Look out below!

I have a number of patients who are morbidly obese and have a large panniculus (a dense layer of fatty tissue growth, consisting of subcutaneous fat in the lower abdominal area). As with most things, there's a grading system (developed by the American Academy of Plastic Surgeons) for abdominal panniculi:

Grade 1: Panniculus barely covers the hairline and mons pubis but not the genitalia

Grade 2: Extends to cover the genitalia

Grade 3: Extends to cover the upper thigh

Grade 4: Extends to cover the mid thigh

Grade 5: Extends to cover the knees or beyond

Below is an example of a grade 5 panniculus in a middle-aged male (this is not a picture of one of my patients but it very well could be-clearly this poor fellow's life sucks!). If he's a candidate, he needs psychological counseling, strict nutritional intervention, general medical care and also needs to be evaluated for bariatric and plastic surgery. It's a long process!

Try to make each day great!

My son is broke.

He's 18, a senior in high school and looking for summer employment.

He and a friend went to the beach this past Saturday. They packed a lunch and just hung out for a few hours.

He had a great time.

I spent part of the same day paying bills, doing yard work, a few loads of laundry and running some errands.

It was a productive day but it wasn't a great day.

Years ago I read a book by Dr. Bruce Baldwin entitled Getting Better Together: Living the good life with someone you love.

In the book he makes the statement that "as our standard of living increases, our quality of life often declines."

Quality of life is measured with moments of joy, not material possessions.

Obviously with maturity, a job and a family comes a lot of responsibility that my son hasn't dealt with yet.

But it's a good reminder to ALWAYS try and do something to make it a great day.

I plan to re-dedicate myself to this concept.

Barmaid owner

Mr. and Mrs. W. owned a bar in Hartford Connecticut for a few years in the mid 1970's. Both are now in their 80's.

"Earl came home one night and said he bought a bar for $20,000 cash," said Mrs. W.. "I said for Christ sake, what the hell do you know about running a bar. I'm at home raising 5 kids and you go and buy a bar. Earl didn't even know what a screwdriver (the mixed drink) was. It also ended up being in a predominately Spanish speaking part of the city. It was over 50 miles from our home but I knew I needed to get involved quickly or we would lose everything."

"I learned two Spanish phrases, cuantos anos tienes, how old are you and que quieres beber, what do you want to drink. Problem was that everyone thought I knew Spanish and would want to talk with me. I would just smile and laugh whenever they would smile and laugh and try to look sympathetic whenever they seemed serious. I had no idea what they were saying...but the bar did well and we were able to sell it for a small profit about three years later."

Parakeet poop

Mr. P. gives his two parakeets free reign of his bedroom.

When I saw him recently he was sitting in his bedroom, watching TV with one on each shoulder.

They're named Boo-Boo and Baa-Baa.

They're both seven years old (the average life span of a parakeet is 12-15 years).

He reports they haven't left his side since he returned home from the hospital.

Periodically each seems to give his ear lobes a little love peck (although it honestly doesn't seem to be without just a little bit of pain).

It's cool he has this relationship.

Looking at his shirt and around the room, however, I think he should have named them Poo-Poo #1 and Poo-Poo #2.

Smoke Psych 101

The Florida Stop Smoking campaign has some interesting slogans:

"Everyone can be a quitter!"

"Find the quitter in you!"

It seems like psychologists could debate these slogans for days.

Wouldn't it be better to say:

"You can be a winner by quitting!"

"Stop being a loser, quit!"

Kitchen lift

Our 1970 kitchen has been getting an update. We're almost done. Being without a kitchen is also a pretty good way to jump start a diet!

Before:

Nearing completion:

Twin beds

I grew up watching The Dick Van Dyke show.

Occasionally there would be scenes in the Master Bedroom during the show.

I often get to take a ride on memory lane when visiting the homes of many elderly patients.

Their bedrooms look just like Rob and Laura Petrie's.

It's pretty funny that showing a married couple sharing a bed was against acceptable rules for TV back in the 60's:

V for life

Today, a 92 year old male reported he had been taking Valium for approximately 50 years.

He told me he was in his late 30's when he started.

I was seeing him for the first time.

I doubted Valium had been around for that long but I kept my thoughts to myself.

A quick check this evening confirms that he was right.

Valium was approved in 1960 and released in 1963.

He was born in 1925.

He would have been 38 in 1963 (his late 30's).

I would love for him not to take it since it's got so many potential adverse effects in the elderly.

However, I'm also practical enough to know that his Valium receptors would be pretty upset with me if I tried to stop it.

It's definitely a case of "if it ain't broke, don't fix it."

A change may be in order

Albert Einstein's favorite definition of insanity: doing the same thing over and over again and expecting a different result.

What a great statement!

This is true in so many aspects of life: interactions with your wife and co-workers, diet and exercise habits, parenting; even spirituality.

If what you are doing ain't working, change the way you are doing it.

Life's too short to be insane!

"I'm sick (cough, cough)"

I keep coming across some words I've never used before.

Presenteeism is the term used for when employees who are under the weather show up and work.

Obviously, it's the opposite of absenteeism.

Although the initial response is to praise those who show up sick, many note to the problem posed by exposing others to illness as well as to the lower productivity of the sick employee.

Employees who are truly ill should remain at home.

It's just that we have all come across some employees who only get deathly ill on Mondays and Fridays; much more than chance could possibly account for.

Unfortunately, those few are the ones who can negatively impact morale for an entire office.

Not so high

Here's an interesting study.

Three nonsmokers were placed in a closed, non-ventilated 10 X 10 X 8 room with eight marijuana smokers who each smoked 4 cigarette sized joints.

None of the nonsmokers tested positive for marijuana on a urine drug screen.

Other studies have also confirmed that although it's true that passive inhalation of marijuana smoke results in absorption of THC (the active ingredient in marijuana) in the body, none of the THC levels were high enough, in the nonsmokers, to cause a positive result using the current screening and confirmation levels mandated by the Substance Abuse and Mental Health Services Administration.

It's good to have these studies.

I can't tell you how many times patients have told me the only reason they tested positive for THC was because they were in the same room with someone smoking a joint.

A light at the end of the tunnel

I recently read an article that discusses the importance of vacations.

It made sense.

"When you're in a state of mental exhaustion and don't go for a break-your business, health and marriage will suffer."

All readers are advised to practice good vacation hygiene.

Just another good term to try and use when counseling stressed out patients and/or caregivers.

Get outside and play!

The quantity and the content of television viewing by children may effect social behaviors long term, with effects that may last into adulthood.

One study followed 1,037 people from birth to age 26 years and found a significantly increased risk for antisocial outcomes in adults who had watched the most TV as children.

In another study involving 565 pre-school aged children in the United States, coaching parents to reduce viewing of violence on the screen and to increase exposure to prosocial programming resulted in significantly less aggression and more prosocial behavior in the children.

TV's didn't become commonplace in American homes until the 1950's.

I don't think it's a great leap to suspect years from now a similar study will be released in regards to the graphic video games many of our children spend hours a day playing.

When our children were young, my wife used an old fashioned kitchen timer and allowed our kids only one hour a day of "electronic time (TV, video games, etc)."

My daughter never had a problem with it.

My son hated the timer but complied.

They both knew that when the alarm sounded electronic time was over for the day.

It was time to get outside and play.

More parents need to do the same.

Lookin' good

Saw a first today.

Two panhandlers were arguing over the rights to an intersection.

Both had a little cardboard sign.

One was actually well dressed; the other was not.

My hypothesis and a question:

-the poorly dressed dude saw the nice duds that the other fellow was wearing and figured it must be a profitable spot.

-why would a panhandler wear such nice clothing and look freshly showered and shaved? Wouldn't most folks be more apt to give money to a disheveled looking fellow?

Resiliency

I'm sure many of you have already seen this you tube clip.

I hadn't.

It's pretty funny!

http://www.youtube.com/watch?v=oRBchZLkQR0

Just talk

My son appeared to be in the midst of a minor controversy that was brewing with a friend.

My wife noticed that he appeared more annoyed with each text he would send and then receive.

My wife had a good recommendation.

"Why don't you stop text messaging each other and just talk it out on the phone?"

He took her advice.

It worked.

I think he was surprised.

My wife wasn't.

Neither was I.

Hopefully he'll remember it for the future even though it's such an outdated way of communicating.

Good advice in a crazy world

My son starts college next year.

My wife has always had good advice in regards to a room-mate selection: "Your college room-mate doesn't necessarily have to be your best friend. He/she just can't be crazy."

The apple of her eye

I recently saw a patient who I hadn't seen for many years.

He alerted me, in advance, to the fact that his wife had gained a lot of weight since the last time we had seen each other.

He went on to let me know how disappointed he was in her and the fact that she had "let herself go." He also let me know that intimacy in their relationship was also lacking.

She looked fine to me.

Like many, she had assumed a middle-aged female pear shape (as depicted by Rubens in his 1615 painting: Venus at a Mirror).



My patient now also resembled a piece of fruit; a large apple.

I really doubt his wife would have said the same things to me about him had we had time together first.



There's actually a recognized disorder call hypoactive sexual desire disorder (HSDD). I wonder how many women have this disorder when in a relationship such as theirs.

I'm sure the apple makes the pear feel very special (sarcastic).

Now that's new

May be you all already know this...

Vuja De is the opposite of Deja Vu; something that's not happened before.

Don't know how long I will rememeber-just figured to get it out there while still fresh in my mind.

It would be a fun word to throw out every once in a while.

I came across it today while reading an article in a medical newspaper.

A partner in sickness and in health

My brother lives a few hours away.

He recently got sick and needed an emergency evaluation due to symptoms that sounded like possible appendicitis.

He's always been a bachelor.

A very successful bachelor (in business that is).

He's a world traveler.

But...he will be the first to admit, he's a terrible patient.

I'm a terrible patient also but I have my wife.

She takes care of me when I'm sick.

She helps me sort through symptoms and keep things in perspective.

My brother doesn't have that.

He needs that.

We all do.

Just one will do

63 year old Mr. C. is chronically ill with cirrhosis and is awaiting a liver transplant.

He's fallen a couple of times recently when he lost his balance.

Most recently he sustained a laceration over the left eye that needed sutures.

He's been very hesitant to accept a cane or a walker to increase his base of support.

"Why?" I ask.

"I don't want to look old," he says.

I pause and then smile.

He grins.

Luckily I had some statistics handy.

"About 17,000 people in our country are currently waiting for a liver transplant. Don't you think a broken hip or severe head injury from a fall would make you a little less likely to be one of the 6000 who actually gets one each year?"

He grinned again.

"Is everything OK?"

"Yep, I'm just trying to figure out how many canes and walkers I need," he answered.

"Let's just start with one of each."

A well done 4 minute video on empathy (with subtitles only)

http://www.youtube.com/watch?feature=player_embedded&v=cDDWvj_q-o8

A lifetime of growing apart

A. and I have known each other since we were 5 years old; we grew up in the same town.

As we got older those remained the only real things we had in common.

I think we both realized we each felt more comfortable with other friends but we kept up the appearance of being best friends for many decades.

We developed different interests and our personalities could not have been more different.

He loved music, cars, speed boats, and always had the newest electronic gadgets. He grew up in a wealthy family.

I enjoyed exercise, sports and writing. I grew up in a lower middle class family.

He's complex, intense; type A.

I'm simpler, more laid back; type B.

His glass is often half empty; mine is usually half full.

He's always looking for a get rich quick scheme; I'm a slow and steady sort of investor.

He went into sales and commission work.

I became a doctor.

We've never really understood each other in terms of life choices or our career paths; even what makes us tick or what causes us stress.

Nonetheless, we remained "friends;" not a whole lot different from an unhappily married couple who stays together for the kids.

We even honored a pack we had made as teenagers to be each others best man when we married.

A few years ago he came to Florida for a vacation with his family.

I came up with an excuse as to why I couldn't meet up with him.

I guess I decided it was time for a change.

I wouldn't expect my kids to spend time with a person they really had nothing in common with and they along with my wife often asked why I continued to foster a pseudo-friendship with A..

A. was pissed. He sent me a letter letting me know how he couldn't believe I didn't take the time to see him. Included something along the lines of "after all the things I did for you as a friend over the years..."

I never really answered him...just continued to send him Birthday and Christmas cards every year.

Well, he just let me know he will be back down next week for another vacation with his family and wants to get together for a drink.

I'm going to see him this time.

I suspect he will want to have a discussion as to why we have grown apart.

I suspect he knows the answer; I was just the first one to say "Uncle."

I'm going to let him know I'll always remember, cherish and appreciate the times we had together as young kids. I still laugh when I think about some of the things we shared as kids.

I'll let him know I still consider us to be lifelong friends; just friends who just haven't had anything in common for many decades.

He has no idea I write this blog or that I use it as a way to get my thoughts together...mission accomplished.

Tied one on

84 year-old Mr. J. had an over 25 year year with the Michigan State police force.

When I asked about alcohol use he had a story.

"I've only been drunk once. It was at a State Police conference on traffic control and ways to spot impaired drivers. It's ironic, I know, but I didn't drink and drive. I just walked, actually stumbled my way, from the hotel bar back to my room."

F & B

Fay's 6 foot, 4 inches and 280 pounds.

He's always been a big man and even at age 84 seems to resent his parents naming him Fay.

He reports his parents were evangelical Lutherans and that Fay means "faith" in their religion.

When he voiced displeasure with his name years ago, they told him to just start using his middle name (Allen).

He says he countered with "why didn't you just name me Allen in the first place?"

We did share a laugh however.

His wife of 64 years is named Bernie.

Wrong time of the day?

I made a home visit today to see a patient who lives at a nudist colony.

Folks were out walking, gardening, swimming, bicycle riding, playing tennis, socializing, etc. while nude.

The effects of age and gravity on the male and female body were very visible.

I was there in the early afternoon and it was a bright sunny day.

I often joke to my wife that I still look "OK" under candlelight when nude.

Perhaps the same would be true for some of the folks I saw there as well.

Much more than just a patient

Don M. died last week.

He was a 79 year old male who led an amazing life.

He was successful in every aspect of his life-as a former athlete, as a father and as a businessman.

He was a patient of mine for many years.

Even more, he was a friend.

He ALWAYS made it a point to ask about my wife and kids when he came in for visits.

He was always a bright spot in an otherwise hectic day in the office.

I was so fortunate to have had him in my life.