Rescued from Addiction

fatherembracingsonWith all of the headlines lately regarding the opioid crisis, it is nice to get to see some good news. Working with patients who have problems with addiction is challenging, but there are rewards that come with seeing success stories. Such is the case with a young man who decided that he needed to get help and came many months ago to get started on a program to get free from addicting behaviors that were ruining his life.

The wide array of substances that people use to get away from reality is an insidious evil plaguing our country. While people are different and some do have predispositions toward addiction that other people do not have, there is still the choice that must be made on the part of the user to take a substance or medication against the advice of their physician and/or the law. Once that choice is made, for many it is a seemingly never-ending, downward spiral. For those with little or no support to help them when and if they want to seek recovery, the chances of making it be free from the chains of addiction are slim. Watching someone slowly deteriorate as this evil takes their life away from them, to hear their heart cry deep from within to be free from the dungeon encasing it while darkness swirls about them trying to keep them from hearing the truth, to see them reach out and then fall back discouraged, to look at those children who don’t have their parent(s) anymore because they are dead from an overdose is to feel some of their pain. It is more than enough to drive me to my knees in prayer.

For this young man, he was traveling down the road of his life when he came upon a detour that took him places he had never been and wondered if he was ever going to find his way back. For him, it was his mother who came with him the first time, and many times after that, as she was not going to sit idly by while her son’s life was taken away from their family. His wife had left him a while back, but his children still needed him as their father. His parents still needed him as their son. God still loved him just as He always did, if he could just see the light shine through. As time passed and changes occurred, the real person beneath the chains began to emerge more clearly. The medication used to help him slowly get away from the illegal substances was being withdrawn from him a little at a time until on this last visit, he was written his last few doses to finish his treatment with this medication. While this achievement, with God’s help, is encouraging, he faces many temptations ahead and must continue to be dependent upon God to help him daily.

The best reward for me was to get to see his father come with him on this most recent visit. As his father sat in front of him and told his son that he would have given his right arm to see him saved, tears streamed down both of their faces. It was a heavenly scene as this son seemed to realize more than he ever had before of his own earthly father’s love for him and to experience from him love, grace, acceptance, and forgiveness. I will never forget watching that unfold and I told him how blessed he was to be able to have that relationship because so many do not. They got up and were leaving to check out when I happened to come back down the hallway and right in front of everyone were embracing one another in the nursing area in a way that made me recall the story of the prodigal son being received by his father who had run to meet him. Despite all of the bad news, the Good News of the Gospel is still the answer for what ails many in our land.

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Less is More, Loss is Gain

whatsyourstory“Losing my leg was the best thing to ever happen to me.” 

I was going about my usual fast-paced day at the clinic recently and trying to keep up with the schedule. Like many people, the routine gave way to a full face confrontation with reality. It was one of those encounters that makes you slow down, think deeply, and then remember it is not always that you are teaching someone else. Those kind of encounters teach you, if you take the time to listen.

Upon entering the exam room, it was not a scene too uncommon at all. A man was sitting in his wheelchair, but not the usual more advanced age person. This forty-something year old sat there as we talked about his medical conditions. He looked a little tired, but had a smile on his face throughout the discussion and examination. As we talked, he then tossed me this surprising statement: “Losing my leg was the best thing to ever happen to me.”  I sat there for a few seconds as I contemplated what he had just said and was trying to decide what would be the best way to respond to this heart moment.

Many times people who have been through traumatic circumstances find it hard to find anyone who understands their life’s journey. Their plight has been one in which they have been in such a bind they either get bound up or get freed from the chains that tried to lock them up for good. It makes you think of when Peter was in prison (Acts 12) and then his chains fell off and he was released by an angel. The very people who were praying for Peter did not believe that he was released when he showed up at their home. How many times are we the same way when the very thing we have been praying for is right there in front of us? Do we do as these early Christians did and not open the door to someone knocking who wants to share with us that very thing we prayed for earnestly? When we hear that heart moment in front of us, do we leave the door still yet unopened while the knocking continues trying to get us to listen?

When there is an inclination detected that a listening ear is near that might understand, a nugget of truth slips out to test the environment and see if their heart can be safely shared. If that knock on the door results in it being opened, then real truth can be heard that can do both the speaker and listener some good. It also does the person a lot of good who is sharing to feel and know that their condition is not without some benefit to someone else. As all of us are walking, or sometimes running, done the road of lives that may be shorter than we think, it pays to take some time to sit on a bench with a friend and share.

This man shared about his journey of working hard and going about the routines that many of us take for granted when one day tragedy struck.  He was left with one good leg and an amputated one. The loss put him in a wheelchair as prostheses were not tolerated well by him. He shared about how this sudden slow down of his routines had changed his life not in a harmful way, but had resulted in him having a deeper walk with God than he had ever had before. He had a demeanor that reflected what he said with a worn, but settled and peaceful look about him. His time of being thrown in a jail did not last long as he had been set free through the experience and then came to knock on my door that day in the clinic. I’m glad I opened the door.  Many times, less can be more and loss can be gain.

Mississippi and North Carolina Democracy versus Liberal Totalitarianism

Mississippi and North Carolina Democracy versus Liberal Totalitarianism

Totalitarianism is defined as “a political system where the state recognizes no limits to its authority and strives to regulate every aspect of public and private life wherever feasible. Totalitarian regimes stay in political power through an all-encompassing propaganda campaign, which is disseminated through the state-controlled mass media, a single party that is often marked by political repression, personality cultism, control over the economy, regulation and restriction of speech, mass surveillance, and widespread use of terror” (Wikipedia, https://en.wikipedia.org/wiki/Totalitarianism). This definition actually describes the type of actions desired by those who want to punish Mississippi and North Carolina for wanting to let their citizens be able to decide for themselves what they want to think and do with their own lives. These liberals want a totalitarian government, not a republic, and not a democracy. They seek to force their viewpoint upon everyone any way they can.

Most of these companies who are voicing public objections to the laws passed by states, which want to allow religious freedom, are solely acting to protect their bottom line financially as they see it and will shift their actions to whichever way they think the wind blows if it will make them money. The same activists who threaten Mississippi and North Carolina also threaten these large corporations if they don’t comply with their demands. If it is okay with people to demand adherence in such a totalitarian fashion, then some other questions should also be asked.

Should Teva Pharmaceutical Industries be boycotted and people be asked to do no business with this company because they refuse to allow propofol to be sold for executions? They are discriminating against what their product is used for on the basis of their belief system even though the death penalty and executions are legal. If Christians should be forced to participate in matters that conflict with their belief system and violates their conscience, then how can one argue that these companies should also not be forced to sell their products without “discriminating”? If it is okay to sue Christians who solely don’t want to perform a service out of moral objections based on their faith, then should not the states who cannot get the medications sold to them for legal executions be able to bring lawsuits against these companies and force them to do what the law states is okay?

Should physicians who have moral objections to participating in abortions be forced to perform them since abortion is legal and physicians who refuse are “discriminating”? How about pharmacists who won’t fill a prescription for an abortifacient drug and are “discriminating”? Should all of these physicians and pharmacists be labeled as promoting “hate”, and boycotted for their “discriminatory” practices?

What about the pastors who refuse to participate in a homosexual “wedding”? Should they also be labeled and treated in the same way? Are these pastors to be listed on a “hate group” registry and hounded for just not wanting to participate?

What about Muslims who will not sell pork, or prepare it for sale, to others based upon their religious beliefs? Should all the pork-loving people all get together and bring boycotts and lawsuits to force the discriminatory Muslims to participate in what they deem objectionable based upon their faith practices?

Should Jewish owned businesses who choose to close their doors on Saturday be forced to stay open and not “discriminate” against those who want to shop on Saturday? Is it offensive to those who don’t hold those beliefs and places undue burdens on those who only can shop on Saturdays since it is possibly their only day off from work?

It is not people of faith who are bringing lawsuits and attempting to ruin others through tactics of fear and intimidation. These are the actions of the liberal, totalitarian activists who people of faith need to be protected from. Should peaceful non-participation be now made illegal also? That is also what totalitarian governments do. No dissent is allowed without retribution.

People of all faiths should be allowed to follow their conscience and faith practices as their traditions commonly dictate and not have their belief systems trampled by totalitarian demands. The pharmaceutical companies should be allowed to followed their conscience while the states are free to pursue other options without forcing adherence. Physicians and pharmacists should be free to practice in ways that do not violate their faith while those who want something different are always free to seek to have services they legally want elsewhere. Pastors should continue to be free to choose whom they will agree to marry as they always have. Jewish people should be free to practice all aspects of their faith as there are other options for those who live under different practices. Muslims should be free to practice portions of their faith practice as they desire to do so and people who want something different can do business with others. Those who want to label these laws as hateful only reveal their own heart toward those whom they disagree. For people of faith, it is about protecting their own conscience by not participating and it is not about doing anything to hurt anyone else. It is about having respect for other people’s faith choices in their lives and giving them the freedom to live their lives with having a conscience intact, unlike those within totalitarian regimes who historically could be argued to have lost any conscience they might have had.

Saying Hello

helloIf you have lived very long, you have had those whom you have loved to depart from life as we know it.  Many times, when there is the blessing of having time to do so, we struggle with trying to say goodbye, while sometimes it is instead like saying hello.  We typically say hello when greeting someone and especially if it is someone whom we have just met.  A lot of things that should have been said much earlier sometimes remain unspoken until the last moments of life.  It is wonderful when people do have the time to make clear what was muddy.

This last week a patient came in for a visit and took some time after we had addressed his medical concerns to talk about a discussion he had with his ill father recently.  The two had a history of disagreeing about many things over the years and their relationship had been strained continually.  The father had gotten older and the inevitable problems of aging had taken its toll on his health.  The son knew his father was ill and went to visit with him.  As they sat and talked, the son recounted the major areas of strife over the years with his father with what previously had been relationship shattering issues then becoming seemingly ever so minor.  An apology was offered from the son to the father.  The son was then surprised somewhat when his father slowly looked over at him and motioned with one of his arms an aw-don’t-worry-it gesture much like Bill Cosby used to do a lot on his program when brushing aside something that just was not important.  The father was telling his son that those issues didn’t matter anymore and that it was okay.  That wave of the arm and hand was signification of forgiveness and it touched the son’s heart so much that he had a small tear in his eye when relating the story. The son finally left after giving his father a hug and started heading back toward home.  An hour later, the call came that his father had passed away.  What had been a visit to say goodbye had become a visit to say hello, for what was old was gone and there was a newness that was granted by that father to his son.  There was no better way for them to depart from one another – although that is only temporary anyway for those who know Christ.

There are many health benefits seen in those who make forgiving others a way of life.  There are hundreds of studies which have linked forgiveness to improved physical and emotional well-being with researcher Robert Enright of the University of Wisconsin Madison stating, “Forgiveness works.”  Among those who practice forgiveness, there are fewer cardiovascular problems and stress-related conditions along with a general feeling of greater happiness.  In 2008, the journal Mental Health, Religion and Culture reported that people who forgave had decreased risk of depression.  A study involving 213 Vietnam veterans found that those who had trouble with forgiveness also had more problems with post-traumatic stress disorder (PTSD).  Mayo Clinic reported in 2008 that holding grudges caused people to have increased blood pressure and heart rates.  A study of more than two thousand twins in Virginia showed that forgiveness was related to less nicotine dependence and drug abuse. That chip on the shoulder might sound like it is small, but it is one of the heaviest things you can carry.  For better health, it makes a lot of sense to say goodbye to those things of the past and say hello to what can be the new you that is found when you practice forgiveness.

Another Way to Deny Health Coverage

Medication BottleMost people who have to take any prescription medication, or need certain imaging tests, that is covered through health insurance are familiar with the procedure of having to get prior authorization (a “PA number”) for the medication to be approved before it can be obtained at the pharmacy, or before the test can be done. Just a few years ago, this requirement was only requested for the most expensive medications or imaging studies. It is certainly understandable in those instances and which should be few in number enough that it is not too time consuming for physician offices to complete. Some companies make the process simpler than others and some make it completely ridiculous.

Because of the present, never-ending increase in the number of medications and procedures for which insurance companies want prior approval for patients, it has become nothing less than an aggravating intrusion into the physician-patient relationship. Insurance companies frequently will communicate to patients that the medication is waiting to get approval by the physician; I have always thought that is what giving a prescription is already. All of this is nothing more than an attempt to deny coverage for patients and then have a way to blame it on the physician. What the physician prescribed is what they approved, it is just not what the insurance company approved; that usually means that it isn’t cheap enough for them; quality is not the primary consideration.

At the beginning of every year, when patients are getting onto new Medicare Advantage health plans or their current plans have formulary changes, there is a barrage of wastefully sent letters wanting changes in medications that the patient is already taking or that are new. There are so many of these letters which come to physicians that many are thrown into the trash without even opening them. There is not enough healthcare staff in clinics to handle all of this mail which does nothing for patient care, but only serves to lower insurance company costs. If all of these changes in medications are saving insurance companies so much money, then it is not obviously making its way back to the patients; insurance rates and medication costs continue to climb.

To give an example, I have a patient just this last week in which it took ten days to get a generic medication approved for her. She has been on this hypertension medication for 2 and ½ years. This patient has to take five medications from different classes to control her blood pressure and she has a very limited income that makes it impossible for her to do much with her life that she would like. She has multiple medical problems and it took a long time to get her blood pressure controlled with the current regimen. A nephrologist has been in agreement with her medication regimen also as we tried to help her get controlled and finally achieved that with continual monitoring by the patient. Earlier this week, she was almost in tears and very anxious that she was going to have a stroke because her insurance company’s drug plan (a Medicare Advantage company) stated that her medication was being prescribed at a level that was not FDA approved, so they would not approve it. This medication was double the usual dosage, but it took that to get her controlled. Two physicians have agreed that this medication is needed, the patient is pleased that it is working, and there are no adverse effects. Despite attempts to get the insurance company to approve this, they kept denying coverage until, once again, I had to take more time to get on the telephone and request to speak with one of their physicians who could hopefully understand this and make an intelligent decision to approve this patient’s medication. She was down to the last day of the medication and could not afford to buy the medication herself, even though it is generic, because medications have been inflated in cost so much. After discussing this for quite a while and asking for a physician to call me, I went home late that evening and never did get a call until the next afternoon. However, the insurance company had sent another fax to the clinic that next morning and had reversed their denial already. I was left wondering why all of that was necessary to achieve what could be so simple.

The practice of medicine and provision of healthcare services must get back to what should be its mission: taking care of the patient. Thankfully, the Mississippi Legislature is in the process of doing something to help physicians and patients with the House already passing HB 301 which would simplify the prior approval process greatly in that there would be a requirement of using the same PA form for every insurance company which can be submitted online, can’t be longer than two pages, and would automatically grant approval if not answered within two days. Thank you to the MS Legislature for putting some common sense back into this process.

How Will You Handle The Coming Suffering?

Every person has at some time questioned why we have suffering and disease.  We all struggle at some point with trying to understand in the inevitable attempt at making sense of what happens to ourselves and others.  It’s an old question that not just physicians ponder when faced with illness, accidents, and death.  One way of trying to gain some meaning in midst of suffering is to consider what our lives be like if we had no suffering at all.  We all long for that.  We all want that.  We work for it. We go to doctors. Insurance policies are in place to try to lessen the damages we face.  Most of us, religious or not, have a concept of what we think of as heaven as a place that is perfect.  As Christians, we think of Revelation 21:4, “And God shall wipe away all tears from their eyes; and there shall be no more death, neither sorrow, nor crying, neither shall there be any more pain: for the former things are passed away.”  In our desire, our longing, for relief from the pain of life, we impatiently want our lives to be like that now.  However, time isn’t spent sometimes in considering what things would be like if we were able to achieve that wish in the present.

What would our lives be like with no suffering?  Since that hasn’t happened to anyone I know, a close comparison would be life experienced by someone for whom all consequences of their actions are allowed to be desirable.  If a child is never allowed to experience any of the results of their decisions and always allowed to do or say whatever they want for fear of them having hurt feelings, there will surely be one spoiled brat.  Therefore, the reasonable among us know that we have to allow for suffering to occur because it is more than just pain; it is molding and shaping us.  How the pain is perceived, in regard to the understanding of the good or evil intentions of the source of it, greatly influences the results of experiencing suffering.  Suffering is guaranteed to occur and it can make us either better, or bitter; the choice is up to us in how we choose to perceive it.

In Romans 5:1-11, we find that Paul wrote that we are to “glory in tribulations, knowing that tribulation produces perseverance; and perseverance, character; and character, hope.”  If we are never allowed to suffer, then we cannot learn to persevere through hardship.  The very nature of persevering produces in us a good character that leads to us having hope.  Look at the lives of those who seem to have everything and want for nothing; many times they do not have the one thing that all of us want – peace.  Those who do not have to suffer lack a hope during this life and also for the afterlife. Too often, we read the tragic stories of early demise of those who seemed to have it all together.  It should make us question what kind of people are going to be the result of a society that thinks it is supposed to remove hardship from everyone’s lives.  The great entitlement society is a clue to this.

I am blessed every time I see certain patients who have such illness, hardship, and suffering in their lives, but possess a peace about them which I do not see in those for whom life has been so easy. They tell me about their struggles and problems while I cannot help but wonder how I would handle the same if it were present in my own life.  It would be prideful to conclude how well I would do.  I don’t know.  What I do know is that I have such admiration for those patients who also hold on to a hope that is outside of them, but also within them. I have noticed that those people who have the best character also have suffered a lot.  So, instead of us looking at the suffering that comes our way with a desire to push it so far away, should we not also understand that it might be a blessing in disguise to produce something in us far greater in value than anything money can buy?

The Broken SNAP

Much debate is occurring regarding governmental spending in the United States for a wide array of programs.  There are many solutions being proffered for reducing the overspending and everything must be examined in the process.  Every program in place has objectives that can be measured to see if the specific program is meeting those objectives while also assessing for other effects of the program that may not have been initially anticipated.  Each of us certainly does that in our own households. We look at what we are spending on a particular area and decide if the purpose of it is being fulfilled while also deciding how that expense is affecting otherwise the household.  Then we make changes depending upon what we find when we assess it.  It is certainly beyond the scope of this article to examine the entire topic, so we will have to focus a little more on one major area of expense.  A major expense in most households is that of buying food.

One can spend a lot of money buying food or it can be less of an expense depending upon what is bought. I remember when I was in college and later, during medical school, I had to make the money I had last for quite a while.  Therefore, I had to budget out what I knew I would have for food expenses and I would stay under a certain monthly amount which wasn’t much.  If I bought a more expensive food item, I couldn’t afford to get other needed items.  I never went hungry, but I couldn’t buy everything I wanted by any means either.  There was not much meat bought except canned tuna and getting anything that had a brand name on it was a luxury. When it’s your own money, you examine things more carefully and buy what is truly needed.  This is a lesson that our federal government does not seem to know; leaders in all parties know how to spend more to appease whom they want to vote for them.  There isn’t much thought regarding what is actually being accomplished or effectively examining the other effects of their spending of other people’s money.  Just as much as I would be careful and analyze what I am spending along with assessing the nutritional value of what is in my own food budget, the government should be doing the same thing. However, they aren’t doing this in the manner that they should. The Supplemental Nutrition Assistance Program (or SNAP; used to be called food stamps) is out of control.  The SNAP has broken.

The SNAP program, as reported by the USDA, has expanded from serving 26 million people in 2007 to the current level of almost 45 million people with expenses increasing, respectively, from $3.6 billion per month to $6.2 billion per month. Obesity rates are continuing to climb while the public is asked to believe that the amount spent on SNAP is justified.  In the last week of time, I have heard two different personal testimonies of witnessing SNAP payments being approved for a cake maker who got over $800 for a wedding cake for one recipient while another person buys large quantities of meat with SNAP money and then that meat is sold for cash from an ice chest on the street.  The state of Mississippi recently reported that there were possibly $2.7 million in fraudulent benefits paid with 1,705 people disqualified during the last budget year due to these discovered improper payments.  In 2000, about 10% of the Mississippi population was on the program while now it is 23% of the population.  The statistics regarding fraudulent payments in Mississippi also reflect the same problem on a national scale.

While there is plenty of evidence of trafficking of EBT cards along with other fraud, there is other waste occurring in this program that is supposed to be helping the poor who are truly deprived of the ability to buy food.  I can remember when it was shameful to even have to get something free from the government during the days of “commodities” that certainly were not what we think of today when that term is used.  People were given staple foods that were truly needed and not allowed to choose such extravagant food items that people who earned the money can hardly afford.  If one needs a lesson on this, just visit your grocery store around the first week of the month and notice how the buggy loads of expensive meats are being purchased.  While there are attempts to educate people with regard to what they should be eating and this makes sense that efforts should be made to help people understand what they should eat, many already know this information and still choose to eat in unhealthy ways.  There should be some changes made in regard to how the money given to people on EBT cards is allowed to be spent so that healthy choices are encouraged in a more direct manner.  An $800 wedding cake on an EBT card – give me a break!  At the rate of inflation for groceries, it won’t be long before greater numbers forget trying to get a break – give me a SNAP card!  It appears that there is no shame in taking from others anymore and, for many, it’s not improving their health, but worsening it.