Fast forward 12 years

Today has the potential to be quite good or quite odd.

We will be seeing my father-in-law for the first time in about 12 years.

We aren't exactly sure of all the reasons he became estranged but he has had a long history of dealing with issues of depression and anger since returning from Vietnam (he lost a leg when he stepped on a land-mine on July 4th, 1968).

He only lives a few hours away and we have had his mailing address the whole time. Birthday cards, Fathers Day cards and Christmas cards went unanswered until he re-established contact with my wife about a year ago.

Twelve years ago our kids were ages 4 and 5; I still even had some dark hair.

I know my wife is sort of nervous about the whole thing. I plan to just sit back and be supportive in whatever way possible.

Of course I'll do my best to keep from opening my mouth and inserting my foot; at least that's my plan going into the day.

I can't guarantee it...but I'll try.

To cpr or not to cpr...that is the question

Cardiopulmonary resuscitation (CPR), in reality, is not at all what is portrayed on television. A study done in 1996 on 96 episodes of “ER,” “Chicago Hope,” and “Rescue 911” in which CPR was depicted showed 75 percent surviving in the short term and 67 percent surviving in the long term.

According to most medical studies, the chance of surviving CPR, is at best, about 20 percent and this includes the most favorable group (witnessed in-hospital arrest). Chance of survival is less than 5% for Bystander CPR (CPR performed by someone). A higher percentage has a return of spontaneous circulation with CPR but survival to hospital discharge percentages remain very low. Of the 5% who survive, an even lower percentage are intact of mind and body.

The chance of survival if "shocked (defibrillated)" within 3-5 minutes is much better at 30% (that's why it's become so common to see defibrillators at stores, malls, and athletic events).

So here are a few things to think about:

“If you should die in spite of all medical efforts, do you want heroic measures attempted to bring you back?”

“How do you want things to be when you die?”

“In the event of your death, some patients would like heroic life sustaining treatments. Others do not want such measures. Where do you see yourself in this spectrum of choices?”

Here are my current thoughts: In the event of my death, and as long as I don't have a terminal and irreversible condition and death is not imminent:

Go ahead and try CPR if my death is witnessed while in a hospital.

Go ahead and try CPR if I drop dead out in public and if a defibrillator can be located and used within 3-5 minutes.

Otherwise...I've had a great life and it's been great knowing you!

Now that wasn't so hard after all!

Looked pretty darn good on the surface

I went to see Mr. C. today.

He's 80 years old and lives with his wife in a beautiful, lakeside, senior mobile home park in Leesburg, Florida.

All the lawns were perfectly manicured and the facilities looked great, practically brand new, even though the community was already 17 years old (they were some of the initial residents).

After I was there for awhile I asked, "this sure seems like a great place to live. How did you find it?"

Mrs. C.: We saw an advertisement announcing a new lakeside senior independent-living retirement community where everyone would be friends and everyone would be able to help each other. Well that's a bunch of bunk, I'll tell ya. The reason why all the facilities look so great is because no one ever uses them. It's always too dang hot and were all too dang old. This place is full of old people who need help. When one of us gets sick and needs help the neighbors can't help because they are all old, sick and already need help as well.

I wanted to ask her how she really felt but luckily decided it wouldn't be the prudent thing to do.

I just made a mental note to cross this place off my list for a possible retirement home.

Have fun and be creative to the very end

"The Three Boxes of Life and How to Get Out of Them" is a book published in 1981 by Richard N. Bolles that reminds us all that we don't have to be trapped by the notion that our lives have to proceed in the order of school, work, and retirement (and then, of course, death).

One way to avoid being trapped is to take a "sabbatical" from your career and go back to school for a while. Obviously, for many reasons, this is not always possible or practical.

Another probably more attainable way is to find a way to make your current career more fulfilling and by continuing to make inter-generational connections.

"All of us have creative potential, even if it's not the power to produce great music, scientific discoveries, or literature. Our lifetime of experience can give us unique abilities to contribute to the lives of others, as long as we maintain our mental flexibility and avoid getting set in our ways. We can also inspire others by our own personal narratives, the stories of our lives. By showing others that you refuse to be defined or limited by your age, and by sharing your wisdom with the younger generation, you will become an Age Buster. We can all avail ourselves of opportunities to feel we are making a difference, no matter what our age (Susan Krauss Whitbourne, Ph.D.)."

Now that's some good stuff!

Age breakers

Satchel Paige, who played professional baseball until the age of 59 was quoted as saying, "How old would you be if you didn't know how old you was?"

I love this quote.

I exercise at the YMCA most weekday mornings and in general, it's a more elderly crowd at 5:30 AM.

By around 7 AM many are gathered around a table drinking coffee and discussing just about any topic.

I get to join in for a short time, on most days.

I know many are in the 70's and 80's; even one in his 90's.

David, Tommy, Jerry, Alice, Kathy, Dan and Oscar; to name a few.

They would all make Satchel Paige proud.

"Research has shown that the most satisfied and successful older adults are the ones who don't focus on age, on their physical changes (within reason), or the stereotypes about age that are so prevalent in our society."

They're great role models for remaining younger at heart than their chronological age.

Reference: How to become an Age Buster by Susan Krauss Whitbourne PhD

A great start

My father-in-law had not seen a doctor for many years.

For a good number of years he has appeared to be depressed and anxious (these two diagnoses often go hand in hand).

He finally consented to go in for a check-up last week.

He saw an acquaintance of mine who has been in practice for many years.

It appears that all the right things were said behind closed doors.

He left the appointment in great spirits and has agreed to start on medication therapy, in addition to continued follow-up and counseling.

We've (my wife and I) been relayed small amounts of the details by my father-in-law.

"The doctor told me:"

"It's not your fault you've been depressed and anxious-you inherited the potential for both from your parents."

"You need to stop worrying so much; You need to remember what it was like to be a boy again and have fun."

"If you like sex and your wife likes sex, you should have sex (we did let him know this was TMI (too much information)-but at least he laughed, which he hadn't been doing for awhile, when he said it)."

I've got to give the doctor a lot of credit.

He was able to get a good read on my father-in-law and high-lite things in an easy to understand way for an individual who has had a real aversion to utilizing the health-care system for many decades.

It was an impressive start to a physician-patient relationship.

A looser definition of quit

Mr. O. is a 75 year old with advanced Parkinson's disease.

He said he was an ex-smoker.

Me: How old were you when you quit smoking?

Mr. O.: Lets see, how old was I yesterday (he laughs)?

Me: You quit yesterday?

Mr. O.: Sort of. My son-in-law and I quit about 2 months ago but we've had about 1 or 2 a day since; but none since yesterday. My son-in-law says he completely quit but that only means he quit buying cigarettes-he still bums them off me everyday.

His son-in-law, who was in the room, reluctantly confirmed the information and in doing so was busted since his wife, who was also in the room, had no idea.

Empty nest trial

For the first time since their birth, both of our children (ages 16 and 17) have been away at the same time.

They've been attending a youth group retreat up in North Carolina for the week. They left their cell phones at home so we've had no direct communication with them.

They are due home around midnight tonight.

My wife and I did fine.

Initially, it was quite odd; eerily quiet.

After we got used to the quiet we settled in.

Evening walks helped as well as a few meals out.

It was a good trial run.

As a not so unexpected benefit, our house has been a lot cleaner, our washing machine is not running 24/7 and we barely needed to leave our trash cans/recycle bin at the curb this week because of a significantly less amount of both.

Same categories 34 years later

I came across an interesting article from the New England Journal of Medicine from April 20, 1978 by James E. Groves MD.

The title was "Taking Care of the Hateful Patient."

The author identified 4 types of patients who might fall into this category:

1. Dependent Clingers
2. Entitled Demanders
3. Manipulative Help-Rejecters
4. Self Destructive Deniers

He went on to emphasize that, at times, a single patient may epitomize more than one of these types.

I was in my first year of college when this was published.

Although I suspect such an article would not be considered politically correct and/or published today, it's good to see the more things change, the more things stay the same...certain patients that is.

A good luck hangover

One last post from my visit with Mr. W.:

Mr. W.: I cheated death a few times but none quite like in 1942.

Me: What happened?

Mr. W.: I was supposed to make a training flight (as an Aviation observer) one morning but got rip-roaring drunk the night before and was so hung-over that I couldn't get up in time. When I came stumbling in at around 2 o'clock in the afternoon everyone came up and gave me hugs. I thought my commanding officer was going to faint, he was so pale. "How are you here?" he said, "the plane went down, everyone on board died, we thought you were dead." All I could say was "I'm here, alive and well, want to come give me a slap? I'm so sorry for the guys that died, I should have been on that flight but I was too sick this morning to make it." I still think about it all the time. I was one lucky son of a bitch.

Break-up diamonds

More from Mr. W., the 92 year old retired former Chief Petty Officer (CPO)...

Mr. W.: I accumulated quite a collection of diamond rings over the years; 43 to be exact.

Me: How did you do that?

Mr. W.: Most of the enlisted men looked to me as a father figure. Whenever I would see one of my boys hanging his head I would say, "whats got you so down soldier?" Many times they would tell me they had just broken up with their fiancee. I would then say, "you got the ring back, didn't you?" A lot would say, "I didn't know I was supposed to get the ring back." I would say, "Hell yeah you should get it back. You should get it back and then sell it for whatever you can get for it" and I would always let them know I would be happy to take it off their hands. I even bought one for $10 once."

He had over a twenty year career as a CPO so it works out to about 2 diamond rings/year by my calculations.

Coffee slick

Mr. W. is 92 years old.

He had over twenty years of serving in the Navy (Aviation) and saw combat during WWII and the Korean War. He was still active during the early part of Vietnam but was in an advisory role only.

He was a "slick-arm" Chief Petty Officer (CPO).

I had not heard of this term prior.

He let me know that he had no hash marks prior to obtaining this high rank for an enlisted man.

A hash mark was received for every 4 years of service in the Navy. A "slick-arm" achieved the ranking in less than 4 years.

Because the Navy expanded so fast during the WWII years, a few enlisted men achieved the ranking of CPO in a third of the time required by most pre-WWII CPO's.

He let me know that during boot camp he kept seeing the same men walking around drinking coffee. When he found out they were CPO's, he quickly decided that he would do everything possible to get to the same rank.

A Navy historical web site confirms everything he said.

He was in the right place at the right time and was obviously qualified to be chosen.

The only draw back, history tells us, was that the slick-arm CPO's tended to be younger and less experienced and many, therefore, felt the prestige of this distinguished position fell somewhat during these times.

Mr. W. was much more than a battle tested veteran when he retired.

He also still loves coffee.

It's Father's Day again

My Dad died in 2001.

Of all the life lessons he modeled, I think the greatest was how he approached each new day for what it was; a new day.

He never seemed to harbor/carry over grudges and always seemed to remain positive in regards to life, no matter what financial or health stress he was dealing with at the time.

For any Fathers out there estranged from your kids, reach out to them again.

Say you're sorry or forgive them for any transgressions.

It's been overused but it's still true nonetheless: today is the first day of the rest of your life.

If you're a Father, but haven't really been a Father, re-start now.

Life's short.

Being a Father is a blessing.

No high-school soccer for you...but a job for me!

A local soccer club made an announcement today. The club was granted entry into the Elite Clubs National League (ECNL), widely considered the top youth girls soccer league in the country.

They also announced that any player who joined one of its 14-18 year old ECNL teams would not be permitted to play for their high-school team.

The executive director noted, "the only motivation behind our decision is fear of burnout and the high potential for career-threatening injuries through over training and over-play."

I'm good at reading between the lines. What I heard him say is, "we have been able to create full time jobs for ourselves, in this poor economy, and we want to do everything to ensure our job stability for the foreseeable future. We don't care that we are taking away a time honored tradition of playing for and representing your high-school."

My wife stated years ago that "kids don't ruin sports, parents and coaches ruin sports for kids."

This is just another example.

Frankly, it's pathetic.

Fake weiners and bladders for sale

I usually perform random urine drug screens on patients who are on chronic narcotics to make sure they are not taking other substances of abuse (marijuana, cocaine, etc). In preparing a brief talk on urine drug screens, I came across the following statement in an article that discusses patients who are trying to beat the system (pass the test when they are worried they might/would otherwise fail):

“In situations where observed voiding (the sample is obtained while being watched) is mandatory for the urine collection, urinary collection techniques can be quite sophisticated. An artificial penis with an electronic, temperature-controlled urine reservoir can be purchased online.”

A quick search revealed the ability to purchase the "Original Whizzinator" online.

http://www.thewhizzinator.com/

There's one additional reason for drug abusers to sleep better at night...it comes in either Flesh, Black or Latino colors to make sure it looks authentic while in hand.

I keep thinking I've heard it all...

Going green years ago

On the way to Mr. C.'s house I drove past a shopping plaza and many other homes in the surrounding neighborhood that were painted the same shade of green.

Mr. C.'s home was the same color.

In addition to owning his home, he let me know he owned the shopping plaza and all the other green homes (his rental properties).

At the age of 90, he's a living legend in his neighborhood and a self made success story.

He worked hard for his money over the years and that's why he thought it was "best to paint all his properties the color of money (of course he then let out a well deserved laugh)."

Vision gone, memories intact

Mr. R. is an 86 year old with a remarkable history.

He had a 12 year career in the ARMY from 1944-1956.

When I asked how he choose the ARMY he replied it was "easy." "I get sick with high altitudes (Air Force was out), can't drink all that water (NAVY was out), and I don't like staying in one place for too long (the Marines were out). The ARMY was always on the move-I liked that."

He had two children, by two different women, before he got married for the first time. "You know how it is, some times you just go walking around and you run into someone-that's how both women got pregnant."

While stationed in Germany he had a relationship with "a Fraulein (an unmarried German woman) for about a year and a half. Those were some amazing years. I still smile every time I think about her."

After active duty he owned a portrait studio for many years and then worked as a cook at a local country club.

"It was a rich man's country club but that didn't keep a lot of the women from hitting on me when their husbands weren't looking (he laughs)."

He divorced after 26 years of marriage. He does acknowledge that he was to blame.

He became legally blind a couple of years ago.

He reported that he loves to socialize, talk and meet new people and to sing Karaoke.

I pointed out that maybe he should just go walking around again and see what happens, like he did in his younger days.

He laughed while reminding me that he "would love to go walking around again but then I would have no idea where I was and how to get home because I'm blind."

He laughed again when I acknowledged it was a pretty stupid statement to make on my behalf.

"Thanks for seeing me today and thanks for letting me talk about my past a little...it seems like it was just yesterday."

No disrespect intended

I saw a male recently who served in the Vietnam War and was active duty from 1966-68.

I made a definite mistake when I asked, "you were a Marine, weren't you?"

He immediately, appropriately, re-informed me that he was "still a Marine; once a Marine, always a Marine."

I acknowledged my error and he seemed to accept it.

It wasn't until I was leaving his home that I also saw a Marine bumper sticker on the car in the driveway that read, "Not as lean, but still as mean."

Not really expired

There have been a lot of articles (again) on the question, “Are Expired Drugs Effective?”

Since 1979, drug manufacturers have been required to stamp an expiration date on their products.

In 1985, due to having a large stockpile of drugs (and facing the possibility of having to discard and replace large quantities of drugs), the Pentagon had the FDA conduct a study.

What they found from the study is that 90% of more than 100 drugs, both prescription and OTC, were perfectly good to use even 15 years after the expiration date.

The exceptions noted at that time were tetracycline, nitroglycerin, insulin and liquid antibiotics.

However, the Pentagon stores its stockpile of medications under controlled temperature, humidity, and light conditions. A medicine cabinet in a bathroom is not an ideal storage environment. The best place to store medications is a cool place, such as the refrigerator.

I would never encourage the use of medications that have expired 15 years ago, but many medications, that have been properly stored, don’t need to be discarded immediately after their expiration date.

A refrigerator door answer

Our teenagers (ages 16 and 17) have a number of friends whose family owns a summer beach house or condo.

After all, we live only about an hour away from some amazing beaches.

Occasionally, over the years, they've asked quite innocently, "why don't we have a beach house?"

The door of our refrigerator is a good place to look for answers (because we usually purchase a magnet from wherever we take a summer trip/vacation):

It reveals magnets from New York City, Washington, D.C., Chicago, New Orleans, San Francisco, San Diego, Sacramento, Baltimore, Atlanta, Lancaster, Toronto, Rochester, Rhode Island, Williamsburg, Charlottesville, Yorktown, Las Vegas, Grand Canyon, Hover Dam, Glen Canyon, Zion National Park, Yosemite, Yellowstone, Costa Rica, Jamaica, Lake Tahoe, Hilton Head, Belize, Niagara Falls, New Smyrna Beach, Anna Maria Island,  Marco Island, and Ireland.

Having a beach house/condo is a wonderful thing, I'm sure.

Using the summer to travel to different parts of our country and the world has also been a wonderful thing.

It's our alternative to owning a summer beach house.

An uplifting exchange

I've seen many couples in my office, over the years, with very disrespectful communication.

More than once I've witnessed variations of the following exchange:

Wife #1: Tell the Doctor about your problem!

Patient #1: It's alright, everything is fine.

Me (directing a question to the wife): Is there anything you want to say?

Wife: He can't get it up anymore! It's like a limp noodle! Something has got to be done about it!

Patient #1(with his head down): Yeah, it's been a problem...

That's why the following recent exchange was so nice:

Me: Is everything alright?

Patient #2 (looking at his wife): Can you help explain things to the doctor?

Wife #2: Sure, Honey (looking at her husband and then toward me), his penis seems to have a short attention span lately, especially since he started on that new medication...

By the way, #2 had a much better outcome, with appropriate interventions for erectile dysfunction, than #1...I doubt you're surprised by that.

I wasn't surprised either.

The post obituary blues

An obituary is a news article that reports the recent death of a person, typically along with an account of his/her life and information about the upcoming funeral or memorial service.

Mr J.'s obituary was in today's newspaper.

I was his primary care provider for a few years, many years ago.

I knew him as a very stoic and quiet male who had severe pulmonary fibrosis.

The obituary, as usual, revealed so much more.

He was a first generation American; his father immigrated from China to Maine.

He was one of 6 children.

He grew up working in the family restaurant.

He joined the Marines in 1945 during WWII and transitioned to the Reserves in 1949.

He was re-activated in 1950 and sent to Korea to join up with the 1st Marine Division and was wounded in battle (and was awarded the Purple Heart).

He moved to Florida in 1952, opened one of the first Chinese restaurants (the China House) in Orlando, and raised three children with his wife.

He remained in the restaurant business for 45 years.

After reading his obituary I felt down.

I have experienced this feeling in the past with obituaries on former patients of mine, from earlier in my medical career, when I was less confident in my abilities and did not spend as much time getting to know them on a personal level.

I haven't made this mistake for many years.

I take every opportunity to encourage young physicians to not make the same mistake...the post obituary blues can be avoided by getting to know how unique and interesting your patient is prior to their death; not after.

A milestone birthday and a ladder lesson

Everyday is a good day!

Today has been even better than most.

It's my daughters 16th birthday and my friend Jerry finally re-appeared at the YMCA, this morning, after a prolonged absence due to a fall off a ladder with multiple injuries and complications.

Two important thoughts from these events of the day: #1 seeing children grow up into happy, healthy and responsible young adults is a privilege, the extent of which one could never imagine prior to becoming a parent and #2 avoid all temptation to climb up on a ladder after about age 65 or 70.

The trickle down benefit from the day: I'll get to have a huge piece of the birthday cake my wife baked for my daughter and not feel guilty because of all the extra calories I burned from talking with Jerry this morning!

A dream still within his view

Mr. L. is  68 year old male who was diagnosed with ALS (Lou Gerhig's Disease) in  September, 2009 and is now end-stage (bed-bound).

He's an amazing man and has a great family (2 children and 5 grandchildren).

He knows that his time left is short.

He retired in 2005, at age 62, after a 22 year career in the NAVY and a 22 year career with the post office.

He was also an amazing carpenter, in his spare time. His family reports that most all of the furniture in all their homes was built by him.

The furniture was beautiful.

Within weeks of his retirement, his mother-in-law, a recent widow, moved in with he and his wife due to having advanced Parkinson's disease and remained with them until her death in the summer of 2009.

He and his wife never considered nursing home placement.

Within weeks of his mother-in-laws death, he was diagnosed with ALS.

As I was leaving, I noticed an RV parked along side their home.

His wife let me know that it was always his dream to travel the country together in an RV.

It was a retirement gift to himself, purchased only weeks prior to his mother-in-law moving in with them.

Family commitments and his health have prevented him from fulfilling this one dream but he appears incredibly content-he has a wonderful legacy of strength, character and devotion to family and he can also see the RV from his bedroom window.

A small sign that changed a life

Mrs. R.(the daughter of a patient of mine) drove by a small sign about ten years ago and immediately thought of her niece.

Her niece, Brandi, was 10 at the time and had been unable to play most competitive sports because of severe exercise induced asthma.

The sign announced a summer golf camp for kids at a local golf course, Winter Park Pines.

She called her brother and told him about it and they got Brandi signed up.

She reports Brandi had a natural swing and went on to win many junior tournaments, as well as a state high school team championship and a state individual runner-up title.

She had over 30 college scholarship offers and choose to go to The University of Southern Mississippi.

She just completed her sophomore year and was the top seed for her team.

The small sign and her aunts thoughtfulness sure opened a sea of opportunity for this young woman.

All decisions in life do not have to be complicated

I've seen the movie "Forrest Gump" many times and, like most folks, have a lot of the lines memorized.

One of my favorite quotes is when he decides to stop running back and forth across the country.

"I'm pretty tired...I think I'll go home now (he had run for 3 years, 2 months, 14 days and 16 hours)."

Mr. B. is a 94 year old man.

Some of his statements were "Forrest Gump like."

He's been an ex-smoker for about a year.

How were you able to quit (I was hoping to get some words of wisdom to share with other patients)?

"I was tired of smoking...I decided to stop (he had smoked 2 packs a day from age 14 to age 93; 79 years)."

There was no need for him to add (as Forrest Gump would say), "and that's all I have to say about that."

He was tired of smoking so he quit-it was that easy.