubert Humphrey, during a visit to Sanford in the 1960's.

He also had a framed Proclamation from the City of Sanford naming a day in his honor, in 2009, for being a "living legacy of dedication, and an exemplary character as an entrepreneur and a lover of mankind."

He knows he has done "pretty darn well in life,"  especially growing up during a time of racial tensions and segregation, but he also wanted to remind me that he was "fortunate to live in the greatest county in the world."

Wednesday, May 2, 2012

A bothersome leak

We had an interesting discussion today on a patient.

He was a 90 year old who had been given a penile C-clamp by his urologist for urinary leakage and dribbling.

I had no idea such a device even existed (but it makes perfect sense that it would)!

The only problem was that he also had some memory impairment and went almost a full day without removing the clamp (folks are normally instructed to remove the clamp and let the urine drain from the bladder every 2-4 hours).


After a quick investigation, I not only came across penile C-clamps but also J-clamps,  the "Dribblestop", the Drip collector and the Manhood Absorbent Pouch. I was surprised to see that no one seems to be advertising the use of a cork!

Below is just one of the many medical supply stores selling these medieval torture instruments, I mean medical devices:

Men, if you're worried a disgruntled partner might use such a device on you while sleeping, immediately delete this post!

Other than the manly sounding (and painless appearing) Manhood Absorbent Pouches, I think I'll just stick with "Depends" if/when the time comes.

Tuesday, May 1, 2012

Cups of Joe

     I'll start by acknowledging I'm addicted to my 3 cups of coffee every morning.
     However, if you are experiencing possible side effects due to caffeine, known as caffeinism (increase in blood pressure, anxiety, nervousness, irritability, restlessness, headaches, palpitations, and insomnia), it's time to taper by cutting back.

     "Slurped in black coffee or sipped in green tea, gulped down in a soda or knocked back in a headache pill, caffeine is the world’s most popular psychoactive drug.”

     “Without that useful jolt of coffee-or Diet Coke or Red Bull-to get us out of bed and back to work, the 24-hour society of the developed world couldn’t exist.”

     “When the nature of work changed from a schedule built around the sun to an indoor job timed by a clock, humans had to adapt. The widespread use of caffeinated food and drink-in combination with the invention of electric light-allowed people to cope with a work schedule set by the clock, not by daylight or the natural sleep cycle.”

For an excellent review on the history of caffeine, read the article by T.R. Reid in the January 2005 edition of National Geographic (all quotes above are from the article).

For adults, try to limit caffeine to 300-400 mg/day. A typical cup of brewed coffee has approximately 100 mg of caffeine (a cup is 8 ounces and most of us drink out of mugs that hold 2-4 cups).

Learn the approximate amount of caffeine in coffee, tea, soda, energy drinks, sweets and medications ( is an excellent source).

Remember that moderation is still probably the best and healthiest practice.

If you're someone who drinks caffeine all day, now's a good time to start cutting back.