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General health problems such as ear infections, pink eye and influenza affect nearly every person eventually. Rod Moser, PA, PhD, shares information and advice here on the most common general health disorders, their symptoms, treatments, and prevention.

Thursday, August 20, 2009

My 40th High School Reunion
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Returning home to my little Appalachian town of Fairchance is a definite memory-jogger. Driving down my old street, looking at trees that I used to climb, and seeing my old house is like time travel. Hometowns never seem to change if you look through the eyes of a child.

Rumpy's Service Station is gone now; so is Rumpy. The pond where I would fish is still there, but now there is a picnic area. The trees I planted along the driveway of my old house are gone, but not before the roots cracked the cement. I see the window of my old bedroom where I used to shoot kids, sniper-like, from my window, with my brother's BB-gun. The apple tree is gone, but I can still taste them. I ate them green; with salt. I still remember getting belly cramps.

My Aunt Norine and Uncle Dave lived across the street. There are strangers living in that house, too. This was the house where my father's casket was viewed. He died in 1957 when I was six. My uncle has passed away, and my aunt, now 95, lives in a nursing home. Several years ago, she gave me her recipe for my favorite homemade dill pickles. I have been making those pickles every year since that time. I brought her a jar of mine this time, much to the suspicious horror of the Transportation Safety Board. My Aunt did not know me, but I hope she remembers her pickles. I was also able to see my Uncle Richard, who was visiting my Aunt Norine. He is the last of my uncles.

Of my mother's 13 siblings, only four survive, including my mother, all over 80 years old. My grandmother's house is still there, now clad in aluminum siding. It looks different now. My cherry tree is gone.

A short walk from the nursing home is the childhood home of my best friend, Terry. His parents are still there. His mean dog, Pepper, fortunately is gone or I would have been bitten by now. His parents still remember me, mainly since they were still getting mail for their long-deceased parakeet, Chipper, up until a few years ago. Terry and I signed up Chipper for some free offer back in the early 1960's and Chip Dawson continued to get junk mail for the next thirty years. Their big chest freezer (with the ice cream) is gone, as is the aquarium that once contained guppies. The guppies met an early death one summer weekend when we ate them, on a dare of course, when his parents were away. Beer was involved.

On every corner, at every house, my brother and I recalled stories. There were windows we soaped at Halloween, the building that once held a bowling alley were we both sat pins, and passed the old cannon in front of the municipal building. There was the church that I attended. The old school is gone; replaced by a brand new one a few miles away.

I have never been to any reunions, so there will be people there that I have not seen in 40 years. The reunion was held at the Summit Inn, an icon at the top of Summit mountain above Uniontown. I signed in and was given a name badge; my actual senior picture from the yearbook. I had straight, dark hair and weighed several thousand pounds less then I do now. My pimples are now gone, replaces by wrinkles of wisdom.

I wandered over to a display board, decorated with pictures of my classmates that are no longer with us. Some old letter jackets, a school cheerleader sweater, and a book of newspaper clippings were on the table. Over 25 people from my class have died, many before the reached the age of twenty. Car accidents. Cancer. Viet Nam casualties. All of them; gone.

I looked around the room for any familiar face. Other than Terry, I saw one - my ex-wife. I had no idea she would be there, but that's okay. She was the captain of the cheerleaders. Her best friend in high school, another cheerleader, passed away from breast cancer a few years ago. For the first time in many, many years, I shared a table with my ex-wife. We shared pictures of our grandchildren.

One by one, people came up to view the picture clipped to my sports coat. Among the shouts of "Oh, My God!", I received lots of hugs and told the same story over and over as to what I am doing now. I expect that I have increased my Blog readership by a few more.

I spotted a few old girlfriends, and several people that I have no idea, even now, who they are. The 60's music was playing way too loud. Old women, once teenagers, were dancing. As usual, the men watched, perhaps remembering sock hops from years past. One by one, several of us retreated to the lobby for a quieter area where we could talk.

Let the stories begin. Four remembered the time that Terry and I created a fake séance, complete with a tape recorded demon that frightened the living hell out of them. I was fondly remembered as the guy that could forge just about any teacher's signature, used for reasons yet disclosed. A slide show of old photographs played in the background. I saw my picture with the Toothless Club - those of us who had partial dental plates that could be removed. Toothless people in Appalachia are relatively common, however.

My friend, Terry, had a cardiac arrest a few years ago, followed by some corrective heart surgery. He is now a diabetic. Don, another old friend came by to comment on his emphysema, a result of his years of smoking. Dog Lehman didn't show due to a recent back injury. We all signed a get well card for him.

We were the last table to go to the buffet, so most of the food was gone. It was not very good anyway, not unlike our old cafeteria. Perhaps, this was part of the theme.

By 11 PM, old farts were dozing off and the women still gabbing. One by one, we said our good-byes, wrote down our e-mails, and promised to stay in-touch. There were many people that I had hoped to see that did not come for various reasons. This was my first reunion, and perhaps it will be my last. The friendships that we fostered in our youth have faded, but memories remain, at least for now. Soon, those too, may be gone, just like my old apple tree.

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Posted by: Rod Moser_PA_PhD at 8:17 AM

Sunday, April 12, 2009

Giving Bad or Unexpected News
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I have been fortunate in my medical career and type of practice settings that I have worked, that giving "bad news" is a rare event. During the course of a typical week, I inform patients of abnormal laboratory tests, or x-ray/imaging findings. Most of these abnormalities are expected and correctable by various treatments, or even "Tincture of Time."

When I order a pregnancy test on a teenager, it is for a reason. They may have been having unprotected sex and are having symptoms of pregnancy, such as a missed period. When I inform them of the results, they have already sort-of prepared themselves. Sometimes, I will simply ask, "How will you react if I tell you that you are pregnant today?" Knowing how they might react, will prepare ME on how to deliver the final news.

Many teenagers play Russian roulette with sex. They secretly wonder if they can actually get pregnant. They are practicing suboptimal forms of birth control, or none at all. Many will be pleased when I tell them they are pregnant; some will "freak out". Both will need some extensive counseling, of course.

Several years ago, I was doing an annual exam on a dear patient of mine. She was in her early 40's and had not had regular periods for years. Thinking she was menopausal, she did not really see the need for birth control.

"Any chance you could be pregnant?" I asked.

"Absolutely not," she responded, as I was palpating a suspiciously-enlarged uterus.

Of course, she was pregnant, and that "surprise baby" was Katie - a beautiful little girl, the love of their lives, and now, a beautiful young woman. This was unexpected news, but not "bad news".

I love giving good news. Who wouldn't? Telling someone that has been trying to get pregnant for years that they were successful; or telling someone who fears their skin lesion is a melanoma that it is benign is all great news. The patient is ecstatic. I feel good. It is a win-win situation. However, life and medicine is not always an endless stream of good news.

No medical provider wants to give a patient bad news, but that is part of our job. If you read my recent blog post about my friend who was diagnosed with a brain tumor last week, you will realize that these types of events are unbelievably frightening to the patient and their families/friends. You pace about and pray for "good news". You stare at the clock waiting for the doctor to come out and reassure you that everything is fine. The tension is thick enough to be cut by a knife.

My friend was five hours into his surgery. Finally, the surgeon came out into the crowded waiting room where the family had gathered. His face was not unlike a jury returning a guilty verdict. Pulses raced. Tears flowed.

In a subdued voice, almost too quiet to be heard, he gave his brief report. "He had a glioma - brain cancer. I was able to remove all of it. I sent the specimen off to pathology for a final report. Your husband is in the recovery room. Do you have any questions?" The only response came from my wife: "When can his wife see him?"

Everyone sat stunned. This was not the news we wanted to hear. Yes, everyone was pleased that the surgery was over and he was in the recovery room, but.....cancer! It is really difficult to hear anything, not even words of encouragement if they were offered, after hearing this dreaded word.

The family decided that it would be best that my friend hear this news from the doctor himself. He went back toward the recovery room.

Later that evening, it was evident that the doctor did NOT tell my friend he had cancer. Perhaps he wanted to wait until morning, after the effects of the anesthesia wore off, to tell him. That made sense.

The next morning, he made his rounds. My friend's wife was at this side. He inquired about how he was feeling, looked at the surgical site, and left after a few minutes. He did not sit down, nor did he discuss the cancer. He did not mention anything about meeting with the oncologist. Nothing.

The following morning, two days after brain surgery, my friend was to be discharged. I was a bit shocked, remembering the days when we would routinely admit men overnight for a vasectomy. The doctor came in and told him to make an appointment in his office for two weeks for a follow-up. Again, there was absolutely no discussion; no mention of his diagnosis.

"I guess I will have to wait two weeks to know if I have cancer."

My friend's wife called in a panic. "The doctor didn't tell him! What should we do? Can you tell him for me? I can't do it."

We were flabbergasted. How could the doctor NOT have told him? Did he forget? Did he think when he told the entire family, that he told the patient, too? Did he tell my friend, who just had brain surgery and was still under the after-effects of anesthesia, and he just forgot? Was he waiting for the final pathology report? Regardless of the reason, my friend needed to know what we already knew. We agreed to tell him.

So, one hour after he came home; sitting at the dining room table where we have shared so many meals and laughs, we told our friend that his brain tumor was, indeed, a cancer.

At first, he sat there in stunned disbelief. Then, he cried. Then, we cried. After a few minutes, our friend was "back". He thanked us for being there for him. He needed time to reflect on the news that was just delivered. He looked understandably tired and frightened.

I had written him a letter while he was having surgery. I read it to him. I will not disclose the content of that letter; it is much too personal. I can tell you that fighting cancer is not an individual battle, but a war - a war that intimately involves all of us. His cancer is a war that we plan on winning.

Now...with the help of God and the miracles of modern medicine, we can plan start those battle plans.

At about 9 PM last night, my friend called to thank us again. He sounded a bit better; more optimistic. Now that he knows his enemy - the cancer - he is ready to join the fight, too.

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Posted by: Rod Moser_PA_PhD at 5:14 PM

Wednesday, April 08, 2009

A Bad Week for Health, My Friends
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The older you become, the more likely you will have to deal with health problems, not only your own, but those of your close friends and relatives.

Last year, it was a friend's wife with lymphoma and my sister-in-law with breast cancer. This week, one of my best friends was diagnosed with a particularly aggressive form of prostate cancer. And, yesterday, one of our closest friends was rushed to the hospital when he could no longer speak. Later in the ER, a CT revealed the cause. He had a brain tumor.

Prostate Cancer
Bob has been my friend since college. We met in line since our school felt it necessary that everyone stand in alphabetical order for various functions. Both of our last names began with "M". We were even assigned dorm rooms in alphabetical order, so he lived two doors down the hall. His major was music, and he could really blow the saxophone, plus play the piano and sing. It didn't take us long to join forces with his roommate Danny (now a Baptist minister in the Midwest) before we had a singing trio - the "A-Courtians". The name originated from the fact that we lived in a dorm called A-Court. For the next several years, the A-Courtians would sing for assemblies and a few gigs for the Office of Admissions.

We were both from Pennsylvania and now, over thirty years later, we both live in California. Of course, I pursued a medical career; Bob used his music background to prepare him for a very successful career owning a pump company. After years of losing touch living our separate lives, we found each other's friendship again. We only get together one or two times per year. That is about all my splitting sides can take, since it is a non-stop laugh fest.

Bob's doctor has been monitoring his PSA levels - an indicator of troublesome prostate activity - for a few years. Sometimes the level was elevated; other times, it would go back in the normal range. It was never at the point where his doctor felt further investigation was needed; until recently, that is. His doctor decided it would be a good idea to do a prostate biopsy, in the office, without any anesthesia. This, of course, would never be something that I would agree to. I am personally at the point where I want anesthesia for a hair cut. Bob agreed to this transrectal procedure, telling me it was the most painful thing he has ever experienced - even worse than the time I hit him in the head with an entire sheet of plywood. A complication quickly developed when the surgeon hit a bleeder - an artery. Bob was rushed from his urologist's office to the hospital, losing about three pints of blood in the process. Having cheated death, Bob felt that he deserved to have the biopsy be negative for cancer. Unfortunately, it was not. Although I do not know the details of my friend's case, Bob tells me that it is a particularly aggressive type.

Aggressive types of cancer require aggressive treatments in my opinion. I insisted that he contact the best oncologist in the area. He was particularly fond of the oncologist that took care of his life-partner's lung cancer several years ago. I told him to make that call. Cancer treatment has made leaps and bounds over the years, and newer, more effective therapies orchestrate actual cures, not just palliative treatments. In the experienced hands of a good oncologist, I expect to be laughing and singing with my friend for decades to come.

Brain Tumor
It started with a phone call from George's wife.

"I think George had a stroke. I gave him three baby aspirins. Should I take him to the hospital?"

"Get off of the phone NOW. Call 911."

The paramedics arrived promptly and the stroke team at the ER was waiting for him. Prompt anti-clot treatment is critical; minutes or even seconds can determine outcome. However, George was not having a stroke.

George is a retired professor of anthropology. He speaks about four languages and has traveled and lived and lectured in many parts of the world, from Iceland to Pakistan. As a connoisseur of all foods ethnic, he was preparing a chicken dish for a lunch. He came up to his wife and started to talk. Instead of the usual rhetoric of a learned scholar, what came out of his mouth was gibberish. George thought he was communicating, but the words were not words at all - they were not words in any of his four languages either. They were aphasic words from a damaged brain.

A CT scan revealed the source of George's sudden loss of speech, and subsequent seizures. Silently, a tumor had been growing in the left side of his brain. Was it a cancer? Was it a metastatic tumor from a cancer somewhere else in his body? At this point, we do not have those critical answers.

Throughout the day, George was having periods of normal communication, followed by odd periods where he was speaking in tongues unknown. The hospital's only neurosurgeon met with him this morning and he is scheduled for surgery in two days. We will keep you posted.

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Posted by: Rod Moser_PA_PhD at 6:00 AM

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