Another Big C

The CDC has recommended that every American born between 1945 to 1965 get tested for exposure to hepatitis C, which can lead to liver damage and liver cancer.

There are multiple reasons why those born in this age group are at risk including the sexual revolution and drug use experimentation.

I was born in 1959.

I don't have either of the risk factors noted above but I was in medical school from 1981-1985 and Universal Precautions were not firmly adopted until about 1987-1988. I had many exposures to patients blood and body fluids during the course of medical school and residency training.

Fortunately, I've always tested negative.

The test  for antibodies to hepatitis C did not become readily available until the mid 1990's.

It's estimated that if all baby boomers were tested, more than 800,000 infections would be detected. It's also estimated that 120,000 lives could be saved.

That's a lot of saves!

Huff, The Magic Dragon

Mr. L., a 63 y/o, finally admitted to huffing.

Huffing is a common term used for inhalant abuse.

The staff at the Assisted Living Facility (ALF) where he lives had suspected possible abuse.

I previously went to see him there and he did have glue and computer-cleaning duster products around his room BUT he was also a hobbyist with a room full of electronic parts, old computers and models.

He denied huffing.

I believed him.

Last week he was literally caught by staff members with the straw of the computer-cleaning duster up his nose.

He admitted to a problem.

He didn't even try to convince the staff there was some dust up his nostril that needed to be cleaned.

Like most chemical addictions (difouroethane in computer-cleaning dusters), it's a pathetic way to spend your life.

We will try to get him some help but I'm not sure what the success rate will be in terms of long term abstinence.

If I can't find any data, I'll have to take a straw poll from some addictionologists.

Could have been a costly "No"

In 2002 the Skene's gland in a female, also known as the paraurethral gland, was officially renamed the female prostate by the Federative International Committee on Anatomical Terminology.

I graduated from medical school in 1985.

I've always been proud of the fact that I've kept up with continuing medical education over the years.

I can honestly say I was not aware of this change until today.

I wouldn't have even thought to use a "life-line" if I was on a game show and was asked "is there such a thing as the female prostate?"

I would have said "NO!"

I could have lost a lot of $$$.

Love is in the air

It's love bug season season again. My car looked like the cartoon below after returning from seeing a patient in the Daytona beach area today. The August-September emergence is called the summer generation while the April-May emergence is the winter generation. The adults only have a life span of 3-4 days. The males prefer the larger and heavier females. When coupled the male faces the opposite direction (backwards) and after a courtship of  only 1.5-10 minutes (with no eye contact!) begins copulating. When coupled and copulating they disperse. After dispersing the male dies and the female deposits as many as 600 eggs under decaying leaves or grass before also dying. It's such an odd life cycle. The larval and pupal stage for the winter generation takes 8-9 months (3-4 months for the summer generation) before becoming an adult to have sex for three or four days (or less when they smash into the windshield of your car) before dying. They have had many nicknames over the years: honeymoon fly, kissing bug, double-headed bug, etc.. I think I'll just start referring to them as "CCD" bugs: coupling, copulating and die bugs.

Have you ever spent time punding?

In researching an article on Parkinson's disease, I came across an interesting term: punding. Learn something new everyday!

From the Urban Dictionary-Punding : Punding is human activity characterized by compulsive fascination with and performance of repetitive, mechanical tasks, such as assembling and disassembling, collecting, or sorting household objects. For example, punding may consist of activities such as: - Collecting pebbles and lining them up as perfectly as possible, - Disassembling doorknobs and putting them back together again, People engaging in punding find immersion in such activities comforting, even when it serves no purpose, and generally find it very frustrating to be diverted from them. Punding is the result of dopamine overactivity. It is commonly associated with side effects of drugs used against Parkinson's disease and with the use of methamphetamine (in which context it is known as tweaking), which increases dopamine release and blocks its uptake. In Parkinson's Disease it can be cured by lowering the medication dose, or adding (atypical) antipsychotics, which act by counteracting the effect of dopamine. Punding is also similar to behaviors associated with autism.

Twenty years!

My wife and I have been together since 1989 (groovy shorts and glasses back then!). Tomorrow we will have been married for twenty years. It's a good thing she said yes before my metamorphosis started. I think most guys can relate. I'm a lucky guy!

Just one of many

My son had a club soccer game this past weekend.

I know one of the Dad's from past club teams as well as from our sons playing on the same high school team for the last couple of years as well.

"Is your son looking forward to the high school season?" I asked, knowing our boys are now seniors.

"Justin isn't sure he is going to play this year," said the Dad, "He's got a part-time job and I think he might use it as as excuse to not play this year. He hasn't really wanted to play soccer since the 8th grade but his Mother and I would never let him quit."

"Oh, that's understandable," was all I could of saying at the time.

Afterwards, I thought a lot about what he said.

It just seems so odd or such a foreign idea to me to make your kids do something they don't want to do when it comes to extracurricular activities.

It's got to be hard for a teenager to figure out what his/her passion might be if/when you are being forced to do something you really don't want to do for years.

Actually, it's sort of sad.

Even sadder is that there are probably quite a few Justin's out there, all stuck in the same predicament.

The game of Life

Here are the latest life expectancy statistics for the United States:

Life expectancy at birth: Overall 78; Male 76; Female 81.

We're ranked 38th as compared to other Countries.

Japan is 1st: Overall 82; Male 79, Female 86 but there is some speculation that their data may be faulty (infant death being counted as stillborn, for example).

Regardless, there's not a huge difference among the top countries.

Greece is ranked number 20. Their overall life expectancy is just one year greater than ours at 79.

So what's the point.

Well, occasionally I overhear in depth discussions on how we need to improve the diet of, for example, a 92 year old male.

My viewpoint is that they should probably just continue whatever it is they have been doing up until now.

They have already won in the game of life (expectancy).

If they consume a huge bowl of ice cream every night my advice is simple: Continue to consume a huge bowl of ice cream EVERY night!

It's Elementary

I ran into Jim, a friend, last night.

He and his wife had recently dropped their 18 y/o son off at college and were about 4 hours into their 8 hour drive back home.

Their son called his wife's cell phone.

He left a message before she was able to answer it.

"I've made a mistake, I don't want to go to college here. I feel sick, nauseous. Please come back and pick me up. I want to come home and go to college locally."

"What should we do? " asked his wife.

"Turn off your phone," said Jim.

They drove the rest of the way home in silence.

Jim has been an Elementary School Teacher for over twenty years. He's well versed in dealing with separation anxiety.

Their son called back about a week later. They saw it was him and answered.

"Thanks for not coming back to pick me up," he said, "I think I'm really going to be happy here."

I'm sure Jim and his wife had their best night of sleep in a week.

A Spiritual snooze

In the midst of looking through some hospital records I read a chaplains note that gave me a brief chuckle.

I'm easily amused.

"Stopped by and visited with patient today and said prayers at the bedside together. The patient's theological position was respected at all times and no effort was made to proselytize. The patient was sleeping soundly."

Here's my interpretation: "Stopped by and visited with a patient who was sleeping today and said prayers at his bedside, along with God. I did not wake the patient to ask his faith or try to convert him to my faith. A good time was had by all."

All dried up

I was sworn in today to give testimony in a court proceeding.

The last time I was sworn in was in 1986.

At that time, I could barely speak, I was so nervous.

I have vivid memories of how badly my voice was cracking.

I also remember the waterfalls coming from my armpits.

Neither happened today.

It's one advantage of getting older.

Either my confidence is much better OR my "fight or flight" nerves have down-regulated and my axillary sweat glands are drying up.

Either way, it was a total bonus!

I don't want to be a foreskin!

90 y/o Mr. H. grew up in a household where a lot of Yiddish was spoken.

We talked a lot about his past, including a very interesting social history.

He has had a wide assortment of experiences and, in the midst of our conversation, mentioned he has come across a number of "schmucks" and "menschen" over the years.

A quick check in a Yiddish dictionary, on my return to the office, allowed me to be more informed.

A mensch is a good person, a person of integrity and honor. 

A schmuck is a prick, that portion of one's penis which is cut off during circumcision (the foreskin), a moron, an idiot, an obnoxious, contemptible or detestable person or one who is stupid or foolish.

I'm sure hoping he won't describe me as being a schmuck if any family members inquire how our visit went!

Needed: raiders of the lost art

Mr. K. is 78 years old.

He converted his garage into an art studio years ago and it's pack full of his beautiful drawings-pencil and water color (many framed, others not).

He lost count of the number years ago.

I would estimate easily in the few 100's.

A few years ago he exhibited many for a month at the local City Hall. Many of the drawings are from sites around town.

He's a widower. They had no children. He reports no living relatives.

He mentioned that he suspects whoever buys his house, when he dies, will just throw them all away.

He would love for them to be passed on.

I gave him some ideas on how to try to distribute many of his "master pieces" before he dies.

I hope he will look into some of the ideas.

I'll have a social worker see him to assist as well.

They belong on walls, not a dumpster.

Risky business

This weekend I received a notification (through the mail) from a drug company about a new indication for a medication.

The medication Truvada is now indicated for pre-exposure prophylaxis, in combination with safer sex practices, to reduce the risk of sexually acquired HIV-1 in adults at high risk.

Included in the information was also about a four page list of the side effects and warnings of use.

High risk individuals are defined as those who have sexual partners known to be HIV-1 infected or engaging in sexual activity within a high prevalence area or social network and one or more of the following: inconsistent or no condom use, diagnosis of sexually transmitted infections, or exchange of sex for commodities (such as money, food, shelter, or drugs), use of illicit drugs or alcohol dependence, incarceration, or partner(s) of unknown HIV-1 status with any of the factors listed above.

Wow, that's quite a list.

Honestly, it makes me sort of queasy. Not because I have a problem caring for or treating high risk patients. It's just because my son just turned 18 this weekend and he goes to college next year-my daughter the year after.

I just hope/pray that neither will ever become a high risk individual.

All parents can empathize.

W cubed

There have been a number of recent new articles and reports about a medical condition called Normal Pressure Hydrocephalus (NPH), and other conditions, as being misdiagnosed as Alzheimer's disease.

The reports emphasize that in 30% of the time, doctors get it wrong, saying a patient has Alzheimer's when the patient really does not.

There's a specific treatment available for NPH that helps in some cases.

The big three to remember for NPH are: dementia (memory concerns), ataxia (trouble walking) and urinary incontinence-also more easily remembered by the phrase "wacky, wobbly and wet (W cubed)."

Other conditions include small silent strokes, depression, vitamin deficiency, medication side effects or alcoholism.

This is good stuff to consider and for you to remember...if your memory is still intact!

Happy 84th

My Dad (shown holding his granddaughter, Ellie, in 1996) would have been 84 years old today. He died in 2001. Parkinson's disease adversely impacted a good many of his adult years but I hope I have been able to teach my kids close to the many life lessons he taught us over the years. Probably the biggest was to always treat others as you would want to be treated. He was a very good man.

Aging ink

I had a funny thought today. What will folks, who decided to get so many tattoos, body piercings and hubcaps done when they were young adults, be saying years from now? Sure enough, some cartoons seem to say it all:

Batman and Robin

My son, Tom, is 18 years old today. He just finished the last section of his college application for next year. The superhero days, with his sister Ellie, seems like yesterday:

A picture is worth a thousand words

My daughter has been away since this past Monday.

It seems a lot longer.

It's always sort of sad to meet folks who, for whatever reason, are estranged from their children; often for decades.

I saw Mr. L., a 63 y/o, who has not seen his daughter or son for over 35 years.

He reports he and his wife had an unpleasant divorce.

She had custody and he had visitation rights but a job forced him to re-locate to Florida.

The last few times he saw his kids he felt as if they had turned against him and then days turned into months and months turned into years without any contact.

He had a number of pictures on a wall in his room at the assisted living facility where he now resides due to having had a stroke.

He informed me they were pictures of his daughter.

He found her on Facebook and luckily her pictures were not "blocked" for him to see and copy (some choose not to only allow their 'friends" to see the pictures that are posted).

He got a little teary eyed when he talked about her but he was also smiling while stating what a beautiful woman she is.

They were really nice pictures.

My poo is not worthy?

A treatment which involves the transplantation of human waste, to treat cases of C. difficle infection of the colon, continues to periodically be in the news.

C. difficle overgrowth is a bacterial infection that can lead to severe cases of colitis and has been linked to deaths as well.

C. difficle is usually kept in check by "good" bacteria in the bowel. Problems usually arise when a person is treated with strong antibiotics for an infection in the body. Sometimes the good bacteria are killed and the C. difficle is then able to flourish and cause symptoms.

The procedure involves getting a close relative of the patient, such as a sibling, to donate several days worth of stool. If the sample is negative for certain diseases, it's then mixed with saline to create a liquid feces that is administered through an enema or a colonoscope.

It brings up a question: How would the stool donor feel if he/she is told his/her sample is not acceptable?

A colleague stated he/she would just need to be told that "you're not worth a poop."

Now that's got to be a pretty bad day!

Finally there

My daughter Ellie and her horse Blues are at the Nationals this week in Upstate New York.

They have had an amazing year. They're entering the finals ranked third and 6th in their two events.

Regardless of how they do, it's an awesome accomplishment to be a top ten qualifier in both events.

I've always referred to Blues as our "JC Penny Thoroughbred (he was considered a bargain when we bought him)."

They competed all year long against some "Neiman Marcus Thoroughbreds."

They have been an amazing team since the first time they met and obviously bring out the best in each other.

No price could ever be attached to that fact.

Petite Red

I've crossed paths with some folks named "Big Red" over the years.

All have been tall, burly men with red hair.

I saw Mr. D. in his home recently.

He had old framed pictures scattered around his bedroom.

The first one to capture my attention was a picture of his boat named "Big Red."

"Big Red," I said out loud.

"I named the boat after my wife (who died a few years ago), " he said.

Honestly, my first thought was that he had been married to a tall, full figured woman with red hair.

I then noticed other pictures around the room of him with a VERY petite woman but whose red hair added about another foot to her height.

I knew I was looking at "Big Red."

Her nick-name was perfect.

Day at the Museum

Mr. M. seems to save everything.

He lives alone.

His three bedroom home is packed full of stuff.

It's pretty cool to look around and take it all in.

He's only 9 years older than me, so it brings back a lot of memories: different types of clocks, stereos and turn-tables, records, 8-track and cassette players, different types of musical instruments, black and white and console TV's, etc..

It's all very well organized.

There's plenty of room to walk around.

I wouldn't use the word "hoarder" to describe it all.

"You sure have a lot of stuff in your home," was all I could think of saying.

"My father, before he died, always said my home as like a museum. I've always bought real good quality things and I've always tried to keep them in real good shape. I'm just not sure what will happen to it all when I die because I don't have any children."

"I'm not sure either but you have a lot of history in your home. There has to be collectors or museum curators out there who will really appreciate what you have accumulated here in your home."

"Your dad was right. Your home is a museum."

A white out

Mr. R. could be described by some as being a "grumpster."

He's 92 and he's got a full head of white hair.

He hit me with a few zingers the last time I went to visit him.

My favorite was the following:

"You look as old as I do. What can you possibly do to help me at your age. Can't I be seen by a younger doctor?"

I laughed.

He didn't.

I'm only 52, but in his defense, I also have a full head of white hair.

Double stone planning

I spent some time recently with Mr. and Mrs. R..

They're both in their 90's and have been married to each other for the last ten years; a second marriage for both.

I asked if they had given any thought to end-of-life issues.

Mrs. R. responded, "You bet, it's all taken care of. My ex-husband is buried in Kentucky. When he died we bought a double (head) stone and plot. Mr. R. also has a double stone and plot where his wife is buried near here. Neither of us were expecting to end up married again. We decided when we got married to be buried next to our first spouse. They're both already paid for. There's no reason to spend any more money than we need to spend."

I actually wasn't expecting this answer but it made sense.

The purpose of my question was to inquire about advance directives (living wills, etc.).

It took me a second or two to get my thoughts together to carry on with my initial intended discussion.

Have a great Labor Day!

"A mind always employed is always happy. This is the true secret, the grand recipe, for felicity." Thomas Jefferson

Definition of felicity (added so I'll remember years from now): the state of being happy, especially to a high degree; bliss; a source of happiness

The lucky ones

Connie is a certified nursing aid who has worked for Mrs. L., a 95 year-old, 8 hours/day, 6 days a week, for the last 5 years. She does the daily routine for Mrs. L.: bath, exercise intermittently through-out the day, dress for the day, prepares breakfast, lunch and dinner, oversees medications, runs errands for groceries and to pick up supplies, cleans and does a load or two of laundry, and dresses for bed. She lives in the same housing complex as Mrs. L.. Mrs. L. called her after seeing an advertisement Connie had placed in their club-house. They agreed on a price of $10/hour 5 years ago. Although Connie knows she has earned a raise, she has never asked for one because she knows Mrs. L. is financially strapped. She also takes a lot of pride in her worked and knows Mrs. L. would not be able to stay home without her. She also arranged for a friend to come the one day of the week she's off.

Kesha, also a certified nursing aid, has worked for Mrs. O., a 61 year old home-bound patient, for the last 3 years, 6 days a week, 6-8 hours/day. A "friend of a friend" hooked them up. Kesha refers to Mrs. O. as "Mom." Her daily duties are very similar to those of Connie. They agreed on a price of $10/hour three years ago. Many others have tried to hire her to work for them, but Kesha would never think of leaving "Mom." She arranged for another woman to come in on the one day she isn't there, but only has her do the basics. Kesha is very particular about things like wound care dressings, etc., and only wants to do it herself.

Mrs. R. lives in a retirement community. She's 78 years old and has severe degenerative joint disease. She needs help but can't seem to find anyone she can afford. She has called multiple home health agencies but the lowest price she has been quoted for a nursing aid is $24/hour.

Connie and Kesha don't work for an agency.

The agencies pay their nursing aids about $10-12/hour. They tack on a 50% administrative fee.

That's the part that most folks have trouble paying.

Only a few are lucky enough to have found a Connie or a Kesha.

Go ahead, make my day

A colleague recently started to read this blog.

He sent me a simple note: "Bill, I have to say your blog is amusing, touching, and insightful. I hope you have lots of readers."

All three terms used, in the first sentence, are exactly why I enjoy writing. I enjoy humor, I enjoy reflecting on patient encounters and I enjoy putting these reflections down on paper. The social interactions with patients and the ability to witness how resilient most folks are has always been the most enjoyable and uplifting part, for me, of my chosen profession. It's a privilege.

I can't say the second sentence is true and that's OK. I've always told anyone who enjoys writing to just go ahead and start without having an expectation that anyone will read what you write. If/when they do, and drop you some feedback, however, it's much appreciated.