On the Road
It’s been six weeks since my last day at the Vanowen office and I’m way overdue to check in. I am in the beautiful central coast area of California, covering a practice very much like my old one while its owner enjoys a well-deserved European vacation.
The pace is so relaxed, the scenery and weather so lovely that it’s almost like a vacation for me too, especially while Cynthia and Gucci were here the past two weeks. I’ve seen interesting patients too.
A 7-year-old boy who while normal in every other respect has never eaten anything but liquid (he nursed for three years) or pureed foods..I had the luxury of an extra half hour to talk to him and his 43-year-old engineer mother. Q: what do you eat for school lunch? A: yogurt and pudding. Q: what about birthday parties? Do you eat cake? A: no- too much sugar. He has been referred to a therapist in San Luis Obispo. My guess: obsessive-compulsive disorder (his uncle has it). Prognosis? I wish I knew.
Three kids have had pre-op exams for dental surgery for nursing-bottle mouth. The worst was a 3-year-old going for his second surgery. Usually I can barely contain my anger when I see such severe and preventable disease; it’s the main reason I’m so strict about weaning from the bottle. But this mom seemed so sweet that for once I resisted being judgmental. Turns out this youngster never had a bottle! Mom breast-fed him day and night for two years. No one told her she could damage his teeth just as badly that way as with night bottles.
A 20-year-old college girl came in worried about hypoglycemic symptoms and I realized she was the first patient I’d ever seen after a gastric bypass. She had lost 90 pounds. That’s the good news. The trouble is she’s still 90 pounds overweight with medical problems more typical of a Medicare patient. Obesity is the great scourge not only of our overindulged society, but of us doctors. We can treat and often cure almost everything – except the morbidly obese. The long-term cure rate is less than 10% and the future cost burden is incalculable.
After 44 years running a mostly solo practice, the changes have been remarkable in medicine. The science has jumped ahead enormously but the art remains a big challenge. Will the patients of tomorrow have personal physicians to talk with? I fear not, especially under Obamacare.
Earlier I was reading a book review about a gentleman who is now a PhD and directs a major ink tank. As a college student he dropped out to pursue his passion of playing classical music in a small touring group. After six years he took what he thought was a dream job playing in a state orchestra in Spain for better money. He hated it. I can relate at this time in my life to what he discovered. The joy was gone; he had to obey the conductor. “The more control you have over your life, the more responsible you feel for your own success (or failure). And as we’ve seen, the more you feel you’ve earned your success, the happier your life will be.”
There are over 200 wineries around here. So far I’ve only tasted two. Sounds like it may be time to try another. Be well, friends.