A Different Christmas

Christopher was a very excited little six year old boy.  He just knew Santa was going to bring what he was hoping for. 

Unfortunately, Christopher was in the ER.  I was on call as a first year resident and he had gotten sicker over the past few days in spite of his pediatrician’s treatment.  The x-ray and labs showed pneumonia.  He needed to be admitted.  

It was 9 PM Christmas Eve.  

I went back in the room to see him after an initial visit.  His parents already knew it was coming.  Christopher clearly didn’t.  

When I told him that he needed to be admitted to the hospital he burst into tears.  He thought that Santa would just skip over his house and he wouldn’t get the thing he was wanting so badly.  His parents tried to console him, but he couldn’t stop crying. 

It was the loss of his ideal Christmas.

Once he settled down a little and could listen, I asked him why he was so upset.  He told me about the thing he wanted.  He told me he thought he would never get it now.  His dad, standing next to him holding him in the bed looked at me with a pleading look of “help me.” 

“So, that’s why you are so upset?” I asked.

“Yes!” Snort. Blow nose.  Cry.  Snort.  Blow nose again. 

“Oh, well I’m sorry.  I haven’t told you we have a special way of handling this sort of situation. Please give me just a minute.” 

I turned to the phone on the wall in the exam room, picked up the receiver, and punched in some numbers I knew.  

“Yes, this is Dr. Littleton in Rome, Georgia.  Please transfer me to Delayed Deliveries.” 

Waited. Waited a little more for effect. 

“Yes, this is Dr. Littleton at Floyd Medical in Rome, Georgia.  I need to ask Santa to delay a delivery for a hospital admission.”

The teary eyed cry-snort-blow-nose routine had stopped at this point and was now big eyes with wiping nose stare.  

“Yes, it is for six year old Christopher Fricks* of Rome, Georgia.  First of all, has he been a good boy this year?”

A concerning glance from Christopher.  

“Okay.  Good.  He’s going to be in the hospital a few days and I’d like to ask Santa to delay his delivery until he gets home.” 

Several more glances to his dad.  A look of satisfaction and knowing now slowly settling on dad’s face.  

“Uh-huh.  Yes.  Yes, that’s him.  Hey, by the way, what’s he getting?  Uh-huh.  Oh, nice.  Okay.  Thanks.  Please let Santa know we appreciate it.” I hung up the phone.  

“You can do that?” Christopher asked. 

“Yes.  It happens a lot, actually.  Not a big deal.  Let’s get you upstairs, get you some medicine, and get you home in a few days. Santa makes late deliveries like the UPS guys in certain situations.  No brown shorts, thankfully.”

He went home after a few days.  His dad thanked me later.  It all worked out as well as possible. 

There will be a lot of people on Christmas Eve this year who know that, because of changes in the past year, their ideal Christmas Day won’t be occurring this year.  I have listened and witnessed some of the most heartbreaking stories this year.  I also have seen some finally see a loved one at peace. 

Their peace still is fleeting on certain days. 

Their will be an absence.  An empty chair or chairs.  One less stocking.  No gifts under the tree with a certain name or names.  

A quiet acceptance of a loss that has now moved from the initial phase of tears to the daily reality of near-tears.  An understanding and acceptance that life will be much different now. 

And this will be the first Christmas Day with that new reality.  

May we all be reminded to say a kind word, pray our prayers, and possibly show a small gesture of remembrance to those who are walking a much different road this year in their life.  

They will appreciate it.  

*(Name changed)

Eric J. Littleton, M.D. (@DrEricLittleton) is a Family Physician in Sevierville, TN.  His office is in the UT Regional Health Center Sevierville at 1130 Middle Creek Road. Topics covered are general in nature and should not be used to change medical treatments and/or plans without first discussing with your physician. Send questions to askdrlittleton@gmail.com

Football and Life: Triumphs Don't Always Have Trophies

It was a miserable football season that needed to be put down.  

The uniforms stunk.  The locker room wreaked of failure.  Even the stadium lights were tired of watching the pitiful display and wanted to be turned off and hibernate for the winter. 

It was Harriman’s 1982 football team.  I was a sophomore and we went 0-10.  We weren’t actually very close to any victory.  It was a miserable experience.  The only good thing to be said was we didn’t quit. Well, at least we didn't quit putting on the uniform.  

We didn’t believe we could win.  We didn’t know what that felt like.  We didn’t have unity in effort and therefore turned on each other in individual battles and conflicts. Our reward for the season was new practice jerseys for the spring that proclaimed “Team First.  Me Second” on the front.  

In striking contrast, the scene that unfolded on the campus of Tennessee Technological University last Friday night was wonderful to witness.  The stands appeared nearly full on the Sevier County side as they faced Independence High School for the state 5A football championship.  The community showed up in support of a team which has represented the community so well.  

The band performed a great halftime routine.  The cheerleaders, constantly leading in rallying support for the team all year, unfurled a banner for the band at the end of halftime in appreciation.  It was a beautiful display of what a community should be.  

The players, as they have all year, went about their business in pregame with an ease and looseness that has been their nature this year.  They had traveled nearly 1,000 miles this season, practiced in heat and cold, seen good and bad plays, and were ready to play one more game.  

They had played on television, unheard of in my day, four times.  They played in a historic castle in Bristol, defeated a strong Morristown West team not once, but twice, and handed a very nice loss to a brash team from Rhea County whose fans had lit up social media prior to the game.  Knowing Rhea County is just south of Rockwood, it’s a safe guess there’s not much else to do there. 

For the Sevier County players Friday night, there was no conversation of skin color or ethnicity.  There was no thought of socio-economic status.  There was no categorizing of players by religious beliefs or intellectual achievements.  It was a team, representing one color, one high school, one community, one goal, working together to see it to the end.  It was the community, the band, the cheerleaders, and the families showing up in the stands to affirm their effort.  

It is a display of what makes this country great.  Or, what should make this country great.  Individuals with unique talents in multiple areas choosing to sacrifice their time to work hard for a unified goal achieved only by delayed gratification, willing acceptance of pain, and yielding of one’s own notoriety in order to see a teammate succeed.  

There is good evidence from scientific studies that a long and happy life is achieved by being an active part of a community and family, interacting, loving, accepting and forgiving as one goes through life.  This is what this team displayed this year.  Every player sees the successes and failures of the other players on the practice field, Friday night, and then on watching the film of the games later on.  And then they move on to the next game. 

Sevier County lost the ballgame to Independence High School, arguably the best team in the state.  Independence twice beat Centennial High School, who had beaten Ravenwood during the season.  Ravenwood beat Maryville for the 6A state championship.  The TSSAA should schedule one more game between 6A Ravenwood and 5A Independence this Friday.  

I realized just prior to the game that thirty years before I had first stepped foot on the beautiful campus of Tennessee Tech to begin my college career. Twenty years ago I began walking the sidelines as a physician in Rome, Georgia, later to take the role of sideline reporter for the local radio broadcast of the Sevier County football games on WSEV 105.5 with my good friends Jay Adams and Greg Davis.  We have seen some great games in our 15 years of broadcasting. The opportunity to be a part of a state championship game was a long held desire and a tremendous privilege.   

The players were clearly disappointed with the game’s outcome, but will realize in time the complete success and victory in the lesson’s outcome.  Every principle for success in life as a person, a student, a businessman, and community leader has been learned from their season - others before self, forgiveness of failures in others and ourselves, focus on the goal, work for the next opportunity, show love and appreciation for those who support and cheer you on, and get out of bed and go to work when others sleep and when it hurts.   

“Do unto others as you would have them do unto you,” and as opposed to our culture’s common “Do unto others before they do it to you.”

It is a victory for the players, and a lesson for all of us.  May this country heed the lessons displayed for us in the football stadiums as we enter the political arena this next year. The peaceful ability to continue to live in freedom and pursue happiness depends on the humility and prayers of the people first, not the politicians. 

Thank you to Coach Linginfelter and the Sevier County Football Team for allowing me to be on the sidelines these many years and to watch and broadcast a game I love.  It’s been a joy and an honor to watch players grow into young men. 

Eric J. Littleton, M.D. (@DrEricLittleton) is a Family Physician in Sevierville, TN.  His office is in the UT Regional Health Center Sevierville at 1130 Middle Creek Road. He was a member of the Harriman High School Football Team during their memorable 8-2 season in 1984.  He is a member of the WSEV radio broadcast for Sevier County High School Football Team. 

 

Death by Television

A public service word of caution to all those (like myself) looking forward to watching some college football on TV this weekend.  

It can kill you.  

No joke.  But so can a binge session of “Justified”, “Top Gear”, “House of Cards”, “Andy Griffith”, or, as I have been painfully exposed to against my will, “America’s Next Top Model.” 

Why, even the DVD series of “The Barbara Mandrell Show” or “The Carol Burnett Show” could be a person’s last memory on this earth.  Imagine Carol Burnett’s singing being the last thing a person hears prior to departing this life.  That’s not a stretch, actually. 

According to research presented at European Society of Cardiology Congress this past Saturday by Mr Toru Shirakawa, public health research fellow in the Department of Social Medicine at Osaka University in Japan, prolonged television watchers are at a much higher risk of fatal pulmonary embolism.  

Pulmonary embolism is a blood clot that usually forms in the the legs and travels to the lung.  It can cause extreme chest pain, shortness of breath, and sudden death even in an otherwise healthy individual.  Many people recognize airline travel as a risk of a pulmonary embolism.  

Now watching television is, also. 

The research is quite impressive.  Over 86,000 people aged 40 to 79 were followed for over 18 years in Japan.  Television watching was journaled and the cause of death was confirmed from death certificates.  

People were divided into three groups:  those who watched 2.5 hours or less per day, those who watch between 2.5 and 4.9 hours per day, and those who watched over 5 hours per day.  

(For the number crunchers reading this, yes, the data was adjusted for age at baseline, gender, history of hypertension, history of diabetes, smoking status, drinking status, body mass index, walking and sports habits and menopausal status.)

During the follow up period it was found that 58 people had died from pulmonary embolism.  If you think that isn’t many, imagine standing in Neyland Stadium with nearly 100,000 of your nearest kinfolk and friends and nearly 60 people will randomly selected from the crowd.  It becomes a very real number.  

The researchers determined that people who watched over 5 hours of television per day were twice as likely to have a fatal pulmonary embolism as those who watched 2.5 hours or less.  

Even more interesting was the finding that individuals under the age of 60 who watched for over 5 hours had a six-fold greater risk of fatal pulmonary embolism than those who watched less than 2.5.  The risk was three-fold greater for the 2.5-4.9 hours of watching in the same group.  

This means, a person who is between the ages of 40 and 60 has the greatest risk of fatal pulmonary embolism after watching television for over 5 hours.  That is roughly two football games, or one baseball game, or one half of a European soccer game (or so it seems). 

That is also equivalent to ten episodes of “The Andy Griffith Show” (easy), two chick flick movies (tougher), or about eight episodes of “America’s Next Top Model” (death already being pondered at that point). 

Mr. Shirakawa commented on the findings of his research that leg mobility, much like with flying, needs to be a point of focus during television watching.  He suggested that getting up, walking, stretching and drinking plenty of water for hydration during regular breaks from viewing needs to be an emphasis for any age group.  

He further noted that fatal pulmonary embolisms have been documented in individuals playing video games, but that it isn’t clear if prolonged usage of computers or smartphones is a risk.  

It makes sense, actually, that television viewing would be a risk.  The blood in the legs moves back to the heart by the action of the muscles in the legs compressing the veins and pushing the blood up the veins to the heart.  The one-way valves in the veins keep the blood from flowing backwards and promotes circulation.  

This is the reason that it is important for the legs to move some while we sleep, but of course not enough to keep a spouse awake.  It is also the reason there is such an emphasis on hospital admissions to reduce the risk of clots in the legs either by walking, compression devices on the legs, and/or blood thinners.  

We weren’t made to be still.  We should be still some for rest, prayer, meditation and social courtesy, but not for prolonged periods of time.  

We are made to move.  Sitting in front of the television (or video game) locks our attention and lowers our motivation to move and be active.  It is a habit that can easily be changed. 

It isn’t too much of a stretch to imagine the day when the television will have a sensor and a camera looking back at us to determine if we are moving enough.  The television will see us sitting still, communicate with our health insurance’s computer, and Boom(!) - change the channel to a re-run of Lawrence Welk and the Polyester Singers.  That will get anyone out of the room.  

Eric J. Littleton, M.D. (@DrEricLittleton) is a Family Physician in Sevierville, TN.  His office is in the UT Regional Health Center Sevierville at 1130 Middle Creek Road. Topics covered are general in nature and should not be used to change medical treatments and/or plans without first discussing with your physician. Send questions to askdrlittleton@gmail.com

Football and Life

My great uncle was killed by a blow to the head in a football game.  

It was the early 1930’s in a little community west of Knoxville called Wheat.  The details are few, but our family genealogist, my brother Mark, shared this with me earlier this year.  He was hit during the game, loss consciousness, and died three days later. It may explain my grandmother’s complete disinterest with any sports activity. We suspect my dad may have been named for him. 

Less than ten years later, the community of Wheat would be forever dissolved by a decision from General Leslie Groves to make room for the Manhattan Project and uranium enrichment.  Somewhere in the secured areas around Oak Ridge there is a grave where my family said goodbye to a young man who died playing a game I love. 

Football, the American version, not that silly European kind where a player automatically surrenders the use of two perfectly good limbs, is my favorite sport. Sports in general are good for the discipline they teach and the family time they can create, but football holds a special place for me.  

I was a freshman in high school, barely over a hundred and thirty pounds, when I decided I wanted to give it a try.  Mom and Dad (Dad, knowing, but not mentioning his uncle had died in a game) gave their permission with one clause:  you must not quit during the season. 

They also told me I had to break the news to my piano teacher of nine years that I was giving up piano lessons to play football.  That wasn’t easy for me to do, but Mrs. Hicks oddly looked relieved when I told her.  She told me to keep playing the piano.  I did. 

My sophomore year at Harriman was memorable.  We lost every game.  We even snatched defeat from the jaws of victory in a game against Seymour.  Snapping the ball over the punter’s head and allowing the Seymour player to fall on it in the endzone is a great way to lose a one point lead. 

We were pummeled by Loudon, destroyed by Kingston, embarrassed by Rockwood and even kicked around by the likes of Oliver Springs. It was awful.  Our steadfast cheerleaders, trying to encourage us, read a letter to us over the PA system as we warmed up for our last game of the season.  Our opponents beat us AND made fun of us for that one. 

Nevertheless, I wanted to keep playing.  I enjoyed the challenge physically.  I liked the mental preparation. I really enjoyed the friendships. 

I learned football represents life in a lot of ways.  You work to gain ground and acquire points.  Eleven players must work in tandem, performing their expected duties, in order for one to possibly score.  It may be hot, or it may be cold, it may be raining - it doesn’t matter.  Play the game. 

I learned things aren’t always as they appear.  My senior year Oliver Springs had the biggest collection of players I had ever seen.  They had no discipline and we beat them soundly.  

I learned cheerleaders can be your number one supporter on the sidelines, but if you focus on them during the game your opponent will run over you. 

I learned breaking old ways of thinking is difficult but it can be done.  Sometimes, it must be done when you hate losing enough.  

I learned halftime isn’t halfway.  I saw my Harriman team score twenty-two points in the last four minutes of a game to win.  I have witnessed Sevier County come back from twenty-eight points down with a minute to go in the third quarter to beat a very talented Kingsport Dobyns-Bennett team in the second round of the playoffs - at Kingsport, no less. 

I learned friendships last longer than final scores.  The numbers seem to fade, but the friendships forged in long hot and cold days of practice and ballgames will last for a lifetime. 

All of these lessons and more are now being learned by the football players who will put on new smelling jerseys this Friday night, tape up the ankles, go through their own personal routines prior to a game, and step on the field before the members of their family and community.  

My favorite time was in early pre-game warmups laying on the ground smelling the freshly cut Bermudagrass mixed in with the aroma of hot chocolate, grilled hamburgers, cotton candy and popcorn.  I would lay there looking up at the sky thanking God for the opportunity to put on the uniform and play a game. 

I remember seeing a young father with his little boy peering at us through the fence as I layed there warming up.  I realized then I was playing for our community - for the little kids.  For the dreams they would have wanting to play on the big high school field someday.  

Some will be remembered for great plays.  Some will be remembered for not so great plays.  All will remember playing. 

Our community is blessed with six high school football teams, five public and one private. We have teams of legendary histories in East Tennessee and one team that has yet to even play one varsity game. We have a vast collection of coaches who, collectively, have hundreds of years of coaching. It is a great place for a player to learn the game.

This Friday night will be the first of eleven weeks of regular season football games this year.  With six teams there will always be a game somewhere locally where players will put on display for their family and friends what they hope will be their best effort.   

There will also be musicians learning how to be a member of a larger group of musicians while still crafting their own musical style.  They, too, are learning lifelong lessons. 

There will be cheerleaders and dance team members who have worked in the off season to contribute their talents and dedication to the community in which we live.  

I would encourage you to consider going to at least one game this season.  The community atmosphere, the drama on the field, the performance by the band, cheerleaders, and dance teams all are well worth the price of admission.  

Football is faced with many challenges in the future given the current and future legal proceedings surrounding concussions.  The risk of injury, either now or down the road, gives many parents a reason for concern for their athlete.  Each family should make their decision after talking through it thoroughly.  

I am thankful my Dad, knowing that he had an uncle killed from the sport, allowed me to play.  The modern football equipment certainly was better when I played than in the 1930’s, but fear can ignore reason sometimes. 

The lessons I learned helped me in life and continue to remind me each day.  I am thankful to be on the sidelines watching, and describing, a new generation embracing it, too.  

Go see a game.  You will enjoy it. 

They will appreciate it. 

Eric J. Littleton, M.D. (@DrEricLittleton) is a Family Physician in Sevierville, TN.  His office is in the UT Regional Health Center Sevierville at 1130 Middle Creek Road. He was a member of the Harriman High School Football Team during their memorable 8-2 season in 1984.  He is a member of the radio broadcast team for Sevier County High School Football Team. 

Dad.

He wanted a date with her.  She worked at the Acme Drug Store soda fountain, made old fashioned cherry Cokes and the best chocolate float in town.  Downtown Harriman was a busy place in the mid 1950's.  He worked at the A&P Store a block away and also repaired Whizzer Motorbikes.  He went by everyday for lunch to see her. For the chocolate floats, of course. 

Jim had been in the Army in Italy and worked on the earliest punch card computer system. He had turned down a job offer from some small computer company in St. Louis named IBM to return home to his family.  And Gloria. 

Gloria was polite, but told him she wouldn't date anyone who didn't go to church with her.  So, Jim did.  He not only went, but joined South Harriman Baptist Church.  It was Summer 1955.  

Gloria had just recently moved to Harriman from West Tennessee.  She knew no one, but was invited by two other teenagers to join the youth choir in church.  She loved the friends she made and the songs they sang.  Jim joined the choir, too, and they quickly became a couple making friends with other couples. 

They would be married in the same church in October. Their new friends, Earl and Emma Ruth Duff were at the small wedding in the sanctuary. 

The couples in the church began enjoying the vacations and trips to the beach in large caravans of cars.  Children, cook outs, beaches, roller coasters and practical jokes all were apart of their world in the 60's and 70's.  

Jim would become a deacon and trustee in the 60's and serve his church for nearly fifty years.  He was the chairman of two separate pastoral search committees, a building committee and choir member until his health intervened.  Even with his service to the church, he would still pay for any copies he made in the church office for any business he handled for the church.  That's just the way he was.  

They saw revivals that overflowed the sanctuary, a steeple blow off the sanctuary in a storm, a beloved pastor die the day before Thanksgiving, and musicals, musicians, and singing that filled the air. They saw an Easter 1975 service with over thirty five people come to the altar to make a spiritual commitment.   

They also saw deaths, disagreements, divorces, and departures.  Those are a part of church life, too.  

Jim began working for Swan's Bakery selling Sunbeam Bread in 1960.  Over the next thirty five years he went from an extra man to a bakery leading sales supervisor for an area from Athens, TN to Whitley City, Kentucky.  He managed men, sales, merchants and the occasional crook with the same core belief - "Be Fair, Firm and Frank." He caught one thief simply because his bread truck’s gas mileage dropped over a few weeks.  Numbers never escaped him. 

When a man would ask Jim for a job, he would tell him the interviews are at 4 AM at the local warehouse.  That's when he went to work and was the best time to meet.  It tended to weed out a lot of weaker applicants. 

Jim was well known around Harriman.  He was known as a pool shark (preferred snooker), knowledgeable mechanic, founding member of Walden Ridge Antique Car Club and a loving but firm father.  He had a temper, but Gloria tamed that quite a bit.  Redheads can be that way, sometimes. 

His two sons knew that if they got in any trouble, it would get to Jim before they got home.  And that was before cell phones. 

Jim and Gloria had opportunities to move away from their church and Harriman, spending one brief year in Sevierville in the 60's along with a few other offers.  They never left, though.  He stayed with the same company. They stayed with the same church. 

Nearly sixty years from the day he joined, Jim was recognized by his church for his years of service.  Weak and frail, but still with a razor sharp mind, he spoke to the church thanking them for the honor and the love and friendship.  The hymns sung were his favorites (including "How Great Thou Art").  Both his sons played the piano during the service.

His funeral was less than two months later - in the sanctuary of the church he had been a member for sixty years.  Gloria, who had been the one responsible for getting him there, stood for nearly three hours greeting the friends she and Jim had made.  It was an incredible outpouring of love and support.  

His good friend, Earl, who had been at his wedding, now attended his funeral.  Six decades of good memories and trips didn't soften the pain of losing an old friend.  

James Edward Littleton died on June 26, 2015 after battling a chronic illness that perplexed physicians from Knoxville to Vanderbilt.  He never lost his ability to think, and he spent his last day talking with an old friend, Marvin, on his porch.  Marvin recalled he said goodbye in a different way when he left. 

His loyalty to church, career, friends and especially family never wavered.  You knew where you stood with him, and you knew what he expected of himself and others. 

That's how it is, and was, for that generation. They connected, loved, and supported each other without Facebook, Twitter, Instagram, email, internet and cell phones.  They spent time together, enjoyed sitting around campfires, played cards on Saturday night and laughed.  

Their limited connections connected deeply while our scores of connections connect superficially.  

Drivers pulled over, as is still the custom in Roane County, for his funeral procession.  One man mowing stopped his mower and took off his hat as the hearse rolled by.  The Chief of Police, another old friend of Jim's, led the column the entire way.  

My Dad was laid to rest in a cemetery surrounded by the graves of members of his church.   He had an extraordinary ability to apply common sense to his intelligence. He could persist when others would quit.  He had a strong sense of right and wrong.  

But above all, he loved his family and friends with loyalty and devotion.  His testimony of work, words, will and worship is an example for his sons and grandchildren, but also of the nature of that generation.  

His wisdom and knowledge, even for repairing a lawn mower over the phone with me, will be deeply missed.  His memory and his legacy will continue to challenge me every day that I have remaining.  I never wanted to disappoint him. That - will never change. 

Eric J. Littleton, M.D. (@DrEricLittleton) is a Family Physician in Sevierville, TN.  His office is in the UT Regional Health Center Sevierville at 1130 Middle Creek Road. Send comments or questions to askdrlittleton@gmail.com

Prostrates and Prostates

He knew he was a defeated man, succumbing to the power that he loved, and now had him sitting in my office waiting for the self-imposed doom that had weighed on his mind for over a decade.  

The power that he loved, his wife, sat next to him.  Just making sure EVERYTHING was done for him.  “Yes, he’s here for a physical.  A FULL physical.  I want him checked out completely,” she said.  

Not just any physical.  He had just turned 50.  It was that physical.  The one every man flinches, and then puckers a little, when he thinks about it.  

In her mind his prostate had a date.  She was there to see it through.  She had dutifully had PAP smears and pelvic exams over the past thirty years as a routine, birthed their babies buck naked and displayed to the world in the birthing room, and, by golly, it was now his turn.  

And he knew it, too.  He had learned, as most wise husbands do, that he wasn’t going to win by posturing, avoidance or denial.  So he summoned the wise courage to have no stupid courage, and agreed to her request.  

She had her list of his problems for me to address, offered him one more look, and left us to go back to her work.  He just wanted out.  Little did he know she wasn’t up to date.  The Task Force had changed their recommendations.  

Per their website, “U.S. Preventive Services Task Force (USPSTF or Task Force) is an independent group of national experts in prevention and evidence-based medicine that works to improve the health of all Americans by making evidence-based recommendations about clinical preventive services such as screenings, counseling services, or preventive medications.”  

This is the source of the majority of guidelines that primary care physicians will use to guide their choices and treatment plans for detecting, treating and preventing illness.  This is the group that stated within the past year that the old standard of the prostate blood test (PSA) and yearly rectal exam was no longer recommended as a screening tool for asymptomatic or low risk men.  At any age.  

Therefore, if a man didn’t have a strong family history or any symptoms suggesting prostate issues, a rectal exam (finger test) and blood work (PSA) was not recommended.   

I was reminded of this at my conference last week in Atlanta.  (Incidentally, driving I-75 across I-275 in Atlanta provokes a certain level of adrenaline.  Driving into Atlanta with heavy sleet, snow and ice is entire new level of peachy fear.  Atlantans, remembering the snow-ice debacle on their roads from 2014, were exiting their city early in a manner probably not seen since Sherman.  It was memorable.)

Not many of my fellow physicians agreed with this recommendation and likely will still continue offering both to their male patients.  It is a challenge to explain the reasoning of the Task Force, especially when it is so personal.  

The reasoning of the Task Force is similar to the old phrase that “more men die with prostate cancer than from prostate cancer.”  This, of course, is only comforting if it is someone else’s prostate.  

Statistically, the risk of cancer and the potential harm that can come from testing suspicious blood tests and exams were weighed by the committee.  Their comments are as follows -

“The reduction in prostate cancer mortality 10 to 14 years after PSA-based screening is, at most, very small, even for men in the optimal age range of 55 to 69 years.”  Translation:  a few will die, but it’s only a few.  

“The harms of screening include pain, fever, bleeding, infection, and transient urinary difficulties associated with prostate biopsy, psychological harm of false-positive test results, and overdiagnosis.”  Translation:  there are some short term complications in pursuing a cancer that may take your life.  

“Harms of treatment include erectile dysfunction, urinary incontinence, bowel dysfunction, and a small risk for premature death.”  Translation:  some men would rather face prostate cancer than living with erectile dysfunction and urinary leakage.  Well, yes, but I’ve seen untreated prostate cancer do the same thing when it spreads. And with a lot of excruciating bone pain, too.

“Because of the current inability to reliably distinguish tumors that will remain indolent from those destined to be lethal, many men are being subjected to the harms of treatment for prostate cancer that will never become symptomatic.”  True, but what if it is symptomatic? What if it is yours?

I will explain these recommendations to my male patients and their wardens, sorry, wives, and then also offer the blood work and exam if they wish to have it.  Thankfully, at least to this point, we as physicians still have some choice in how we manage the care of our patients.  The day of the cookbook, impersonal, data-driven medical care is upon us and rapidly taking over.  Some days I feel I am a modern day blacksmith looking at the first Model T Ford rolling into town.

The simple reason I will do this is based on the one thing, the very thing that is crucial here, that all of the data, documents, digital dividing and doctoral discussions on committees cannot measure - fear.  The fear of the unknown.  Is it there? Is it not? Is it possible?  

My experience is that patients fear the unknown much more than they fear the known.  Given a challenge with an abnormal result, I have seen the most anxious patients courage-up and want to know if it is good or bad.  I cannot recall one patient telling me “I don’t want to know.”

My male patient?  His fear of his wife overcame his fear of blood work and exam.  He’s already preparing his researched defense for next year, though.

Eric J. Littleton, M.D. (@DrEricLittleton) is a Family Physician in Sevierville, TN.  His office is in the UT Regional Health Center Sevierville at 1130 Middle Creek Road. Topics covered are general in nature and should not be used to change medical treatments and/or plans without first discussing with your physician. Send questions to askdrlittleton@gmail.com

Glen's Treatment Dog

Research has uncovered a new treatment for patients with advanced cancer.  It improves the social and emotional scores of patients undergoing chemotherapy and radiation treatments even as their functional and physical scores plummeted.

Science may have just confirmed it, but I knew about this treatment when I was a boy.  

Glen was my next door neighbor growing up.  He was the same age as my two grandfathers and he and his wife had no children.  I became an unofficial grandchild.  

He had served in the Pacific in WWII.  He was married thirteen years before the country asked him to leave Harriman for three years of service.  He traveled from island to island, sending home cryptic letters to his wife asking about a certain cousin moving north to Oakdale or Coalfield.  That's how she tracked him from island to island while he was gone.

He saw a lot of horror, hate and death in the Pacific.  He enjoyed every day with a smile and a laugh.

He taught me checkers. He taught me quick humility at checkers on many Friday nights as we watched a Braves ballgame (they usually lost, too).  He taught me how to toss horseshoes and bounce them in.  He bought me a pair of Hee-Haw overalls when I was five (all of those photos are in my possession).  

And he taught me how to love dogs. More importantly, he taught me how dogs can love.

A study released in January 2015 in the Journal of Community and Supportive Oncology reported a remarkable improvement in the social and emotional scores of cancer patients undergoing chemotherapy and radiation treatment for head and neck cancer.

The lead researcher, Stewart Fleishman, MD, of Continuum Cancer Centers of New York Beth Israel Medical Center in New York City stated he was "amazed" at the effect on the group of patients studied.  

This isn't new, it is just newly documented.  Documented research gives footing to further research and funding for payment.  Animals have been known to provide therapy for patients, but it hasn't been studied.  

The 37 mostly male patients had an average of 18 visits over 7 weeks for treatment of radiation and chemotherapy.  The course usually resulted in the patients having significant pain, skin lesions, difficulty swallowing and eating, and fatigue.  Nevertheless, even as those life altering symptoms physically affected the patients, their measured emotional scores improved.  

One patient even stated she would have given up but wanted to see the dog for the next visit.  

The dogs were daily groomed and bathed, and special care given to cleansing their paws prior to each visit.  No mention of the breed was noted. (I would guess labs, but I am completely biased).

Further research is already ongoing, especially for children with cancer.  Dr. Fleishman also noted most cancer centers already have therapy dogs as part of their treatment across the country. Again, no one had measured its effects.

Glen loved all the dogs in our neighborhood.  Every yard had a dog path that lead to his house for the distribution of snacks.  You could set your clock by it.  I remember waking up on summer mornings and hearing through the open window Glen playing his mandolin on his front steps as the dogs formed his audience.  

Glen and his wife had a Truce Marriage.  They were of a generation that rarely even said the word divorce, much less did it, and didn't believe in murder, either.  Therefore, they had a truce.  They had routines (6 ounce Coca-Cola split evenly at 11:30 each day) and quick verbal sparring along with the pleasant social appearances and diligent work on the house.  

If they were busy on the house and yard, they didn't have time to argue. My dad told me "she is a Martin and they are a cold bunch" but I found that personally difficult to believe. A few of the Martins seemed to be rather pleasant.

Then Glen got cancer.  His bone marrow, possibly from some radiation he was exposed to in WWII, decided to make unusual cells.  Treatment was limited and brutal back then.  He became too weak to leave the bed in the hospital.  He just wanted to go home to die.  

She said no.  She didn't want to care for him.  They had plenty of money to pay for the care, but she didn't want him there.

After sixty plus years of marriage, service in WWII, successful small business ownership, Glen ended up in a nursing home bed with his failing body and functioning mind.  My mother had always been close to him and he asked her for one favor.  

Bring a dog in to see him.  

Special arrangements were made, the owner of the nursing home happened to be out of town, and Sophie, our white Eskimo Spitz, made her way into Johnson's Nursing Home.  The effect was obvious.  Glen didn't last long after that, but he died with the faith of a Christian man and the peace of a dog lover.  He didn't say much about his wife.

Dog's, at least most dogs, teach unconditional love.  They are happy to see us, quick to forgive and will quietly wait for sometimes even just a glance or a touch.  A treat? Well, yes, of course.  A bad day?  Well, let's just be excited about seeing each other and it will all be better.  

Dogs love their masters.  (Cats work their staff.)

Unconditional love is a trait that Christians and churches are supposed to have.  Love even when there are faults.  Embrace even when there are bad days.  Forgive and work to have a better relationship.  Never reject or push out the door for faults, but work to find a way to love and serve even as we are weak and flawed.  Dogs teach that.  We all fail at it.  Sometimes miserably.  

Unconditional love can make unbearable conditions tolerable.  Research now has documented it, but it was already known to anyone who has loved a dog.

It should be a part of our nature, but we fail at it.  Maybe dogs are our quick reminders of traits we need to have and show each other, especially when the days are challenging.

His wife? She died alone in her own nursing home bed many years later after, according to my dad, "enjoying many years of poor health." She loved pills and not people.  She enjoyed attention but struggled to give it.  She had less than ten people stand around her casket and no funeral.  

Whatever may have caused her coldness, she kept it to the bitter end.

I never saw her pet a dog, either.

Eric J. Littleton, M.D. (@DrEricLittleton) is a Family Physician in Sevierville, TN.  His office is in the UT Regional Health Center Sevierville at 1130 Middle Creek Road. Topics covered are general in nature and should not be used to change medical treatments and/or plans without first discussing with your physician. Send questions to askdrlittleton@gmail.com