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.