Monday, June 20, 2011

Message #14 - Whassup, Doc?

I love Frank Sinatra’s beautiful ballad, “It Was A Very Good Year.”

When I was seventeen, it was a very good year for small town girls and soft summer nights.

When I was twenty-one, it was a very good year for city girls with all that perfumed hair.

When I was thirty-five, it was a very good year for blue-blooded girls of independent means.

And finally:

But now the days grow short, I’m in the autumn of the year,

And now I think of my life as vintage wine from fine old kegs

From the brim to the dregs

And it poured sweet and clear

It was a very good year.

He speaks for me when he sings of life as it is now – sweet and clear. I am grateful that I’ve lived long enough to savor this very good year.

Most of you are younger. You feel good. You have a lot of energy. Your health is not your major concern. You are immortal, right? Wrong!

If you’ve inherited good genes, and avoided accidents, and not been stricken with a disease that limits your ability to live life fully, then at 17 and 21 and 35 and beyond you haven’t had to think much about taking care of your well being. You haven’t had to think much about doctors.

I say that whatever your age you are your own best doctor. And so it’s fair to ask, Whassup, Doc?

I know that on this subject I’m like Sisyphus trying to roll that stone up to the top of the mountain. Or to be more explicit, this one is like shoveling shit against the tide. There is only a small chance you’ll pay attention. Even so, I’ve got something to say and I’m going to say it.

I’ve practiced what I’m preaching forever. I’ve been exceedingly responsible about my health. This is not surprising since one of my mantras for life is: “Protect yourself from the unexpected.”

Predictably, I’m a defensive driver. I assume fools who can’t be trusted surround me. When I travel I go to extraordinary lengths to minimize the impact of everything that can go wrong – late planes, missed flights, lost baggage, etc. I feel that I lose nothing by taking precautions. If they are unnecessary, fine. If one of my fears is realized, I’ve outsmarted it.

So of course I am a fierce advocate of preventive medicine. If I’m advised to have a colonoscopy every three years I do it. It I’m told to have a dermatologist check me out once a year I do it. If it is smart to have a yearly eye exam I don’t put it off. And for sure I faithfully set up my annual physical.

So in December 2003 I was in Jane Hightower’s office for my yearly checkup. Jane is an extraordinary Primary Care Physician. Careful, persistent, knowledgeable, with a commitment to customer service. Her patients are not bodies quickly moved in and out to maximize her cash flow.

At that time I’d been seeing her for six or seven years. I’d been unhappy with my previous primary doc and decided to interview replacements. I recognized that taking this approach was out of the ordinary, but I wanted to be happy with the person who was to monitor my well being.

I talked with three doctors. One was willing to talk with me and seemed fine, but was a little too conventional. A second didn’t hide his disdain for my process. How could an ignorant layperson like me presume to know enough to make an intelligent choice about who his doctor should be? Obviously, he didn’t make the cut. Jane was head and shoulders the best, and the years since then have validated both my process and the decision I made.

During my physical, a routine urine test showed some blood in the sample. That led to a trip to a urologist, which led to a kidney test (negative), which led to a bladder scoping which revealed two small malignant growths on the surface of the bladder. Low grade, not difficult to remove, but very dangerous if undiscovered and left to grow and penetrate into the bladder wall and beyond.

In the intervening years I’ve had regular cystoscopies and there have been recurrences. It is a condition that appears to be chronic and needs management. The game is to catch them before they catch you. Not surprisingly, I rigorously manage this process.

My bladder is beside the point. What is on point is that my annual checkup was not a pro forma exercise. It made a life saving difference. This is not a subtle message.

Whassup, Doc?


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