An added "O"

A relatively new administrative staff member wanted to relay a message.

"Mrs. J just called and said her husband had a colonic seizure earlier today. He has a past history of colonic seizures but hadn't had one for awhile. She wanted to know if he needed to be seen."

I hope she didn't see me smile because she did a good job of relaying the message.

I was curious, however, if she actually thought it was colonic or if Mrs. J reported a colonic seizure instead of a clonic seizure.

I didn't ask but may re-visit it in the future when she's more settled into working here and gets more comfortable with my, at times, warped sense of humor.

He paid it forward

Mr. W adopted a boy who was 2 years old and significantly disabled due to cerebral palsy. His son is now 30 and working full time as an executive chef after graduating from high school, college and culinary school.

Mr. W adopted a girl who was abandoned at age 3 by her drug abusing parents. His daughter is now 35 and has a family of her own.

Mr. W is now 87 and totally dependent, for the last 5 years, due to an unfortunate series of events.

His son and daughter go to great length to help Mrs. W care for Mr. W.

Both have nothing but wonderful things to say about their father and how he went to such great lengths to provide for them despite their less than optimal start.

They let me know they will go to great lengths to help provide for their father in his time of need and to make this stage of his life as wonderful as possible.

Mr. W doesn't say much these days but I'm sure I saw him smile when he overheard this discussion.

Microwave Joe

When asked if he's still preparing his own meals, 91 year-old Joe C. reports that his nickname for many decades has been "microwave Joe."

His daughter either makes meals for him that he can re-heat in the microwave or purchases ready made meals for which he can do the same.

He thinks he might have had one of the original microwave ovens.

He remembers it being called the "Radarange."

Some quick research shows that, in 1967, Raytheon offered for sale the first popular in home countertop microwave oven; the "Radarange."

It sold then for almost $500, close to roughly $4000 in today's dollars.

So it's easy to make a couple of conclusions:

1. Since about age 49 he's been microwave Joe
2. Back then he was rolling in the dough!

Happy tears

Mr. G (name changed). is 87 years old and has advanced dementia.

I saw him recently for a medical evaluation.

His wife is his devoted caregiver and showed me all the many picture Christmas cards of their children and extended families.

They have a beautiful family.

Mrs. G. wanted me to know more about this man who now has great difficulty communicating.

"I married my first husband at age 16 and we had 4 children. He died unexpectedly from a brain hemorrhage. I didn't know what I would do. Rob was a college professor. We fell in love and got married two years later. The kids were all still so young. We've been married for 54 years and he's been a wonderful father. We had a family celebration at our 40th wedding anniversary and everyone wanted us to give a speech. Rob's was short. He wanted to thank two people: my mother for giving birth to me and my first husband for being the biological father of his 4 amazing children. There was not a dry eye in the room that day."

There was still not a dry eye in our room.

Human lameness

I've often been jealous of my veterinary colleagues who get to use the term "lame" to describe a variety of physical illness/diseases that usually afflict older animals.

There's finally a human equivalent: Frail.

Frailty is an important medical syndrome that occurs as a result of a range of diseases and medical conditions. A consensus group agreed on the following: it has multiple causes and contributors and is characterized by diminished strength, endurance, and reduced physiologic function that increase an individual’s vulnerability for developing increased dependency and/or death.

Two commonly used and validated tools are:

The FRAIL tool:

The FRAIL tool asks five questions and those who answer yes to at least three likely are frail.

·         Fatigue: Are you fatigued?

·         Resistance: Do you have difficulty walking up one flight of steps?

·         Aerobic: Are you unable to walk at least one block?

·         Illness: Do you have more than five illnesses?

·         Loss of weight: Have you lost more than 5 percent of your weight in the past six months?

And the Clinical Frailty Scale:

http://cwcg.mcms.org/Portals/0/Guidelines/Clinical%20Fraility%20Scale.pdf

The four things that are currently identified as being able to potentially improve physical frailty include exercise, protein-calorie supplementation, Vitamin D (when low), and the reduction of polypharmacy.

An inordinate preoccupation with oneself?

Here's part of an interesting 2006 article published in the European Journal of Internal Medicine:

"Physical disease as a narcissistic threat. Sigmund Freud, in his landmark work On Narcissism: An Introduction wrote that, when in a state of physical stress such as illness,"the egoism of the instinct of self-preservation" is expressed.

Illness and disease are a threat to a person's integrity. It's therefore, not uncommon for many competent, responsible individuals, when faced with the threat of an illness, to behave in an uncharacteristic manner.

Today, this situation may be compounded by an excessive preoccupation and search for information relating to their symptoms/ illness on the Internet, as well as by the breakdown of relationships, family life and community structure that has been such a characteristic of the 21st century.

All of this may contribute to a feeling of loneliness and alienation in the suffering individual and further engender a sense of need to fend for oneself as well as a distrust of the medical system."

I’m sure this would also pertain to “emotional” disease.

Many folks have very poor social supports in terms of empathy and optimal communication with significant others and have become very computer savvy. 

I can't stop pondering how Freud came up with "the egoism of the instinct of self-preservation" quote in 1914.

Scary smart guy!

Sicker than I thought?

"I'm going to need to have some labs drawn when possible," I mentioned to the nurse as I was about to leave the patient's home.

"Are you a heart stick?" I heard the nurse, who was of Caribbean descent (and still had an accent), ask the patient.

I stopped at the door.

"What, I don't understand," said the patient.

"Has anyone ever told you that you were a heart stick?" the nurse repeated.

"I don't think I've ever had a heart stick," said the patient.

Finally, I interrupted,"She wants to know if you are a hard stick, h-a-r-d...if it's ever been hard to draw your blood in the past."

"Oh...I don't think so. Thanks for clarifying. I was a little worried there for a moment that I might be sicker than I thought."

The balls are still in play

Three Dads (including me) were talking at a Christmas party gathering at my daughter's riding barn.

One of the Dad's had two young children running around.

Another asked him if he was going to have more kids.

"No," he replied, "I'm a Gelding. I used to be a Stallion but now I'm a Gelding."

We all laughed.

We determined that we were now all Geldings.

We shared some more laughs reminiscing about our vasectomies; we even hammed it up whenever our wives came by.

All the way home my wife gave me a realty check.

"At least you only had your tubes cut. Stallions have their balls cut off," she reminded me.

"Yep, you're right," I said while just slightly squirming at the reminder.

One-armed bandits

I hadn't seen Mr. A. for awhile but he just sort of seemed out of it.

He was still in bed when I got to his house at about 10 AM.

He's a 78 y/o male who had a previous major stroke but I was worried he had something acute taking place that was making him so drowsy.

After examining him and looking for signs of infection I relayed my concerns to his wife who had been standing next to me the whole time.

"I'm a little worried about your husband. I'm thinking I might need to run a few tests to try and see if everything is alright," I said to Mrs. A..

"Oh he's OK," said Mrs. A., "he just had an exciting night. We didn't get back from the Hard Rock Casino until a few hours ago. He's just still sleepy. He didn't get to bed until almost 4 AM."

She let me know that he could still play the slot machines without any trouble (his previous stroke had "only" left him paralyzed on one side of his body).

I sure wasn't expecting her comment.

I hadn't mentioned noticing the new handicapped accessible mini-van in their drive-way so I guess Mrs. A. decided not to mention being out so late partying.

I left their home sort of grinning to myself.

Still brings grins

Mr. Farner (name changed) let me know he tricked his wife into thinking he was rich before they married because he dressed well and had a nice car.

He reports that it wasn't until later that she found out his nickname for most of his life had been "All Show, No Dough Farner."

They are now both in the 90's.

I'm sure he has told this story a lot over their 65 years of marriage but hearing both laugh after all these years was still pretty awesome.

A memorable face

On meeting 85 y/o Mr. W. for the first time I said, "it's great to finally put a face to your name."

About 15 minutes later he said, "I gotta ask ya, did my face disappoint you (he laughed)?"

"I'm sorry, why would you ask that," I replied.

He then reminded me of my opening comment.

We both laughed and I decided I could hold off on asking him any short term memory questions for now.

I left laughing at the thought that the same couldn't be said for me.

The Redneck Medical Dictionary-not sure of the origin but it's funny

Medical Term	Redneck Definition
Artery	The study of paintings
Bacteria	Back door to cafeteria
Barium	What doctors do when patients die
Benign	What you be, after you be eight
Caesarean Section	A neighborhood in Rome
Cat scan	Searching for Kitty
Cauterize	Made eye contact with her
Colic	A sheep dog
Coma	A punctuation mark
Dilate	To live long
Enema	Not a friend
Fester	Quicker than someone else
Fibula	A small lie
Impotent	Distinguished, well known
Labor Pain	Getting hurt at work
Medical Staff	A Doctor's cane
Morbid	A higher offer
Nitrates	Rates of Pay for Working at Night, Normally more money than Days
Node	I knew it
Outpatient	A person who has fainted
Pelvis	Second cousin to Elvis
Post Operative	A letter carrier
Recovery Room	Place to do upholstery
Rectum	Nearly killed him
Secretion	Hiding something
Seizure	Roman Emperor
Tablet	A small table
Terminal Illness	Getting sick at the airport
Tumor	One plus one more
Urine	Opposite of you're out

Heartache>toothache

I’ve go a lot of crowding of my teeth.

I still have all 32 teeth and intermittently have trouble with infected gingival pockets.

I’m in the midst of a recent flare-up and was feeling sorry for myself.

Today I saw a 30 year-old man in his home who has an inoperable brain tumor. He was diagnosed 4 years ago.

He’s blind in his right eye, cannot hear in his right ear, has a tracheostomy, uses a ventilator when napping/sleeping because he stops breathing when he sleeps, has significant let sided weakness and is fed through a feeding tube.

His parents and a sister are his caregivers.

He has custody of his 7 year-old son.

He’s responsive, respectfully communicates and wishes to do everything possible to remain alive.

He is certain that his ex-wife will do everything possible to get custody of his son after he dies.

My tooth wasn’t troubling me on my drive back to the office and I am no longer feeling sorry for myself!

DSB

Medical record reviews have consistently shown that 75% of patients who are given a diagnosis of an upper respiratory infection (URI's) and greater than 90% of those given a diagnosis of acute sinusitis leave a medical encounter with a prescription for antibiotics.

This is despite the fact that studies have consistently shown that virtually 100% of URI's and 70% of those with acute sinusitis will improve without antibiotics.

One pediatrician attributes this to drug-seeking behavior (DSB). She also attributes this to the abundance of walk-in clinics that may spend a minute or two with a patient prior to sending them on their way with an antibiotic prescription.

She notes that "when patients don't get what they want from me, they often turn to urgent care clinics instead to get the prescriptions they are seeking."

The pediatrician "shamefully admits to having caved under pressure at times and written a prescription that she didn't feel good about writing."

I admit to the same.

Shame on us and shame on the drug seekers!

I'm not overly optimistic things will ever change in this regard.

It's estimated that one complication from either a URI or acute sinusitis is prevented for every 4000 antibiotic prescriptions written.

Everyone is so concerned about being part of the 0.025% of folks who may have a complication instead of the 99.975% of those who don't.

White and clean?

A recent article in one of our medical newspapers reported that when surveyed, patients still prefer for his/her doctor to appear professionally dressed, including wearing a white lab coat.

I suspect those surveyed may have had other opinions if given additional data.

Many studies over the years have shown that medical personnel change their lab coats very infrequently. In one study, over 50% reported less than once a week. Other studies have shown that many antibiotic resistant bacteria, such as C. Difficile and MRSA, can thrive on a lab coat for a month or two if the coat is not properly cleaned.

I stopped wearing a lab coat years ago for this very reason.

I ALWAYS think of this whenever I see my colleagues who still do.

Poor choice of time?

An advanced stage of brain cancer is never a good thing.

A study recently released showed that those with stage IV Glioblastoma had a median survival of only 6.5 months if they were not given access to the highest level of treatment available that includes aggressive surgery, radiation and chemotherapy.

The median survival in those aggressively treated was still less than 12 months.

Median survival is defined as the time after which 50% of people with a particular condition are still living, and 50% have died. For example, a median survival of 6 months would indicate that after 6 months, 50% of people with that condition would be alive, and 50% would have passed away.

I've seen a few folks who have gone the aggressive treatment route.

I know it's hard to know what any of us would choose in a situation such as this, but I haven't been convinced yet that an increased quality of life is experienced by those you get to have their median survival increased by 5 months.

But those choosing the aggressive route definitely get to spend more money and an increased amount of time in doctors offices and at diagnostic/treatment centers.

I, personally, would pass on aggressive treatment unless the statistics considerably change.

Medications to the rescue!

Mr. B. is a 76 year old with a steady girlfriend for the last 6 months.

"She's a much younger woman (age 66)."

He inquired about what options might be available to allow him to perform intimately again.

I first inquired if they had decided on this together.

"She's ready," he said, "she just told to make sure I got something that would at least let me finish whatever I started."

An uplifting tale (forwarded by my brother)

A 92-year-old, well-poised and proud man, who is fully dressed each morning by eight o'clock, with his hair fashionably combed and shaved perfectly, even though he is legally blind, moved to a nursing home today.

His wife of 70 years recently passed away, making the move necessary. After many hours of waiting patiently in the lobby of the nursing home, he smiled sweetly when told his room was ready.

As he maneuvered his walker to the elevator, I provided a visual description of his tiny room, including the eyelet sheets that had been hung on his window.

"I love it," he stated with the enthusiasm of an eight-year-old having just been presented with a new puppy.

"Mr. Jones, you haven't seen the room; just wait.."

"That doesn't have anything to do with it," he replied.

"Happiness is something you decide on ahead of time."

"Whether I like my room or not doesn't depend on how the furniture is  arranged .. it's how I arrange my mind.  I already decided to love it."

"It's a decision I make every morning when I wake up. I have a choice; I can spend the day in bed recounting the difficulty I have with the parts of my body that no longer work, or get out of bed and be thankful for the ones that do."

"Each day is a gift, and as long as my eyes open, I'll focus on the new day and all the happy memories I've stored away...just

for this time in my life..."

"Old age is like a bank account. You withdraw from what you've put in."

"So, my advice to you would be to deposit a lot of happiness in the bank account of memories!"
  
"I'm still depositing."

  "Remember the five simple rules to be happy:


    1. Free your heart from hatred.


    2. Free your mind from worries.


    3. Live simply.


    4. Give more.


    5. Expect less."

Yum, yum!

I've been seeing a lot of fast food signs recently noting to a bargain on chicken nuggets.

Here's a interesting study to digest:

http://ftpcontent4.worldnow.com/wlbt/PDF/ChickenLittle.pdf

Microscopic examinations on nuggets from two different fast food chains revealed:

Nugget from chain #1: 50% skeletal muscle, with the remainder composed primarily of fat, with some blood vessels and nerve present

Nugget from chain #2: approximately 40% skeletal muscle with generous quantities of fat and other tissue, including connective tissue and bone spicules

This is the answer to why fast food chicken nuggets are often only a $1 if ever asked on Jeopardy!

Eat, sleep and be active

Army Surgeon General Lt. Gen. Patricia D. Horoho recently announced the implementation of the Performance Triad pilot program for the troops.

Healthier soldiers are better soldiers.

The program, at its core, recognizes the importance of adequate sleep, regular physical activity and balanced nutrition on the health and optimal performance of ANY person.

Seems pretty obvious but it's amazing how many us just don't seem to get it.

Marriage Isn't For You

Here's an excellent short article by Seth Adam Smith:

http://sethadamsmith.com/2013/11/02/marriage-isnt-for-you/

I hope I'll offer similar thoughts to my own children down the road...

A genitalogist

A 70 year old male wanted to know if he should go see a "penis-machinist (a urologist)."

He laughed.

So did I.

"My wife used to get upset whenever I would call him a peckerologist, so I needed to come up with another name."

Knowing they are loved

A good friend recently commented, after reading a post in this blog (Home sweet home), that he has always felt guilty about placing his Mother in a nursing home prior to her death.

I completely understand how he's feeling.

My Dad also spent some time in a nursing facility before he died.

I've often felt guilt as well.

Every situation is different.

Not all families have the ability to keep a loved one at home.

Sleep deprivation and other issues (behavioral issues of Dementia-outbursts, impulsivity, loss of social graces, sun-downing, absence of multiple caregivers, etc.) can completely wear the most motivated of caregiver(s) down and render attempts at home care more problematic and dangerous than care in a nursing facility.

My mother spent a considerable amount of time at his facility everyday as did my brother who lived relatively near-by.

Given a multitude of factors however, including the ones mentioned above, keeping my Dad at home near the end of his life was not possible for us.

I'm sure my friends Mother knew how much she was loved, as did my Dad.

This is the most important thing at the end of life.

Staggering statistics

When I was accepted for admission into the University of Virginia (in 1977) 10,000 students applied for a first year class of 2500 students.

Last year, over 30,000 students applied for a first year class of 3500 students.

So, in 36 years, the first year class size increased by 40% while the number of applicants increased by 300%.

Did I do my math correctly?

The application deadline for the class of 2018 was yesterday.

Best of luck to all who applied!

A comedian without even trying

My daughter is a senior in high school and has applied to my alma mater, The University of Virginia (UVa).

I've been following a blog written by an Administrative Dean to keep up to date with the news.
 
Recently there was a letter written in response to a post by a person named Momofahoo.

I made a statement to my daughter about it being such an odd name.

She started to crack up and so did my wife when told.

"It stands for Mom-of-a-Hoo (students at UVa have been called the Wahoos since the early 1900's)," my daughter let me know.

"Oh...I see," I said while they continued to laugh.

It's good to know I keep adding to things to be joked about for the rest of my life.

I suspect my daughter has always wondered how such a goof-ball of a Dad could actually have ever become a doctor!

See one, do one

I recently saw a 33 year-old who needed to be detox'd from street drugs.

I'd never seen him before but was able to assist him in being admitted to a facility for the same.

I had a chance to review his in-depth admission papers recently.

It reported he had started to use and abuse alcohol at age 8, hallucinogens at age 10, opiates at age 16, marijuana and other club drugs at age 17, cocaine at age 19, amphetamines at age 20, and heroin at age 30.

It's possible he was raised in a dysfunctional family and that the apple did not fall far from the tree.

I've often come across parents socially who are disappointed that their children have dabbled in alcohol and drugs at an early age.

They're often "hammered" when voicing their displeasure over the choices their kids have made.

Home sweet home

Mr. H. had a devastating stroke in April.

He's 82 years-old, unable to talk, swallow effectively or move one side of his body.

He's at home surrounded by family pictures and his pet birds.

One of his 4 children is there at all times to assist his 80 year-old wife in his care.

The children are taking turns flying in from other parts of the country and stay 2-4 weeks at a time.

There are no plans for Mr. H. to go to a nursing home.

"Where we are from (a Caribbean island)," says his daughter, "there is no such thing as a nursing home. We take care of our own."

She said this as she was helping to re-position her father in his bed after assisting her Mom in giving him a bed bath.

I'm certain there are a lot of folks in nursing homes who wish they would have been born into this family.

Hiding in the midst of a bunch of other questions

Included in a 70 year-old male's medical records was his military discharge medical exam performed in 1965.

Prior to the physical exam were a series of about 50 questions: While active duty did you suffer from any of the following?

1. Joint pain

2. Trouble breathing

3. Neuritis

4. Homosexual tendencies

5. Visual problems

6. Hearing related concerns

7.-->50. etc.

I suspect the answer to #4, in 1965, was always "No."

The discharge form used these days, obviously, has a different question #4!

Staying put

Mr. M. is 97 years old and Mrs. M. is 96.

They still live independently  in a townhouse with assistance for only 3 hours a day from a home health agency.

They never had children and have been married for 77 years.

Before I could ask they commented that many health care professionals over the years have recommended they move to an Assisted Living Facility.

I decided to not join the ranks of the many.

On my drive back to the office I had just two thoughts:

1. 77 years!

2. Amazing!

Possible reincarnation

Mr. H. has widely metastatic cancer and is under Hospice care.

He and his wife are Paganists; in fact his wife is a Pagan minister.

There are are some excellent web sites on Paganism that review the origins, beliefs and thoughts on death.

One site is:

http://www.patheos.com/Library/Pagan/Beliefs/Afterlife-and-Salvation.html

I'm still a little confused after reading the information available.

I'll just continue to offer empathy.

The Ultimate End-of Life Plan

Nice job by the author:

http://online.wsj.com/article/SB10001424127887324577304579054880302791624.html?fb_action_ids=10202024718245363&fb_action_types=og.recommends&fb_source=other_multiline&action_object_map=%7B%2210202024718245363%22%3A631353013564187%7D&action_type_map=%7B%2210202024718245363%22%3A%22og.recommends%22%7D&action_ref_map=%5B%5D

Not so little anymore

Mr. D. was married to "Big Red (red hair runs in the family)" for over 50 years.

They had 7 children together.

She unexpectedly died before he did.

She spent years caring for him after a devastating stroke.

Their youngest daughter, nick-named "Little Red," is now his caregiver.

She also takes care of her older disabled brother (after an injury), her two high need step-children (both with fetal alcohol syndrome), and her disabled 27 year son (after a severe MVA at age 16).

Her husband helps whenever he can but is out working multiple jobs to provide.

She admits to some tough times emotionally but, in general, appears filled with an incredible sense of gratitude.

I questioned if I could do the things she's doing with my own family, if circumstances ever led to that point, on my drive back to the office.

"Big Red" would be very proud.

A cure for what ails ya!

Mr. M. is my age.

He's been quadriplegic since an accident in 1990.

He was back home after another hospitalization and a close call with death.

He was septic but responded to fluid resuscitation, IV antibiotics and artificial ventilation.

He's back at his baseline.

He still has a glint in his eye, loves to joke and make sarcastic comments and is so looking forward to his favorite outing in the whole (his) world...traveling by electric wheelchair to get Dunkin' Donuts about 1/4 mile from his home.

He's got a better outlook on life than most intact folks I know.

I've been feeling sorry for myself lately due to a lingering cold and a hacking cough for a couple of weeks.

I don't feel that way after my visit with Mr. M.

Hard knocks

I had the pleasure of meeting Joe Auer at the YMCA yesterday.

Joe is a former NFL running back and he's probably best remembered for his 95 yard kick-off return in the first regular season game the Miami Dolphins ever played against the Oakland Raiders in 1966.

He ended up being the Dolphins MVP that same year.

He lives in my town and regularly works out at the "Y."

We briefly talked about the recent NFL settlement for 765 million dollars for the former players and families in regards to information that was reportedly hidden pertaining to the potential long term effects of head trauma and multiple concussions.

Joe played for a total of 5 years and is getting a small NFL pension.

He's now 71 years old.

He has some evident word finding difficulties and he had me introduce myself three times so as to help him remember my name.

I did not ask him the one question I would have loved to ask:

"If you had known about the potential effects of head trauma and concussions, would you have still played nonetheless?"

Like most athletes, I suspect he would have said yes.

Good for business?

The Walgreens near our home now has a Take Care Clinic.

The sign out front advises folks driving by to "come on in to get healthy."

The sign also had the following:

Flu shots now available
Ice Cream 2/$6.00
Lays Chips 2/$3.00
Coke 2/$2.50

Letting go

I'll be honest...having my son go off to college has been harder than I thought.

While our home is a lot cleaner and quieter, I miss being able to talk to him everyday about sports and other things.

I even miss getting annoyed with him about stuff.

I just haven't been able to get my words out.

It's been two weeks and things are starting to feel better around here, probably because we know he seems to be settling in so well.

He weight-lifted this morning before class, went for a run between classes, is planning to go watch the Men's soccer game at 5 PM and then he's playing Ultimate Frisbee from 7-9 PM.

That's my boy.

My daughter's still home for one more year and she's been talking more than ever.

My wife and I are talking more also.

Things are good!

I just wish I could get them both a little more interested in sports.

Life sustaining collapse

It’s an honor, and a history lesson, to get to know WWII Veterans.

We admitted a gentleman today who was a POW and contracted Tuberculosis in the early 1940’s.

Prior to the development of the antibiotic streptomycin in 1946, the only treatment, other than going to a Tb sanatorium for “fresh air and relaxation,” was surgical intervention, including the “pneumothorax technique,” which involved collapsing an infected lung to “rest it” and allow the tuberculosis lesions to heal.

He was treated with pneumothoraces.

He gets easily winded if he walks too far; he has since 1942. 

He turns 93 years old next week.

An uplifting lunch

My wife and I had a somewhat emotional good-bye at about noon Saturday with our usually tough and seemingly self confident son.

He had a difficult week leading up to the start of his first year in College-our family dog of 13 years died the day prior to leaving and he was also being separated from his girlfriend of almost two years. As we left to drive back home he was upset and questioning his decision to enroll. He missed lunch to try and compose himself prior to an afternoon class meeting.

It was a silent ride home for my wife and I.

He texted us at about 250 PM to let us know he was feeling much better.

My wife called him back.

After the meeting he went to get lunch.

The woman at the front register told him the cafeteria was closed to get ready for dinner.

As he turned to walk away she asked if everything was alright.

He said that he was fine but was just hungry because he hadn’t had anything to eat since about 8AM.

She told him to “come on in and get yourself some food."

My wife and I really feel this simple act of kindness played a significant role in helping him through a difficult transition and we are very thankful.

I don’t know the name of the woman, unfortunately, but this simple and kind gesture did not go unnoticed.

Where's the pig sty?

I woke up this morning and things were different.

There weren't clothes and shoes thrown all over the house, all the kitchen cabinets weren't open and there wasn't a pile of dishes all over the place from a late night snack.

Then it dawned on me...we took our 18 year old son to college yesterday.

It's sure a lot cleaner and quieter around here.

I guess this will be the new norm...better get used to it.

Drop off day!

We're driving our son to his first year of college today. He's ready and we're ready. He's a great guy and we're excited to see what his future holds.

Bailey (2000-2013)

Our Beagle, Bailey died early this morning at home. She was an imp and a great member of our family for the last 13 years (this picture was taken about 11 years ago).

A room with family?

Mr. W. is an 85 year-old man who lives in an assisted living facility (ALF).

He has severe dementia but it hasn't stopped him from talking.

His social graces are intact and he gets a sparkle in his eye when being engaged in conversation.

He has errors of commission-he answers a question with an answer that has nothing to do with the question that was asked.

"How are you doing today?" I ask.

"You bet I do. Back when I owned a bar in Hartford Connecticut I pretty much did everything so that's why I have 21 shirts now, all different colors for when I worked for the post office and my wife was having an affair and I only get one egg and a piece of toast."

"Are you happy with the food here?" I then ask.

"Not as well as I used too 'cause I've got one bad ear and I like to walk as much as I can and I had a good bowel movement today and I wish we had a television in our room."

This went on for awhile.

"You have a great day!" I say while shaking his hand preparing to leave.

 "Are you going to take me with you?" he inquires.

"You have a great day also," I respond with my own error of commission.

He had a big smile on his face when I left.

I was sort of bummed on my way back to the office again trying to contemplate why he doesn't have a family member, somewhere, who would open up their home to him.

I think of this frequently whenever I leave an ALF.

No turning back

I saw a patient recently who has a condition called elephantiasis nostras verrucosis (ENV), a rare and unfortunate result of chronic lymphedema (in his case due to excessive weight). His ENV involves both lower extremities as well as his lower abdomen and scrotum. It very unlikely that his condition will improve much, unfortunately. He's miserable and depressed. He rarely leaves his home.  I know he so wishes he could turn back the clock. I wish the same for him.

He has my complete empathy. It's the least I can do.

Up for an alternative?

There's always a free magazine at the "Y" every month (the "Y" doesn't sponsor).

It's devoted to alternative medical therapies.

A lot of former traditional Medical Doctor's have transitioned into alternative care and it still doesn't surprise me.

Over ten years ago I wrote a short article for the local newspaper and my thoughts haven't changed that much:

http://articles.orlandosentinel.com/2003-02-06/news/0302060096_1_shui-traditional-medicine-alternative-treatments

I've got to admit, however, that I would love to be a fly on the wall and watch former colleagues perform Visceral Manipulations, Emotional Freedom Techniques, Detoxifications, and Colon Hydrotherapies. 

Try to be kind

Here's an excellent graduation speech by George Saunders at Syracuse University this past June:

http://6thfloor.blogs.nytimes.com/2013/07/31/george-saunderss-advice-to-graduates/?smid=fb-share&_r=0

They're movin on up

Mr. and Mrs. M. are proud of being simple country folk.

They have thick southern accents and talk real s----l----o----w.

I asked them about their children.

Mrs M. answered.

"The oldest lives up in Pennsylvania with his family...he's a nuclear engineer. My oldest daughter lives a few miles from here with her family... she's a family nurse practitioner. My youngest lives in the next town over with her family...she's a pharmacist..she's head of the pharmacy at the regional hospital."

To be completely honest, I wasn't expecting that answer.

It was awesome!

Their song

Nearing the end of my visit I had concluded that 83 year-old Mr. E. and 75 year-old Mrs. E had a very poor quality of life.

I didn't verbalize my thoughts.

He's been bed-bound and poorly responsive for a couple of years, after a series of devastating strokes, and she's been his devoted caregiver 24/7.

He spends his days in a hospital bed.

She sleeps in a single bed in the same room in case he needs anything during the night.

Their bedroom was filled with his medications, creams, diapers, and pads.

"Can I show you something?" she asks.

"Of course."

"Honey, honey (she says as she gently shakes her husbands shoulders until he opens his eyes), I love you..."

"A bushel and a peck and a hug around the neck," says Mr. E., as clear as day.

"Why are you the luckiest man in the world?" she then asks him.

"Because I'm married to you," he says with a slight grin.

Mrs. E. smiles as she strokes his hair while he closes his eyes and drifts back off to sleep.

"That was really great," I say, " thank you."

"Oh it's just something we've done since we were married," she says.

They recently celebrated their 55th wedding anniversary.

It was also another excellent reminder for me to not be so quick to judge a persons quality of life.

Better know these facts!

Here’s an interesting study from Spain:

Asking patients two questions: “How old are you?” and “What year were you born?” had a specificity (the probability that a person not having a disease will be correctly identified by a clinical test) of 97.8% and a negative predictive value of 98.9% in helping to rule out dementia.

(Reference: JAMDA, Volume 14, Issue 8, August 2013)

I just quizzed myself and passed...phew!

Mom, Dad?

I went to an excellent talk today.

It was part 2 of a series on taking care of transgender patients.

He presented many terms used by the "trans" community but never mentioned the term transvestite.

I inquired.

He let me know that the politically correct term to use now was "cross dresser," since the term transvestite was usually used, in the past, to describe men who dressed as women and who usually also had sexual fetishes.

He reported that there is a large group of men and women who simply enjoy to dress as the opposite sex occasionally and who often gather socially to discuss clothing, make-up tips, etc. with each other and then return to their families and their gender correct roles as husbands, wives, fathers and mothers.

It's all sort of bizarre, but it was some interesting information nonetheless.

Mirror, mirror on the wall

Narcissism is characterized by extreme egocentricity, vanity, pride, and an excessive focus on meeting one's own needs, even at the expense of others.

Here's an interesting study that looks at a possible correlation with watching reality TV shows and increased narcissistic traits:

http://www.medscape.com/viewarticle/805064

I enjoy some reality TV shows such as Survivor and The Amazing Race.

It's time to do a little self reflection...

I just can't reflect too long since I'm going to watch the final episode of The Bachelorette with my daughter tonight in about 1/2 hour!

My back hurts-make it stop!

Here's a brief article on back pain and the needless diagnostics that are often performed:

http://www.sciencedaily.com/releases/2013/07/130729231551.htm

Diagnostics for back pain (without worrisome clinical findings) are very similar to antibiotics for viral infections-patients can't stop demanding them and many health care providers can't stop ordering them.

Unfortunately there's not an easy solution for both!

Same ol' results!

I went to the driving range two days ago and hit great.

I was thinking, that at age 53, I had finally mastered the secrets of the golf swing.

I played 18 holes today and played horrible except for the last three holes (3 pars).

Nothing new; the story of my life in regards to golf.

Funny thing, however, is that the last three holes will probably be all I will choose to remember and the good memories are sure to bring me back for another day.

Now if I could just figure out why I played so great on the last three holes...

Maybe next time...

3-in-1

Mr. and Mrs. S. have been married for 61 years.

Although Mrs. S. was not Catholic (Mr. S was) they went to Catholic church, as a family, throughout their marriage and their children were brought up in the Catholic church.

She never took part in the Sacrament of the Eucharist-Communion.

When she was in her 70's she decided to join. She reports being Baptized and going through First Holy Communion and Confirmation all on the same day.

It was a busy day and she reports to being a little embarrassed, "with everyone watching," since it was Easter Sunday.

She laughs when she says she suspects the Priest wanted to make sure she didn't change her mind.

A protective eye

Mr. and Mrs. S. are both 80 years old.

They were in a terrible accident a little over a year ago.

They were told they should have died.

They escaped with relatively minor injuries.

Mrs. S. wasn't surprised.

They have had a turkish evil eye hanging from their car rear view mirror for many years.

I'm really happy it worked for them!

"Attempts to ward off the curse of the evil eye has resulted in a number of talismans in many cultures. As a class, they are called "apotropaic" (Greek for "prophylactic" or "protective," literally: "turns away") talismans, meaning that they turn away or turn back harm."

Ashes of "T (ime)"

Is it Chihuahua or Chiwawa?

I can never remember.

Regardless, Mr. and Mrs. L., who are both in their 90's, have had a number over the years.

They all had names that began with a "T."

When last at their home I met Toby.

When I returned for a second visit, Toby was no where in site.

I inquired.

He had recently died.

Mrs. T. then asked me to follow her to the fireplace mantle.

There sat a picture of Toby next to an urn with his ashes.

Next to Toby's picture was a picture of Tina with a small urn, that was next to a picture of Tiny with a small urn, that was next to a picture of Tubby with a small Urn and that was next to a picture of Trixy with a small urn.

It's quite a memorial.

A wonderful tribute to an incredibly faithful breed of man's best friend.

Mrs. L. let me know that they aren't planning on getting another due to their age.

I sort of bet things might change if/when someone happens to show up at their home with a Chihuahua puppy.

Hopefully, if that happened, they would be able to come up with another name starting with a "T."

A 1/2 page summary

The CDC recently released a 50 page article entitled, "The State of Aging & Health in America 2013:"

http://www.cdc.gov/features/agingandhealth/state_of_aging_and_health_in_america_2013.pdf

For those who want to save some time here's a brief summary:

Get Screened (when clinically appropriate)-less than half of men and women aged 65 years or older are up-to-date on preventative services

Get vaccinated

Be Physically Active

Eat Fruits and Vegetables Daily

Quit Smoking

Take Medication for High Blood Pressure if needed

She's outstanding in her field

I was looking over a resume today and the applicant stated, on a cover letter, that she had a panoply of experiences that would make her a great fit for the position.

Most define panoply as "a wide-ranging and impressive display or array; a magnificent or impressive array."

I had to look it up.

Good word.

It's great to know she thinks so highly of her past work experiences.

A wild and crazy couple

My wife and I did something we had never done before last night while out on a date at a restaurant we had never been to before.

We felt pretty sneaky and very risque.

We're not sure if anyone noticed but since we were feeling so bold we didn't even care.

We...walked out after looking at the menu and the prices (we were already seated and had already been served water).

It seemed like a normal restaurant and not too fancy but we couldn't help but wonder if the owner previously had an establishment in South Beach.

Everything was expensive and a la carte.

The least expensive item was a hamburger-it was $24.00.

A side order of fries was $6.00.

We went to Five-guys instead.

We went home full and with a lot more money left in our pockets.

Oops!

It always amazes me how many patients report that their narcotic medications accidentally fell into the toilet.

I get a kick out of thinking they actually expect me to believe that they precariously perched their narcotics on the edge of the toilet hoping they wouldn't fall in.

A colleague recently sent me a note on a short article that outlines factors involved in prescription abuse.

One is that the provider falls for the hydrophilic medicine excuse when the patient states the medications fell into the toilet, sink or any other container containing water.

I won't say I've never been duped by it but I usually let certain patients know that lightening can only strike once in regards to narcotic medications.

Fool me once...

Compliments always appreciated

Mr. and Mrs. S. have been married for 71 years.

He's 93 and she's 92.

They met in their high school home room.

"What was the first thing he said to you?" I asked.

He said, "Hello Blondie. I really like your hair. He was always so complimentary before we got married but not so after marriage. A woman has to wait a long time for a compliment after she's married."

I obviously struck a cord.

She also has significant caregiver stress.

He developed Dementia a few years ago and she's cognitively intact.

I did let her know I would have our social worker talk to her about looking into some respite care in the home.

I also made a mental note to be even more complimentary to my wife of 21 years.

Always open

I went to a pretty rural section of Central Florida yesterday to see a patient.

Within a less than 10 mile radius I passed three churches:

1. Open Door Bible Church

2. Open Gospel Bible Church

3. Open  Book Bible Church

It seemed like a great place to live.

The folks there are well covered.

They can walk through an Open Door of any Church and hear the Gospel from the Book.

I wonder if that's what the churches had in mind all along?

One busy dude

A new patient had a thick medical file.

Unfortunately, he had also been Baker Acted (admitted to a psychiatric facility against his will due to an acute emotional decline) a few times over the last year or two.

In looking over the records, on every admission LEO was involved:

"After being seen by LEO, he was Baker Acted;""LEO was notified and he was Baker Acted;" "the family called LEO and then he was Baker Acted."

LEO seemed to be available 24/7.

WHO WAS LEO?

I hate asking stupid questions of co-workers so of course I goggled "LEO and Baker Act," and up popped the answer to the identity of LEO:

" A Law Enforcement Officer (LEO) is usually involved to help carry out a Baker Act..."

Time keeps on slippin', slippin', slippin' into the future...

Mr. and Mrs V. have a strong desire to stay at home.

She's 97 and he's 93 years old.

They live in a mobile home park and three different residents, of the same park, rotate shifts to help care for them 24/7.

Connie, a next door neighbor, helps to coordinate everything.

The day and evening shift (from 8 am until 10 pm) get paid $10/hour and the night shift (10 pm-8 am) makes an even $25 (for the shift to sleep in their home and be available for emergencies).

It's $165/day, approximately $4950/month and about $60,000/year for their 24/7 care.

They're rapidly going through their life savings.

They been given other options.

However, they love their home and don't want to think about moving.

I don't know which will run out first; their time or their money.

Music for romance

Mr. C. has been sick for awhile.

He lost a lot of weight but his wife knows he's starting to improve.

"How do you know?" I asked.

"Two reasons, " she stated, "he recently started to play his guitar again, which he hadn't wanted to do the entire time he was ill, and his penis is starting to grow and get hard again. It was shriveling up while he was ill. We're both glad to see it starting to come around again (She grinned)."

He's 82 years old and they've been married almost 60 years.

I think her clues to his recovery are probably as good as, or much better than any sophisticated medical test could possibly be.

Independence Day 2013

• The American Revolution was a beginning, not a consummation-Woodrow Wilson
• This nation will remain the land of the free only so long as it is the home of the brave-Elmer Davis
• If our country is worth dying for in time of war let us resolve that it is truly worth living for in time of peace-Hamilton Fish

The most beautiful legs in Trinidad

Mr. T. met his wife in Trinidad.

He was stationed there while in the Navy and she had recently moved there from St. Vincent for a job.

They dated only a few months before they eloped.

They report neither knew each others age until they filled out the marriage certificate.

It was only then that they realized he, at age 20, was seven years younger than her.

"She had Betty Grable legs...she was so beautiful...I wasn't going to let anything get in the way of getting married. When I left for boot camp my mother told me to bring back a souvenir from wherever I ended up. She was my souvenir."

They married 64 years ago (he's now 84 and she's 91).

She was wearing long pants.

I admit I was curious (to see her legs) but didn't ask!

Excavation

During the question and answer period, an individual asked why it seemed the transgender surgery for male to female was so much more advanced (and successful) than the transgender surgery for female to male.

I'm sure it wasn't the first time the speaker had been asked this question but he gave a thoughtful pause before answering, "frankly, it's much easier to make a hole than a pole."

Most of the audience nodded in agreement (and did a good job of not laughing too loudly).

I'm a cissy!

I went to a talk today on working with transgender and transsexual patients.

In the midst of many definitions, I found it interesting to learn that if a person's self perception of their gender matches the sex they were assigned at birth they are now, from a research standpoint, being called a cisgendered individual.

The good old days...

This was forwarded to me: For those of you born between 1930 - 1979: First, we survived being born to mothers Who smoked and/or drank while they were Pregnant. They took aspirin, ate blue cheese dressing, Tuna from a can and didn't get tested for diabetes. Then after that trauma, we were put to sleep on our tummies in baby cribs covered with bright colored lead-based paints.  We had no childproof lids on medicine bottles, Locks on doors or cabinets and when we rode Our bikes, we had baseball caps not helmets on our heads. As infants & children, We would ride in cars with no car seats, No booster seats, no seat belts, no air bags, bald tires and sometimes no brakes. Riding in the back of a pick-up truck on a warm day Was always a special treat. We drank water >From the garden hose and not from a bottle. We shared one soft drink with four friends, >From one bottle and no one actually died from this. We ate cupcakes, white bread, real butter and bacon.. We drank Kool-Aid made with real white sugar. And, we weren't overweight. WHY? Because we were Always outside playing...that's why! We would leave home in the morning and play all day, As long as we were back when the Streetlights came on. No one was able To reach us all day. And, we were O.K. We would spend hours building our go-carts out of scraps And then ride them down the hill, only to find out We forgot the brakes. After running into the bushes a few times, we learned to solve the problem. We did not have PlayStations, Nintendo's and X-boxes. There were no video games, no 150 channels on cable, No video movies or DVD's, no surround-sound or CD's, No cell phones, No personal computers, no Internet and no chat rooms. WE HAD FRIENDS And we went outside and found them! We fell out of trees, got cut, broke bones and teeth And there were no lawsuits from these accidents. We ate worms and mud pies made from dirt, And the worms did not live in us Forever. We were given BB guns for our 10th birthdays, Made up games with sticks and tennis balls and, Although we were told it would happen, We did not put out very many eyes. We rode bikes or walked to a friend's house and Knocked on the door or rang the bell, or just Walked in and talked to them. Little League had tryouts and not everyone made the team. Those who didn't had to learn to deal with disappointment. Imagine that!! The idea of a parent bailing us out if we broke the law Was unheard of. They actually sided with the law! These generations have produced some of the best Risk-takers, problem solvers and inventors ever. The past 50 years have been an explosion of innovation and new ideas. We had freedom, failure, success and responsibility, and we learned how to deal with it all. If YOU are one of them...CONGRATULATIONS! You might want to share this with others who have had the luck to grow up as kids, before the lawyers and the government regulated so much of our lives for our own good .

Flights to honor

Honor Flight is an organization whose mission is to take WWII Veterans to the WWII Memorial in DC.  There are Honor Flight hubs across the country and I urge you to look into whether there is a group in your area.   

The national web site is:  http://www.honorflight.org/

You don't remember, really?

The Centers for Disease Control and Prevention is urging Hepatitis C testing for all Americans born between 1945 and 1965, as new data indicate that the baby boomers account for the largest proportion of cases yet are largely ignorant of their status.

“The take home message from the report is that you may not remember everything that happened in the 60’s and 70’s, but your liver does,” said CDC Director Thomas Frieden at a press conference.

Who knew the Director of the CDC had a sense of humor?

I think the quote could have said "the take home message from the report is that you may not want to remember everything that happened in the 60's and 70's..."

Only a nonagenarian

Mrs. C. comes from some good stock.

She's currently 82 years old, the youngest of 4 children.

She has a brother who's currently 96, and two sisters ages 86 and 87.

Her Grandmother and Grandfather, who lived on a Greek island, lived to be 113 and 114 years old, respectively.

Her Mother lived to be 108 years old.

"My dad died young...he was only 93."

She didn't smile or laugh so neither did I.

Longevity is a pretty serious topic in her family.

I couldn't help but wonder...maybe her Dad was a smoker...I didn't ask.

"Sea" what happens when you stay at home

Mr. C. loved being in the Navy.

After almost 7 years he was a ME (Metalsmith)-3 and trying to decide if he should stay in for a career.

(A Metalsmith was a U.S. Navy rating established in 1948. ME's performed the metal work necessary to keep all types of shipboard structures and surfaces in good condition. They also maintained shipboard plumbing, sanitation systems, repaired small boats, and maintained the ballast control systems.

In 1957 ME's were redesignated as Shipfitters.)

His first daughter was born while he was at sea.

When he came home she was almost 1 and "cried at the site of me because she thought I was a stranger."

He decided then that he preferred to be a family man so he separated when his time was up.

He went on to a very successful furniture making business.

He even reports doing the waiting room sectional sofas for both Bob Hope and Michael Jackson.

He has no regrets.

He feels like he made the right decision.

He's been married for almost 61 years, has 6 children and a combined 35 grand and great-grandchildren.

He's a family man for sure.

One of the amazing WAVES

Mrs. V. was part of the WAVES (Women Accepted for Voluntary Emergency Services) in WWII.

The official name was the U.S. Naval Women's Reserve, but the nickname of the WAVES stuck.

She was 25 years old at the time and, due to her previous education and training as a school teacher, was put in charge of running the women's living quarters while stationed at the Naval Training School in Georgia.

She served for 2 and 1/2 years.

She's now 96 years old and crippled with arthritis but is still very quick witted.

Once she got rolling, it was one funny or sarcastic comment after another.

I was cracking up and she had a satisfied smirk on her face.

The presence of women in the military was very controversial in the 1940's and many, even though they were performing vital duties at home so as to free up men to fight overseas, were subjected to ridicule and crude remarks.

I suspect her wit and sarcasm served her well back then and that many men left an encounter with her with the short end of the stick.

I would love for my daughter to spend some time with her.

We need to talk

Here's a well done video on how to deliver important (often bad news) to a patient or to loved ones:

http://www.youtube.com/watch?v=7kQ3PUyhmPQ

Probably the biggest take home points for me were the reminder that up to 70% of  human communication is nonverbal and the importance of ask-tell-ask.

Transcatheter Aortic Valve Replacement (TAVR)

Mr. H. (at age 92) is planning to have a TAVR procedure performed for critical (and very symptomatic) aortic valve stenosis.

The attached 2-minute video reviews how the procedure is performed:

http://www.youtube.com/watch?v=csxJYTLXNJY

It’s a procedure performed for patients who are not necessarily a candidate for an open aortic valve replacement due to age, frailty and underlying medical problems/co-morbidities.

As with many other procedures that are being performed on our elderly population (left ventricular assist devices, ICD’s, etc), the TAVR procedure is not without controversy. Below is one blog site that comments on the same:

http://www.geripal.org/2012/08/tavr-life-prolonging-and-palliative-or.html

Too easy?

Electronic cigarettes continue to be very controversial.

I completely agree with ALL attempts to not allow children/teenagers to have access to them.

I always try to make sure patients are aware of the controversies, along with the current FDA and other Federal warnings.

However I will, off the record, admit to being amazed at observing patients of mine who were smoking 2-3 packs of cigarettes a day being able to transition completely to the E-cigarette.

While the jury remains out as to their safety, without fail, the patients and the family members are thrilled, and in general there has been a considerable cost savings.

In my experience, the "E" should stand for "Easy" way to quit smoking tobacco.

Only further follow-up will reveal if in fact they have less health consequences.

Location, location, location

A study in 1971 revealed that about 20% of the American soldiers in Vietnam were addicted to heroin at some point during their term of service overseas.

Almost half (45%) had used either opium or heroin at least once during their tour of duty.

I've often wondered, if/when faced with the prevailing conditions in Vietnam, if I would have been part of the 45%.

Interestingly, however, when re-examined a year after their return home, only 5% had resumed heroin use.

Prior to this study, the conventional wisdom was that heroin addiction was a disease and typically had very high relapse rates (close to 90%).

For soldiers in Vietnam, heroin use had become associated with being in Vietnam. Back home (in their homes, workplaces or classrooms and associating with their family and friends) they did not have the same cues and opportunities for heroin use.

To a behaviorist, context is a critical component in the formation and shaping of behavior.

They hypothesize that heroin use was a habit, not a disease. Like all habits, it's best broken by avoiding people, places and things that are linked to the habit.

It seems like a pretty sound hypothesis to me.

Let's make a deal

The Mamasan in charge of cleaning the Hooch, that Mr. O. lived in for part of his tour in Vietnam, had a lot of connections.

He reports that he could give her 4 cartons of cigarettes in exchange for an extra-large sized garbage bag of marijuana pods.

Mr. O. didn't smoke cigarettes and had no use for the easily obtained and inexpensive cartons.

He did smoke marijuana, however.

The cartons of cigarettes had a high trade value on the streets for the Mamasan.

She could trade them with street dealers for money or other goods.

They in turn would roll the cigarettes back and forth to loosen and remove some of the tobacco in order to "spike" them with a vial of heroin, which was then re-sold at a much higher cost.

The Mamasan and Mr. O. were each others best customer.

Mr. O. also reports that he had a very clean Hooch.

I believe

I went to a conference on Friday.

One of the talks was on the high percentage of marijuana and heroin use by members of the armed forces while serving in Vietnam.

This article from 2002 is long but does a fairly good job of reviewing many of the prevailing conditions at the time:

http://www.library.vanderbilt.edu/central/Brush/American-drug-use-vietnam.htm

I happened to see a Vietnam veteran today.

In the midst of taking his history I asked him about the drug culture during his time in Southeast Asia.

He remembers what he was told by a member of his unit when he first arrived in Vietnam:

"Man made booze, God made grass; I believe in God. Do you believe in God?"

He went on to say, "I was 18, scared to death, and looked up to those guys. I started smoking marijuana soon after I arrived."