NEVER FORGET: SOMETIMES THE DOCTOR IS WRONG

THE  DOCTOR  WHO  WANTED  TO  AMPUTATE  MY  BIG  TOE
In  that  piece  on  premium  gas  which  I  posted  the  other  day,     I  noted  that  once,  when  I  pumped  gas  for  16  hours   in  the  snow  one  extremely  frigid  December  day  40  years  ago,    the  frostbite  in  one  of  my  big  toes  was  so  severe  that  the  toe  froze  solid.     My  heavy  winter  sock  froze  to  it,    and  when  I  managed  to  get  the  sock  off   the  toe  was  so  solidly  frozen  that  if  I  tapped  it  with  metal,  it  made  a  clicking  sound.

At  Frankford  Hospital  at  on  Frankford  Avenue  and  Wakeling  Street,  next  to  the  Frankford  El  in  Philadelphia,  the  Emergency  Room   doctor  said,    "Well,  Mr.   Dawson,  that  is  one  bad  case  of  frostbite.    That  toe  is  coming  off."

I  thought  to  myself,  "Losing  that  toe  will  be  a  life-changing  event.   It's  going  to  ruin  sleep  for  years  with  phantom  limb  pain.  That's  going  to  interfere  with  law  school  and  work.   It's  going  to  interfere  with  exercise.   It's  going  to  affect  relationships.    No.  I'm  not  going  to  just  blithely  give  up  my  toe."

So  I  told  the  doctor,  "No,  you  are  not  going  to  amputate  my  toe."

The  doctor  became  upset   and  said,  "But  the  flesh  on  your  toe  is  going  to  die  and  rot  and  fall  off   and  turn  gangrenous!     It  could  kill  you!"

I  responded,   "I'm  sorry.  We  are  going  to  try  to  save  the  toe.     And  you  are  going  to  prescribe  antibiotics  to  pre-medicate  me.  You  are  also  going  to  give  to  me  the  instructions  you  normally  give  to  someone  who  is  only  a  little  bit  frost-bitten.  If  it  turns  out  that  we  have  to  amputate,  then  we  will.    But  not  yet."

40  years  later,    I  still  have  that  big  toe.    Sensation  in  the  toe  is  only  about  50%,  but   it  is  a  working,  normal-looking  big  toe.

The  doctor  was  wrong.

I  was  right.


THE  DOCTOR  WHO  WANTED  TO  CASTRATE  ME
Years  ago,  my   wife  Rise`  was  Director  of  the  Volunteers  of  America  Day  Reporting  Center  for  parolees  in  Camden,  New  Jersey.

One  day,  one  of  the  Center's  new  clients,  newly-released  from  Camden  County  Jail,     reported  to  the  Center  for  the  first  time.     Unaware  that  virtually  his  entire  body  was  covered  with  a  thin,  sweet-smelling  sheath   of  colonies  of  bacteria   referred  to  by  epidemiologists   as   the  Camden  County  Jail  strain  of  Methicillin-resistant  Staphylococcus  aureus  ("MRSA"),   the  parolee  asked  to  use  the  Men's  Room,  emerged  after  not  thoroughly  washing  his  hands,  and  introduced  himself  to  my  wife,  shaking  her  hand.  When  he  did  that,  he  left  on  her  hand  an  invisible  splotch  of  the  bacteria.

My  wife  suffers  from  chronic  excema  on  her  hands.    She  probably   scratched  a  minor  itch   on  the  hand  that  shook  the  hand  of  the  new  parolee.

By  giving  her  minor  itch  that  little  scratch,  she  injected  herself  with millions  of  MRSA  bacteria.

One  of  the  bacteria  traveled  in  a  vein  about  a  foot  up  her  arm,  and  implanted  itself  in   the  wall  of  the  vein,  and  emerged  within  48  hours  as  a  boil  on  her  arm,  and  began  to  attack  and  dissolve  blood  corpuscles  at  the  boil  site,   with  one  goal:     To  consume  the  iron  atoms  in  her  hemoglobin  protein  molecules.  The  rest  of  the  bacteria  were  destroyed  by  Rise`'s   immune  system.

None  of  us  understood   how  dangerous  MRSA  was  when  Rise`  first  brought  it  home.      We  thought  that  she  simply  "had  a  boil."   She  went  to  the  doctor  for  it.  He  gave  her  an  antibiotic,    which  made  the  boil  go  away.   We  thought  that  was  it.

But  first  one  son,  and  then  another,  and  then  another,     got   boils.   And  suddenly  we  realized  that  we  had  a  mini-epidemic  in  our  house.

At  first  I  thought  that  I  was  immune  --  I  was  the  only  one  in  the  house  not  getting  boils.

What  I  did  not  realize  was  that  though  my  body  initially  resisted  the  boils,    a  subtle  change  in  the  normal  odor  given  off  by  my  skin,  in  the  direction  of  what  might  be  described  as  "sweetness,"   meant  that  I  had  become  a  very  dangerous  carrier  of  the  disease  --  that,  undoubtedly,  without  getting  any  boils,     I  had  that  same  sweet-smelling  invisible  sheath  of  MRSA  bacteria  covering  my  entire  body  that  the  parolee  had  had,     so  that  I  was  leaving  splotches  of  MRSA  bacteria  on  everything  I  touched.  Additionally,  my  clothes  were  becoming  dangerously  suffused  with  MRSA,  so  that  every  time   my  wife  or  I  did  the  wash,  just  disturbing  my  clothes   caused  an  invisible  cloud  of  MRSA  spores  to   rise  over  the  clothes,  so  that  whoever  was  doing  the  wash  breathed  it  in.

I  am  fanatically  clean.    However,   one  good  shower  a  day  was  not  enough  to   wipe  out  the  MRSA  colony.    The  rule  is  this  --  thoroughly  soaping-up   and  rinsing-off  in  a  shower   washes  90%  of  the  bacteria   off  your  skin  and  down  the  drain,  leaving  a  10%  presence  on  all  parts  of  your  body,  which   fully  grows  back  in  about   16  hours.

The  MRSA  colony  on  my  skin  finally  overcame  my  body's  immune  system,  and  I  developed  a  big,  ugly  MRSA  boil  on  my  scrotum.

A  typical  MRSA  boil,

with  smaller  boils  "orbitting"  around  it

By  this  time,  I  was  beginning  to  understand  MRSA  --  better,  frankly,  then  our  family  doctor,  Dr.  Leonard  Kabel.   I  rushed  off  to  him,  to  get  him  to  lance  the  damnable  thing    and  prescribe  antibiotics.

"Pete,"  he  said,  "Relax!  It's  just  a  boil,  which  is  really  nothing  but  a  big  pimple.    If  you  leave  it  alone,  it  will  probably  go  away  by  itself!"

"You're  wrong!"  I  said,  with  some  urgency.     "I'm  fairly  sure  that  it  is  this  new  flesh-eating  disease,  MRSA.   It's  dangerous!"

"Pete,"  he  said,  "You  read  too  much.     Go  home.  It'll  go  away  on  its  own."  

One  week  later,  I   was  back  in  Dr.  Kabel's  office.     The  boil  had  infected  the  testicle   beneath  it.    The   testicle  had  grown  to  the  size  of  a  plum,  and  my  scrotum  had  an  enormous,  frightening  looking  boil,  surrounded  by  about   10  other  tiny  boils,  on  it.

Dr.  Kabel  was  shocked  at  the  changes,  and  he  whispered,  "Pete,  it  may  be  too  late   for  medication.    I  think  that  you  may  be  in  serious  trouble,  here.

"Would  you  consider  castration?"

His  change  from,  "Don't  worry  --  it's  only  a  big  pimple!"  to    "It's  too  late  for  meds  --  let's  castrate"    in  one  week's  time  made   me  crazy.

I  lost  it.  I  stomped  out  of  his  office  for  fear  that   I  would  yell  at  him  or  punch  him  for  not  giving  me  an  antibiotic  the  week  before,  and  decided  to  find  another  doctor.

I  also  did  something  else.

As  I  had  become  too  old  for  jogging,   I  reverted  to  "power  walking."    I  was  up  to  three  miles  per  night.

One  of  the  things  I  had  discovered  with  4  mph  "forced-march"  style  "power  walking,"  involving  hard,  fast,   walking  with  constant  deep  breathing,   was  that  everything  --  even  skin  blemishes  --  got  better  quicker.

So,  because  of  my  MRSA  infection,   I  doubled  it.

I  did  3  miles  in  the  morning,  3  miles   at  night.

As  I  continued  looking  for  a  new  doctor,  within  24  hours,  I  noticed  a  difference  in  my  infection  from  the  "power  walking."

With  48  hours,   the  infection  --  and  my  testicle  --  had  begun  to  shrink.

Within  72  hours,    I  had  once  again  had  a  single  small  boil  on  my  un-swollen  scrotum.

Within  96  hours,    all  I  had  down  there  was  a  small  pimple.

By  the  end  of  the  week,  the  really  mean  MRSA  infection,  that  had  infected  a  testicle  and  made  it  huge,  and  covered  my  scrotum  with  a  frightening-looking  set  of   boils  --  and  motivated  my  doctor  to  request  that  I  agree  to  be  castrated  --  was  gone.

I  later  found  out  that  what  I  had  stumbled-into  wasn't  that  "exercise  is  healthy."  Rather,  it  was  the  not-yet-well-known  weakness  of  the  MRSA  bug:   The  receptor  it  uses  to  invade  and  destroy  the  blood  corpuscle  to  get  at  its  iron  atom  is  closed  when  the  corpuscle  is  oxygenated  --  when  it  is  carrying  its  oxygen  load  to  serve  the  body's  functions.

So,  to  deprive  it  of  food,    all  one  has  to  do  is  cause  oneself  to  be  well  hyperventilated   during  each  MRSA  bacterium's  life  span.

Which  would  ordinarily  be  impossible   except  for  the  fact  that  the  total  life  span  of  each  MRSA  bacterium  is  only  20  minutes.

So,  by  engaging  in  hyperventilation-causing  "power  walking"   for  90  minutes  twice  each  day,   I  was  functionally  starving  to  death,  twice  a  day,    billions  of   MRSA  bacteria  which  could  not  find   un-oxygenated   blood  corpuscles  to  invade  and  dissolve,  to  survive  and  reproduce.

The  doctor  was  wrong.


I  was  right.



THE  DOCTOR  WHO  SECRETLY  USED  ME  AS  AN  EXPERIMENTAL  PHARMACEUTICAL  GUINEA  PIG
I  suffered  from  asthma  beginning  when  I  was  a  child,  but  it  went  undiagnosed.

When  I  was  in  my  30s,    one  of  the  girls  who  did  typing  for  my  law  practice,  Mimi  Bird,    heard  me  complaining  about  phlegm  which  I  could  never  seem  to  cough-up,  that  it  was  ruining  my  sleep.    "Pete,"   she  responded,    "Maybe  that  sensation  of  phlegm  is  an  illusion.  Maybe  you're  experiencing   constriction  of  your  bronchial  tubes  due  to  asthma  inflammation.  Go  buy  yourself  a  Primatene Mist  inhaler  and  see  if  it  relieves  the  symptoms."

I  took  Mimi's  suggestion.  It  worked.  She  was  right.

So,    my  buddy  Mimi  saved  me  by  diagnosing  my  true  problem.

The  problem  with  Primatene  Mist  is  that  one  can't  take  it  for  chronic  asthma  problem.    Albuterol   (which  should  be  sold  over-the-counter,   in  my  opinion,  since  it  is  gentler  than  Primatene  Mist,  and  longer  lasting  in  its  effects)  should  be  prescribed,  instead.

And  so  I  began  to  take  Albuterol.

Until   the  pharmaceutical  industry  came  up  with  Serevent.

One  day,  the  family  doctor,  Dr.  Kabel,  asked  me,  "How  many  times  a  day  do  you  take  albuterol?"

"I  inhale  two  shots,  twice  a  day,"  I  responded.

"That's  too  much!"   he  responded.    "I'm  prescribing  a  new  inhalant,   Serevent.  Let's  see  how  you  do  with  that."

I  looked  at  his  prescription.     It  was  for  two  shots,  twice  a  day.

Upset,  I  said,  "The  Albuterol   works  fine.   You  have  me  inhaling  this  new  stuff  exactly  as  frequently.    Why  try  to  fix  it,  if  nothing's  broken?  You're  not  getting  drug  company  kickbacks  of  some  sort,  are  you?"

Dr.  Kabel  was  silent.

So,   I  flipped  over  to  Serevent.    It  worked  fine.  But ...

But,  shortly  after  I  began  taking  it,  I  developed  mitral  valve  prolapse.

At  night,  every  time   I  began  to  go  to  sleep,    the  mitral  valve  in  my  heart  "clicked,"   startling  me  awake  with  a  jerk.

I  would  jerk  awake   10  or  15  times  a  night,  until  exhaustion  from  lack  of  sleep enabled  me  to  sleep  soundly.

Once,  I  was  lazy  about  refilling  my  Serevent  prescription.    And  the  mitral  valve  prolapse  vanished.

Immediately,  I  realized   that  the  Serevent  was  causing  the  sleep-destroying  mitral  valve  prolapse  "click"  in  my  chest  at  night.

I  experimented  by  substituting-in  Primatene  Mist  for  Serevent  for  a  week.     No  mitral  valve  prolapse.

So,  I  made  an  appointment  with  Dr.  Kabel,  and  I  told  him  about  my  experiment.

"No   more  Serevent,"     I  said.   "Just  Albuterol."

Dr.  Kabel  answered,  "Pete,  I'll  tell  you  what:   Let  me  try  this  other   brand  new  inhaler,  Advair,  and  you  won't  have  the   mitral  valve  prolapse  problem  anymore."     

I  looked  at  his  prescription.   Two  shots,  twice  a  day.   I  started  to  become  angry.

"Doctor,"   I  said,    "Once  again  you  have  me  inhaling  exactly   as  much  of  this  new  drug  as   Albuterol.    Albuterol   is  fine.  My  lungs  love  it.  Let  me  just  go  back  to  that."

"Just  try  this  new  stuff,  Advair,  and  let  me  know  how  you  do,"    he  responded.

As  soon  as  I  started  on  Advair,  I   started  suffering  from  mitral  valve  prolapse,  again.    Click,  click,  click,  click,  click,  every  time  I  tried  to  go  to  sleep  for  the  night.   I  angrily   went  to  Dr.  Kabel's  office  without  an  appointment.

"This  new  stuff  has  Serevent  in  it!"  I  asserted.    "My  heart  is  clicking  away  again  every  night.   It's  ruining  my  sleep.   You  lied  to  me!"

"Okay,  okay!"    he  admitted.    "Yes,  it  has  Serevent  in  it!     I  was  just  testing  you,  to  see  if  it  was  all  in  your  head!"

"WHAT???!!!"  I  objected.    "YOU  WERE  RUNNING  AN  EXPERIMENT  ON  MY  BODY  WITH  DRUGS  WITHOUT  TELLING  ME???!!!"

"Oh,  calm  down,"  he  responded.  "Here's  your  Albuterol   prescription!"

The  doctor  was  wrong.


I  was  right.


THE  DOCTOR  WHO  INJURED  MY  KIDNEYS
Another  doctor,  whose  name  I  will  not  name,  because  he  is  still  alive  and  practicing  and  would  not  want   the  truth  broadcast  in  a  website,   prescribed   Norvasc   for  my  gradually  increasing  blood  pressure  for  years. 

One  day,  when  the  sphygmomanometer   gave  a  blood  pressure  reading   of   140/100  -- a  blood  pressure  level  that  was  okay  by  me,  but  not  the  doctor   --   the  doctor  said,   "Pete,  I   want  to  try  to  get  your  reading  down  to  120  over  80.  Some,  I'm  going  to  try  the  next  step  up  in  blood  pressure  medications."

I  responded,  "Doctor,  why  not  leave  well-enough  alone?  My  body  is  perfectly  happy  with  Norvasc.   Why  play  around  with  the  meds  for  a  few  more  points  on  the  shygmo-whatever-you-call-it?"

But,  he  refused  to  prescribe  Norvasc,  and  went  with  amlodopine  benazepril  instead.

When  I  went  into  the  doctor  for  my  re-prescription  of  the  benazepril,    he  took  urine  and  blood  samples  for  general  battery  testing,  too.

Then,  I  got  a  call  to  come  in.

"Pete,"   he  said  with  a  grim  look,  "Your  creatinine  level  is  suddenly  'off  the  charts.'  I've  examined  and  re-examined  and  re-re-re-examined   your  file,   and  all  I  can  think  of  is  that  your  kidneys  reacted  badly  to  the  benazepril.    I'd  like  to   make  a  referral  to  another  doctor,  to  talk  to  him  about  going  on dialysis."

I  thought  to  myself,  "He  has  injured  my  kidneys  because  he  wanted  to  do  a  stupid  experiment   with  my  blood  pressure  meds,  to  try  to  get  negligible  progress  on  my  blood  pressure  reading.  And  now  he  wants  me  to  do  DIALYSIS???!!!"     I  had  grounds  for  rage,  but  I  kept  my  cool.

I  thanked  him   for  the  referral  --  and  never  went  on  dialysis.

Instead,  I  re-upped  my  walking  to  6  miles  per  day  again,    drank  a  lot  of  water,  and  prayed.

When,  a  few  years  later,    I  went  to  a  nephrologist   (a  "kidney  doctor"),  he  said  that  my  kidneys  had  repaired  themselves,  and  I  was  good-to-go,  again.

The  doctor  was  wrong.


I  was  right.


THE  "BOTTOM  LINE"
What  is  the  "bottom  line"  on  all  of  this?

Is  it,  "Ignore  your  doctor's  advice"?

No.  Your  doctor  is  a  smart  guy.

But  he  isn't  God.

He  (or  she)  may  think  so.  But  he  (or  she)  isn't  God.

He  (or  she)  is  just  a  very  smart  fallible  person.

BUT,  just  because  your  doctor  says,  "X,"   DON'T  conclude  that  "not-X"  is  impossible.

Think  things  through.

Exercise  discretion.

If  I  hadn't  done  that,  I'd  be  a  eunuch  with  no  right  big  toe,  on  dialysis,  whose  clicking  heart  made  him  jerk  awake  about  20  times  a  night.

Listen  carefully  to  your  doctor.

But,  beware.