Friday, August 31, 2012

Almost zero growth for a change

Having lived in Florida since 1993, I've driven through some towns with odd names: Cadillac, Christmas, Festus, Frostproof, Early Bird, New York, Sopchoppy, Wacahoota and Two Egg, Florida to name a few.

This past week I drove through Okahumpka, Florida.

How was the town named?

Some quick research shows the name derives from an Indian term for "lonely or bitter waters."

The most recent census in 2010 reports a total population of 267.

The previous census in 2000 reported a total population of 251.

Only 16 people were added to the census in the last ten years!

Maybe that's what the forefathers who named the town planned all along...a town that never grows!

To steal (and alter) a line from a great movie, The Field of Dreams, "If you name it Okahumpka, they will not come."

Or maybe, it's just too lonely there and the water really is bitter!

Thursday, August 30, 2012

Medicines cheesy future?

The Cheesecake Factory and possible ways to enhance medical care in the future seems like an odd combination. Take the time to read the attached article from The New Yorker. It's long but excellent:

Wednesday, August 29, 2012

A rural health food stand

I drove through a pretty rural part of Florida today on my way to see a home-bound patient.

A few miles before the turn-off for her home there was a roadside stand.

The offerings included (there were home-made signs about every 20 feet, for 2 miles, before the stand):

* Tomatoes
* Sweet peaches
* Boiled P-nuts
* Gator jerky

I didn't stop coming or going but had a thought.

If they would make it a Gator jerky sandwich and serve it and all the other offerings with a glass of milk, they would cover all 5 food groups (vegetables, fruits, protein, grains and dairy).

Maybe I'll put a copy of this blog entry into a bottle and toss it out the next time I head up that way and pass the stand.

I'm sure they would really appreciate my suggestion.

Tuesday, August 28, 2012

Confession of a narcotic over-prescriber

I graduated from Medical School in 1985.

Here are some of the reasons I was so accepting of narcotic use for the treatment of chronic noncancer pain (CNCP) starting in the late 1990's.

      * The World Health Organization developed the 3- step ladder for cancer pain relief in 1986 (over time it became widely used for the treatment of all types of pain).
      * A study of 10,000 dying patients published in 1995, in JAMA, in which researchers found that almost half of the patients died in severe pain.
      * In 1998, a working group in Congress was established to examine what role the federal government should play in alleviating pain and in other end-of-life issues.
      * Position statements by various organizations that usually included a summary statement such as: “narcotics are underused and have low addiction potential when used for CNCP.”
      * Numerous CME conferences for catch-up education. No "ceiling dose" for narcotics was emphasized. I remember how impressed I was at one particular case study in which an elderly woman was taking over 1000 mg of morphine/day, for severe DJD,  and remained functional and independent.
      * Mini-fellowships for the treatment of pain became available. In the early 2000’s, a colleague became a "pain specialist" after spending 4 days with a pain team.
      * There was little noticeable support for primary care providers in the early days.
      * Private pain clinics appeared in abundance. For awhile, there were more pain clinics than cash-advance shops or pawn shops around our city.
      * Non steroidal anti-inflammatory (Vioxx, etc) and acetaminophen (Tylenol) scares.
      * Delays in obtaining many complimentary services (PT, pain anesthesia) and the unavailability of many other services (chiropractic, massage, etc.).

So, fast forwarding to now.

A quote by Maya Angelou is very appropriate: “I did then what I knew how to do; now that I know better, I do better.”

The efforts by various authors/educators have been very helpful, including an article this month in American Family Physician: Rational Use of Opioids for Management of Chronic Nonterminal Pain.

The efforts by Physicians For Responsible Opioid Prescribing (PROP) are also greatly appreciated.

One member, Jane Ballantyne MD, a pain specialist from Seattle, WA has stated, “we started on this whole thing because we were on a mission to help people, but the long term outcomes for many patients are appalling, and it’s ending up destroying their lives.”

I now have access to vastly improved pain management services.

As a Primary Care Physician, it feels as if the pain cavalry has finally arrived.

Monday, August 27, 2012

A full day of activities

I recently went to see a patient who was living in an Assisted Living Facility.

In many locations, around the facility, they had the weekly activity calendar.

I grabbed one on my way out.

Here's a sampling of just one day's activities (this is from a Tuesday). I added my thoughts in the ( )'s:

8 AM: Car Detailing (I wonder if folks without a car can join in?)
9 AM: Blood Pressure Checks in the Activity Room (I wonder if they'll be doing an activity at the same time?)
9:30 AM: Coffee Social (it's good to wait until after the blood pressure check)
9:45 AM: Aqua Fitness with Mindy-meet at the pool (good thing they clarified "the pool"-someones tub might have been crowded)
10:30 AM: Stretch and Flex with Myriam-Dining Room 2 (I guess Mindy is still water-logged)
11 AM: Meeting for Residents with Power Chairs (sort of sounds exclusionary to me unless it's just to discuss all the scuff marks on the walls)

1 PM: Wii Bowling with Myriam (seems like a reasonable post-lunch activity)
2 PM: Yahtzee with Myriam (I love Yahtzee!)
2:30 PM: Scrabble with Merry K (can folks with dementia bring a dictionary?)
3 PM: Dominoes with Merry K (sounds like fun!)
3:30 PM: Jackpot Bingo with Myriam (1. Myriam's a busy lady! and 2. what's the jackpot?)
4 PM: BYOB (bring your own booze or own body?)
6:15 PM: Bridge (I sort of remember Bridge games causing some arguments for my parents and their friends from years ago--->see 7 PM activity)
7 PM: Bible Study (to give thanks for the day and to ask for forgiveness for any arguments that may have occurred during the days activities)

Man, I'm ready for bed...what about you?

Sunday, August 26, 2012

I bet it's a lot of fun

I'm usually pretty good with clues...

So after the third car sped past me on the interstate today, with the passengers wearing customes and the cars deck out with slogans and memorabilia, I knew someone was up.

Sure enough, a quick internet search announced that "Star Wars Celebration VI" was taking place in Orlando this weekend.

The site does remind anyone interested that the celebration doesn't have a permanent home-instead it travels around the world to avoid imperial detection (that sure was reassuring!).

It's been a 4 day event with guests including Mark Hamill (Luke Skywalker), Carrie Fisher (Princess Lela), and many others.

Some of the other events include: collectors showcase, fan tables, a costume pageant, Star Wars laser tag, a Star Wars Tattoo Pavilion, and for those consenting adults, a Star Wars speed dating event.

It would have been a fun thing to check out but for probably just part of a day.

"May the force be with those who are attending!"

Time is money

Mrs W. is 95 years old.

She married a younger man 65 years ago. Mr. W. is only 91 years old.

They have had paid nursing aids 14 hours a day, from 8 am until 10 pm, 7 days a week, for the last 4 years.

They also know they are very fortunate because they "only" pay all $10/hour.

They found all their help privately, without the use of a managing service/company. Costs would be close to double what they currently pay if they had.

The math is easy to do-$140/day, $980/week, $4200/month.

They also have the other usual expenses-water, lot rent for their double-wide home, food, medications, etc..

Mr. W. reports to being a worry-wart.

He really "stresses over finances."

He's worried they will run out of money.

It's a valid concern...they report both sets of their parents lived to be greater than 100 years old.

I'll assume they might

My son goes to college next year; my daughter the year after.

"During the first few weeks of college, students, especially freshman, are at highest risk of alcohol-related harm. We see a spike then because anxiety is high, and the rigor of course work hasn't yet taken hold," said Michael Cleveland, researcher at Penn State's Prevention Research Center.

"Every year, college drinking leads to 1,825 deaths among students age 18-25, according to the college task force report to the National Institute on Alcohol Abuse and Alcoholism. Drinking also contributes to 599,000 injuries, 696,000 assaults and 97,000 cases of date rape on college campuses each year."

Man...those are some scary statistics, especially for parents who were sure an alcohol related incident would never involve their child. I can't imagine their grief if/when they have to attend their child's funeral...every parents worst nightmare.

I've got great kids who have made great choices to date. However, I won't pretend that they won't possibly experiment some while in college. I'll emphasize that if they do, I just hope (and pray) they will do it responsibly.

I'd rather assume they might and be wrong, than to assume they won't and be wrong!

Reference: Drinking Spikes As Freshman Taste Freedom At College-the Orlando Sentinel

My daughter and her horse, Blues, are a great team!

Ellie and Blues are going to the National Marshall and Sterling Finals @ HITS-on-the-Hudson in Saugerties, NY September 12th-16th

Thursday, August 23, 2012

My blogic entry for the day

Why have the terms telephonic and telephonically become so popular?

It initially annoyed me (I'm often easily annoyed) but, like most other things that bother me, I'm getting used to it.

"I will get in touch with them today telephonically," announces a co-worker.

"I had a telephonic consult today with the nephrologist,"says one of the nurse practitioners I work with.

"If he doesn't answer the e-mail I sent shortly, I'll try to get in touch with him telephonically," says an office assistant.

Even the sports radio talk show I listen to every morning has a "telephonic coordinator."

I admit that it does sound like a more prestigious position than "telephone answering dude."

It's amazing to think that all the telephone needed was either an "ic" or an "ically."

Maybe, in a few years, others means of communication will join in?

We could send an e-mailic to each other or communicate e-mailically.

Wednesday, August 22, 2012

Wings sure would be helpful

We discussed a patient today who is quite overweight.

The nurse let me know the patient doesn't understand why he can't lose weight because "he eats like a bird."

"That could be the problem," I said, "mature birds eat close to half their body weight in food everyday (baby/young birds are known to eat close to their full body weight in food everyday)."

""Birds are also known to eat all day long."

Everyone briefly chuckled.

The above facts are (pretty much) true.

But you know, even with their daily consumption, I can't remember ever seeing a fat bird, in it's natural habitat, can you?

So if we could just teach our patient to fly, the pounds might come flying off...

Unfortunately, we'll just have to come up with some other weight loss options.

Tuesday, August 21, 2012


A drop down list, in the pharmacy menu, under the title "DIAPERS" exists for health care providers to order different styles of adult absorbent garments/briefs or depends for incontinence.

Most medical professionals have been trained to use alternative terms rather than diapers for the sake of an individuals dignity.

(The most common definition of diaper is an absorbent product worn by a BABY)

I asked why such a term was being used in the drop down menu.

A pharmacist informed me that a lot of hard work went into developing the drop down menu and that the term "DIAPERS" was felt to be the most inclusive given the assortment of styles and sizes to choose from.

I asked a simple question (via e-mail of course).

If/when you are in the latter stages of your life, living in a nursing home, cognitively intact but frail, and incontinent, which would you prefer?

A. For a nursing aid to SCREAM down a hall for a co-worker to "bring me ANOTHER DIAPER for (fill in your name)-he/she just soiled him/herself again!"


B. For a nursing aid to SCREAM down a hall for a co-worker to "bring me ANOTHER BRIEF for (fill in your name)-he/she just soiled him/herself again!"

(Even though I would prefer no SCREAMING whatsoever, I'd have to go for choice B every time)

I haven't heard anything back yet from the pharmacist.

I came across a statement I like from the Health Guide (By Jasmine Schmidt): using an alternative term to diapers is "an important step towards helping the public to perceive incontinence as a medical condition that should be treated with dignity and respect, just as you would with any other disability."

Monday, August 20, 2012

Something special

“To me, there are three things we all should do every day. We should do this every day of our lives. Number one is laugh. You should laugh every day. Number two is think. You should spend some time in thought. And number three is, you should have your emotions moved to tears, could be happiness or joy. But think about it. If you laugh, you think, and you cry, that's a full day. That's a heck of a day. You do that seven days a week, you're going to have something special.”

Jim Valvano, former college basketball coach, 8 weeks prior to his death from cancer in 1993

Sunday, August 19, 2012

Less than 1%

"War is an experience that keeps on giving-addiction, divorce and flashbacks."

Suicide rates among our military men/women are at an all time high.

It's hard to imagine many of the things that these young men and women have experienced.

It's hard for most Americans.

"At any given time in the past decade, less than 1 percent of the American population has been on active military duty, compared with 9 percent of Americans who were in uniform during World War II."

"The result is a military far less connected to the rest of society. Typically when our nation is at war, it's a front-burner issue for the public. But with these post 9/11 wars, which are now past the 10-year mark, the public has been paying less and less attention."

Another reminder: the 24/7 national hot line for ANY service men/women contemplating suicide is 1-800-273-8255 (TALK).

Please help to pass the word.

Reference: November 25, 2011 NY Times: As Fewer Americans Serve, Growing Gap is Found Between Civilians and Military.

Saturday, August 18, 2012

1-800-273-8255 (TALK)

A headline from today's newspaper:

"Army suicides hit 26 in July, doubling June to set monthly record"

An editorial  in a medical journal ( reminds of all of the following:

"War is an experience that keeps on giving-addiction, divorce and flashbacks"

The Defense Department has made suicide prevention a top priority. More behavorial health care providers have been added to front-line units and primary care settings.

"To combat it effectively will require sophisticated solutions aimed at helping individuals to build resiliency and strengthen their life coping skills," said Army vice chief of staff, Gen. Lloyd Austin.

A (24/7) national hot line has also been set up: 1-800-273-8255 (TALK).

Friday, August 17, 2012

No more room at the Coffee House

I went to see Mr. D. recently.

The home is in a nice neighborhood but the grass was about 2 feet high.

A middle aged woman, who was holding a cup of coffee, answered the door.

I said, "hello, are you with Mr. D?"

"I guess you could say that, he's in the kitchen," she said as she turned around and walked away.

Mr. D. was sitting in his motorized scooter, in the cigarette smoke filled kitchen, with the lights off.

As I was starting to sit down another middle aged man appeared.

He said "hey," as he turned on the lights, got a cup of coffee from the coffee maker and walked away.

I could see another middle aged man sitting on the back porch, presumably drinking coffee.

A short time later another middle aged woman appeared from a back bedroom. She saw me, did not answer when I said "hello", got a cup of coffee, turned, walked back into her room and closed the door.

A short time later another younger woman appeared and said "hey" as she also got a cup of coffee from the coffee maker, put in about 4 tablespoons of sugar and walked away.

"That's my daughter," said Mr. D.

It was all a little strange but we still had a good visit.

I noticed both the den and the dinning room had bunk beds but didn't inquire.

I said goodbye and walked to the door.

The first man who had appeared in the kitchen, other than my patient, walked me outside.

"How are you doing?" I asked.

"Hanging in there," he said.

"It seems like you have a pretty busy household here."

He then proceeded to connect all the dots. "The woman who opened the door is my wife. She's pretty stressed out right now. She and I have owned this house for about 15 years. Things were fine when it was just the two of us. The other woman you saw, who probably didn't talk, is my wife's sister. She had a breakdown a few years ago and she and her husband, who hasn't worked for years (the man on the back porch), would have been homeless if they hadn't moved in with us. The younger girl is Mr. D.'s daughter. She's married to my son who's in jail for selling crack. She also has a problem with drugs but seems to be keeping clean lately. They lost their home so she and their 4 children moved in with us also. The 2 girls sleep in the den and the two boys sleep in the dinning room. They started back in school this week. When Mr. D. got sick, he pretty much lost everything and after his wife died of breast cancer, he tried to commit suicide. We told him he could move in with us. It's helped him a lot being around his grand kids. I've just about lost all my savings because I got laid off from my trucking job last year and no one is looking to hire a 56 year old long distance truck driver with a screwed up back. So we've got 10 of us living in this house and no-one is currently working. When our son gets out of jail next month we will be back up to eleven."

I thanked him for filling me in and wished him all the best. I wasn't able to begin to problem solve after such a rapid fire revelation but will contact a social worker for assistance as soon as I get my thoughts together.

Thursday, August 16, 2012

A great team

Mr. O. has advanced Alzheimer's disease.

He and his wife have been together since high school and recently celebrated their 64th wedding anniversary.

Mrs. O. reports that he was always a "man's man, and loved to take care of me and our family. He took real pride in being a great provider, husband and father."

"He was upset when we first moved here (they moved to an Assisted Living Facility over a year ago) but I just kept thanking him for finding us such a great final home. Now he seems to think it was his idea all along."

"I tell him he's the boss everyday...I just make all the decisions now. It works for us."

Wednesday, August 15, 2012

The Munchies

Mr. S. is a 64 year old who has chronic pain and depression and has been on long term narcotics and anti-depressants.

The staff reported he was doing really well lately.

"In what way?" I asked.

"He's more sociable and talkative. He's also snacking all the time on Little Debbie's."

I quickly searched my memory and remembered these exact symptoms from directly observing many college friends and acquaintances from the late 1970's.

Sure enough, Mr. S.'s urine drug screen (UDS) was positive for marijuana.

It's good to know my long term memory is intact but bad for Mr. S. because of the interventions that will need to follow in regards to his chronic pain medications.

Tuesday, August 14, 2012

A pleasant surprise

I've been to a lot of incredibly beautiful Assisted Living Facilities (ALF's) in which the residents, I was visiting, spent the whole time complaining about the facility.

Yesterday, I drove to an ALF I had never previously visited.

It seemed old and fairly plain on the outside and the grounds were neat but by no means as glitzy and fancy as most.

Mr.and Mrs. O. (85 and 82 years old) have lived there for over a year.

They could not stop talking about how happy they were.

Here are just a few of their unsolicited comments:

"The staff is always respectful and friendly"

"They always go out of their way to assist and help whenever asked"

"The food is great"

"We could not be happier here"

It sure was a pleasant surprise. It's the old, "you can't judge a book by the cover."

You notice I haven't revealed the name of the facility. I don't want the word to get around in case my wife and I need a spot there in about thirty years!

Monday, August 13, 2012

Sticking with 500 plus 1

The back-to-school ads are coming on strong.

They present more and more options to young adults every year.

Even buying jeans is getting more and more complicated.

This weekends ad for Levi's now give young men/men the following options: original, regular, regular taper, relaxed, relaxed straight, comfort fit, boot cut, loose straight, slim straight, and skinny.

Ten different styles with ten different numbers.

I like Levi's.

I'm easy; 501's all the way...the original style.

I don't have a clue why any young man would ever want to wear the skinny version!

Wednesday, August 8, 2012

Life changing poor choices

M.E., a local high school principal was recently arrested for driving while intoxicated (DWI).

I know her personally.

She was the principal of our local middle school prior to being promoted.

She's well liked and respected by students, parents and faculty.

I have heard her advise students, at many school functions over the years, to "always try to make good decisions in life."

Unfortunately, she recently did not.

"Life presents many choices, the choices we make (may) determine our future (Catherine Pulsifer)."

I added the (may).

I know at least once I got behind the wheel of my car, when I had had too much to drink, while in college, and drove home. I didn't get caught.

I haven't done it since but my future MAY have been different if I had been or had injured myself or someone else.

M.E. wasn't as fortunate as me.

Tuesday, August 7, 2012

Should I try to be Facebook 'friends' with my teenagers?

If you Google "should parents be 'friends' with their kids on Facebook?" you will come across an assortment of opinions at different sites and discussion groups.

Folks make some great arguments for and against.

Obviously Facebook didn't exist when I was a teenager.

My kids are now 16 and 17 (going into 11th and 12th grade of high school), are great kids and do well in school.

They have some good friends and to date, pretty much across the board, have made excellent choices in life.

We have discussed what is and isn't appropriate for the Internet and we have made sure all possible security measures have been activated.

But, I have not asked to be their 'friend.'

My only reason is that honestly, when I was a teenager, I wouldn't have wanted to be 'friends' with my parents, if a social media existed at the time.

I had great parents and I was a good kid, but I still choose to not discuss all the details of my social life with my parents.

My kids have earned the same right so, for now, I'm not going to ask them.

Enough said, case closed.

I still reserve the right to re-visit the issue when they go off to college however-maybe I'll ask them to just let me look at the pictures!

Monday, August 6, 2012

"I owe you"

Carmen is the caregiver for her father, Mr. V., a 92 year old with advanced dementia.

She lost her husband many years ago to a heart attack, her mother died 9 years ago, and her daughter, grandson and grandsons father also live with her.

Mr. V. is close to total care.

Nobody knows how she does it.

I asked her.

"My Dad was a great father. He was a hard working man (worked for years in the Steel-mill and latter in the Insurance business), a political activist (was one of the originators of the Puerto Rican Parade Committee of Chicago (PRPC)-"group founded in 1964 (and still active) by visionary leaders with the mission of better representation and greater opportunities for the Hispanic community"), and a poet. I always let people know I'm not forced to care for my Dad, I choose to care for him. I'm just trying to repay a lifetime of IOU's from his better years, for everything he did for us over the years."

It would be a better world if a lot more folks felt obliged to repay theirs.

Sunday, August 5, 2012

A sign of the time

In the past men wore fairly big watches and women wore small, dainty ones.

Ever since many women started to wear man-sized watches, many men have transitioned to practically wearing wall clocks on their wrists.

The entertainer Flavor-Flav started things off by wearing a wall clock around his neck as jewelry. I'm sure everyone who attends his gigs always appreciates knowing the time.

Last night my son and I ate at Panera Bread.

I forgot my watch.

Fortunately, I was able to read the time on a mans watch who was sitting on the other side of the dinning area. It was much appreciated.

Maybe she's too worried about her diet?

Recently saw this post, from a friend, on Facebook. While I suspect the author found the worst possible photo of Gillian McKeith (maybe someone snapped the picture immediately after she underwent a colonic irrigation?), it's still sort of an amusing short piece that promotes dialogue.

Some time back I read about folks who practiced a VERY RESTRICTED calorie diet. They hypothesize that they will live longer (we know calorie restricted laboratory rats do live longer). Only problem to date has been the markedly increased risk of osteoporosis and fractures and a markedly decreased libido (sexual drive). That sure sounds like a great way to spend your extra days on earth!

My recommendations for diet tends to be the same as I try to practice everyday-moderation (although I'll be the first to admit I've gone overboard in the past on things like my Oreo consumption).

Saturday, August 4, 2012

"Date Night, Notarized"

A colleague recently sent me a copy of this Joel Stein article from the June 11th issue of Time magazine:,9171,2116121,00.html

It's got some great stuff condensed into one page (the perfect length).

A whole lot of empty courts

I visit a lot of retirement communities seeing patients. Without fail, they all have shuffleboard (also called shovelboard) courts. The full history of shuffleboard is not known but we do know the following:

"The game was played and gambled over by King Henry VIII of England, who prohibited commoners from playing; evidently he did not always win, as the record of royal expenses for 1532 show a payment from the Privy Purse of GB£9, 'Paied to my lord Wylliam for that he wanne of the kinges grace at shovillaborde' -contemporary translation: 'Paid to Lord William, for he won, by the king's grace, at shovelboard' (reference: Masters, James, 1997. The Shovelboard Family History and Useful Information)."

The picture below is a great example of what I usually see:  a beautiful court (s), in a beautiful setting, with no one in sight playing. Maybe all the residents are commoners? I'll have to start asking the folks I see. Maybe I'll also ask anyone I see playing if they have any royalty in their background.

Bad timing

I knew the President was scheduled to be in town yesterday (for a rally speech at Rollins College).

The local newspaper and news show reported "some streets will close temporarily for the President's motorcade."

(The motorcade has two parts: the first is the secure package-usually 2 limousines that are heavily guarded by local law enforcement and the secret service (all cars are driven by professional drivers) and the second part-vans that transport White House staff members and select members of the press, vans for communications, an ambulance and additional police vehicles)

I was out making home visits.

I was approximately ten miles from Rollins College but when I left one home to go to another, ALL the streets in the vicinity were shut down (I was ten miles from Rollins College, but was only about 3 miles from the executive airport where he had flown into bad!).

I tried multiple short cuts and alternative routes but to no avail.

I finally settled in and spent 50 minutes sitting in my car waiting for the motorcade to appear and to pass (a police presence precedes the beginning of the presidential motorcade to clear the way and to block traffic).

I came across some previous articles on the Presidential motorcade. One stated, "it's exciting when you spot a motorcade, but once the initial thrill is gone, well, you find yourself cursing the motorcade's existence as you wait for the long flow of vehicles to pass by."

I can confirm that this is a true statement.

On further reflection, however, given the evil presence in the world, I wouldn't want it any other way. I spent the rest of the day behind schedule but had a good excuse.

Friday, August 3, 2012

It's Friday!

Some quick Maya Angelou quotes:

“I’ve learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel.”

“If you don’t like something, change it. If you can’t change it, change your attitude. Don’t complain.”

“Be a rainbow in someone else’s cloud.”

“Most people don’t grow up. Most people age. They find parking spaces, honor their credit cards, get married, have children, and call that maturity. What that is, is aging.”

“Nothing can dim a light which shines from within.”

And finally, “I don’t trust anyone who doesn’t laugh.”

Wednesday, August 1, 2012

I can't drive anymore?

Obviously, most adults cannot fathom being questioned about their ability to drive safely.

It's stressful at any age, including the very elderly. "American life is built around the car. More than just getting around, driving has an emotional component. It represents competence, independence, and freedom."

Statistics confirm that the absolute number of accidents in the elderly is much lower than the younger population, but the percentage of accidents PER MILES DRIVEN is much greater.

Also it's hard to estimate the number of accidents that occur behind an impaired driver who continued on his/her way, unaware of the commotion that occurred behind him/her.

In Florida, to report a possibly impaired driver, go to the following website:

It's confidential.

"What happens when I send the report in to the department?
Reports are carefully screened by medical disability specialists and forwarded to investigators who work for the department. These investigators make contact with the driver and submit reports on their findings to the medical review section in Tallahassee. Investigators may interview family members, neighbors, or the driver’s physician as part of the investigation. As a result, drivers may be requested to submit a medical report from their physician, or they may be required to report to a driver license office for re-testing if necessary. If the investigator does not find any substance or validity to the complaint, no further action is taken."