One of my favorite pastimes during the Pandemic has been the weekly conversations with two new friends. Through Conversation Exchange (conversationexchange.com), I have been able to practice French with Michel and Spanish with Sebastian.
Michel is a French man living in the south of France. Before he retired recently, he was a flutist in the Regional Orchestra of Montpelier, a city about 60 miles away. He is also a flight instructor. He loves learning to speak English and he and I have a good time correcting each other’s mistakes.
Sebastian is a younger man who lives in Buenos Aires, Argentina. He works in the financial division of a software security company. Sebastian has several other “language friends” in the U.S. because he is trying to learn to speak American-style English.
With my language partners, we are not afraid to point out the errors that each one of us makes. This often leads to some very funny discussions. With both Michel and Sebastian, the conversation is free flowing; there’s no script or pre-defined lesson.
Our three languages are full of expressions which often don’t translate well from one to another. We enjoy explaining the origins of these expressions and their correct usage. We also try to teach each other how to converse more like native speakers instead of sounding as if we are reciting vocabulary lists. For example, last week I was telling them how in normal conversation, we use words like “wanna,” “gonna” and “gotta.”
In addition to practicing a foreign language, it is interesting to notice how one’s mother tongue is so rich in vocabulary and idioms. Now when I talk in English, I am much more aware of the complexity of our language.
I have discussed with Sebastian that English must be a very difficult language to learn. Since Spanish is an almost completely phonetic language, I have often said that most English-speakers think Spanish would be an easy second language. He is quick to point out that Spanish grammar is full of complex rules with many different tenses and moods (such as the indicative and subjunctive). He complains that it takes a lot of memorization to remember how to pronounce similarly spelled words like “cough,” “rough,” “dough” and “bough.” I then remind him how hard it is to learn the genders of new words.
Last week, we had an interesting experience. The three of us arranged to have a Zoom call. We did it mostly in English, but since Michel understands Spanish, we conversed in Spanish for a few minutes too. It was a lot of fun connecting three continents while sharing our mutual passion for learning foreign languages.
Growing up in the 50s in New Jersey, I always stood out as the pale-skinned redhead. Even though I used to get compliments all the time from my mother’s friends, I hated it.
“Hey, Red!” is how people would always call me. They wouldn’t have to remember my name since the most easily identifying feature was the color of my hair.
Being so pale, I was very prone to getting sunburned. From the time I was a very little boy, I can remember the painful blisters on my back and shoulders when I didn’t follow my parents’ advice to limit my sun exposure.
Yes, I was that kid in the swimming pool wearing the white T-shirt. I hated that too, but it conditioned me to being much more of an indoor kid than an outdoor person. You can’t get sunburned very easily when you’re inside practicing for your weekly piano lesson.
Now that I’m a retired senior citizen, the red curls have faded and I don’t get called “Red” anymore.
Unfortunately, as a young adult, I was excessively cautious of the sun. I would hardly ever wear shorts and I pretty much stayed inside. As I got older, however, I realized that I enjoyed outdoor activities like kayaking and tennis. But I can still hear my mother reminding me not to forget my hat.
In Florida, where it often gets up to the mid-90s by the middle of the morning, our outdoor routine has been confined to the early mornings and early evenings. Late in the day, as the sun starts to set, the temperature drops a few degrees and we are thankful that it goes down to the mid-80s.
For the past 20 years, my wife, Meryl, has been trying to get me to go swimming in our neighborhood pool. I had every excuse under the sun (pardon the pun) for why I didn’t want to expose myself.
But finally this summer, I agreed to go early in the morning to the pool which is an easy five-minute walk along the lake. Occasionally there is another person there but most of the time we have this gorgeous pool to ourselves.
Last week, since the pool was closed for repairs, we decided to go to our favorite beach. It is only 20 minutes away and at this time of year if you arrive early enough, you’re guaranteed a parking space. Just after sunrise, there are some serious walkers and joggers, and even an occasional person doing Tai Chi.
The water temperature is in now the mid-80s. With the air temperature up in the same range, it is delightful! Sometimes there can be an overgrowth of seaweed, and other times, a mild riptide reminds you to be extra careful.
But yesterday, the conditions were absolutely perfect! The sunrise was beautiful, the cloud formations were amazing and the humidity was a bit lower than usual.
As is often the case in Florida during the summer, it suddenly started to rain. We were in the water at a depth of about three feet when the raindrops appeared to be dancing on the surface. Just beyond the trees on the shore, a double rainbow appeared, arcing over the whole western sky.
The experience of luxuriating in the warm water combined with the sound and sight of the rain was very powerful. We couldn’t remember when we had ever enjoyed ourselves as much at the beach.
My wife, who used to say that the Florida summer heat was “oppressive,” has changed her tune completely. She now gets me out of the house early enough so that we can take advantage of what Florida offers us at no cost.
And when I think that it took me this long to enjoy swimming in the pool or the ocean, I laugh at myself. I guess it’s never too late to appreciate what we have so close to home!
Have you ever desired, indeed craved, something from the bottom of your heart? Have you talked about it night and day and asked, nay beseeched, only to have your requests fall on deaf ears? Have you single-handedly done everything in your power to possess it? After having done this, have you come tantalizingly close to your object of desire, only to see it slip away or snatched away from your tenuous grasp? And suddenly, if one day, out of the blue, your object of desire just fell into your lap, how would you feel?
It was on a sunny evening in March of 2020 when we took Nikhil to the mall as well as to Costco. These are his two favorite places to visit, indeed Disneyland and Disney World for him. Little did we realize that the Covid Tsunami was bearing down on all of us. Once the restrictions were enforced, we stopped going to the mall but our pilgrimage to Costco continued. The only difference was that I went in with a mask and gloves while the rest of the family waited in the van.
The first few times we pulled into the parking lot in Costco, Nikhil clapped his hands in anticipation of a visit but to his disappointment, he would find himself strapped in his car seat for the twenty to thirty-odd minutes it took me to shop in Costco. It wasn’t just Costco, it was the same with the Indian store, Trader Joe’s, and the grocery store.
At first, Nikhil used his iPad to tell us that he wanted to go to the mall and to Costco. This was, of course, after he had told us that he wanted to go to school. We kept telling him that the mall was closed and that he could not go into Costco. Nikhil is not one to take no for an answer and he kept asking us optimistically only to be turned down. But he persisted.
Last month, Nikhil resumed in-person school. He was ecstatic! This gave him hope and his pleas to visit the mall became even more urgent. Indeed, for the last month, his conversation with me has only dwelt on two topics – mall and Costco. It’s not really a conversation, it is a barrage of hand signs and furious jabs on the iPad with just a pause to see if I would reply in the affirmative. Nikhil got his second dose of Pfizer vaccine three weeks ago and today we finally decided to surprise him with a visit to Costco as well as the mall.
We chose a Monday evening figuring Costco and the mall would be less crowded. As we pulled into Costco, Nikhil must have resigned himself to another thirty-minute wait. His surprise knew no bounds as my wife unstrapped his seat belt. His reaction was spontaneous – a whoop of joy and ecstatic clapping followed. The whoops of joy continued all the way to the entrance. Fortunately, the Caroline’s Cart (adapted cart for special needs children) was available at the entrance. After I had wiped it down, Nikhil sat and looked around with joy and amazement. But there was no time to rest and take in the moment. There were appliances to be seen!
We entered the aisle that I call the “Appliance Hall of Fame”. Nikhil pointed excitedly. There were his familiar buddies, the refrigerators, dishwashers, cooking ranges, and last but not the least, the greatest of them all – the microwave! I had carried a paper towel with me and I had to open each door with the towel in my hand so Nikhil could make sure they were doing alright! I got caught up in the moment too and I rushed Nikhil down the aisle until my wife asked me to slow down. “He has waited 15 months for this moment!” she said. Nikhil wanted to visit every aisle. Even the humble sack of potatoes was worth a “dekho” (a glance).
There were no samples but Nikhil did not seem to mind. His eyes lit up as he saw his familiar food items in the coolers. Ravioli and Taquitos. Creme Brulee and cakes. It was Christmas on a sultry New England summer evening! After a leisurely stroll through Costco, we stood in line to check out the items. Nikhil was still excited and I told the cashier that he was visiting his favorite store after fifteen months. “We could hear him from the other end of the store” she smiled “I’m glad he enjoyed his visit”.
As we pulled out of Costco, our daughter asked Nikhil if he would like to visit the mall. There was no tentative answer today. “Mall yes, yes Mall!” replied Nikhil using his iPad. He must have felt like he won the lottery when we pulled up to the food court and we entered the mall. More whoops of joy! We followed our old ritual. I took him to the restroom where he washed his hands. It was followed by a dinner of Chinese food. As he ate, Nikhil started plotting his next adventure. “mall stairs, elevator,” he said. I must admit it felt surreal sitting in a food court and eating with other people around us.
A quick visit to Target followed where Nikhil was able to ride the elevator up and after a brief reconnaissance, he and I rode the elevator down while the ladies continued with their shopping. I returned to the van with him and barely had I seated him and strapped his seat belt when I felt him tug at my sleeve and point to his shoulder. His way of saying he wanted to visit the mall. “Not again, Nikhil,” I groaned “we were just there!” But he was insistent and I guessed that he wanted a recap of our day. “So, Nikhil, did you enjoy your day at Costco today?” He grinned and looked on in anticipation. And so I recounted his glorious adventure again for him, starting from Costco to the food court and the ritual washing of hands. A grin lit his face all through and he clapped at the good parts.
He sang to himself as we drove back home. Was it a perfect evening for Nikhil? Not quite, his favorite pasta place at the mall had closed down even before Covid. The automatic paper dispenser in the restroom had run out of paper. There were no food samples at Costco. But it was not bad at all and in fact, it felt good. It was the first time all four of us were visiting Costco and the mall. Mundane chores during the best of times but it felt like a special treat to us. Indeed, it felt like a family outing to Disney World! Nikhil does not ask for much and sadly, in the last fifteen months, it was not possible to fulfill his basic wishes. But in the words of Aamir Khan from the Hindi movie “Three Idiots”, “Aal izz well”, at least for the moment.
And as I write this, I can’t stop singing to myself “In his bedroom, his cozy bedroom, Nikhil sleeps peacefully tonight!” Uyimbube! Uyimbube!
Raj Nayak is the author of “Memoirs of an Average Joe (memoirsofanaveragejoe.com). He lives with his family in Massachusetts.
In the past two weeks, I’ve bumped into several of my old patients. When we pediatricians say “patients,” it doesn’t mean just the kids we cared for. It means the whole family. In order to be a happy pediatrician, you don’t just have to love children. You have to love their families too. It is important to fully understand family dynamics in order to enjoy practicing pediatrics.
The question I am most often asked when I see people from the past is if I miss working. It’s been more than six years now since I retired, and there’s never been a day that I wished that I could go back to work. I have been very happy staying busy with so many other projects that it is hard to imagine having to work at the same time. Additionally, in a very practical way, I would have found it impossible to wear a mask the whole day. It’s not just the problem of my glasses fogging up constantly. If can’t totally see a person’s face, I would find it hard to communicate.
More importantly, the one thing that I do miss is the personal interaction with the babies. I used to pride myself on being able to take a crying baby and get them to smile within a few seconds. My staff used to call me “the baby whisperer.” Interestingly, this never worked as well with my own children, but with my patients, I loved holding a baby in my arms, and magically, they would smile.
My favorite age of babies was from six months to a year. This is when you would observe the early signs of alertness and interpersonal connection, and it was so gratifying to be able to tell the parents that their baby was developing normally. Nowadays, the biggest fear among parents is that their child may be on the autism spectrum. The incidence of developmental disorders seems to have increased over the span of my career (starting in the 1980s), and parents are relieved when I would reassure them at a very early age that everything appeared OK. I loved seeing the look of relief on parents’ faces, especially first-time parents. Experienced pediatricians can spot developmental issues earlier than most people, and we are well aware of how very young babies normally focus on facial expressions such as smiling and eye contact.
In our practice, we offered new parents who had not yet chosen a pediatrician to come for a “newborn consult.” These new parents were hungry for information and guidance, and became some of the most loyal and trusting patients. The bonding that occurred from that initial visit and then continued after the baby’s birth is something that many parents recalled many years later at my retirement party.
I was very fortunate to live in a very diverse community in South Florida. There were some patients who were attracted to my practice because I spoke Spanish, but I loved the assortment of other ethnic groups that I would see on a daily basis. There were families from many Spanish-speaking countries, but in my panel of patients, I had patients from India, China, Brazil, Finland, the Philippines, Thailand, Viet Nam and Korea.
Since the schedule of check-ups is heavily concentrated during the baby’s first year, I got to know the parents very well during those “well-visits.” Many grandparents attended these visits along with the parents, so I would often become familiar with the extended family.
An experienced pediatrician can do a complete check-up in a very short period of time, so the rest of the visit is left open for discussion about whatever concerns the parents may have had. As the parents became less anxious and fell into a routine (especially after the babies started to sleep through the night after about six months), we had much more time to talk about other topics. I was always interested in their native languages and their cultures, sometimes to the point that parents would invite me to visit their countries.
I used to joke with patients that I might take them up on their offers. My wife and I have unique memories of Japan, Bali, Finland, Thailand, Hong Kong, China, Ecuador, Brazil, Turkey, Spain, Angola, Israel and India because I accepted these invitations. Sometimes they were there while we were traveling, but more often, we had the opportunity to visit their relatives whom I had met in my office. Every one of those visits was a special personal experience, much more than any of the usual tourist attractions. At first, my wife was leery, thinking that it would be awkward to visit people’s homes, as she wondered if these people really had been sincere about inviting us. After a few of these special visits, she looked forward to the meet-ups that I would try to plan into every trip.
Early in my career, I started to give out small, framed photos of places that I had traveled to. The kids enjoyed getting something to remember from their yearly check-ups, and surprisingly, many parents would ask for their own “Dr. Kraft pictures.” This became a tradition so I would bring along these small pictures on our travels as an ice-breaker or as a way of thanking people for their hospitality or other special favors.
I loved teaching patients about the places that were seen in my photo gifts. I would usually tell the school-age children to read up more on the countries where we had traveled.
So back to the question about whether I miss working. What I loved about being a pediatrician was that I was often considered a trusted friend to those families. Since pediatrics is a long-term commitment (in my case, 35 years), I was very fortunate to have met so many marvelous families over several generations. Now that even though I am, in a way, “out of the picture,” I have wonderful memories and several long-lasting friendships to savor.
All of us can remember exactly where we were at the time of a catastrophic world event. In my parents’ generation, the attack on Pearl Harbor and the ensuing entry into World War II was the incident which created a permanent memory for them.
In my generation, two events stand out: The assassination of President Kennedy in 1963 and the 9/11 attack in 2001.
I can still remember sitting in 9th grade Spanish class in Verona High School (New Jersey) when our principal, Edwin Willard, came into each class to announce what had happened. A hush followed and we all crowded around a small transistor radio which one of the students had brought to school. I can still remember the facial expressions of my fellow students when we heard that he was pronounced dead.
When the attack on the World Trade Center occurred, I was driving to the hospital to see a patient. When the broadcast was interrupted to say that the first Tower was hit, I immediately returned home to be with my wife to watch the horrific events which occurred within the next few hours.
On a much more pleasant note, I also have very strong memories of what happened when I was in 10th grade in 1964. I was sitting in Mrs. Alleine Graef’s Biology class when Mr. Willard entered the room. The class froze because it was not even a year after he had delivered the news of the JFK assassination.
But this time, he had a wide smile on his face. He held up a telegram and read it aloud. Mrs. Graef’s son, Jed, had just won the Gold Medal in swimming (backstroke), setting a new world record.
I can still remember the expression on Mrs. Graef’s face. She then told us proudly about his swimming achievements which many of us had never heard about.
In 1964, live coverage of the Olympics was very limited. There were a few broadcasts transmitted by satellites but nothing like today where we feel as if we are standing next to the Olympic athletes.
Jed graduated from Princeton University and he went on to receive a Ph.D. in psychology at the University of Michigan. At the age of 79, he lives in Vermont and is still working in software development.
We’re now approaching almost a year and a half since the 2020 Pandemic started. Putting all of the negative consequences of enforced isolation behind us, most people are beginning to exit from their cocoons and are trying to re-adjust to “normal” living.
It has been a long siege but for many retirees like us it hasn’t been so painful. We were already used to having every day feel like a weekend so when the months just rolled by so quickly, it wasn’t such a terrible ordeal. I believe the survival formula is to stay busy, do daily exercise, become a good cook if you weren’t already, and stay in touch with your friends and relatives (even if it’s by Zoom).
We have been living in a South Florida family community for over twenty years. It wasn’t unusual to see people moving in and out of our neighborhood during this time whom we had never known, but surprisingly in the past year, we have been getting to know more neighbors than ever before. We now go on our early morning walks with a person who has lived down the block for as long as we’ve been here, but we hardly knew her or her husband.
To keep things from getting boring, we’ve been trying to vary our morning exercise routine. My wife has been trying for years to get me to go swimming in the community pool which is just a few minutes away. It is warm and well-maintained, and early in the morning, there’s hardly ever anyone there. I had always resisted going there because I didn’t want to bump into patients asking me for medical advice while I was trying to relax.
At least once a week, we’ve been trying to go to the beach. The closest one is about 20 minutes away and if we get there early, there’s almost no one there. Recently, there has been someone learning Tai Chi. The ocean temperature is about 83 (perfect for me) but there have been some riptides and more seaweed than usual. Pure relaxation!
For as long as we’ve lived here, we’ve had a two-person kayak. During the past year, we have taken it out on the lake more times than during the past twenty years. It is so relaxing out in the middle of the lake which stretches over a mile through many of the neighborhoods in our community.
While kayaking, we have seen a different picture of many of the interesting places within our community. Some people have done extensive landscaping in their backyards, making us regret that we had done nothing except planting a mango and a papaya tree just in the past three months. If we had done this 20 years ago, we would be enjoying our harvests and could be sharing our bounty with our neighbors.
One day last week as we were kayaking through an adjacent neighborhood, we saw some women knocking down ripe mangoes from their trees. As we rowed closer to the shore, they called out to us and asked us if we wanted some. They were some of the most delicious mangoes we had had in a long time. And we met some very friendly neighbors in the process.
Our two-story house has been a blessing. In our second-floor office, both my wife and I have our main computers, but since the Pandemic, I’ve taken over the kitchen table with my laptop. I feel inspired to write when I am looking out over the lake where I frequently observe such diverse wildlife activity. (Check out the following link for a previous post: https://sincerelydrdan.com/2020/10/23/our-daily-wildlife-show/)
Just outside on our patio, we have a covered area which protects us from the sun. We have had 90% of our meals out there since the Pandemic started. For a while, we enjoyed bringing our breakfasts out on the second-floor balcony just outside our bedroom. We loved to fantasize that we were on a cruise having our meals on our stateroom balcony.
When it became hotter and more humid a few months ago, we returned to the cool shade of the downstairs table. Not a day goes by that we don’t see one of our feathered friends walking or flying past us as we enjoy our meals.
“Can you believe that we used to pay for those excursions on a cruise just to see a couple of birds?” my wife loves to ask. By the time we would go out on a visit to a bird sanctuary or a nature preserve, they would all be within the shade of their favorite trees and frustratingly difficult to observe.
I used to believe that it was only while traveling that I would learn more about the world we live in. Adjusting to the Pandemic has reminded me that if I keep an open-minded attitude, the old adage, “There’s no place like home,” rings true once again.
As promised, a new feature of my blog, “Sincerely, Dr. Dan,” will be a monthly presentation of images from members of the Boynton Beach Camera Club, a club where I have been privileged to be a member for the past six years. I have already explained in a previous post that before becoming a member, I used to think that I was a good photographer. My patients used to enjoy seeing my images that I captured while traveling which I would post on the walls of my office. When I retired and had more time to devote to my hobby, I realized that I still had a long way to go to become a better photographer. By observing the high quality of many of the other members’ work along with their encouragement, my photographic skills have improved.
In appreciation of the high level of talent in our club, I will be interviewing one member at a time. I have requested that they choose their favorite images from their vast collections. They will explain why the five images that I have chosen demonstrate their special skills as a photographer.
My first featured Guest Photographer is Helen Pine, half of the “Chuck and Helen” team which has contributed so much to the success of the Boynton Beach Camera Club. Their pre-Pandemic soirées at their home were legendary and were often the inspiration for many new members to pursue a deeper interest in photography.
Helen’s interest in photography dates back to her childhood in the 1950s when she received her first gift of a Brownie camera. In the 1990s, she became more involved when she joined a camera club in New York City and was inspired by other members’ encouraging comments.
Helen is an expert in post-processing techniques using Photoshop, Topaz Studio and Nik software, to name just a few of the programs she uses on a regular basis with her images.
Since Helen and Chuck have traveled extensively, she has thousands of images to which she enjoys returning to discover another one which possesses her award-winning potential.
“The photograph is just the beginning,” Helen explains modestly. She can take an otherwise busy, crowded image and transform it into a masterpiece.
I would describe Helen’s style as “minimalist” since she is able to distill the unnecessary extraneous details from the original image in order to produce her unique version with that desired “Wow! factor.
In Palm Beach County, we are blessed to have several outstanding locations where herons, egrets, spoonbills, wood storks and many other species congregate in man-made, but naturally appearing sites.
Helen’s expertise in blending the color of the sky with the silhouettes of the people passing through the arch is seen in this image. The detail of the stone arch is brought out nicely.
Many of our club members are skilled at capturing bird images at Green Cay or Wakodahatchee Wetlands. The combination of the bird and its catch is what makes this a special image.
Helen captured this image by placing the camera on the ground at exactly the right angle to position the central flowers against the blue sky with the distant flowers serving as a frame on either side.
My favorite image of Helen’s is called “Rainy Day on Daytona Beach.” This location is one of Helen and Chuck’s favorite places to capture images of people and birds with the background of the Atlantic Ocean. I especially love the position of the child’s back foot and leg as she walks across the sandy beach. Helen uses the blank “white space” on the right side of the image to her advantage as a minimalist technique, forcing the viewer to focus on the child. Helen and Chuck have taught many photographers to concentrate on subtlety. As Chuck often says, “Less is more.” Enhancing the small details in an image without being obvious or heavy-handed is the skill seen in all of Helen’s work. Each of the above images demonstrates the “Wow! factor” that all of us photographers are seeking in our own images.
Thanks to Helen Pine for allowing me to feature her work.
I can vividly remember one afternoon ten years ago when three teenage boys came to see me who each weighed more than the scale could measure! That’s greater than 300 lbs (almost 140 kg).
The third boy had come in for a sore throat and his weight had jumped by over 10 pounds (~4.5 kilos) from his visit two weeks before when he was seen for a regular checkup. His mother warned me from the beginning of the visit that they were there only for the sore throat and that I BETTER NOT discuss his weight or weight increase.
I first took care of his sore throat, but before they left my office, I explained to them that it would have been negligent on my part to not call attention to his weight increase. I know she didn’t want to hear it again, but I feared that she was exactly the kind of patient who would have sued me for not warning her of the dangers that he would experience in the future.
And I was certain to document everything in the medical record that I discussed!
Yes, it was extremely frustrating!
Before I finished writing this post, I was worried that I would be accused of “body-shaming” because I expressed my frustration about treating childhood obesity. In fact, I believe that I am very understanding of those children and adults whose lives are adversely affected by obesity.
Since the Pandemic began, it was clear that obesity, along with the often co-existing problems of diabetes and hypertension, was the number one risk factor if you contracted COVID-19. You would have thought that the CDC and the medical establishment promoting COVID vaccination would have taken the opportunity to change the course of people’s lives by emphasizing healthier eating patterns. I’m still waiting for someone to stand up and make this the most important priority for the future of our world’s health, not just during the Pandemic. If we don’t get the epidemic of obesity under control, we will have to prepare ourselves for decreasing life expectancy in succeeding generations.
The campaign for healthier eating needs to start early in childhood, but it requires the parents’ acceptance and involvement. If parents are not willing to listen to their pediatricians’ advice and react defensively, we will never win this battle. I accept the fact that changing one’s habits is a very difficult task. However, if our society doesn’t approach this problem head-on with honesty, courage and dedication, we will be facing a greater “existential threat” than anyone would have imagined.
Several years ago, I was sitting in a very crowded movie theater with my wife.
Directly in front of us was a mother who had brought her newborn baby along with her after we were already seated. Several times during the movie, the baby fussed and she would nurse the baby, but it was very annoying to have the baby crying and the mother talking to her trying to calm her.
I finally asked the mother to take her baby outside to nurse her. She angrily replied that she was a doctor and that she had every right to nurse her baby wherever she wanted.
“You must be one of those people who don’t like to see people nursing!” she said.
“No,” I replied, “I’m a pediatrician who supports breast feeding 100%. Just not in a movie theater when I’m trying to enjoy a movie.”
We finally moved our seats to the other side of the theater.
Most of the time it just isn’t worth getting into an argument.
I am a retired pediatrician who has had personal experience with a condition known as Chronic Idiopathic Urticaria (CIU), a diagnosis which was made after an exhaustive workup which included many visits to subspecialists.
About six years ago, after a long post-retirement trip outside the US including Europe, Africa and several islands off the African coast, I began to experience intense itching all over my body.
The symptoms were randomly distributed on different parts of my body and occurred without any warning or preceding ingestion of food. At times, the itching was accompanied by painful hives (urticaria) and the sensation of having been slapped. It happened more often at night and prevented me from sleeping normally.
My evaluation began with a visit to my internist who suggested that I see an allergist. He explained that even after I would go through an extensive workup, the final diagnosis might still be classified as “idiopathic” (of unknown origin) and “chronic” (not acute).
I wound up seeing a rheumatologist, a dermatologist, a cardiologist and an infectious disease specialist. The dermatologist biopsied the urticarial lesion and sent the slides to a pathologist who was a specialist in CIU. He concluded that it looked like “normal CIU” (whatever that was) but that there were some subtypes of the pathology which occasionally go along with certain connective tissue disorders including lupus or psoriasis, or even worse, certain malignancies such as lymphomas. This fear encouraged me to pursue the workup even further. It has always haunted me that I still had something undiagnosed that was more serious.
At least the infectious disease expert was intelligent enough to ask me the right questions about my possible exposure to certain parasites. After all, I had visited some South Atlantic Islands including the former Portuguese colony of São Tomé where I had walked barefoot on beautiful beaches where wild pigs roamed freely. He ruled out that I had picked up a parasite.
The allergist brought it all together after about six months. He concluded that since no one had specifically found anything wrong, it would be termed CIU which in most cases, the origin is never discovered . By that time, my symptoms were pretty much controlled by daily dose of an over-the-counter antihistamine, cetirizine (Zyrtec) and a dose of a prescription, hydroxyzine (Atarax) for the occasional, but thankfully less frequent and less disturbing painful flareups of the urticaria. He also gave me the option of using omalizumab (Xolair), a monthly injectable biologic treatment, but I rejected this option because the symptoms had lessened with a more conservative treatment.
Several times since then, I have tried stopping my daily dose of cetirizine to see if the problem still exists. Usually within a week, I would start to feel “itchy” and sometimes I would develop some mild hives, but these minor outbreaks are always controlled within a few hours with my plan B medication, hydroxyzine. I decided that it is just easier to continue taking the low dose of the oral antihistamine to keep things under control especially since I don’t have any side effects from the medication
I admit that I still have a nagging fear that there is an underlying problem which caused the original problem. Time, however, is on my side since I haven’t really experienced any acute flare-ups in many years. But having unanswered questions leaves me with the worry that it will eventually resurface and that it may represent something much worse.
But as a doctor, I must tell myself that not everything in medicine has a clear explanation. I have been in the position many times in my career when I had to tell a patient, “I don’t know.” Some patients can accept this fact. Others are upset when doctors admit that there isn’t an adequate answer.
As I get older and the visits to the doctor unfortunately become more frequent, I have to admit that it’s not fun being on the other side of the doctor-patient relationship. I believe that I was the type of doctor who understood patient anxiety, but unfortunately, now I am the patient, I hope that I can always find the doctors who will fully understand my particular fears or concerns. I will try very hard to accept when my doctors say, “I don’t know.”