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A Closer Look

'Death is coming out of the closet'

Death be not proud, though some have called thee mighty and fearful – John Donne.

I thought of this iconic poem after I signed up as a volunteer for Hospice of Palm Beach County, and again after I met Zachary Morfogen.

As I entered the hospices in West Palm Beach and was given the privilege of visiting patients, I soon forgot all notions I had of horrible endings. Maybe that’s too saccharine. Occasionally, as I swing by patient rooms, I see that death is nearby and, clearly, it isn’t wearing a party dress. But its specter no longer scares me.

Morfogen presents himself that way, too.

At 81, after years of being a pivotal volunteer and donor for hospice locally and nationally, he seems assured through his faith and his belief in the mission of hospice, that a good death – one with as little pain and suffering as possible – is a well-sought goal. And achievable.

I had to ask him, of course, the most obvious question as we sat in the sunny home that he shares with his wife, Marilyn. They met in high school in New Jersey and seem still to be those special sweethearts they were then.

Do you think your service with hospice will better prepare you for your own experience with death?

Almost immediately, Morfogen answered.

“Absolutely. It will be easier for me to accept it than dealing with the acceptance of my wife’s death if she predeceases me,” he said.

Marilyn, a vibrant woman whom Morfogen depicted with splashes of color on canvas for her 80th birthday – he calls the art and poetry that accompanies it her “yellow bird” – is tethered to an oxygen tank as I enter their home.

He would not have become founding chairman emeritus of the National Hospice and Palliative Care Organization and the National Hospice Foundation if he had not been brought into the hospice movement by his wife whom, he said, was one of the first hospice volunteers in New Jersey.

Pondering the more than 35 years since hospice became active in the United States, he says – quoting an article he remembers well – “Death is coming out of the closet.”

He recalls his own tours of hospitals with dying patients early on, when he was on a New Jersey hospital board.

“I reacted with comfort at first. But I saw patients crying out so I asked the nurse, ‘Why aren’t you taking care of them?’ " he said. “I was told, ‘That patient is going to die.’ That was outrageous.”

It reaffirmed his determination to nurture the hospice movement and to give patients at the end of life the respect and care they deserved. He emphasizes that he is only a volunteer and never was a medical professional. But he lauds the combination of professionals and volunteers that make hospices tick.

“Let’s face it. You walk into a crowded restaurant or down the street and everyone here is going to die. Death is part of life. You have to accept the fact that at some point you’re going to die. We have a group of well-trained professionals that help you do it with grace, and to deal with your loss with grace.”

Getting care that ends the needless suffering of the patient while helping family members understand and prepare for their loved one’s passing doesn’t hasten death. It reaffirms life.

Write to Carolyn Susman
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When less is more

After 30 years in medical practice, there’s very little left that will shock or surprise me.

Two recent hospital encounters caused me to reflect how too often we physicians are occupied with doing things “to” rather than “for” patients. > More

After 30 years in medical practice, there’s very little left that will shock or surprise me.

Two recent hospital encounters caused me to reflect how too often we physicians are occupied with doing things “to” rather than “for” patients.

Mrs. A was a fragile 83-year old nursing home resident with a bit of dementia. She was sent to the hospital emergency room because of a sudden change in her behavior and was found to be having a stroke. A medical brain specialist, or neurologist, was immediately consulted, who after examining her and doing a CAT scan of brain, decided to administer an intravenous “clot-busting” drug.

After initially improving, she took a turn for the worse later that night and was moved into the intensive care unit. That is when I was asked to see her for an abnormal EKG.

Glancing at the squiggly lines of her heartbeat, I instantly knew she was having a heart attack. Since she was given the clot-busting drug the day before, she was not a candidate for more of this or any other blood thinners, as she might bleed into her brain. As interns and residents raced to place her on a breathing machine, I noted in her chart a living will and do-not-resuscitate order.

I quickly called her guardian, who confirmed that the family did not want her on life support. Rising quickly from my chair, I halted the training doctors just before they inserted a breathing tube in her throat. She died later that day.

In the rush to do as much as possible to save her life, not one of her doctors had called her family to ask about the patient’s wishes and advanced directive. At any age, a heart attack and a stroke within 24 hours has a very small chance of survival.

***

Mrs. B was recently placed on kidney dialysis. Although mentally sharp, she had many heart and medical problems. I was asked to see her for chest pain and an abnormal heart rhythm. Committing someone to dialysis is always a serious decision, but I was stunned to find out that she was 96 years old! This seemed to be clearly out of the range of common sense for me.

I wondered if her kidney doctor, the surgeon who placed the port in her arm for dialysis, or her family physician ever talked to her about the implications.

As reimbursements for procedures decline, physicians and surgeons become increasingly competitive. There is a common perception that if they don’t do what the family doctor wants, a competitor will.

I see these as cautionary tales. They remind me that although we have taken an oath to protect patients, sometimes our actions prolong the natural process of dying, rather than just adding days or months to living.

Please check out my other blogs at www.davidmokotoff.com.
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Family doctor comes through in minor crisis

Sickness of the vomiting and diarrhea variety hit our home last week. Imagine my shock -- and delight -- when I got a return phone call from my family physician's office at 12:30 a.m.! > More

Sickness of the vomiting and diarrhea variety hit our home last week. Imagine my shock – and delight – when I got a return phone call from my family physician's office at 12:30 a.m.!

A real doctor called in a prescription to the all-night pharmacy. Total time from phone call made to medication being administered: 40 minutes. Impressive.

Other random musings:

Co-worker Rory and I are still weighing in every Monday, and so far I've dropped about seven pounds since we started this a month or so ago. The changes have been minor, but I'm noticing a difference in how my clothes fit, which is nice.
I've noticed that breakfast really jump-starts my system. I used to wait until lunch to have the first bite of the day, often not hungry all morning as I fueled myself with coffee. Now after a breakfast of some Greek yogurt and Total cereal at 6:30 a.m., I find myself needing a snack by 10 a.m. By lunchtime I'm starved. Guess my body wants all those small meals. Greek yogurt has about twice the protein as “regular” yogurt and is about as thick as sour cream. Love it. It can even double as sour cream in some recipes.
Talked to a massage client the other day who came to the astute observation that we take better care of our pets than we do ourselves sometimes. He mused that we're willing to race the pet to the vet for the most minor of issues, attention the “country dogs” of our childhood never received. “My cat looks lethargic,” he said his daughter mused. “Maybe she needs to go to the vet.” “It's a cat, that's what they do,” he told her.
Doctors Without Borders, the international non-profit that sends medical teams all over the world, has an experienced team from Florida working in Haiti. It's a highly competitive process to be chosen to work for the organization and they are seeking qualified workers now. “Florida should be proud,” said Kathy Dedieu, one of the agency's field human resources recruitment officers. “Considering we have people from all over the world, it's pretty impressive Florida had an experienced team (ready) to go.”

Kumari Kelly, a licensed massage therapist, can be reached at kumari_kelly@yahoo.com.
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Don't shoot the messenger

I think I lost a patient last week. No, he didn’t die, but after his office visit, I had the distinct impression that he might not come back.

As a physician, I’m actively in charge of my patients’ care. They depend on that, and really, it’s my job. But sometimes I’m just the messenger. I report back to them on lab results, diagnostic studies or interpret what the consultant has to say.

His first visit was just over four years ago. At that time he was already medications for diabetes, high blood pressure, high cholesterol, insomnia, arthritis, reflux and allergies. His numbers were actually quite good, with his diabetes, cholesterol and blood pressure under adequate control.

I would regularly encourage him, and his wife, to lose weight, explaining that diabetes, hypertension and elevated lipids could be controlled with weight loss. Losing weight would also take the stress off his painful lower back.

Then in 2008 he was diagnosed with cancer. After surgery he gained more weight. I had often suggested Weight Watchers as I feel the program can be quite successful in motivated patients, but he said he just didn’t have time for it. His job entailed a lot of travel around the state.

Considering all his ailments, his numbers remained good.

He came in last week for his routine visit and to review recently drawn lab work. His triglycerides and blood pressure were also a little higher than normal. He was still on over a half dozen medications. His weight was 249 pounds.

I explained that I didn’t want to add any more medications, and that losing weight was the key to improving his health. He immediately became defensive.

I tried to be rational and explained that he was about the same weight as he was 4 years ago, so if he would just eat 250 fewer calories a day, he would theoretically lose 2 pounds a month, and two years from now he would be about 200 pounds. I told him not to eat the top of the bun on the quick burger that he grabbed – that would save 100 calories. “Well, I’m driving; I have to hold onto it with something.” I told him that not only shouldn’t he be eating while driving, he should also avoid talking on the phone while driving.

At that point I sensed the visit was over. I told him I’d see him in a couple months and he went up to the front desk. I told my staff a few minutes later that I didn’t think he’d be coming back. They said that he told them, “Dr. Lubin doesn’t listen to me, he doesn’t bond any more with me.”

I’m not sure what else I could have told him. Should I have assumed my “Dr. House” personality, screaming at him while waving a cane? Would he then have listened and followed my directions? Maybe, but I couldn’t really do that, even if I felt like it.

Sometimes you may not like what you hear from your doctor, and you may ignore what he tells you, but please, please, don’t shoot the messenger.

David Lubin, a Tampa family practitioner and award-winning photographer, can be reached at www.dajalu.com.
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CONSUMER CORNER

Frustrated with the health-care system? Don’t know where to turn for help? Want more on the human side of health care? We’ve got you covered.

Tingle likely doesn't come from denture cream

3/11/2010 St. Petersburg Times
News that zinc in denture adhesives could lead to neurological damage has led hundreds of denture wearers to call lawyers. But the lawyers say these folks should call their doctor instead.

FDA says it hasn’t found a fracture link to Fosamax

3/10/2010 © Palm Beach Post
The FDA said it had found no link between leg fractures and Fosamax, but its review is ongoing with other osteoporosis drugs. Recent reports had raised the question about whether there is an increased risk of this type of fracture in patients with osteoporosis using these medications.

Study: More sex = good health

3/11/2010 © Palm Beach Post
Two researchers from the University of Chicago’s OB-Gyn and geriatrics department found that people in good health do have more sex, and they continue being sexually active later in life.

Deaths prompt baby sling safety warnings

3/10/2010 © The Associated Press
The U.S. government is preparing a safety warning about baby slings — those popular and fashionable infant carriers that parents can sling around their chests to carry their baby. The concern is that infants can suffocate, and a few have.

Group preaches preservation -- of bodies

3/10/2010 © Florida Today
Can life be extended through technology? A non-profit group based in Brevard County plans to teach first-responders and funeral directors how to transport and preserve people for future resuscitation.

Medicare terminates Fox drug plans

3/9/2010 © South Florida Sun Sentinel
Medicare has terminated prescription drug plans offered by New York-based Fox Insurance, saying the company had improperly denied, delayed and restricted its 123,000 members from getting their medications.

Hearing aids hook up to Bluetooth

3/9/2010 © Sarasota Herald Tribune
Baby Boomers just beginning to need hearing aids are gravitating toward ones equipped to handle their Bluetooth-enabled gadgets, or disguise the hearing aid as one of them. A new hearing aid transmits signals wirelessly so that it can connect to your Bluetooth-enabled phones and other devices.

Feeling ill? There's an app for that

3/8/2010 © South Florida Sun Sentinel
With so many health-related apps available for the Apple iPhone, sorting out the ones that can make life a little easier from those that are just waste of time can be challenging.

Test drug stops tumors' growth -- for 9 months

3/9/2010 © Florida Times-Union
Paula Heacox of Jacksonville, who has advanced melanoma, has a chance to live longer than predicted by flying to Houston once a month.

Doctors to offer free colonoscopies

3/8/2010 © Gainesville Sun
During March, gastroenterologists at Digestive Disease Associates and North Florida Endoscopy Center are offering free screening colonoscopies to 50 people who are 50, have lost their jobs, are uninsured and have never had the test.

Pet hotel helps out when senior owners need medical help

3/8/2010 © Orlando Sentinel
Seniors could soon benefit from a program the Osceola Council on Aging is starting: a pet hotel, free of charge, for seniors who need to spend time at the hospital.

Publix, Pringles recalls linked to vegetable protein

3/8/2010 © The Associated Press
Publix Super Markets has voluntarily recalled four kinds of seasoning mixes that may possibly be contaminated with salmonella. The mixes were made with hydrolyzed vegetable protein supplied by Basic Food Flavors. That protein is also the reason for a recall of two Pringles potato chip flavors.

Doctor's wife spreads the word on lung cancer

3/8/2010 © Gainesville Sun
Caren Gorenberg, a doctor's wife and non smoker, has been diagnosed with one of the most virulent forms of lung cancer. Now she is making it her personal cause to spread the word about lung cancer.

Ways to keep food-borne illness at bay

3/8/2010 © St. Petersburg Times
You can lower your risk of food-borne illness through knowledge and safe food handling. Here are some basics that everyone needs to know.

Hundreds try out for a shot at 'Biggest Loser'

3/7/2010 © St. Petersburg Times
A crowd of close to 800 people lined up at the Seminole Hard Rock Casino in Tampa on Saturday to audition for Season 10 of NBC's weight-loss reality show The Biggest Loser. It was the first day of a national casting call for the show.

Salmonella contamination leads to massive product recall

3/5/2010 © The Associated Press
A wide range of processed foods — including soups, snack foods, dips and dressings — is being recalled after salmonella was discovered in a flavor-enhancing ingredient.

Gene test claims to help with diet

3/5/2010 © Associated Press
Promoters say their gene test will tell you which diet works best for you; skeptics say it's just another product being pitched without sufficient science behind it.

Metal hip implants causing problems

3/3/2010 © New York Times
Some orthopedists have stopped using a popular type of hip implant because it can cause severe tissue damage and need replacement within a year or two.

Thousands of food products recalled

3/5/2010 © New York Times
A vegetable protein used as a flavor enhancer in thousands of canned and frozen foods is suspected to be tainted with salmonella.

Burt Reynolds 'feeling great' after heart operation

3/4/2010 © The Associated Press
Burt Reynolds' manager says the actor has been released from a Florida hospital after a planned heart bypass operation. He says Reynolds told him he has "a great motor with brand new pipes" and is "feeling great."

Hear the voices of fibromyalgia

3/3/2010 © New York Times
It took Christine Wysocki of St. Augustine three years before a close friend believed she had a health problem. Such is the lot of those with fibromyalgia, the illness that many people -- including doctors -- don't believe exist.

Low car-accident rates dispel myths about age

3/3/2010 © Orlando Sentinel
Fair or not, scrutiny often falls on Florida's senior drivers whenever one is involved in a fatal wreck or a crash that gains publicity. But the reality is, licensed seniors in Florida are far less likely to be involved in crashes than their youngest counterparts.

'Dr. Oz' tackles Acreage cancer cluster

3/3/2010 © Palm Beach Post
Dr. Mehmet Oz has been taping interviews with families affected by the cancer cluster and is tentatively scheduled to air the issue March 9.

Kids getting schooled on obesity prevention

3/1/2010 © Daytona Beach News Journal
Local efforts are under way to prevent today's children from becoming the first generation in history to experience shorter life spans than their parents because of what they choose to eat, as some experts have predicted.

Electromagnetic therapy treats depression

3/2/2010 © St. Petersburg Times
Transcranial magnetic stimulation, or TMS, offers an alternative to electric shock therapy to treat depression, doctors say. "TMS is far higher in acceptability to the patients and a lot less invasive," said Dr. Patrick Marsh of the USF Neurotherapies Clinic.

Healthy living the best defense against prostate cancer

2/28/2010 © St. Petersburg Times
You can't control your age or genetics. But there is still a lot you can do to improve your odds of getting prostate cancer. It has been estimated that 40 percent of all cancers could be prevented by a healthy lifestyle. Smoking and obesity are the biggest culprits.

Heart failure not a death sentence

2/28/2010 © Lakeland Ledger
Medications, implanted devices and practical guidelines for reducing demand on the heart can make a tremendous difference in extending the length and quality of individual heart-failure patients' lives.

Medicare punishes Fox drug plans

2/28/2010 © South Florida Sun Sentinel
Medicare officials suspended Fox Insurance prescription drug plans from advertising or enrolling new members, saying the company went too far in preventing seniors from getting medications.

Surfer rides waves with metal rods in his spine

3/1/2010 © Sarasota Herald Tribune
Tayler Brothers began winning surfing competitions at the age of 11 and has been a nationally ranked surfer ever since. Perhaps even more impressive, Brothers, 18, excelled despite a childhood diagnosis of scoliosis and metal rods that now line his spine.

Neck arteries can be treated with stents

2/26/2010 © Associated Press
A large study finds that surgery for neck arteries narrowed by atherosclerosis isn't necessary, that stents are safe.

Some insurers covering macular degeneration test

2/24/2010 © Naples Daily News
A genetic test for age-related macular degeneration came on the market last year but insurance companies were not covering. Now insurers are covering the cost if someone already has been diagnosed with early stage disease.

FDA warns of Maalox mixup

2/24/2010 © Los Angeles Times
The packages say Maalox Advanced and Maalox Total Relief, and consumers might think that they're two versions of the same product. They're not, and mix-ups have resulted in at least five reports of serious reactions, the FDA said Wednesday.

Hottest way to run? Barefoot

2/24/2010 © Tampa Tribune
Runners are getting amped up about going au natural — from the ankle down, anyway. Hitting the pavement in bare feet promotes the natural mechanics of the human foot, enthusiasts say.

Tallahassee, Tampa hotbeds of cold & flu

Triaminic graphic

2/24/2010 © Health News Florida
A Web site for parents, sponsored by Triaminic cold and flu products, makes CDC data charts user-friendly and shows the levels of cold and flu symptoms around the country. In Florida right now, Fort Myers is the place to be and Tallahassee and Tampa Bay are definitely not.

Fat, but not happy

2/23/2010 © Palm Beach Post
Each time federal health authorities update the obesity map, the picture for Florida looks worse.

Protect those baby teeth

2/23/2010 © St. Petersburg Times
The American Academy of Pediatric Dentistry has an education campaign aimed at getting parents to take their babies to a pediatric dentist by the time the first baby tooth appears. Studies show dental costs are 40 percent lower in the first five years than for those who do not see a dentist prior to their first birthday.

Dentist makes house calls for seniors

2/23/2010 © Fort Myers News-Press
Dr. Kristin Outlan frequently takes her services to the homes of Lee County seniors unable to get out. With many seniors opting to “age in place” -- stay home rather than moving to a nursing home -- Outlan's idea might gain steam.

Treating a controversial 'addiction'

2/22/2010 © New York Times
Tiger Woods publicly apologized last week for behavior that some call "sex addiction," and others call "hypersexual disorder." The apology appeared to be part of a therapy program modeled after Alcoholics Anonymous.

Eyewear program a boost to students

2/22/2010 © Florida Times Union
Fifty Raines High School students got the help they needed with free eye exams and glasses, thanks to a grant from Baptist Health. Michael Lanier, vice president for community health at Baptist, said the grant is meant to help students get the most out of school.

Don't put off these 8 tests, doctors say

2/22/2010 © St. Petersburg Times
Skipping an exam because money is tight can cost more in the long run, especially for those who have a chronic disease or are pregnant. Here are eight tests that doctors say shouldn't be put off.

Super Poligrip to go zinc-free amid complaints

2/19/2010 © St. Petersburg Times
Facing lawsuits from consumers who say denture adhesive caused them serious health problems, the maker of Super Poligrip announced that it will stop making and distributing all its denture products that contain zinc.

FDA issues warning on 4 asthma drugs

2/18/2010 © The Associated Press
The FDA has issued warnings for the drugs Advair, Symbicort, Foradil and Serevent. The FDA issued the safety restrictions to lower an uncommon but potentially life-threatening risk that asthma could worsen suddenly.

Fitness pays off with lower premiums

2/18/2010 © Daytona Beach News Journal
Your weight, whether you smoke and, in some cases, even your blood sugar level could have an impact on how much you pay for health-care premiums. The more fit you stay, the less you're likely to pay. Companies offering wellness initiatives can't say whether slimmer employees have fattened their bottom line. But they say it has increased employee morale.

Hospital comparisons get simpler

2/18/2010 © St. Petersburg Times
With the many hospital-quality programs that abound on the Internet, it's hard for consumers to know which to trust. The gold standard is the Joint Commission, the nonprofit organization that accredits most U.S. hospitals, which publishes a consumer-friendly report called Quality Check. It grades hospitals on how well they follow care practices that are known to work, ranging from infection control standards to educating patients.

Study: Aspirin might reduce breast cancer recurrence

2/17/2010 © Los Angeles Times
Women who took aspirin two to five days per week were 60 percent less likely to have a recurrence of breast cancer and 71 percent less likely to die from the disease, according to new findings from the ongoing Nurses' Health Study. Researchers caution the results are preliminary.

Couple survives back to back heart attacks

2/16/2010 © Florida Today
After 35 years of marriage, Phillip and Nohra Farber aren't lacking for shared experiences. But in December, the Farbers experienced something they're lucky to have survived: back-to-back heart attacks. In Phillip's case it was Nohra's CPR that helped saved his life.

Foreclosures can break up families, study finds

2/17/2010 © Bradenton Herald
A study of the impact of foreclosures within the Hispanic community found family members were often forced apart in the search for refuge; it also found anxiety, depression, and a cut in health care, including skipped medication.

A new tool in stroke prevention

2/16/2010 © Jacksonville Times Union
A new device is making carotid angioplasty and stenting safer, say the makers of the Mo.Ma. The device's catheters and balloons prevent blood clots and plaque from traveling to the brain, where they could cause a stroke.

Clinics take part in breast cancer screening study

2/16/2010 © Fort Myers News Press
A clinical center has been selected for a nationwide study to determine if the 3D Automated Breast Ultrasound combined with routine screening mammography is more accurate in detecting breast cancer in women with dense breast tissue than only a routine mammogram.

Lab helps students find a voice

2/16/2010 © Sarasota Herald Tribune
The assistive technology lab at Oak Park School helps a wide range of students, from children whose learning disabilities make it difficult to write words on paper to those who cannot speak.

Resources

We’ve collected a list of resources for you, including federal and state agencies and private associations. This is a free listing, without paid advertisers. Read More

Updated Medicare primer

The Kaiser Family Foundation has updated its Medicare primer that explains key elements of the program. It describes characteristics of the Medicare population and how much people pay out-of-pocket. The updated 2010 Medicare primer is available at http://www.kff.org/medicare/7615.cfm.

Consumer health information

The FDA has created a partnership with Everyday Health to deliver FDA's consumer health information to the 30 million users who visit EverydayHealth.com each month. EverydayHealth.com/FDA will offer health information from FDA on food and medical product safety as well as prevention and wellness topics.

Mesothelioma cancer risks in FL

A national group that seeks to inform the public about this type of cancer lists environmental risk factors in Florida.

State offers flu hotline

The Florida Department of Health has launched a toll-free hotline, 877-352-3581, to provide public health information and updates on the H1N1 "swine" flu.
It is open from 8 a.m. to 8 p.m. daily. Information is available in English, Spanish and Creole.

Information can also be found at the department's website, doh.state.fl.us.

New consumer guides

Spanish-language consumer guides are now available from the Department of Health & Human Services's Agency for Healthcare Research and Quality for consumers and clinicians. To access the guides in Spanish as well as English, go to effectivehealthcare.ahrq.gov. Audio versions of many guides also are available.

Suspect insurance fraud?

Call Florida's Fraud Fighters Hotline at 800-378-0445. It's operated by the Insurance Fraud Division of the state Department of Financial Services.

Helpful hint

Did you know the state offers a Web site where you can quickly find the best price in your local area for the drugs you take? The Drug Finder can save you money.

Kaiser Family Foundation’s Florida Health Facts

Prescription Addiction Radio: Breaking the Silence

Clinician’s Network Educational Conference

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