Medical Humor - E-mail Exchange About New Prescription

I recently exchanged the following e-mails with my doctor’s chief nurse about a new prescription I have been given.  Please forgive me; I just could not overlook an opportunity to generate some humor.  I hope the nurse and her associates got a laugh out of it.  They do a great job of boosting their patients’ morale and are always there when we need them.  I imagine that their job gets depressing at times.  I have edited the e-mails to protect the innocent.

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From: Larry Cox [mailto:LarryCox1200@gmail.com]
Sent: Thursday, March 24, 2011 9:40 AM
To: Nurse
Cc: Esther Cox (EstherCox@yahoo.com)
Subject: Several Questions About My New Prescription

Nurse,

Dr. X prescribed Fluvoxamine 50mg Tablets for me….  I just got the prescription filled as Walgreens had to place two special orders for it.

I read the information sheet that Walgreens provided with the tablets and have several questions.  Perhaps you can find the information in my files or ask Dr. X.

1.  The common uses for this drug are listed as treatment for obsessive compulsive disorder (OCD) and depression.  I do not believe I have OCD nor am I depressed.  I remember Dr. X talking about some symptom but for the life of me I cannot remember what it was?  Can you look it up in my files?

2.  I swear that I did not make up the following.  The information sheet has the following special caution:

 “FOR MEN: This medicine may rarely cause a prolonged, painful erection.  This could happen even when you are not having sex.  If this is not treated right away, it could lead to permanent sexual problems such as impotence.  Contact your doctor right away if this happens.”

a.   Are these “painful erections” like the ones I experienced as a teenager when I thought I would explode?  How are they different?

b.   What is the recommended treatment for such an occurrence?  I am not sure that Esther’s health is up to a “prolonged” standard treatment.  (I would try to remember your advice in yesterday’s e-mail about pacing my exercise to 5 minutes of strenuous exercise followed by 5 minutes of rest.)

c.    If I need to go to the Emergency Room for treatment, will it be OK to be driven there by car or should an ambulance be called?  I can see the 911 Operator reacting the same way you are as you read this:  “You’re kidding me----a 70-year old man is having a painful prolonged erection….”

d.  Just to be on the safe side so I don’t accidently cause such a problem, how much of a dosage of this Fluvoxamine would I have to take to experience this side effect?

Thank you in advance for getting back to me on these serious questions.  I am trying to be very careful about the prescriptions I am taking.

Sincerely,

Larry Cox

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From: Nurse

Sent: Thursday, March 24, 2011 3:30 PM
To: 'LarryCox1200@gmail.com'
Cc: Esther Cox
Subject: RE: Several Questions About My New Prescription

Hi Mr. Cox,

The reason that we prescribe the fluvoxamine is for pseudobulbar affect which is a form of emotional liability that is commonly associated with ALS.  Because this is sort of an “off label” treatment, you may not find this info in the medication handout. As far as the potential for a prolonged erection, I would be willing to bet that the odds of this happening are extremely low, and we have never had a patient experience this problem in relation to fluvoxamine.  If it happened to 1 person the drug companies are required to put it in the literature.  I wouldn’t worry about it, but if it does occur you should go to the local ER immediately, either by driving or calling 911.  If you were unlucky enough for this to happen (which again I wouldn’t worry about)  I am not sure exactly what they would do to treat it, but I believe it involves aspirating blood/fluid from the penis to dissipate the erection.  (Italics added by editor.)

Hope this helps put your mind at ease!

Thanks

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From: Larry Cox [mailto:LarryCox1200@gmail.com]
Sent: Thursday, March 24, 2011 3:57 PM
To:  Nurse
Cc: 'Esther Cox'
Subject: RE: Several Questions About My New Prescription

Nurse,

Thank you for relieving my concerns.  The “aspirating blood/fluid from the penis to dissipate the erection” sounds ominous.  (Editor:  Like sticking a sharp needle in and draining the blood.  Ouch!  I will try to talk the doctor into a Rx for Viagra.)

Larry Cox

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Re-Inventing Your Life After A Challenge

I just finished a great book on living after a life challenge.  The book is “A Whole New Life – An Illness And A Healing” by Reynolds Price.  I highly recommend the book to: anyone facing a life challenge, their caregivers, their family and friends.  I also recommend the book to any professionals who treat people facing such challenges.

Reynolds Price was an acclaimed author of novels, stories, poems, essays, plays and several memoirs.  He taught narrative writing at Duke University beginning in 1958 until his death in January 2011 at age 77.

In 1984, at the age of 51, a large cancer was discovered in his spinal cord.  (“The tumor was pencil-thick and gray-colored, ten inches long from my neck-hair downward”.)  Urgent surgery failed to remove the growth.  Radiation treatments temporarily arrested it but left him a paraplegic in tremendous pain.

Price recounts without self-pity what became a long struggle to withstand and recover from this appalling, if all too common, affliction (one American in three will experience some form of cancer).  He charts the first puzzling symptoms; the urgent surgery that fails to remove the growth and the radiation that temporarily arrests it (but hurries his loss of control of his lower body); the occasionally comic trials of rehab; the steady rise of severe pain  and reliance on drugs; two further radical surgeries; the sustaining force of a certain religious vision; an eventual discovery of help from biofeedback and hypnosis; and the miraculous return of his powers as a writer in a new active life.

The whole book is compelling reading but I found the last chapter to be the most rewarding.  Price states that he wrote the book because “friends and strangers have asked me to add my recollections to the very slim row of sane printed matter which comes from the far side of catastrophe, the dim other side of that high wall that effectively shuts disaster off from the unfazed world….I shared their frustration for some fellow-words to consume those weeks after radiation when I finally recovered the will to read and searched....for any book, essay or sentence that might speak directly to the hole I was in----anything more useful than crackpot guides to healing or death, impossible complex starvation diets, alfalfa pills and karmic tune-ups.  But nothing turned up….apart from short sketches of the Bible….”

“I needed to read some story that paralleled, at whatever distance, my unfolding bafflement----some honest report from a similar war, with a final list of hard facts learned and offered unvarnished----but again I never found it.  Admitted, there are richly useful methods…. But nobody known to me in America, or on the shady backside of Pluto, is presently offering useful instruction in how to absorb the staggering but not-quite-lethal blow of a fist that ends your former life and offers you nothing by way of a new life that you can begin to think of wanting, though you clearly have to go on feeding your gimped-up body and roofing the space above your head.”

Price is writing towards people facing such life challenges as “birth disasters, unstoppable cancers, disorders of the blood and lymph, external wounds to flesh and bone, those devastations in which the body turns on itself and eats its own substance, the mind’s estrangement, the still irreparable disconnection of electrical service to major parts----each of a thong of catastrophes as common as influenza or migraine….”

The final chapter is devoted to Price’s recount of the “minimal facts that eventually worked for me, at least part of the time, and are working still.”  He writes that “three facts stand at the head of any advice I’d risk conveying to a friend confronted with grave illness or other physical and psychic trauma.”

1.  “You’re in your present calamity alone, far as this life goes.  If you want a way out, then dig it yourself, if there turns out to be any trace of a way.  Nobody-----least of all a doctor-----can rescue you now, not from the deeps of your own mind, not once they’ve stitched your gaping wound.”

2.  “Generous people-----true practical saints, some of them boring as root canals----are waiting to give you everything on Earth, but your main want, which is simply the person you used to be.”

3.  “But you’re not that person now.  Who’ll you be tomorrow?  And who do you propose to be from here to the grave, which may be hours or decades down the road?”

“The first two facts take care of themselves; if you haven’t already known them in spades and obeyed their demands, they’ll blow you neatly down till you concede their force.  Harder though, and even more urgent, admit the third fact as soon as you can….  Grieve for a decent limited time over whatever parts of your old self you know you’ll miss.

“That person is dead as any teen-aged Marine drilled through the forehead in an Asian jungle, any Navy Seal with his legs blown off, halved for the rest of the time he gets; any woman mangled in her tenderest parts, unwived, unmothered, unlovered and shorn.  Have one hard cry, if the tears will come.  Then stanch the grief, by whatever legal means.  Next find your way to be somebody else, the next viable you-----a stripped-down whole other clear-eyed person, realistic as a sawed-off shotgun and thankful for air, not to speak of the human kindness you’ll meet if you get normal luck.”

“Your mate, your children, your friends at work----anyone who knew or loved you in your old life----will be hard at work in the fierce endeavor to revive your old self, the self they recall with love or respect.  Their motives are frequently admirable, and at times that effort counts for a lot----they prove that you’re valued and wanted at least----but again their care is often a brake on the way you must go.  At the crucial juncture, when you turn toward the future, they’ll likely have little help to offer; and it’s no fault of theirs (they were trained like you, in inertia.)”

“Many well-meaning mates, lovers and friends will stand by, observing that you’re in the throes of blind denial----Give up, Let go.  Get them out of your sight and your hearing with re-hot haste; use whatever force or fury it takes.  Then try to choose life.  Then see who you can live with now.

“More likely, they’ll stall you in the effort to learn who you need to be now and how to be him or her by tomorrow or Monday at the latest.  Yet if you don’t discover that next appropriate incarnation of who you must be, and then become that person at a stiff trot, you’ll be no good whatever again to the ruins of your old self nor to any friend or mate who’s standing beside you in hopes of a hint that you’re feeling better this instant and glad of company.”

“The kindest thing anyone could have done for me, once I’d finished five weeks’ radiation, would have been to look me square in the eye and say this clearly, “Reynolds Price is dead.  Who will you be now?  Who can you be and how can you get there, double-time?”  Cruel and unusable as it might have sounded in the wake of trauma, I think its truth would have snagged deep in me and won my attention eventually, far sooner than I managed to find it myself.  Yet to this day, with all the kindnesses done for me, no one has so much as hinted that news in my direction; and I’ve yet to meet another dazed person who’s heard it when it was needed most----Come back to life, whoever you’ll be.  Only you can do it.”

“How you’ll mange that huge transformation is your problem though and nobody else’s.  Are there known techniques for surviving a literal hairpin turn in the midst of a life span----or early or late----without forgetting the better parts of who you were?  What are the thoughts and acts required to turn your dead self inside-out into something new and durably practical that, however strange, is the creature demanded by whatever hard facts confront you now?  So far as I’ve heard, nobody else knows----or knows in a way they can transfer to others.  If they know, I haven’t encountered their method.  I’ll go on sketching my own course then.”

In Price’s words, “if I were called on to value honestly my present life beside my past---I’d have to say that, despite an enjoyable fifty-year start, these recent years since full catastrophe have gone still better.  They’ve brought more in and sent more out----more love and care, more knowledge and patience, more work in less time.”

R.I.P. – Reynolds Price

New Your Times Obituary: “Reynolds Price, a Literary Voice of the South Dies at 77”

http://www.nytimes.com/2011/01/21/books/21price.html

Profile on PBS Religion and Ethics Newsweekly January 21, 2011 (sound volume is low)

http://www.pbs.org/wnet/religionandethics/episodes/by-topic/reynolds-price-1933-2011/7992/

Book available from Union County Public Library and book and Kindle Version available form Amazon com.

Tip: Raise The Height Of Your Recliner

This Tip illustrates how I raised the height of our recliner sofa to make it easier for me to stand up and sit down.  This Tip was prompted by a discussion at a meeting of the Palmetto ALS Support Group (Lancaster, SC).

I have had trouble getting up from low chairs ever since my bout of Guillain-Barre’ Syndrome.  I have always assumed that most chairs are designed for people much shorter than my 6’ height.  I assumed that shorter people could stand up from a low chair easier than I could.  I was one of the taller people at the Support Group; the ladies were much shorter than I am.  Somehow, the topic of getting up from chairs came up.  I mentioned what I had done to raise our recliner couch and everybody seemed excited about the idea.  Apparently a lot of ALS patients must have recliners and also have trouble standing up from them.

The following is a step-by-step description of what I did to the couch.

1.     My recliner has a leveling screw on the bottom of each corner.  I got someone to help me tip the couch so that one of the leveling screws was several inches off the floor.  I put something under the front frame to hold the couch off the ground.

2.     I unscrewed one of the leveling screws.

3.     I took the leveling screw to my local hardware store.  I searched for a nut that would fit the leveling screw.  Then I used the nut to find four 4 inch bolts that matched the leveling screw.  I also purchased four flathead washers that fit the bolts.

4.     Next I went to my local lumberyard and had a 4” X 4” board sawed into four blocks about six inches long.  Most lumberyards will make these cuts for free.

5.     Next I found a local machine shop with a drill press and had a hole drilled in each block.  The hole is just large enough for the bolt to slip through.

6.     I went home and painted each block to match the color of the recliner; or you could match the carpet.

7.     I got somebody to help me tilt the couch back farther.  Again I propped it up for safety.  Then I took a bolt with a spacer nut and inserted it in the hole in the block.  I screwed the bolt into the hole for the leveling screw.  Then I repeated the process for the other three corners.

Everything has worked for at least three years; and our couch takes a lot of punishment.

This picture shows the block under the rear corner of the recliner couch.

Esther, my beautiful wife, demonstrating that the recliner with blocks is still as comfortable as ever.

Brother, Can You Spare A Hug?

Since I have lost my voice, I have developed a great craving for human contact----either a hug, a handshake or just a pat on the arm.

When I was in Rehab at Good Samaritan Hospital in Baltimore after my bout of Guillain-Barre’ Syndrome, many of the nurses and therapists went out of their way to give hugs and pats to their patients.  I appreciated the attention but did not recognize their therapeutic value.

A simple Google of “hugs have therapeutic value” brought up 8,500 hits.  One article “The Therapeutic Value of a Hug” by Glen Fiero quotes a book Touching: The Human Significance of Skin by Dr. Ashley Montagu:

 http://ezinearticles.com/?The-Therapeutic-Value-of-a-Hug&id=2515633

Dr. Montagu writes,

“Both the hugger and the person being hugged benefit because they have the immediate positive outcome of feeling good.  Hugs are heartwarming and can have the effect of leaving one energized and rejuvenated.  A caregiver’s hug accurately expresses to a child feelings of love, acceptance, comfort and a desire for closeness.”

“Hugging is health-enhancing because it reduces tension and stress, aids the immune system, helps with sleep, assists in building self-esteem and best of all has no negative side effects.  When we open our hearts and arms to others, we inspire them to do likewise.”

In “A Touch of Love”, Eric Kreye says:

http://www.amazingjoy.com/helpdailyliving/help18hug.htm

“Jesus knew the importance of touching and He used it in His contact with people all the time.”

“Mark 10 records an occasion when "they brought young children to Him, that He might touch them."

“In Bible times leprosy was the most dreaded disease and was incurable.  Since it was also contagious, anyone who had it was shunned.  In fact, such a person was sent away from the rest of society.  The constant call "unclean, unclean" was a sickening cry by lepers as they begged for food and clothing. They were the untouchables of that society.”

“But Jesus wasn't afraid to give a touch of love.  When a leper approached Him one day asking for healing, Jesus "moved with compassion, put out His hand and touched him...."  Immediately the man was made completely well.  (See Mark 1:40-42.)”

“There was healing in a touch from Jesus.  By His touch the blind could see, the deaf could hear, the lame could walk and run.’

According to Kreye “Professionals in the field of medicine know the value of touch. At New York University the therapeutic value of touch is part of their nursing program. One study revealed that 93% of doctors believe that touch helps relieve a patient's fear of treatment.”

I guess that I am not out of line in asking “Brother, can you spare a hug?”

How Do I Feel Inside About Losing My Voice?

I am a “people person”.  I have depended on my voice all my life: as a teacher, public speaker, management consultant, human resources manager, and executive recruiter.  I have been very active in my church, the local and regional Lions Clubs and many civic and professional organizations. 

My feelings have gone through several stages corresponding to how much of my voice I have lost.  In the early stages, a large part of my feelings were due more to my swallowing and choking problems than to the loss of my voice.  People could still understand me when I talked although my voice was slurred.  I felt that I had to give up attending any social event where food was being served because I could not socialize and eat at the same time.  This caused me to stop attending Lions Club meetings (which are primarily dinner meetings), some church functions, and going out to lunch and dinner with friends.  I want to thank my friends for trying to comfort me; but unless Esther, my wife, was along to carry the conversation, I felt it was too much effort.  I was afraid of choking and I always felt like a wallflower.

Suggestion:  If you want to comfort someone who has a similar condition to mine, arrange to visit him or her at home when it is convenient for the patient.  Don’t be bashful about going to their home; I know I appreciate visits from friends.  I can visit without worrying about food problems.

Then my voice deteriorated further where many people could not understand me.  Esther could not understand me over the phone.  In person, she had to read my lips or ask me to repeat myself until she understood me.  This was probably my darkest period----I felt like a monk who had been forced to take an oath of silence.  I withdrew from society and did not venture out much other than for necessities.  I felt that there was no purpose in life.

Along the way, the decision was made to move from our home on the Eastern Shore of the Chesapeake Bay to a smaller home near our children in the Charlotte area.  I became paranoid during this period.  I felt that Esther and our family were making major decisions about selling the house and moving to Charlotte without consulting me and sometimes against my will.  Since I could not express my ideas vocally, I felt that they were treating me like a mushroom---by keeping me in the dark and covering me with s!@#.  I became very angry.

I purchased a small white board and started printing my side of conversations so the other person could read them.  I also upgraded my laptop computer so that it could do text-to-voice synthesis; it worked, but it was too large and clumsy to rely on.  I used the laptop when I knew I was going to get into an extended conversation.  My low-tech white board remained my primary communication device.

My voice comes and goes.  I never know how it is going to sound when I try to speak.  Often, I cannot understand myself.  I am surprised when my voice is understandable and sustainable.  Over a three month period, I had two  conversations that went on for almost an hour; primarily because the other parties in these conversations were experienced in working with people with voice problems and could understand my speech which seems to be primarily grunts and growls.

We lived in a rural area in Maryland where there were not many social activities in which I could participate----even if just as a wallflower.  After we moved to the Charlotte area, I craved a social life.  I would go to Wal-Mart during its busiest times and walk around just to be near people.  We moved during the first week in December and there was a multitude of holiday church and family events to keep me busy.

I remembered that God had seen me through two previous life challenges and decided that losing my voice was just another hurdle to clear.  My New Year’s resolution was to find a way to participate in life again and to make myself useful to society.  I resolved to make an effort to “socialize” again----although at the time, I did not know how I was going to do it.  (I will discuss my efforts in a later blog.)

Since I made that resolution, my life has become much more positive.  I am over my anger and my relationship with my wife and family has improved.  My new-found positive attitude has had another pleasant side effect----I feel that my health has improved, although my voice has not.

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Good Things About My Voice And Swallowing Problems

Since May of 2009, motor neuron disease has slowly attacked my tongue and esophagus.  My tongue has gotten very weak; it is difficult to chew solid food; I have to be careful when I swallow that I don’t choke; and my voice has deteriorated to little more than a growl----sometimes I can’t understand what I am saying.  

This presents some interesting challenges.  I now carry a small white board so I can write out messages for family, sales clerks, wait persons, etc.  Or I type messages on my laptop.

However, everything is not all bad; the following is a list of the good things resulting from this disease:

1.       I am no longer called a “loud mouth”.

2.       I can really frustrate telemarketers when they call.

3.       My wife doesn’t have to suffer from my horrible singing in the shower.

4.       My friends and family don’t have to listen to me repeat the same stories for the umpteenth time.

5.       My wife is winning a lot more of our arg……, I mean discussions.

6.       Our grocery budget is a fraction of what it used to be.

7.       Cute young saleswomen fall all over themselves to be helpful.

8.       People remember me and my white board.  After just one visit to a store, I am treated like an old customer the next time I come in.

9.       I have a good excuse for not calling Verizon, the cable company, Medicare, etc. to get a billing adjusted.

10.    When I go out to eat, I bring home a doggy bag with most of my meal; it will usually provide 3 to 5 more meals at home.

11.   I have finally found a way to lose the excess weight that I have been packing on since college.

12.   I can finally wear my “thin” clothes that I have been saving for years.  Are powder blue leisure suits back in style yet?

13.   I can chow down on all of the high calorie fatty foods whenever I want to.

14.   I get a “perfect” martini the first time.  When I write out my detailed order for a martini, the waitperson just takes the white board to the bartender.

15.   I quit cussing (at least out loud).

Two Questions To Ask A Person Facing A Life Challenge

A very insightful person, who I had just met, recently asked me a simple question of: "how do I feel inside about losing my voice?"  Then this person just sat and waited while I collected my thoughts and then write my lengthy answer on my white pad.  Not only did it make me stop and think but it showed that the other person had compassion for my speech problem.

Over the last six months, I have met with many doctors, three speech therapists, the people at the ALS Clinic at Johns Hopkins, a psychologist, my physical therapist who has treated through all my challenges, my friends, my pastor (and good friend), and my wife and family; I’m sure that somebody has asked me the question before, but I cannot remember anybody waiting for me to respond before moving onto another topic.

Then this person asked another great question: "if I had the means, what is the one thing that I want to do with my life"?  (Or something close to that.)  Again, the inquisitor waited while I mentally composed my answer.  I came away from that conversation thinking of what that thing is and how do I achieve it?

My answers to these questions will be the subject of future blogs.  My point is that these two simple, but very compassionate, questions can have great positive impact on someone who is facing a life challenge----but you must wait while the person is composing his or her answer.