Needles and Grins

Rights of passage. We all celebrate at least one in our life: The anniversary of our birth, the one day when even the most humble of us secretly relishes celebrity status. We may demure that, "It's no big deal, not to me." But neither was creation, neh? Honestly, who really doesn't enjoy or need birthday recognition?


Other times we extend our natal noteworthiness to a week, or even a month, with multiple celebrations; and sometimes by participating in recurring annual events that coincide with the day or month of our birth. Bureaucratic organizations in particular find our DOB a useful adjunct to our SSN for all sorts of purposes. The Navy, more specifically Navy Medicine, is one such sentinel of annual life cycles.


So, there I was a couple of days ago dutifully completing my annual Physical Health Assessment (PHA) and annual dental exam.


Recently described by a Navy colleague as "the world's oldest doc", I thought I knew what to expect from this preventive-health-model-for-a-national-strategy-focusing-on-prevention-instead-of-costly-disease-care (ref: my blog post of March 22). You get a dental exam and x-rays, answer a bunch of questions about health-related personal behavior, plus a screening of your health record to identify disease-risk factors and to be sure all required immunizations are current. Then you sit down with the healthcare provider for counseling and advice if your answers indicate a need for lifestyle modification. Once completed, you get a stamp on your health record validating that you are good to go, world-wide deployable, fit for full duty for another year.


The process is elegant in its simplicty, has fairly good predictive value, and is much more cost-effective than treating the future preventable disease. We also provide assistance in the form of physical enhancement and smoking cessation programs. We must assume that sailors duly counseled really do follow through with our carefully crafted advice and assistance. Therein lies the rub on any such program. Ultimately the human individual chooses whether or not live a health promoting lifestyle. Sadly, some put a lot more thought and energy into their next automobile or vacation, but such is the human condition.


Having just entered my 65th year on the planet, I approached this year's PHA more seriously than usual. I certainly consider myself healthy...just completed my 6th marathon run less that a month ago and I feel great. But as a physician I am very aware of the specter of occult disease, and I recall friends and colleagues who never made it this far in life. I dare not take my health or relative longevity for granted. Nor do I believe that I am smart or objective enough to be my own physician. So this year I looked forward to my annual assessment and counseling, especially with a medical colleague on this ship whose expertise and judgment I greatly respect.


Well, I got a couple of surprises, but none directly related to my current state of health. The first was the digital dental x-ray process, which was new to me. Not having to bite down on annoyingly sharp little cardboard x-ray widgets was a pleasant change. This process uses a softer cassette, and you can actually smile when asked to so as they shoot the image. I enjoyed looking over the dentist's shoulder as he manipulated the digital images on the screen, magnifying my teeth to King Kong dimensions. And good news, no cavities. My mother says, "It's from growing up in Arizona with all the fluoride in the water." That's one of many Mom tapes that still run in my head.


Not quite so fortunate on the physical assessment. Oh, I am healthy all right. But I had somehow never gotten around to taking my 6th and final anthrax shot, and I was overdue for typhoid immunization and tuberculosis skin test. So the next I knew, a very robust hospital corpsman seized the opportunity to plunge hypodermic needles into both my arms...the day before a port visit. (Did I mention that these shots notoriously make your arms really sore?)


So here I am, two days later about to head into town to join my fellow officers in another Navy rite of passage, a Hail and Farewell where we welcome new officers to the command and say good-bye to one especially popular guy as he transfers to command of a Naval Air Station in Europe. Happens to be the same guy who christened me "world's oldest doc" a few days ago. Such is my admiration for this officer and gentleman that I will ignore the gnawing pain in my arms to raise my glass in a toast to him for "Fair winds and following seas."


And I will offer another toast, silently just to myself, a sincere thanks for my own good health, and a wish for the continued good health of my shipmates, friends, and loved ones.


A sante!