Hoping all goes well

A relative was recently diagnosed with Alzheimer’s disease.

He’s in his mid to late 70s.

He’s planning to initiate treatment with one of the recently FDA-approved monoclonal antibodies.

Monoclonal antibodies have been shown to delay progression of early Alzheimer’s disease but are not curative.

He will be getting an IV infusion every 2 weeks for the next 18 months, and will need follow-up brain MRI’s after the 3rd, 5th, 7th, 14th and 26th infusion, if all goes well. If there’s any evidence for an amyloid-related-imaging-abnormality (ARIA), due to swelling or bleeding in the brain, he would need MRI’s monthly until stability is assured.

The infusion takes approximately an hour, if all goes well, without unexpected waits/delays. The total time, obviously, is much longer due to travel time to and from the infusion center, the preparation of the infusion, and required post-infusion monitoring.

A brain MRI typically takes about an hour, if all goes well, without unexpected waits/delays. The total time, obviously, is much longer due to travel time to and from the imaging center, the possible need for sedation, and the possible need to repeat the entire study if accidental movement results in less than optimal images.

Clearly, this is no where the amount of “medical-care-time” that those on hemodialysis endure (4-5 hours every other day), but is still significant and like hemodialysis, pretty much keeps you anchored close to home.

Total billed costs are tremendous. The amount an individual pays varies depending on many factors.

I’m not sure what I would do yet, if/when faced with a treatment decision such as this.

But, I’m hoping all goes well for my relative.

Quick subtraction and not sucking

I saw a former neighbor at a memorial service, for another former neighbor, last week.

Our families lived across the street from each other for 23 years.

He’s an attorney, but let me know he retired last year.

He updated my will, in 2015, when my first wife died unexpectedly at age 45.

I let him know I retired 4 months ago.

My neighbor: “Did you know my wife died in 2022? She was only 70. That’s too young to die. Nobody should ever die that young. Doesn’t retirement really suck? One can only read so many books and watch so much TV, right?”

Just as I was about to come up with some sort of reply another former neighbor walked up to exchange pleasantries, unfortunately (or…thankfully?).

I’m not exactly sure how I would have replied but quickly:

1. Did subtraction (70 years minus 45 years equals 25 years).

and…

2.  Determined the question of if retirement sucks would never be answered in the affirmative.

We only had a brief encounter prior to being pulled away from our conversation.

I’m sorry he’s not doing well in this stage of his life.

I know he has 3 children and 3 grandchildren, but don’t know the current status of their relationships.

If I can find his contact information, or we cross paths again, I’ll try and share retirement pearls I’ve come across, if he’s seems open to it, approachable.

A retirement sensei

Some quotes by Daniel Waters, DO:

“When you retire, what remains of your medical life is your reputation and your contributions. All well and good to be envied for what you amassed. Better, I think, to be respected and admired for the things you did and the way you did them.”

“Most physicians leave a mark on their community, hospital, specialty, colleagues and their trainees. Some, however, leave a stain. One hopes physicians who exploited their healer’s status and privilege strictly for financial gain will be appropriately judged in the afterlife.”

“Staying sane for an entire medical career is not luck-it’s takes dogged persistence and constant self-reminding that you are not locked in a bank vault in Stockholm.”

“A lifetime of medicine is a chapter book. Page upon page of pathos, conflict, drama, joy, absurdity and humor.”

“A sense of humor is like having a reliable and endlessly renewable source of fresh water while hiking in the desert.”

“Think of it (retirement) like tapering a steroid or an opioid. You want to be clearheaded and unimpaired when you walk out the door for the last time.”

“Retirement is something that evolves because new variables are always being introduced. Health concerns, for ourselves and those we love, marriages, the arrival of grandchildren, unexpected deaths or departures-takes us in new directions, imbue us with new goals, higher hopes and different dreams.”

I could not agree more.

Huge thanks to Dr. Waters for sharing his wisdom.

No more pockets full of change

The popularity of beepers exploded during the 1980s.

They were a symbol of status-a person of importance who needed to potentially be reached 24/7-such as doctors and drug dealers 😂!

I finished medical school in 1985, family medicine residency in 1988, and a geriatric fellowship in 1990.

A beeper was on my belt, or in my shirt pocket, through all.

During residency, I did come to dread 4 numbers: 2050.

This was the emergency room extension and always meant there was a patient who needed to be evaluated for possible admission.

Once, after finishing a 36-hour obstetrics (OB) tour, I was driving home when my beeper notified me of the need to return to the OB ward stat.

I was more than half-way home, realized I had forgotten to change the name and beeper number of my replacement on the on-call board and started to speed in order to get to my apartment asap.

I was almost immediately pulled over by police.

I hopped out of my car, frantically told the officer what was happening, and was allowed to get back in my car and speed the rest of the way home with a police escort.

If out and about when on call, a pants pocket was always filled with change in order to use a pay phone to call whatever extension I was “beeped to.”

Finally, around 1988,  during my fellowship, I had access to a Motorola portable phone when on call. I was participating in the call rotation with the family medicine faculty.

Whomever was on call would take possession of the shoe-sized phone, with two possible antennas (one with a 25-mile radius, and the other a 50-mile radius), and the shoebox-sized charger. A 10-hour charge would allow for approximately 30-minutes of talk-time.

A beeper was still my constant companion, but the absence of a pocket full of change clanging allowed me to be somewhat less conspicuous.

I also did not need to always look for restaurants that had a pay-phone nearby.

So, therefore, I’ve obviously been high-tech since at least the 1980s! 😂.

I’m sure many will be impressed.

Makes me laugh!

A comforting denial

I recently applied for a long-term health care policy and was turned-down.

The phone interview, done by an RN, was “interesting.”

Early into the call:

“What operations have you had in the past.”

“I’ve had bilateral total hip replacements.”

“Why?”

“I had advanced degenerative joint disease.”

“Oh, okay.”

A bit later:

“Have you had any abnormal X-ray studies in the past?”

“Yes, on my hips.”

“What was abnormal on the right hip X-ray?”

“It showed advanced DJD.”

“What was the outcome?”

“I had a total right hip replacement.”

“Oh (and not, oh yeah) okay, what was abnormal on the left hip X-ray?”

Me, after briefly contemplating if I was being punked:

“It showed advanced DJD.”

“What was the outcome?”

“I had a left total hip replacement.”

“Oh, okay, let’s move on to some additional questions.”

The interview continued with more questions, many of which were redundant.

Clearly the RN was reading through a list of questions, having had to, hopefully only temporarily, abandon her common-sense once our encounter had commenced.

Prior to the call, I had looked into what to expect for the over-the-phone cognitive screen.

One question always apparent was, “in the next minute, name as many animals as you can.”

(Naming 15 or more is considered normal)

I was ready.

However, I was queried , “in the next minute, name as many fruits and vegetables as you can.”

Despite being temporarily stunned, I quickly recovered and proceeded to peel (pun intended) off, greater than 30.

A few weeks later a thin envelope arrived with the insurance company logo.

Remembering college application days from the 70s, when a thin envelope was consistent with being denied acceptance, I knew a disapproval was most likely before I opened the letter.

However, I was oddly comforted: “A long-term health care policy cannot be underwritten due to having had bilateral hip replacements.”

There was no inkling of cognitive deficits!

I admit…I’d prefer to be somewhat functionally impaired and cognitively intact than the alternative-functionally intact and cognitively impaired-before leaving earth!

My work email compromise, remembered

I just got back from a long weekend, out of town, with friends.

Prior to my retirement, a colleague was always my surrogate for any urgent/emergent issues when on vacation.

Nonetheless, the email barrage continued.

I struggled with the following: keep up with work emails when away, or just face hundreds once returning to the office.

Keeping up adversely affected family-time.

Deciding to not keep up also had an adverse effect…intrusive thoughts, that I tried to suppress, about the hours of work pending once returning to the office.

But fortunately, the intermittent feelings of gloom did not usually kick in until the second half of a vacation, only when the vacation was winding down.

Eventually, I compromised.

I would spend the hours needed to address and clear at home, to whatever degree possible, the night prior to returning to the office, or would go into my office the day prior (usually on a Sunday), when nobody else was there, if/when travel arrangements allowed for the same.

It never stopped the “thank God you’re back, you won’t believe what happened when you were away” comments from my staff on most every return, but I did enjoy my time away to a greater degree and always slept somewhat better the night before returning to the office.

FDA approval

During my career I would remind patients of the statements, “these statements have not been evaluated by the Food and Drug Administration (FDA) and this product is not intended to diagnose, treat, cure, or prevent any disease,” when patients would ask for my opinion on a dietary supplement or brochure/advertisement that they had seen.

Many had already purchased and some had already started taking the supplement in question.

I always tried to look into further for them.

I just finished reading, No More Tears (2025), by Gardiner Harris.

It’s extensively referenced and an excellent read.

I never knew the FDA was funded by industry, not taxpayers.

I should have made the following statement to patients, over my career, whenever I started them on any FDA approved medication/medical device:

This medication/medical device has been approved by the FDA but the approval may have been made by members of a review panel who had a financial incentive to approve and/or without the results of clinical trials that concluded adverse outcomes, due to being intentionally excluded from the submitted application, by the pharmaceutical company.

Gardiner Harris makes excellent recommendations on the last few pages on how to move forward from here.

It will be interesting to see if anything changes.