With middle age comes a mid-life crisis for some.  For others it means stepping into the wide world of decline when health problems start to raise their ugly little heads.  Some people may be blessed with a great genetic make-up, but for most of us who spent our younger years flying by the seat of our pants and teetering on the edge, we find ourselves the products of those years of bad choices, risky lifestyles and life's glorious excesses.  So what do we do?  So do we freak-out and quietly fall apart?  Or do we do the unthinkable and explore a new world of using pharmaceuticals for actual medicinal reasons?  Do we start taking our doctor’s advice as our medical charts start to grow thicker with lab results, surgical reports and progress notes? Those carefree days of recreational use and abuse have now ceased and we stand humbled as our doctor writes each Rx.  We stand wondering what side effects might follow hoping that the cost of our healthcare will result in lower cholesterol, lower blood pressure, a peaceful sense of well-being and ultimately a longer life.

In the past few years I’ve learned a lot about the healthcare system as a whole. Most of the following things may be commonsense things that will prompt a quick response of “I knew that”, but often times we get in a doctor’s office and go blank. Consider this a refresher course or just a gentle nudge in the right direction.

Life is full of choices. Remember that when selecting a doctor! Word of mouth referrals are probably the most helpful in weeding through all the doctors from Dr, Jekyll to Dr. House to Dr. Welby to Dr. Doolittle. Ask your friends, relatives and co-workers who they use. Doctors develop reputations that follow them wherever they go. Your doctor isn’t supposed to be the enemy, so if he or she acts like the enemy it’s time to find someone new. Nothing says you have to feel entirely uncomfortable for those few minutes while you’re prodded and probed, so why pay for someone who makes you feel like a pin cushion and like just another chart number to be filed away and forgotten about as soon as you leave the building? If you don’t feel good about the person with whom you’ve entrusted your life then it’s time for a change. And keep changing it until you find someone you like, respect and trust.  This person might have to assist you in making some life and death decisions along the way, so it might benefit you to get a doctor who not only knows your name, but knows your person.

After you find the right doctor, my first suggestion is to start making a list of things you want to discuss during each appointment. You spend your hard-earned money to pay for your office visits, so get your money’s worth while you’re there. I’ve found that doing a little homework about my health problems makes it easier to talk to my doctor.  The internet is great resource for medical information. Arm yourself with facts and don’t be afraid to ask your doctor questions about new procedures and new medicines.  A good doctor will take note of the interest you show as being a signal that you might be more apt to be compliant in any prescribed course of action.  Often times I forget that my doctor isn’t a mind reader and can’t properly diagnose and treat me unless I’m completely candid about my symptoms.  Even small details might be crucial in an accurate diagnosis because many illnesses mimic each other in their early stages, so don’t dismiss anything as being insignificant if it consistently bothers you. Let the doctor be the judge of a symptom’s significance.

Next, definitely learn about the drugs that you may have to take for the rest of your life. Find out what the long term effects may be and if periodic lab work will be required to make sure you remain within normal ranges. For instance, those people taking lithium to treat bipolar disorder need to be closely monitored because the difference between an accepted therapeutic level and a toxic level is a very small range. Also, ask your doctor about new drugs that may come available in the near future.  Trust me; your doctors are constantly courted by many drug reps wanting them to write prescriptions for their drugs. A good doctor knows which drugs work best and will recommend them without hesitation.

Tune in next time for the commonsense approach to health insurance. For now, this is Nurse Ratched signing off to get some much needed beauty sleep.

The residents of Maine can be divided into two camps.  The first are Mainers.  They epitomize the true heritage and values of Maine.  Then there are the Mainiacs who have incorporated their New England heritage and values into this new millennium.  They realize that few things in life are black or white.  Yes, they know right from wrong, but more importantly they realize that in the real world most people live in the many shades of gray somewhere between black and white (right and wrong). Yes, they know the times they are a changing!

Splashed across the news a few days ago was a story about a middle school in Maine.  The school board voted on giving King Middle School in Portland, Maine the right to distribute oral contraceptives to its female students.  The big issue that sparked many debates seemed to be the age of the females that might benefit from their decision.  No one wants to believe children ages 11 to 13 are having sex because in an ideal world people wait until marriage to engage in sexual activity.  But at this school, some brave girls have stepped forward and have admitted to having sex.  I guess their ugly admission of truth blew the whole ideal world concept to smithereens.  It forced people to think about the unthinkable.  OMG, the world isn’t ideal afterall!!!

I listened to a couple debates and wondered why the people debating this issue kept missing the most important point...11 year old girls are sexually active.  It didn't matter what each side said because right and wrong had already been transcended.  Right and wrong was no longer the issue. The damage couldn’t miraculously be undone.  I think the school board simply was trying to step in and make a responsible decision leaving morals out of the ugly reality they needed to face.  Yes, people were outraged and they should be outraged.  Children should be children, but I'm afraid society entices our children grow up faster now than in times past. As a result, children eleven years old really do have sex.  It’s a scary thought, isn’t it?

Everything a child is exposed to from day one teaches them about life.  Think about what they have learned from television, music, movies, books, magazines, friends and unfortunately many well-meaning adults as they grow up.  Can anyone deny how strong these influences are on our children as they try to emulate their idols?  Yet denial is what we do each time a young girl turns up pregnant or something bad happens.  We shake our heads and talk about what a shame it is.  How she’s ruined her life and how terrible her parents must be.  We want to tar and feather the hooligan who got her pregnant.  We’re all quick to pass judgment and slow to face the real problem.  

I think the part that really got my attention was learning that the old double standard is alive and well in this liberal New England hamlet.  In the year 2000, no one raised an eyebrow when the same school board decided to make condoms available for the male students.  For 7 years, the male students have benefited from their decision.  In a perfect world, parents educate their children about sex so they don't have to learn about it through other means.  So in an imperfect world what do we do?  Do we ignore the fact that too children are sexually active and becoming pregnant?  Do we ignore the fact that children are spreading sexually transmitted diseases?  Do we turn the other way ignoring the problem and criticizing those who aggressively try to address the issue?  Do we blame them for our children having sex or do we thank them for trying to protect all the children who have fallen through the cracks and are products of flawed values, weak role models and dysfunctional families?