jmj11

Well my whopping WBC count of 46 k is, as of this morning 0.71 k. This drop is from the nasty (and intended) work of Mephalan. My new stem cells have been "on-board" for 6 days, however, they will not start to set up "house keeping" for another week. This is my vulnerable week of little defense. But, back to my original point, the human body is amazing. It is incredible what the human body can endure. I've known people who see their (very healthy) bodies as so fragile that they only drink lukewarm water, fearing the cold or heat of drinks.

I don't want to talk about "back in the day," but with the point of helping you to feel a bit more encouraged, I will. I graduated in 1982 from the University of Kentucky. Jobs were very tough to come by. I wanted to stay in Kentucky and made contact with 124 (if I remember right) practices and not one interview was offered. In my class of 16, by 6 months after graduation, only 2 had PA jobs, and both had these jobs arranged before going to PA school. I was poor as a church mouse and would go through the lobby of dorms, looking for loose change under the cushions. I took two part-time jobs, one at Sears and one with "Manpower" (which was the bottom-dweller job place, and I met other PAs working there, and that was sad). But I had to, to buy food. So, I finally decided that I had to go out of state. I had to borrow money from a roommate (which I don't recommend, but he is still one of my closest friends after these years) to drive to Michigan for my first interview. It was a bad job at the BOP. But, I eventually got it (and it was much worse than I had expected). But I worked this terrible job for six months. Then, I started to look in Michigan and found many good jobs advertised and they all wanted to interview with me. I took a fantastic job and that launched my career after a very hard start. Mike

This is not a simple yes or no. The reality is that some do and some don't. Being "corporate" doesn't exclude the ability to care for patients first, if they are willing.

Of course advance directives are a good idea. However, the insurance companies are pushing advance directives like crazy. I have been approached over and over about my AD and I do have one on file. But it saves the insurance companies a huge amount of money to end life early. My brother just recovered from MRSA septicemia. It looked bad with him on a vent, doing dialysis and was given up as hopeless. The hospitalist wanted to pull the plug but his oncologist (he has leukemia was in for a stem cell transplant) fought to give him a few more days. He's home and doing well. So, we have to be careful as not to pull the trigger too soon just to save the insurance some money. Thinking of which, I need to call him.

Here is where I'm perplexed. The Dutch are civilized with advance medical care. There are so many options in treating depression, I just cannot believe all those options were exhausted. I read a previous debate (in a BBC report I think, but see the report belowhttps://www.vice.com/en_us/article/434yaj/a-doctor-built-a-machine-that-helps-people-die) were a proponent of assisted suicide decided that depression, at any age, was reasonable for suicide. In a pure Darwinist (the way I use the term here would upset Darwin himself) view, you might reach that conclusion. But has compassionate care givers, we must always give hope. I was distressed when I was in ICU in January, just diagnosed with cancer, and a new-grad RN said to me, after I mentioned this long-hard road ahead, and she said, "Well, you are 63. Some people in your position would say that you have lived enough and to save the money and suffering, they would end their life now). I asked her, "Can't anyone talk of hope?"

I owned my own clinic for 4+ years. I advise you to read a couple of books (at least) on running a business. When you do your business plan, under-estimate your collections by 25%. Insurance companies find a millions excuses not to pay you. Have a very good biller (or billing system that you can monitor). Don't over-spend on support stuff, like software. My downfall was having to constantly fight with insurance companies and using a front office + back office software. It was expensive to purchase and failed terribly in the billing and collection department. I almost sued them but was too burnt out. If I were to start over, I would be bare-bones at first. I would be very leery of vendors. If possible, don't get a business loan. If you do, as I did, it will set you back 4-5 months of paperwork. It can be very frustrating. I met roadblock after roadblock when mid-level underwriters would call me and said they are cancelling my loan because (as if they were trying to educate me) "Medical Assistants cannot own a medical practice in our state." Very frustrating to have that conversation over and over again.

I have quoted (in the chart) specialists, including their names, when I've received curbside advice. It has been to protect my own ass. I've been in situations where people (SPs, other physicians) have asked, "Why did you do X?" I want to be able to say, "Dr. Y, the head of the Z department a the local University Medical Center recommended that I do X, so that they would not think I just pulled the idea out of my ass. But I think it is a travesty to hold Dr. Y responsible for the out come as he/she did not know the patient or the full story. Only I, the immediate provider knew both the patient and the adviser and I should be held legally responsible. However, in a court of law, me mentioning the name of Y shows that I did due diligence in trying to find the best treatment and not just throwing darts at a wall of options.

Ironically, a long time ago I could find a job in Kentucky (horrible job market in 1982) and had to move to Michigan to find a job. Lived in Michigan for about 10 years. Loved the UP but at that time (mid 90s) the job market there was not so good. Eventually had to leave the state. Good luck, but like others have said, be open to relocating.

How does one have space for RBCs in such a leukocytic enviroment?

I should buy you a beer!

As I've endured my battle with Multiple Myeloma, I have been amazed about the resilience of the human body. This past week I witnessed the highest leukocyte count I've ever seen . . . and it was my own, 46,000. This was after three days of high-dose Filgrastim to mobilize my stem cells, for collection, in preparation for an autologous stem-cell transplantation. I thought it would have been funny to walk into the local urgent care center and complain I have a fever and watch their eyes when they drew a CBC. Of course, they would think leukemia.

I watched a documentary yesterday on vitamins. Today, virtually all vitamins come from just a handful of chemical factories, most are in China. Most vitamins are created from petroleum (source of the carbon chains) and end up as a powder in big barrels. From there they are shipped to all the major supplement companies. The companies then create the pills and labeling. The labeling says, "Vitamins from an all natural plant source." There is no federal guidelines to ensure safety, consistency, or labeling of these supplements. If the "natural" patient only knew.

Has anyone read this book? I just heard a review this morning and it sounds very interesting. Spending more time as a patient than a provider these days, I am disappointed at the basic level of compassion within our system. Compassion means things like knowing the patient's name, knowing their diagnosis and medical history before going into the room. Those simple things that I had always took as granted as what I should do. https://www.amazon.com/Compassionomics-Revolutionary-Scientific-Evidence-Difference/dp/1622181069/ref=sr_1_1?crid=130FY276ZGZCD&keywords=compassionomics&qid=1556408042&s=books&sprefix=compassion%2Ctoys-and-games%2C217&sr=1-1

One patient had a related cerebellar infarct and had significant ataxia, forcing him to loose his company (a house painting company). Chiropractic manipulation was the cause.

That sucks! Just had a patient who broke her radius (right and she is right-handed) during a self-defense class and I felt sorry for her, can't imagine what you've been through. Seen it after chiropractic manipulations but never after martial arts.