Saturday, March 23, 2013

From a friend of mine...

So that's what it's called!

Patients often want letters written on their behalf, for multiple reasons.

Some will even write the letter for me and just ask for my signature.

One such letter request recently included the following:

"The following over the counter items are medically recommended in order to maintain optimal health and well being, due his delicate medical condition:

Pinot Noir of California-to thin blood and lower blood pressure
Sunblock Hat
Stress Relief Ball-to relieve stiffness, stress and tension
Blongo Ball Set-to help with range of motion

Pinot Noir of California is a wine.

I included a picture of a Blongo Ball Set. I've seen it frequently at tail-gate parties over the years; just didn't know what it was called.

I didn't sign the letter.

90% off!

It's always an eye opener to review health insurance statements.

My wife recently had some routine labs performed for follow-up on her thyroid gland.

The submitted charges, by Quest Diagnostics, were $360.88. The plan allowance was $36.09. The total $36.09 was paid by the insurance company. We owed the provider $0.00.

The plan allowance was only 10% of submitted charges.

The provider of services agreed to drop their rate by 90%!

It's great to be fortunate to have insurance but it sucks for those who don't.

"Our" healthcare system has some MAJOR flaws.

This is just one of them.

Thursday, March 21, 2013

Worse than severe!

A lot of diagnoses in medicine are rated in terms of mild, moderate or severe.

Our audiologists add one additional category that's even worse than severe; profound.

A patients audiology test came back as showing severe hearing loss on the left but profound hearing loss on the right.

I suspect most will think severe and profound are the same.

Now you'll know things are not looking good at all if something you have going on with you is rated as profound.

Now that's profound!

Tuesday, March 19, 2013

GOD only knows

Mr. A., an 84 year old, was discharged from a local hospital on Hospice care due to end stage COPD.

I went to see him the same day at approximately 1 PM.

He wasn't oriented but that was his baseline.

He was signing songs and his social graces were intact.

He thanked me profusely for coming to see him and said he looked forward to seeing me in the future

A hospice nurse called the next day at approximately 1 PM.

He had died.

I would have never guessed he would have had such a quick exit.

It shook me up.

I'm so glad I got to see him one last time.

Too funny

My nurse let me know we just received a consult on an elderly male.

His daughter, a Nurse Practitioner who lives in another part of the state, called us to give a heads-up that her Dad is a nudist.

No problem I thought.

"What's his name?" I asked.

"His last name is Johnson," said my nurse.

"Wow, I'm going to see a male nudist named Mr. Johnson (I laughed)."

After a pause, she did also.

I still laugh every time I think of some of the Johnson T-shirts I've seen over the years:

Monday, March 18, 2013


Many men with prostate cancer don't need to do anything definitive.

The general consensus is that we (The US) have been too aggressive (with surgery and radiation) in treating many stages of prostate cancer. It's felt that many men have had their lives adversely effected by side effects to aggressive attempts at a cure such as incontinence and erectile dysfunction.

Our long term outcomes are very similar to many other countries that do a lot more "watchful waiting."

A research trial is underway and has also confirmed that men here don't like the term "watchful waiting." It seems to give the impression that the medical community has given up on them and that death is the only thing sure to follow.

Interestingly, the term "active monitoring" does not conjure up the same feelings amongst men.

That's potentially an easy fix.

We'll just need to see what the future holds.

Most men want to stay "up" with the latest news as well (pun intended).

Sunday, March 17, 2013

Wanted: a good guy

Roberta is now a companion with Mr. M..

She answered a Craig's list personal ad he had placed a little over 2 years ago.

She's 62 and Mr. M. is 60.

Mr. M. is physically/functionally impaired and Roberta does a great job meeting his needs.

She reports that when Mr. M.'s father recently visited he pulled her aside and commented that his son sure is the one benefiting the most from their relationship (he was trying to acknowledge all the things she was doing for his son on a day to day basis).

She let him know that she thought it was a 50-50 relationship.

She reported that no man had ever been so kind to her (she had ended an 25 year abusive marriage prior to meeting Mr. M.).

"He's just a good guy. If I had placed an ad, that's what I would have asked for."

"That's great to hear," said his Dad.

Pre-prom marketing

There's a lot more involved these days in asking someone to the high school prom. Years ago, I would just call and say, "hey, do you want to go the the prom?" This year, my son asked my wife for some ideas. He and his girlfriend have been dating for over a year now. This is what they came up with. It worked. She said yes!

Saturday, March 16, 2013

300 pounds ago...

Mr. M. is 60 years old.

He played baseball in college, was a medic in the military, once fought Chuck Norris in a martial arts contest, and went on to become a nurse while also earning his Masters and PhD in Written Communication.

He still writes children's books.

I saw tears welling up in his eyes.

"Are you alright?" I asked, "you sure have done some amazing things in your life to date."

"You're the first doctor, in about twenty years, who has asked me about what I did when I was younger, and thinner. People, even health care professionals, look at me and assume I've always been this way. I haven't been and I just appreciate being able to reminisce."

He now weighs over 500 pounds.

He understands that it's a crucial time to get his life back.

I'm hoping the few minutes we spent reviewing his thin life will allow us to continue to work as a team to accomplish just that goal!

Thursday, March 14, 2013

The cone of shame

Our 14 year old beagle keeps getting "hot spots."

She chews herself raw.

Along with all the other possible interventions we finally have resorted to using a cone.

She looks pretty pathetic:

I know it sounds cruel but I can't stop laughing every time I look at her.

If she could talk I'm sure she would be saying, "what the F--K are you doing to me? What's up with the lampshade for Pete's sake!"

Wednesday, March 13, 2013

White bread

I've lived in the same town for many years and know a lot of health care professionals in the area.

A new patient, a 92 year old male, had previously seen one such acquaintance.

I had obtained some old medical records and asked the patient, "I see you've seen Dr.---- previously."

The patient smirked.

"Why are you smiling?" I asked.

"No reason, I remember Dr. ---- well. He's what I would describe as a slice of white bread."

"A slice of white bread? What do you mean?"

"You know, just a plain slice of white ham and cheese, no peanut butter and jelly...just plain...dull, you know?"

I smiled and let him know I appreciated his honesty and asked for him to let me know if he ever came up with a nickname for me.

He laughed.

I chuckled inwardly as well.

His description of the other doctor was right on the money...or should I say the slice.

Great save!

Tom's (my son) soccer season is now really over.

He was named the First team All-Metro conference goalkeeper and this past weekend played in an All-Star game. He was the starting goalie for the Orange County team.

One of his great saves was included in this video clip from Bright House Sports (go to the link and click on the video highlights):

Tuesday, March 12, 2013

His last trim?

"Is it alright if I trim your toenails?" I asked Mr. R..

He had onychomycosis and onychogryphosis and was complaining about pain in his feet when walking.

"Why would you want to do that?" he asked, "I don't have much longer to live."

He took me surprise.

Luckily as soon as I was about to speak he let me off the hook by smiling.

"Got tongue tied there for a second, didn't you doc?"

Standing room only-barely

Mr. and Mrs. D. are hoarders.

Their 3 bedroom, one bath home is definitely a "you've got to see it to believe it."

Words can not possibly describe the inside of their home and the decades of things they have accumulated.

Mrs. D. was embarrassed but was not open to any help at this time.

"I'm sure it's hard thinking about trying to get rid of things," I said trying to show empathy.

"Every time I do, I get the thought that I would have such regrets later on," she replied (I could see tears starting to well up).

"Let me know when I can help with some ideas," was all I could think of saying.

This isn't a picture of their home but is very representative with one exception; they had more "stuff."

Up to 85% of compulsive hoarders can identify family members with similar tendencies.

That's potentially a lot of dumpsters for one family!

Sunday, March 10, 2013

Lucky #9

Mr. R. is now blind due to end stage glaucoma.

He's hoping he can still find a way to get to and from church.

He's a Pentecostal.

He let me know that his gift is the interpretation of tongues.

I always wondered how that worked.

He filled me in. He works in tandem with those who possess the gift of "diver kinds of tongues." Without tongues there's no need for interpretation. His gift gives him the ability to interpret tongues. It's the spirit who gives interpretation of the tongues.

The nine gifts are 1. the word of wisdom 2. the word of knowledge 3. faith 4. gifts of healing 5. the working of miracles 6. prophecy 7. discerning of spirits 8. diver kinds of tongues and 9. the interpretation of tongue.

I plan to have our social worker assist in helping to identify transportation possibilities if his church isn't able to help.

Without #9, you can't really have #8. I also hope he's good friends with anyone who possesses gift #4 &/or #5.

He was just waiting for the right question

Mr. R. is 87 years old and doesn't say a whole lot these days.

When I arrived at his home his daughter let me know the same.

He pretty much answered every question I asked with a one or two word answer.

"You like you've been a hard working man your whole life," I said.

"Been working since I was about 8 years old," he answered.

A nine word answer, I thought; let me stay on this line of questioning.

"What kind of work did you do at that age?"

"After my parents died, my brother and I were raised by our Aunt and Uncle in Miley, South Carolina. It was a sawmill town. We had a still out back and my bother and I would sell the moonshine through our kitchen window to the men going to and from the sawmill. A 10 cent bumper was a 1/2 pint. A 20 cent bumper was a full pint. I was so small at the time I could barely lift the gallon jug so I would use a funnel and the edge of the table to act as a lever..."

I didn't need to ask any more questions for awhile.

It was a pretty cool history lesson.

Drinks not included

For many years, during the 1950's and 60's, Mr. C. ran a special.

He owned a restaurant/lounge in Torrance, California.

A $5 ticket would get you a bus ride to and from a Los Angeles Rams home football game, a ticket to the game, and a spaghetti dinner back at his restaurant after the game.

"How were you able to offer such a good price for so many years?"

"I didn't make any money on selling the ticket. The tickets for the game cost me $3 apiece. But folks were happy they were getting such a good deal. I sold liquor to and from the game and back at my place. I made out pretty darn well. I always made some good bucks. Every year I needed to buy more tickets. By the end I was taking over 100 people to every game. It took a long time for others to finally figure out what I was doing. I had a lot of loyal customers. I treated them right and they treated me right. It's really just that simple."

A different picture

89 year old Mrs. L. looks so small, sitting in her Lazy boy recliner, at the Assisted Living Facility where she lives.

Hanging on the wall, over the chair, is a picture of her in a military uniform during WWII.

"What branch of the military were you in?" I inquired.

"The Marines," she replied.

"When were you active duty?"

"1943 to 1946. I started at Hunter College in NY and then went to Camp Lejeune and worked as a clerk."

Honestly, I didn't know woman were in the Marines during WWII.

She didn't look so small anymore!

(Military history web sites report The Marine Corps Women's Reserve Schools opened in July 1943. Officer candidates and recruits in training at Mount Holyoke and Hunter Colleges were transferred to Camp Lejeune, where nearly 19,000 women (17,640 enlisted and 820 officers) became Marines during WWII. They were initially taught by reluctant male drill instructors and often subjected to ridicule. However, the woman filled many very important noncombat roles-clerical, parachute riggers, mechanics, radio operators, welders and more.

On its first-year anniversary, 13 February 1944, The Marine Corps Women's Reserve received a treasured message from President Franklin D. Roosevelt:
The nation is as proud of you as are your fellow Marines — for Marine women are upholding the brilliant traditions of the Corps with a spirit of loyalty and diligence worthy of the highest admiration of all Americans. You have quickly and efficiently taken over scores of different kinds of duties that not long ago were considered strictly masculine assignments; and in doing so, you have freed a large number of well-trained, battle-ready men of the corps for action.)

Meers, Merrill, Szoroletta, Vredevoogd

All smiles

Mr. S. is 92 years old and very dependent on his wife of over 40 years for his care.

It was a second marriage for both.

She's about thirty years younger.

I commented that she's doing an amazing job of caring for him.

She responded, "He was in his 50's and I was in my 20's when we met. I had a three year old boy and a good for nothing husband who was a womanizer. I prayed to GOD and said if you can help me find a man to love me and help raise my boy I will be a great wife. He's a beautiful man and he gave us a beautiful life. I'm so thankful. I will do anything for him. All I can do is give him my enduring thanks and loyalty."

Mr. S. grinned and whispered something. I asked him to repeat what he had said. "My first wife never smiled, so the first time I saw her big smile I knew I wanted her in my life." He smiled.

She smiled also.

Saturday, March 9, 2013

What's your PPD status?

What's your PPD status (In the United States, PPD stands for purified protein derivative and is a skin test performed to check for exposure to tuberculosis)?

In Scotland, a patient’s PPD status is considered vital information for those approaching the end of life.

Their PPD status. Do they have severe outbreaks of tuberculosis among the dying in Scotland?

No, PPD stands for Preferred Place of Death.

Patients are asked about their preferred place of death as part of the advance care planning process, it's documented, and all possible efforts are utilized to get the patient to that setting as death approaches.

Now that’s awesome!

Thursday, March 7, 2013

Rich memories

Mr. C. was very successful for many years.

He owned a Restaurant/Night club (Corso's) in Torrance, California for 27 years as well as a Bowling Alley/Lounge, a Jewelry store and a ladies ready to wear clothing store.

He never smoked or drank alcohol and kept himself in good shape over the years by playing Racquetball three days a week, boxing and swimming.

He had one vice however; gambling.

He lost almost everything gambling on sports.

He's now 92 years old and lives in a 400 square foot studio apartment.

Almost all of the wall space is taken up with photo collages that his daughter put together. There are pictures of him with all the famous people who frequented his establishments over the years; Frank Sinatra, Sammy Davis, Dean Martin, Sonny Liston, the Ink Spots, members of the Los Angeles Rams, etc..

He's one of the richest persons I've ever meet in terms of wonderful memories.

Man does he get a glint in his eye when reminiscing.

He's so thankful for having had such a great life.

Wednesday, March 6, 2013

Minding the store for over 30 years!

Mr. T. was active duty in the Navy from 1953 through 1983.

He was a Storekeeper.

He lived in multiple places during his thirty year career.

His wife's favorite was Hawaii. His was Key West.

One of the oldest Navy ratings, Storekeepers are tasked with maintaining ship or company military supply stores.

Effective October 1st, 2009, the Ratings of Storekeeper and Postal Clerk in the Navy were merged to become Logistics Specialist. Postal clerks had a cool insignia:

But the Storekeeper Insignia won out. The new Logistics specialist insignia is the same as the Storekeepers:

His highest rank was an E-9 (the most senior enlisted sailor). He had some great photo's around his home in his dress uniform:

US Navy E9 Storekeeper Blue Rating Badge.Worn on the left sleeve of Dinner Dress Blue and the Navy Dress Blue uniform .All Rating Badges are made to military specifications.

He had a stroke about ten years and never regained the use of his left side. He also has some cognitive impairment but he sure gave me a strong handshake when I said goodbye and thanked him for his years of service to our country.

He's quite a man.

Sunday, March 3, 2013

Young at heart

Mr. C. is 92 years old.

He lives on the 6th floor of a senior living complex.

He seems like an amazingly sociable man but reports spending most the time alone in his apartment.

The facility has a lot of activities planned but he rarely takes part.

"Everyone is just so old," he says.

I jokingly remind him of his own age.

He clarifies, "everyone just acts and thinks so old. Age is just a number. I'm just tired of people spending all their time talking about how bad things are compared to how they used to be and about all their ailments and upcoming doctors appointments. It's depressing."

My mother thinks the same way. It's why she says she will never consider moving to a retirement community.

If there was a senior complex that had rules concerning not "acting old," both Mr. C. and my mother might be much happier.

Saturday, March 2, 2013

The Second Amendment

Regardless of your personal views on assault weapons please take the time to read this editorial from U.S. Medicine:

Your money slip sliding away...

It always amazes me how many cash advance stores are present in and around certain areas of town. Sometimes there's one on nearly every corner. There's obviously a noticeable absence of banks in these locations as well.

One such franchise advertises their commission rates:

To cash personal checks or money orders: 9.9%

To cash payroll and handwritten checks: 4.5%

To cash government checks over $1900.00: 2.9%

So here are a few examples:

Someone cashes a $100.00 check from say a relative: they get $90.10 back

Someone cashes a $2000 government check: they get $1942.00 back


Life instructions

An evangelical patient asked me a question the other day.

"What does the Holy Bible stand for?"

I wasn't sure how to answer.

Luckily he intervened.

"Holy One Left You Basic Instructions Before Leaving Earth."

I suspect many of you already knew this.

Regardless if it's factual or not, it's still pretty cool!

What about your name?

I saw an elderly male recently with the first name of Rufus.

It got me thinking...I haven't come across many boys being named Rufus in a long time.

An interesting web site, (reviews the etymology and history of first names), confirms its popularity in the United Sates has declined over the years:

But so has my name; William:

I've come across a number of boys named Tyler lately. Sure enough, statistics confirm the same: