7.31.2022: Still waiting to hear on whether I’m a candidate for surgery. I will call the program tomorrow and hopefully get some guidance on time. For now, we are seeing patients at the office as usual. I have fewer office hours because of my own appointments so please call to schedule with more advance notice than usual. I will have a hard time fitting people in at the last minute. Thank you all for your support.
8.1.2022: Surgery tentalively schedule for 8.17.22. Any patient with an appointment scheduled from 8.15.22 to 9.15.22 should email me for instructions, or call Nancy if you do not have email. I want you to email just so that I know that I have YOUR email to respond to you. Please send the email to firstname.lastname@example.org and be sure to include ALL of the following – your DOB, your name, AND your mailing address. Thanks!
8.2.2022: Waiting to hear on insurance. Lined up for 3 days of tests at UCSD starting next week – VQ scan, heart cath, pulmonary angiogram, and of course a COVID test…. then if all falls into place, surgery on 8/17. I am seeing people this week. If you need meds in August, get your email to me soon!! MUST include all of the things mentioned above — DOB, mailing address, dose, type (cap/tab), number per day.
8.3.2022: If you haven’t emailed me, be aware that I will not receive emails, or respond, after noon on 8.5.2022. I really hate the idea of people running out of medication, but I will have no options after that time for at least a couple weeks, maybe longer. I keep hearing ‘oh, I never check my mail’…. For those of you seeing this for the first time, if you will run out within 30 days – before September 3 — email me ASAP with ALL of the following. Read carefully — if it isn’t there, I cannot send anything. Med INCLUDING capsule or tab or film, dose, number per day, YOUR DOB, YOUR HOME ADDRESS. Do it NOW — I will not be in any position to make exceptions. Thank you!
8.6.2022: Yesterday was tough. Got a call saying a place opened for N to stay, next to the hospital – great news. Ten minutes later I got a message that the insurer denied the surgery because it is out of network. But there are no places ‘in network’ that do the surgery I need to get better. My docs are calling the insurer on Monday to make my case to the insurer’s medical director. So please send convincing thoughts in that direction so that I can get this done. UC San Diego scheduled my testing and surgery for one week later, and I hope to be there.
8.8.2022: Just got another lovely call from Walgreens near my office. Their new pharmacist refused to fill Vyvanse for a patient because she added up all the days she came a day or two early, and now she has ’12 days extra’, and she is making the patient wait.
PLEASE avoid Walgreens if at all possible, surely the one near my office. New pharmacists do not understand health, or care, and certainly not healthcare. They will fill your script at 28 days, month after month, and then cut you off out of the blue. They would rather make you sick for a week than do anything to help you.
Yes, I’m a little stressed…
Still 8.8.2022: Less crabby because I got a call from my health insurer that my surgery will be approved. Thanks to all of you who sent positive thoughts my way. Testing starting 8.16.22 and surgery tentatively on 8.23.22. Typically ICU 3-4 days, then 2-3 weeks in the hospital.
8.10.22: Some patients were seen and given prescriptions before the date that Walgreens, followed by other pharmacies, suddenly started demanding addresses on controlled substance scripts. I’m sorry – there was no advance notice, and before that date there was no address requirement. IF you are one of the persons, you can stop by my office tomorrow Thursday 8/11, and I will add the address for you. We will be in the office from 10:30 AM until 3:30 PM. I’m sorry – that’s the best I can do!
After tomorrow I’ll be packing, then leaving for California. Thanks for all of the nice emails and wishes.!
8.11.22: The office is closed for the next few weeks. If you have an emergency, please go to the ER or call 911. I will try my best to get emails — email@example.com — but there will be days when I am out of commision, especially between 8.24 and 8.31. Please, if you think you are out of medication, check first with your pharmacy. Medications were called in for most people and you may have refills waiting for you.
Schedule II substances will be very difficult for me to prescribe until I get back to town.
I’m going to repeat instructions because I am still getting messages from people without the information I need to help you. For ANY medication refill request, your email must have ALL of these things: 1. the name and dose of the med, and whether it is a capsule or tab, and the number per day; 2. you date of birth; 3. your home address; 4. the pharmacy name, location, and phone number.
8.14.22: Staying over in Chicago to fly out early tomorrow morning. Staying in the ‘La Jolla House’ when we get out there — a place for long-term patients and their families. Believe it or not, hotels are expensive in La Jolla! (I was there about 30 yrs ago… ocean, mountains, beaches, always about 75 degrees… hope I’m not there too long!!). Thank you all so much for the wishes and prayers. Tomorrow mostly off… blood tests and ‘VQ scan’ on Tuesday, then cath and echo the next couple days. I’m scared, of course. But I don’t have a choice, as I have more and more trouble doing things. I love autumn, especially in Wisconsin — so that’s what I’m shooting for. I had a nice, spur-of-the-moment visit from my son this weekend. More later…
8.15.22: From emails I’ve received, I think I have more readers of this than I did back in the days of the ‘Talk Zone‘ … which is all good! We got to San Diego this AM… I pooped out in O’Hare and it was humbling being pushed in a wheelchair. I had the same thought though that I had at Disney years ago. They cut me into the security line — do people ever ask for a wheelchair when they woke too late to make their flight?
We are staying in a place that is basically part of a dorm for UCSD. No air conditioning, and every time I use a rock to prop open the door to our hall, someone moves the rock and closes the door. They must be on the cooler side of the building. Got here at about 9 AM so we drove down to the ocean for sushi. Such a different world. Surfers wandering around, little restaurants and dive shops, the constant smell of THC in the air… ‘just like in the movies’!
Testing starts tomorrow. My VQ scan was moved up earlier in the day, which is good. I keep thinking that maybe I’ll wake up and my oxygen saturation will be normal, but it is still at 84% – 88%.
The place where we are staying has several pages of rules, and warnings that violations will get us ‘removed’. Masks are mandatory; the communal kitchen doesn’t have dishwashers but it does have two ‘sanitizers’ that must be used on any dishes that we use… all surfaces that we touch must be wiped down before we leave the area.. it’s like we stepped back to 2020. The entry person even took the pen I used to sign the papers and said ‘I’ll clean this for you’. But it is about 20% the cost of a hotel, so what can you do?
Went to Whole Foods this afternoon and parked the car blocking two electric vehicle chargers, just for fun… (yes, I’m joking). But I did get a good-looking rotisserie chicken to take to the room for dinner.
Hope you’re all doing well. Thank you, again, for your positive thoughts.
8.16.22: Tough news. VQ scan shows clots in subsegmental branches of both lungs. The closer clots are to the heart, the larger the vessel and the easier they are to remove. The pulmonary artery has lobar branches, then segmental branches. then subsegmantal branches. I have clots all the way down, through both lungs.
The good news is that my doc is a pioneer in repairing these ‘defects’. This paper describes the patient selection process, and the primary author is my doc: https://www.atsjournals.org/doi/10.1513/AnnalsATS.201601-014AS
I meet with the team tomorrow. I’m obviously no expert in this field, but I understand the basic science – and I expect the issue to be whether I’m a good surgical candidate, given the extent of disease. The distal arteries are fragile, and if they tear one of the arteries, I’ll hemorrhage when they restart my circulation. They may suggest that I wait for a lung transplant – something I would not be a fan of, given the psychology of waiting and waiting for a pair of lungs to become available.
I’m 62 years old. I’ve lost so many good friends over the years — people who did everything right, who had brilliant pasts and futures. Most of you have heard about them over the years (as I have know most of you for 5, 10, or 15 years). My best friend from college, Dan Shanower — killed on 9/11 while reviewing intelligence about the attacks in NYC. (https://pentagonmemorial.org/biographies/cdr-dan-f-shanower-usn/)… one of the best people I’ve known. He had so much passion for life, for service… he died on the last day of my treatment for OUD, and I have a beautiful Dutch-Elm-resistant American Elm in my yard that was planted shortly after his death that keeps growing like crazy! The plaque on the trunk is covered more and more by bark each year, as if we’re supposed to eventually forget and move on.
My friend Todd VonBlaricom, a brilliant surgeon for small-towm medicine in FDL, who died in the mid-2000’s. Dr. Mike Strigenz, one of the nicest docs and best ENT’s I’ve ever met, who passed a couple years ago from a horrible, rare illness. My anesthesia partner Pontus, who died from a pulmonary embolus last year, 12 days after retiring. Ian, a great surgeon and neighbor, who died after a freak incident while visiting Thailand. And so many patients who shared their life stories with me… Larrie, Bernie, Joe, Nicole, Connie… all people who died prematurely.
Sorry – I know this is all pretty morbid. My point is that death is a part of life, and we all tend to see it as something that will happen to someone else, not to ‘ME’ — the person we are now. I think most of us think of it in the abstract, even though it is the one certainty in our lives. And that’s the gift from my current situation — as it provides a reality check, albeit with risk attached. I am ‘guilty’ of not appreciating every moment. Yes, I love autumn, I love a good movie, and I love watching the Packers on a wintry Sunday (especially when the Seahawks are in GB). But I’ve spent too many days THINKING about the things I wanted to do ‘some day’.
So if you’ve read this far, take a moment and think about what you’re grateful for. If you’re wasting time, consider taking the action you keep thinking about. I know and respect everyone who is reading this, and my wish for you is that this story adds a little something to your lives — maybe the decision to call someone you lost connections with, to stop wasting each night in a THC or alcohol haze, or to take that ‘boot camp’ in a field that will provide you a better life going forward.
I’ll check in tomorrow or the next day, depending on how things go. On a lighter note (always have to end on a lighter note or you lose your audience — blogging 101 — I’m watching ‘Fleabag’ on Prime. Not something to watch with mom and dad, but it is entertaining, at least most episodes. I preferred ‘Catastrophe’, another British series that is free with Prime. Of course I only watch the British nonsense if Liam Neeson or Michael Strahan doen’t have new revenge flicks out there….
A couple last thoughts…. I’ve learned that nobody will see you if you sit in a wheelchair. Even healthcare workers — they look at the person pushing, and ask questions as if the person in the chair isn’t there. Put on oxygen and you’re even less visible. I think of a movie from decades ago — The Doctor, with William Hurt (most of you have no idea who that is, I know…). He made the med students sit on gurneys and have enemas to help them understand the patients’ perspective. My preceptor in med school actually did something similar, even before the movie came out — he made us lie on stretchers and get pushed through the hospital to show us how humbling it was. I tell you — I HATE sitting in that chair, and I practically jump from it when I leave each day. I feel bad for joking about security a few posts ago. It is not fun to be pushed around, and I can’t imagine how horrible it is for those who CAN’T get up.
Finally, you all know I love dogs… and some of you have shared pictures of your fur-babies (some of you even bring them to appointments!). Send me a pic of your pups – or even your cats (I have both and it took me a long time to warm up to cats — but my Leo is over 20 yrs old, and he has grown on me!) I do get your emails, and I appreciate them!
8.17.22: Some cute pups out there! Today was a better day… although it started at 2 AM with a dream that some of you can relate to… in the dream the doc said that they COULD fix me, but they won’t because I did things to screw up my body, and I would probably do those things again so they would be wasting their time. I woke up with that thought and expectation. That didn’t happen, but the NP did ask about my history, as many of you have described with your own surgeries. ‘Many people do fine with Tylenol… with your history, do you think you should get opioids or midazolam? Usually the younger patients have more pain and need more pain meds than the older patients’.
I pointed out that the history was well over 20 years ago, and that I really didn’t want to be a hero about pain control when my chest is cut open and an endotracheal tube is in my throat. But the fear is there — that my complaints of pain will be interpreted as ‘drug seeking’. We have all talked about the issue many times — a piece of stigma that can’t be avoided. I’m going to teach Nancy hand signals so that she can advocate for me when I’m intubated — like a peace sign if the pain isn’t too bad, a fist if I am in pain, and maybe the middle finger, waved back and forth, if I’m really struggling…
The good part was that they think I’m ‘probably’ a surgical candidate pending tomorrow, which is considered the toughest day of testing. I have a right heart cath at about noon, and then a left heart cath/coronary angiogram later in the day. The PA said that ‘they were having problems in the cath lab today but hopefully things will be fixed by tomorrow’. Not sure what that meant exactly but he was optimistic about whatever was wrong!
This is becoming quite the document…. but you all know how I like to talk… I also filled out the Advance Directive form (although it needs to be signed by someone who isn’t my wife, so I’m technically still in control!). The questions really make one think…. would you rather be on a machine, unable to think, or at home with your pets? I’m exaggerating a little, but most of the questions were easy for me to answer. I had to write in my choice — ‘I’d like to go back to my office and keep doing what I’ve been doing’.
What else…. for lunch I only had a short time so we went to a place that was in a research park just north of the med center. The restaurant was for the people who worked ‘on campus’ , which consisted of a bunch of tech companies. The restaurant section was exactly like you would see in a TV series about California… very zen-like, with a vegetable garden for fresh produce (that we were welcome to walk through), a ‘quiet area’ for meditating…. and at the table next to us, about 20 people who alll looked about 15 yrs old, talking about (honestly) how to handle their company stock, and whether it is good to diversify or ride the wave of their employer. I thought they were all drinking beers, but I overheard that it was ‘Kombucha’, a beverage that only LOOKS like beer. Such a different world.
One difficult issue for me is when I’m at the hospital, and I overhear the chatter between anesthesia residents (which happened this afternoon when I was writing the last prescriptions people needed, which BTW were mailed an hour ago). I remember those heady days as a anesthesia resident, talking about the big trauma case the night before, and the feeling that I could, and would, accomplish anything I put my mind to… I struggled back then with the decision whether to stay in academia, or to instead move back to the Midwest to be closer to family, so that my kids would know their grandparents. We chose the latter, and most of the time that feels like the right call. But seeing the excitement at this place makes me wonder if we chose right.
The problem, of course, is rehashing and questioning a decision that I made… 30 yrs ago?? I would tell my patients that the questioning is the problem– something that cannot lead to anything positive, but can and will lead to all-things negative. So much easier to give advice than to take it! There is a whole study out there about the way people deal with ‘choices’ — about how some choices become more certain over time, and others become less certain. I don’t remember the details but maybe I’ll write more about that sometime.
I’ll stop because I’ve taken alot of your time today. But ‘TLDR’ – a good day.
8.18.22: today was a long day, and I’m supposed to keep a wrist immobilizer on my right wrist until tomorrow so I won’t type much. Most good news though. The right heart cath shows that my R heart is very enlarged, with high pressures — but good systolic function. The lung angiogram showed what I knew – lots of clots. My R upper lobe is infarcted and almost completely blocked from blood flow, explaining the shart pain I woke up with about 6 weeks ago. But they think I’m a good candidate, and they hope to clear enough clot to reduce pressures in my R heart. Then they did a L heart study/angiogram and my coronaries are clear, with good L ventricular funtion.
I used to put in ‘Swan Ganz’ catheters in a small room outside of the OR, without imaging or draping (for sterility). That was 30 years ago! Now it is so much safer, and the catheters are so much smaller… all done under flouro, with everything draped off. The coronary angio was likewise so much different.. through the radial artery in the wrist instead of the femoral artery in the groin. I’m grateful that things have improved so much.
I’m on for surgery, admitted next Tuesday and surgery on Wednesday. I will likley be a 10+ hour affair. I’ve read so many articles about the operation and I’m amazed at what they say they can do.
I keep hearing that my condition is likely 20 times more common than it is diagnosed. That’s a good lesson for everyone. But I keep asking the docs, how could this have been discovered earlier? … and the only way would be to have a VQ scan every few years, which is not considered a reasonable thing to do at this point.
We met a neighbor in our dorm — the wife of a firefighter from Louisiana, who had almost the exact history that I had. He is younger – 40 – and his surgery is two days before mine. As with me, he exercised and was in very good health, then developed dyspnea this year. He is filled with clots too… he (and another patient who was discharged last week for the same thing) blames his Moderna vaccine. It is a strange and frightening time right now, when getting the answers to such questions is impossible because of the need to ‘encourge vaccine use’, and even wondering about the issue labels a person as a ‘right wing nut’. The amazing vaccines that doen’t do all that much, but that must be used if you don’t want to be blamed for ‘extending the pandemic’. Amazing that so many people still buy into that story, and still blame people for exercising their own choices – even after triple-vaxed Joe and Jill caught COVID.
I’ve received great pictures from many of you. I’ll stop this ‘short’ post and see if I can figure out how to put up images of my own buddies,
Sorry to totally inundate you but I started going through them and it is hard to pick my favorites!
Dogs are a lot of work, but I can’t quantify the joy they have brought into my life — and that’s not even counting my childhood. If you have the room, two dogs are 10 times more fun than one. Don’t get me started with my videos, but it is so much fun to watch a group of dogs work things out, figure out who is in charge, decide when playtime starts and when it has to end….
8:19.22: Going to go out today. The ‘team’ meets today (without me) to review all of the data and prepare for surgery. I’m amazed at how many people are involved, all to care for one person (me, this time around!). The pulmonologist said last night that it all looks good, so I don’t expect problems as long as I don’t test positive for COVID!! I have my third test scheduled for Monday. They do it here every few days.
Many of the people I see do not have health insurance. I understand the temptation to go without, but the process I’m undergoing would be impossible without insurance. I suppose a person would wait for the ‘marketplace’ sign-up time, and eventually get covered. But if you have an emergency, you can easily end up with tens of thousands of dollars of debt, or even hundreds of thousands. The echo tech told me how she tripped on her cables, at work, breaking her femur in 4 places about 12 months ago… she had a rod inserted and was off work for months. The cost of insurance isn’t bad for a young person, and the subsidies reduce the cost even more — so please consider it, at least a high-deductible plan for worst-case-scenarios.
Nancy and I have wondered why the people at our local healthcare system are so miserable, or at least seem to be when we’ve been there. I noticed years ago how the staff at Community Memorial in Menomonee Falls were so friendly… everyone smiling and saying ‘hi’ as you pass them in the hall, and smiles and nice greetings from people at counters. It is like that here, and it really makes a difference. People say things like ‘thank you for trusting us with your care’ and ‘I’m really hoping things go well!’ Even staff we pass in the hall smile and say hi. I asked one of the nurses about it, and she said it is ‘part of their compensation’ – that the hospital collects data and feedback, and being nice to patients impacts their pay. That makes the kindness sound insincere but I don’t think that’s what’s going on. I think that kindness, even if the initial gesture isn’t entirely ‘genuine’, becomes infectious. Seeing your coworkers smile and act nice makes you want to be nice too – for ‘genuine’ reasons.
Don’t worry, I won’t go soft on you. None of these people would last a month in a Wisconsin winter! But it is a nice thing while I’m here!
8.19.22: Psychiatrists don’t talk much about spirituality. We’re taught that way — or more accurately, we are taught in a way that completely ignores the topic. I’ve received so many emails from people telling me that they are praying for me, and until recently I struggled with how to respond. More self disclosure… my parents were very involved in the Methodist church, and I was taken to church weekly for most of my childhood. I was in church youth groups, went to summer church camps, got married in a church, and took our kids to church until they were adults.
As part of my recovery decades ago, I became very involved in the steps. In fact I felt that for the first time, I really understood what Faith consisted of. I had always thought that some people believe in God or a higher power, and some people didn’t, as if the belief just came to some people. Maybe some people came across enough proof of a higher power, and that led them to believe. But as I read and read 12-step literature (at a time in my life when I was humbled and desperate… yes, I’ve been here before) I realized that Faith was the opposite of what I’d always thought. I realized that if a higher proved him/herself to me, it wouldn’t be Faith at all. I realized that Faith requires making a decision to believe, when evidence does NOT exist.
I found that realization to be the start of the best years of my life. But I struggled to match that feeling to the religion that I was dragged to over my early years, and over time I drifted away from both AA and the church.
My struggle now, when people pray for me, is that I don’t feel that I have earned those prayers. I don’t do the legwork — i.e. go to church, participate in all those boring church committees, take communion, tithe… and yes, I realize that most faithful people say that those things are not required; that you are still welcome to belief in a benificient holy spirit, even if you haven’t done the church legwork. But I grew up knowing what the ‘regulars’ thought about the people who only showed up to church on Easter and Christmas (because I heard my parents talk about those people!).
I loved being a boy scout more than going to church, and I always felt an instant connection to a higher power when I was in a tent, late at night, hearing the wind blowing through the trees. I loved being in the woods after dark, or the ‘silent swim’ contests we used to do at camp where we would try to sneak up on someone on a pier, after dark, without them knowing we were in the water. That’s another thing I drifted away from, living in larger cities and being too busy to drive to remote areas. Or maybe I just started enjoying hotels too much!
I think that all of the monty python and woody allen movies I’ve watched (my dad was a big fan) made me a little cynical too. I think of a woody allen movie when he feared he had a brain tumor, so he ran out and bought a crucifix and a picture of Jesus ‘just to be on the safe side’ (he was Jewish). I can’t help but feel like I’m doing the same thing now.
I’ll close with pictures from tonight. We are just waiting now until my admission on Tuesday. My daughter Laura is flying out and hopefully she will get here before visiting hours end on Tuesday. They say they won’t try to wake me until at least Thursday, maybe Friday. I’m glad that they do it this way — they deliberately give people a few days after the tests to settle in to the idea. I’m getting there.
AMAZING what an I-phone can do!
8.20.22: Watched ‘Fall’ at a matinee this afternoon: https://youtu.be/aa5MXOMN1lM
Took a couple pictures in case you don’t want to watch the trailer:
Probably broke a dozen California laws posting those pictures so I hope you all appreciate them!
Bored as heck. All I need to do before Tuesday is a COVID test on Monday, and then finding a notary to get my Advance Directive completed. Supposedly they have notaries at the UPS store.
Nancy has been very patient with all of this. She is stuck here for weeks too, and she doesn’t even get any narcotics!! That’s a JOKE by the way….
If anyone has a great series we should watch, send me an email and let me know. Finished Fleabag last night, and I give the series a couple thumbs up. But maybe don’t watch it with your mother (unless she is extremely sexual, in which case she might like it!).
Oh…. here is something to mention… in ‘Fall’, the big message was that ‘life is short, so take on challenges and live it out as big as you can’. But then at the end, they repeat that and it isn’t clear whether they are only messing with the audience, or whether the suggestion is intended to be taken seriously. Personally after watching the movie I don’t feel like doing anything at all beyond sitting in a chair at home! Let me know if you got something deep out of it.
BUT.. I will go off on a message that I hope most of my patients get from me, either now or from appointments in the past or future: Most of the people I’ve seen over the past 15 years have made amazing changes in their lives. Society still puts a scarlet A on people who go through a bout of addiction, but those who judge have little or know idea of how well many people do. The reason I like addiction medicine so much is because it is a specialty where I see people start from a horrible place, and progress to a much better place.
But there are people who, for whatever reason, do not use their ‘second chance’ as I wish they would. I mentioned Woody Allen… in ‘Annie Hall’ he says that relationships are like sharks in that they have to keep moving forward, or else they die (he described his relationhip in that movie as a ‘dead shark’). Recovery is like that too. BTW the word ‘recovery’ is so overused and stigmatized that I wish I had something better to describe the process… I wish we could just see addiction the way we see ANY illness, and talk about ‘being sick’ and ‘getting healthy’. Maybe once we figure out which pronouns everyone should use, we can work on other terms…
Some people go through a course of addiction, get treatment, and do better. I find those people to generally be better off psychologically than they would have been, had addiction never entered their lives. After all, the experience teaches us who are real friends are, and who they aren’t. It washes away all of the superficial BS that most people obsess over. And it leaves a person acutely aware of how easily things that we value, can be lost – and never gotten back again.
I was a Bio major in college but a few other topics stuck with me… Diane Arbus was a photrapher whose last works were about ‘freaks’ — dwarfs and other circus performers who were born with horrible deformities. One of her more-famous quotes was that ‘Most people go through life dreading they’ll have a traumatic experience. Freaks were born with their trauma. They’ve already passed their test in life. They’re aristocrats. More here: https://www.artsy.net/article/artsy-editorial-revisiting-diane-arbuss-final-controversial-series
I”m not saying addiction patients are ‘freaks’… or that their experiences are the same as the people referred to by Arbus. But there are similaries in the way they are viewed by society. Frankly, I’ll never interact the same as I did a month ago when I come across anyone in a wheelchair, for the same reasons. I think you all get my point…
I have to add here that Woody Allen (gosh, why am I so stuck on this guy??) said that the world consists of ‘the miserable and the horrible’. The horrible are people who suffer from the worst diseases, who are born and raised in horrible conditions… and the miserable are everyone else…
Back to my point… but some patients, a minority, don’t seem to learn as much from their experiences. I have had patients who did great for years, who I came to respect in many ways… who got caught up in methamphetamine (which from what I’ve seen is the fastest way to lose everything). Relapse to opioids has been extremely rare in my patients — maybe 1% at most (of about 700 patients). But some of my current patients still have friendships with ‘active users’, and even hang with those people. You know who you are, and I do too… the people who end up having meds stolen, who go from one crisis to the next, who can never come up with money for an appointment at a time when starting pay is well over $20/hr in our small town.
Don’t be a dead shark! Move forward. If you’re young and healthy, get to work! Yes, I realize what a judgy post this has become, but some people really need to get this message. A recession IS coming, if it isn’t already here – and the people who are satisfied right now be working part-time so that they can ‘focus on their lives’ are going to be the first to be laid off next year. Should ‘doing better in life’ really require that a person WORKS a JOB?? I don’t know if it ‘should’. But it DOES. My patients who work hard almost never slip backwards. Those with lots of idle time? THOSE are the patients I always worry about. If you are reading this, and having trouble moving in the right direction, let’s talk about it when we meet later this year.
Looks like pizza tonight. Did Uber eats for the first time a couple days ago… are you supposed to tip the restaurant? or just the driver? or both??
8.21.22: A long, boring Sunday… Nancy has read 3 books in the past week. I tell her to think of this as being in prison, with only a few days to go. I worked in a max female prison (TCI) for few years btw… I was surprised that the new ‘residents’ (they were not called inmates) all had to be in the max unit for at least the first month, and they had no ability to use a phone or see visitors. The worst thing (besides being stuck in a room, bored for most of the day, over and over) was the lack of privacy. Women who ‘acted out’ would end up in the ‘obs’ unit – a line of cells aross the hall from the guard unit, with the facing cell wall entirely glass and transparent. Women were often there on suicide watch, so they were not allowed clothing. Entrants to the unit walked down that hall, pass the glass walls, to get to the other cells, including ‘isolation’, where some people were held as long as a year, entirely alone. One hour per day to stand in a concrete-walled square room, with a view of only the sky. The women got clothes during a brief time during a lawsuit, when inspectors would visit.
I know I can be over-dramatic. But this is a tough operation — tough for the surgeons I mean. I have a lot of peripheral disease, where the vessels are tiny. In the past few years they have attempted to work on smaller and smaller vessels, but that’s where the risk is with this operation. I’m not afraid of death, although I know many of you are afraid of my death, given the horrible options for people on buprenorphine. If I die, I’m truly sorry. I’m not joking. I feel guilty about this situation, and I wish I’d been able to provide more warning. I’m realizing that I thought I was healthy until July 19th, when I had the stress test! Even after that, I assumed they would just dissolve the clot. I hadn’t even heard of ‘CTEPH’, but I know all about it now!
As an aside, if I die, you all know, hopefully, that there is nothing that Nancy can do. She is my employee, just like an employee at the hospital or any office. She has been able to call in a prescription if I tell her exactly what to order — but if I can’t tell her what to order, she cannot call a pharmacy from my office for any reason. I am the sole owner of the practice, so the practice will cease to exist if I die. I’m sorry, again — but I also want her to be with family, focusing on whatever she needs to focus on to move forward – and that will not include FDL Psychiatry. Please use NAABT.org to get a new doc; they are out there more and more, and hopefully you’ll be OK. I also suggest checking here, and if you don’t see anything from me a week from now, reduce your dose of buprenorphine by half. Consider a reduction in dose even now.
My PLAN is to be back at work by October. They tell me that the recovery will be difficult, but they won’t what the difficulty will be because there are so many different things that can happen. If my lungs bleed, I might need reoperation. Infection or sternal dehiscence would keep me hospitalized. My biggest fear is stroke, after recently reading about actor Bill Paxton’s family’s lawsuit after he death a few years ago (heart valve/aorta repair and a stroke 11 days later).
But if I die, I’ll either be in a better place, or I will cease to exist. I read a great deal about consciousness research… an article came out recently about how understanding consciousness depends on understanding theories of relativity. I’ll let anyone interested look it up from there…. another recent article discussed theories about WHY our universe exists, and how odd it is that we have just the right quailities in this universe, this galaxy, and this solar system to allow for carbon-based life forms. Y’know, if it wasn’t for the giant planet Jupiter, Earth would be inundated with meteors that would have made the planet a mass of dead rock, millions or billions of years ago.
8.22.22: Mojo day! No more morbid stuff. I posted some thoughts about death last night but Nancy read them and asked me to remove them. I think she was correct. I don’t want to go into all of this with a negative attitude.
I’m so appreciative of your emails. All of you who’ve written have expressed yourselves so well. One of you even went through emails I’ve sent over the years, and turned them around toward me — which provided me with a slap of insight that I really appreciate. Funny how it is so much easier for me to offer suggestions for others than to remember them myself!
Did the third COVID test. I have tested negative through the whole pandemic despite living in rural WI, where we ditched masks well over a year ago, while sitting in a small room with most of you numerous times, shopping in grocerty stories, going to Menards and Fleet Farm, etc. My 89-y-o mom tested positive at her assisted living place despite their crazy lockdown procedures, and I sat with her, maskless, for an entire day on a Tuesday, before the result from Monday’s weekly tests came in (she was asymptomatic but tested positive for a couple weeks).
I’m not a fan of broad orders from the government, especially when it isn’t clear how the order will impact society, and when half the country isn’t on board. If find it bizarre that the half of the country that valued free speech and freedom of thought now favors the opposite. If one Googles masks now, you’ll find tons of weak studies claiming that they are ‘effective’ – but that effectiveness varies widely from study to study. Studies comparing Eastern and Western European countries with varying mask usage found little or no value to masks. The problem with science, in general, is that studies that find the ‘popular’ results are much more likely to get through peer review than those with ‘unpopular’ findings. That bias impacts every branch of science, and since the academic community is so uniformly on the left of the spectrum, the bias is magnified.
Obviously, masks are a good idea on a person who is sick and coughing or sneezing. Of course, that masked person is going to be completely covered in active virus from wiping his/her nose, sneezing when the mask was not on earlier in the day, etc — so everything touched by that person will be covered in virus for a day, maybe longer. The person who wipes it down will have areas on the rag that don’t have sufficient cleanser to kill virus, so that rag will likely spread virus to other places. The silliest part of masks is putting one on to get in a restaurant, than taking it off to eat… then putting it on again to walk to the restaurant bathroom. And we all know by now the outcome of the lockdowns and shutdowns – including more suicides and overdose deaths, more mental illness, more division in the country, and who-knows-what horrible impact on the education of young children. I’ve personally heard from so many of you, about your children going from A students to C or D students when classrooms closed.
Of course writing anything but the media line would label me a ‘Trumper’ or a ‘white supremacist’ or worse… no matter what I think about Trump or minorities. A poll last week showed that almost no left-identifying college students would be willing to room with someone from the right. On the other hand, most righ-identifying students WOULD be willing to have a roommate from the left. And that’s frankly been my experience…. I’ve never heard a racist comment from my patients, who talk about all sorts of feelings and thoughts, and who are mostly on the right. I hear complaints about how things have changed so fast in so many ways, but I don’t hear expressions of hatred for people who think differently.
Just realized that the last paragraph is what I get when looking for mojo….
But seriously, people need to spend more time thinking about how to get back to the country we all loved. If your kid can’t interact with other kids in a way the respects diffent ideas, then shame on you! My dad, rest his soul, was firmly on the left. A good man, and a product of his youthful experiences (very poor, raised by a single mother since birth) – so I can’t blame him for this – but sometimes our kids see us more clearly than we even do ourselves – and I noticed how he assigned a group of characteristics to people of a different political party before he even met them. I remember saying in my teens — ‘but you don’t even know him!’ Politicians and the media, have very strong interests in protecting their ‘sides’ – so I long for a day when we all turn them off and tune them out.
I started talking to a guy at the UPS store this AM who was also waiting for a notary. He had a mask on and I didn’t, so I was worried that he would run away… but he talked with me. He said ‘I love Wisconsin- my company did business in Milwaukee and the people there were so friendly and welcoming… it isn’t like that out here.’ I haven’t been here long enough to judge, although I notice that I am always the first one to say ‘hi’ in the hall (or UPS line) and people often look surprised when I start speaking with them. In the Philly suburb where I once lived, people would talk with each other in the park – but that was in Bala Cynwyd, a very close-knit, wealthy community (I lived in an apartment on the outskirts at the time). When we moved back to WI after 11 years away, I was disappointed that people 1. didn’t go to parks, and 2. didn’t interact much if they did. But despite the media narrative, things seem much more integrated in WI (I haven’t seen more than three Black people in La Jolla since I came here, and the three were in the movie theater where ‘Nope’ was playing — honestly!!).
And over the last 30 years I’ve had so many experiences with people I didn’t know, offering to help me out in one way or another — as all of you have. And ‘white supremacists’? Seriously? There were Klan rallies when I was a kid — even the ACLU protected them and the six idiots who marched in them. I’ve never seen an actual swastika tatoo – has anyone? There are idiots on both sides — Antifa on one, Proud Boys on the other. Never met either, but the media seems to elevate them – at least one of them. Why?
Sorry about the diversion. I spend so much time reading — always science or news. I read the WSJ, NYT, and NY Post mainly. I encourage people to try to understand each other – even when it is difficult or you feel ‘provoked’. Stay calm, and be nice. If the discussion gets heated, don’t do what has been suggested by our ‘leaders’ and go ‘low’. Just wish the person well, and move on. Some and maybe most minds can’t be changed these days. I try my hardest to keep an open mind, and use my knowledge to decide what’s true and what isn’t, what’s best for America and what’s not, what’s good for the human spirit and what destroys that spirit, and what allows people to live with a sense of freedom — and what doesn’t. I’ve stopped reading politics lately because it is truly a waste of time.
I will close with pictures from La Jolla Cove, about 10 minutes from my ‘dorm’. I parked the car and walked down to the ocean, where there were tons of people in a nearby park and others swimming in the ocean — surrounded by sea lions and seals. Then had sushi, which I must admit is pretty incredible out here. But struggled to get back to the car, as I didn’t realize the trip had been all downhill and was uphill going back. I realized that I NEED this surgery.
I don’t know when I will post again. I don’t know if they will let me have my laptop in my room. But a friend will update my progress when I’m unconscious. We’ll talk soon.
8.23.22: I guess this is happening… Just got the call from admissions that they will be ready at 4 PM, an hour from now.
Some planning ahead… my goal, if things go well, is to get home by Labor day, and back to work by October. I’ve never had major surgery so I might be foolish to have this goal, but heck — us psychiatrists only have to sit, listen, and talk! Oh, and write prescriptions I guess.
My daughter’s flight was on time out of O’Hare so I hope to see her tonight… and my other daughter comes this weekend. My son visited me in FDL the weekend before I left, and drove us down to O’Hare. My brother and his wife are living at our house and caring for our dogs, our cat, and their dog…. my sister-in-law sent pictures of our dogs, and they look so sad! The next day I came across an article about a study that showed that dogs’ eyes tear up when they are reunited with their humans, after a period of separation. I need to get back home!
Thank you all for your wonderful emails. I am the luckiest doc in the world, to have so much support.
8.24.22 – 6:45 PM (CST): There is great news from Dr. Junig’s wife, Nancy, in California. Dr. Junig’s surgery was completed today as scheduled. The surgeon reports he was able to remove all of the blood clots from within his lungs as well as repair a heart defect. He is headed to the intensive care unit (ICU) where he will remain for at least a few days as is typical for this type of surgery and was planned. Nancy and the children that are with her will be able to see him later this evening after he is settled in ICU. He will be kept unconscious until at least Thursday or possibly Friday in order to help him recover in a more controlled manner. This again is standard and was planned. They are all of course thrilled as will Dr. Junig be when he wakes up and hears the great news. We will continue to provide updates here as Nancy has them or until Dr. Junig is doing well enough to log back in and do it himself – and knowing Dr. Junig as we all do, that will likely happen sooner rather than later. The Junig family wants to thank you for all of your support. Keep watching for further updates.
8.25.22: More great news from the west coast! Imagine the shock and surprise when the update text appeared to come directly from Dr. Junig himself! “Sneaking a call in the ICU,” he texted. Although he was cautioned he might be kept unconscious for a few days following surgery, he was already doing well enough within the first 24-hours on Thursday morning to stop the sedation, wake him up, and remove his breathing tube. He’s been able to get out of bed, sit up in a chair, talk with family and staff members, and evidently sneak a few texts on his phone. His surgeon told him that everything went “perfect.” He will still spend Thursday night in the ICU. The next step will be to come out of ICU and eventually be stepped down to a regular care room as he continues to progress in his recovery and in his hopes of being released back home by Labor Day where his dogs and cat are anxiously awaiting his return!
8.26.22: Sitting up and continuing to recover, here’s a photo of Dr. Junig on Friday as he rests a bit following a walk around the hospital ward. He says that his breathing is still a little difficult, but now it’s due more to the pain post surgery. His heart, which had been working overtime by beating over 100 times a minute, is now ticking back at a normal rate again. All good signs and even a thumbs up!
8.28.22: The recovery for Dr. Junig continues. He has been transferred out of ICU to the coronary care unit or CCU. They continue to get him up and have him walk around and are slowly trying to remove the mechanical support and medications as he works towards getting released. His chest tubes were removed today. Because the surgeon had to get inside both of his lungs to do the surgery, chest tubes were placed in order to help the lungs reinfate and stay inflated after surgery. Chest tubes can be extremely painful going in and very painful coming out. According to Dr. Junig, “If felt like a lizard running through the center of my chest as the chest tubes were taken out.” We’ll all have to ask him to tell us about the first time that he had a lizard running around his chest to know what it first felt like and how did the lizard even get in there? Yes, just a little humor there. However, he is very happy to now have the tubes out. Hopefully they got the lizard out as well.
He was hoping to be released back home by the Labor Day weekend but as of today he thinks he may be in California for at least another week yet. Of course, anyone who’s ever been in the hospital knows it can be rather unpredictable when your release date actually will arrive. It can be even more difficult to know after a major surgery.
On the positive side there have been no major complications following his surgery and only a few minor and somewhat expected ones. He says he feels like he’s slowly getting better but it “still hurts like heck.” Everything is still looking good so it’s just going to take some time to feel better. This page will continue to be updated as that journey continues and before too long Dr. Junig should be able to start updating it on his own and catching up on your emails to him. Until then we’ll continue the updates from the text messages he’s able to provide.
11.29.22 : Dr. Junig is back and writing his own updates again. Click over to the new “RETURNING” page to see the latest.