Archive for August, 2013

Ensuring Meaningful Doctor Visits

August 31, 2013

Andrew Siegel, MD  Blog #117

Doctor-patient interactions are simply not what they used to be.  Patients now have access to an infinite amount of information that they were previously not privy to.   The Internet, medical websites and social media offer some potentially excellent sources of medical enlightenment that can easily be tapped into.  Many patients now arrive to the office much better informed than years ago, although the source must always be considered, as not all information is reliable.  In some circles, these Internet-informed patients are referred to as “e-patients”!  At times, too much searching for the source of their signs and symptoms can lead one to be a “cyber-chondriac” a new form of a hypochondriac.

Clearly, time with your doctor is limited and it is important that at the conclusion of your visit your questions have been addressed satisfactorily and you have a good understanding of the advice and guidance delivered. Many physicians now consider their relationship with their patients in terms of a “collaboration,” with both parties actively engaged in the health and welfare of the patient.  It thus becomes of paramount importance that there is direct communication between patient and doctor and doctor and patient.  Therefore, prior your visit it is a very good idea to think about exactly what issues you would like addressed.   Consider creating a list of questions or concerns to focus the conversation and home in and prioritize the problem list.  Even consider writing a short narrative detailing the important details of what you would like communicated.  Please recognize that there may not be sufficient time to discuss all of these, but a written list or narrative allows the patient and physician team to prioritize.

It is imperative that your doctor have access to labs, imaging studies, and any other relevant information, so if you can obtain copies and have them in hand, it will be a real bonus, particularly for second opinions.  If you have had imaging studies, see if you can pick up the disc, as physicians like to view the actual films in addition to reading the report of the radiologist.  It is also crucial that you either know—or preferably have in writing—all medical history including medical problems, medications, surgeries and their dates, allergies, etc., as well as up-to-date insurance information.

It is essential that you leave the office with a clear understanding of what your doctor has advised and recommended for you.  It is a fine idea to take notes, and some doctors—myself included—supplement the verbal information delivered with handouts, brochures, booklets, or educational videos that review the salient take-home points. If the medical issue is a very serious one, such as cancer or a problem that will require surgery, it is a very good idea to have a family member or friend accompany you to act as a second set of ears.  We doctors often use a very complicated language—“medical-speak”—and as much as we try to translate into understandable English, at times we fail to do so.  Additionally, we use some very confusing terminology—with physicians, sometimes “no” does indeed mean “yes.”  For example, when we speak of a test being “negative” we do not mean “bad” or “unfavorable,” but simply that the test was normal. Similarly, when a test is “positive,” it does not imply “good” or “favorable,” but that the test was abnormal—“your biopsy came back positive for prostate cancer.”  How confusing is that?  So, never hesitate to ask your doctor to clarify a statement if you don’t grasp it, or medical jargon if you don’t understand it.

It is crucial that you receive the results of important tests that have been ordered. In my office, we make every effort to call back the results of all laboratory tests if not discussed at the time of an office visit. Never assume that not receiving a call means the test was okay—the assumption should be that if you have not received the results, your physician never saw them…even if he/she has, it is always wise to confirm test results.

Tips to ensure a meaningful interaction with your physician:


·      Have a plan. In advance of the appointment, think about the reason for the visit, write down any questions that you may have, and consider writing a narrative of your issue and concerns–this helps you focus and organize your thoughts and will help you clearly communicate the problems to your doctor and to help prioritize them.  I have had many patient encounters in which the patient was at a total loss as to why they were in the office!

·      Bring a written copy of your pertinent medical records including medical history; surgical history with dates of surgery; medications with doses; and allergies. If there have been studies that will have bearing on the office visit, please have copies of relevant labs, pathology reports, imaging tests, etc., with you at the time of the visit.

·      Consider bringing a family member or a friend if you have a complicated or serious issue or simply want another pair of ears present.

·      Make sure you clearly understand the information and advice you have received from your doctor—do not hesitate to scribble notes and ask questions.

·      Be patient with respect to delays—as much as we diligently try to remain on schedule and often experience anxiety when we are behind schedule, we are often faced with unpredictable emergencies, phone calls from emergency rooms and other physicians, and complicated patients that prevent our schedule from functioning like dinner reservations at a restaurant.  If truth be told—ironically—the integration of electronic medical records has slowed down the function of our offices substantially, because of the time it takes to enter and update data.

·      It is a terrific idea to keep a medical file at home that has your test results including lab reports, imaging, pathology and other tests.  We will be more than happy to give you copies of your reports to contribute to your personal medical database.  This can prove very useful in the future as reference points.

·      Be an educated patient. Sy Syms’ (of the now defunct Syms discount clothing fame) mantra was, “An educated consumer is our best customer.”  I borrow and modify it to be “an educated patient is our best patient.”  By educated, I do not mean having a doctorate in rocket science but simply knowing why you are in the office and having access to the details of your medical history to facilitate a smooth and effective physician-patient interaction. 


Andrew Siegel, M.D.

Author of Promiscuous Eating: Understanding and Ending Our Self-Destructive Relationship with Food:

Available on Amazon in Kindle edition

Author of: Male Pelvic Fitness: Optimizing Sexual and Urinary Health, in press and will be available in e-book and paperback formats in the Autumn 2013.

Blog subscription: A new blog is posted every week.   On the lower right margin you can enter your email address to subscribe to the blog and receive notifications of new posts in your inbox.  Please avail yourself of these educational materials and share them with your friends and family.


What The Heck is Urology?

August 24, 2013

Andrew Siegel, MD  Blog #116

“Urology” (uro—urinary tract and logos—study of) is a medical specialty concerned with the study, diagnosis, and treatment of diseases of the urinary tract in females and of the genitourinary tract in males. The organs under the “domain” of urology include the adrenal glands, kidneys, the ureters (tubes connecting the kidneys to the urinary bladder), the urinary bladder and the urethra (the channel that conducts urine from the bladder to the outside).  The male reproductive organs include the testes (i.e., testicles), epididymis (structures above and behind the testicle where sperm mature and are stored), vas deferens (sperm duct), seminal vesicles (the structure that produces the bulk of semen), prostate gland and, of course, the scrotum and penis.  The reproductive and urinary tracts are closely connected, and disorders of one oftentimes affect the other…thus urologists are referred to as  “genitourinary” specialists. Urology involves both medical and surgical strategies to approach a variety of conditions.

Urology has always been on the cutting edge of surgical advancements (no pun intended) and urologists employ minimally invasive technologies including fiber-optic scopes to be able to view the entire inside aspect of the urinary tract, as well as ultrasound, lasers, laparoscopy and robotics.  There is a great deal of overlap in what urologists do with other medical and surgical disciplines, including nephrology (doctors who specialize in medical diseases of the kidney); oncology (cancer specialists); radiation oncologists (radiation cancer specialists); radiology (imaging); gynecology (female specialists); and endocrinology (hormone specialists).

Urologists are the male counterparts to gynecologists and the go-to physicians when it comes to expertise in male pelvic health.  Urologists, in addition to being physicians, are also surgeons who care for serious and potentially life-threatening illnesses, particularly cancers of the genital and urinary tracts.  In terms of new cancer cases per year in American men, prostate cancer is number one accounting for almost 30% of cases; bladder cancer is number four accounting for 6% of cases; and cancer of the kidney and renal pelvis (the inner part of the kidney that collects the urine) are number six accounting for 5% of cases.  Urologists are also the specialists who treat testicular cancer.  Urologists also treat women with kidney and bladder cancer, although the prevalence of these cancers is much less so than in males. 

Very common reasons for a referral to a urologist are the following: blood in the urine, whether it is visible or picked up on a urinalysis done as part of an annual physical; an elevated PSA (Prostate Specific Antigen) or an accelerated increase of PSA over time; prostate enlargement; irregularities of the prostate on examination; urinary difficulties ranging the gamut from urinary incontinence to the inability to urinate (urinary retention).

Urologists manage a variety of non-cancer issues. Kidney stones, which can be extraordinarily painful, keep us very busy, especially in the hot summer months when dehydration (a major risk factor) is more prevalent. Infections are a large part of our practice and can involve the bladder, kidneys, prostate, or the testicles and epididymis.  Urinary infections is one problem that is much more prevalent in women than in men.  Sexual dysfunction is a very prevalent condition that occupies much of the time of the urologist—under this category are problems of erectile dysfunction, problems of ejaculation, and testosterone issues. Urologists treat not only male infertility, but create male infertility when it is desired by performing voluntary male sterilization (vasectomy).   Urologists are responsible for caring for scrotal issues including testicular pain and swelling.   Many referrals are made to urologists for blood in the semen.

Training to become a urologist involves attending 4 years of medical school after college and 1–2 years of general surgery training followed by 4 years of urology residency. Thereafter, many urologists like myself pursue additional sub-specialty training in the form of a fellowship that can last anywhere from 1–3 years.  Urology board certification can be achieved if one graduates from an accredited residency and passes a written exam and an oral exam and has an appropriate log of cases that are reviewed by the board committee.  One must thereafter maintain board certification by participating in continuing medical education and passing a recertification exam every ten years.  Becoming board certified is the equivalent of a lawyer passing the bar exam.

In addition to obtaining board certification in general urology, there are 2 sub-specialties within the scope of urology in which sub-specialty board certification can be obtained—pediatric urology, which is the practice of urology limited to children and female pelvic medicine and reconstructive surgery (FPMRS), which involves female urinary incontinence, pelvic organ prolapse, and other female uro-gynecological issues.  The FPMRS boards were offered for the very first time in June 2013, and I am pleased to announce that I am now board certified in both general urology and FPMRS.  There are approximately 100 or so urologists in the entire country who are board certified in the urology subspecialty of FPMRS.

In terms of the demographics of urology, although urology is largely a male specialty, women have been entering the urological workforce with increasing frequency.  This is because female students now comprise approximately 50% of United States medical school population. There are 10,000 practicing urologists in the USA, of which about 500 are women. Urologists have a median age of 53, so we are not a particularly young specialty. The aging population will demand more urological health services and the Affordable Care Act will result in the dramatic expansion of the number of American citizens with health insurance. These factors combined with the aging of the urological workforce and the contraction due to retirement, all in the face of growing demands, does not augur well for a balance of supply and demand in the forthcoming years.  Hopefully there will be enough of us to provide urological care to those in the population that need it.

Andrew Siegel, M.D.

Author of Promiscuous Eating: Understanding and Ending Our Self-Destructive Relationship with Food:

Available on Amazon in Kindle edition

Author of: Male Pelvic Fitness: Optimizing Sexual and Urinary Health, in press and available in e-book and paperback formats in the Autumn 2013.

Blog subscription: A new blog is posted every week.   On the lower right margin you can enter your email address to subscribe to the blog and receive notifications of new posts in your inbox.  Please avail yourself of these educational materials and share them with your friends and family.

Tainted By Testosterone: The Ultimate Double-Edged Sword

August 10, 2013

Andrew Siegel, MD  Blog #115

Many brilliant men have experienced their demise and downfall that can be explained in part— perhaps a large part—by a potent hormone known as testosterone, or more commonly as “T.” Bill Clinton, Elliott Spitzer, Anthony Weiner, John Edwards, Mark Sanford, Arnold Schwarzenegger and San Diego Mayor Bob Filner are all members of the “tainted by testosterone (TBT) club,” who have sustained career derailments partially attributed to the powerful effects of this chemical produced by the testicles and adrenal glands.  Aside from these well-known political celebrities, many a lesser-known man—just your average Joe—has similarly succumbed to the influence of T and joined the TBT club.

The nickname “T” has become very much in vogue these days. Many of my patients come into the office specifically asking for me to check their T levels—thank you, America Pharma.  The pharmaceutical industry is largely responsible for increasing grass-roots awareness of testosterone issues via direct-to-consumer advertising and promotion of testosterone replacement products. Once a subject that was primarily the domain of urologists and endocrinologists, T has gone mainstream.

What exactly is this powerful chemical that can have such a profound influence on a man’s behavior?  Many of us who enjoy the company of canine friends can attest to the dramatic change in behavior of our male pets after they are “fixed” by surgical castration. Man’s best friends become less aggressive, more docile, less alpha male, and less likely to hump your guest’s leg.  The term “fix” seem to imply that something was broken.  Extrapolate to human beings and one can understand how, when our brains are bathed in T, our thoughts, behaviors, and actions are influenced and modulated.

T—manufactured primarily in the testicles although a small percentage is made by the adrenal glands—is an all-important male sex hormone that goes way beyond male sexuality.  T is regarded as a key element in driving and maintaining men’s health. Current evidence suggests that a man’s testosterone level might serve as a very good indicator and marker of general health.  Aside from contributing to libido, masculinity and sexual function, T is responsible for all of the physical changes that occur at the time of puberty, including pubic, axillary and facial hair, deepening voice, prominent Adam’s apple and increased bone and muscle mass.  Additionally, T contributes to mood, bone and muscle strength, red blood cell count, energy, and general mojo.

T is nothing short of being a drug with profound psychopharmacological effects. One can appreciate the potency of this powerful chemical simply by observing the physical, emotional, and libidinal changes that result in the transition from “little boy” pre-pubertal status to “big man” post-pubertal status. Not in any way to diminish the role of environmental factors that most certainly play a role, T is the difference between the little boy in the backyard playing with the toy soldier and a water pistol and the little girl on the porch playing with her dolls and jacks.  T is rocket fuel that can make a man all “piss and vinegar.”

T is most certainly a double-edged sword—on the one hand, it is essential for male health and masculinity, but at the same time it can drive our libido to the danger zone in which temptation and opportunity conspire, with potentially perilous results in terms of relationships, careers, lives, etc.  By no means am I implying that this hormone is solely responsible for man’s impulsiveness, improprieties and indiscretions, but it unquestionably plays a significant role.  Assuredly, “It wasn’t me, it was my T” would be an unsatisfactory justification of the behaviors of Clinton, Spitzer, Weiner, Edwards, Sanford, Schwarzenegger and Filner.  However, the role of T cannot be discounted and helps explain the biochemical basis of male behaviors.  If we treated the men of our species similarly to the way in which we treated our male canine pets by “fixing” them (I am not in any way suggesting this), then we most probably would not bear witness to the kind of career-slamming, self-destructive and life-disruptive indiscretions that have been such common occurrences.

Having a low T is clearly not a good thing.  We know this from observing two populations of men—those who have suffered the consequences of low T that has developed coincident with the aging process and those who are put on medications that purposefully lower T, usually for the management of prostate cancer. Most men will have an approximately 1% decline of T each year after age 30; however, this will not always be symptomatic.  40% of American men aged 45 or older have low or low range T.  Low T is associated with metabolic syndrome and diabetes, bone mineral loss, and altered sexual function.  Specifically, symptoms of low T may include one or more of the following:  fatigue; irritability; depression; decreased libido; erectile dysfunction; impaired orgasmic function; decreased energy and sense of well-being; loss of muscle and bone mass; increased body fat; abnormal lipid profiles; and more. Essentially, low T accelerates the aging process.

So, low T is bad and normal T can influence men to behave badly. Is it possible to find a balance between healthy masculinity and unhealthy philandering and other inappropriate male sexual behaviors?  I sure hope so.  For the record, I don’t really care what politicians do in their free time as long as they do their jobs well. Clearly, they face tremendous stresses and pressures and need outlets for release.  However, it certainly would be nice if they didn’t make such a public spectacle and so embarrass themselves and their families. One has to consider that the very potent chemical T plays a vital role in determining the powerful alpha-male personality that is so fundamental to political ambition and ascent. Unfortunately, it is the very same T that contributes to influencing men to behave badly and stupidly, ending up in sabotaging political intentions and, more importantly, causing their lives to spiral down into a freefall. As borne out by the activities and affairs of many politicians in power, T can be thought of as “fertilizer” for the penis and the very brain that governs and guides that penis.

For some men, T engenders a situation akin to walking around with a loaded shotgun that begs to be unloaded, and the longer it’s been since the weapon has been fired, the greater the need to unload.  T has undoubtedly played a major role and influence in terms of male aggressiveness, violence, homicides, destruction, power struggles, wars, and death that run rampant in our civilization.  Our male gender has been both blessed and cursed by this powerful chemical that is one of the drugs within our internal pharmacy.  The challenge is to use this drug responsibly.

Who Knew?  Many women claim that men think with their “little brains.” All joking aside, there is genuine scientific merit for this insofar as testosterone is a hormone that has many biochemical functions and effects.  Men’s brains are literally bathed in this hormone that can profoundly influence emotions, behavior and thoughts. As a Yiddish proverb from Phillip Roth’s ‘Portnoy’s Complaint’ stated: “Ven der putz shteht, ligt der sechel in drerd,” translated as “when the prick stands up, the brains get buried in the ground.”

Who Knew? The comedian Robin Williams famously said: “God gave every man a brain and a penis, but only enough blood to make one work at a time.”

Who Knew? Too many of us use our penises as our compasses, navigational instruments that give us “direction.”

Who Knew? The athletic “cup” is the device that provides protection to the male genitals for those participating in sports like baseball, hockey, soccer and boxing. The cup was devised years before the first protective helmet for one’s head was used.  This tells you where men’s priorities lie—big head/little head!


Andrew Siegel, M.D.

Author of Promiscuous Eating: Understanding and Ending Our Self-Destructive Relationship with Food:

Available on Amazon in paperback or Kindle edition

The Who Knew?  quips are from my forthcoming book, Male Pelvic Fitness: Optimizing Sexual and Urinary Health (in press).

Blog subscription: A new blog is posted every week.   On the lower right margin you can enter your email address to subscribe to the blog and receive notifications of new posts in your inbox.  Please avail yourself of these educational materials and share them with your friends and family.

Time Ticking

August 3, 2013

Andrew Siegel, MD   Blog #114


The following article appeared in the August 1 New York Times and was written by Steven Petrow. I found it to be a very sobering analysis of a subject that we just don’t like to think or talk about, and it very much reminded me of a post I did a few months ago, which is re-posted at the conclusion of the article.


“With every new silver hair sprouting from my scalp, I can’t help but think of the shortening arc ahead of me. Now in my mid-50s, for the first time I’m no longer looking up, over and beyond. Rather, my trajectory points downward at the approaching horizon. In this frame of mind, I recently found myself at, the “Internet’s friendly” — if not scientific — “reminder that life is slipping away … second by second.” After I completed the short questionnaire, the Death Clock’s algorithm quickly did the math, concluding: “Your personal day of death is Wednesday, April 23, 2031.”

That’s a scant 18 years — although the clock gave it to me “in seconds left to live.” At the time, it was 563,037,386 … and counting down.

Old enough not to believe everything I read on the Web, I queried my doctor about my expected longevity. He quickly e-mailed back: “All things being equal, I believe your estimated survival time would be around 72 to 75. Good luck.”

Good luck? I spent a few moments processing the possible meanings behind “good luck” (none of them particularly appealing), realizing my good doctor had pretty much corroborated the Death Clock’s calculation, then sat there feeling sorry for myself, imagining the hourglass emptying. Then, not allowing myself to wallow one grain of sand longer, I decided to quit my day job.

Yes, just like that. Call me crazy. I worked as an editor and, ironically, my soon-to-be-former boss had once given me a copy of Malcolm Gladwell’s “Blink: The Power of Thinking Without Thinking,” suggesting I needed to act more on impulse than rationality. I had previously underlined this particular section: “Decisions made very quickly can be every bit as good as decisions made cautiously and deliberately.”

I’d long been toying with — even planning for — the day I’d quit. But so many fears had stood in my way, starting with the most basic: dollars and cents. Yes, my partner and I had downsized. Yes, I’d been squirreling away a rainy-day fund. And yes — and most significantly — I’d been talking regularly with my therapist not just about quitting, but about how to live a truly meaningful life. I knew it wasn’t sleeping my way through the workdays to get to the weekend.

Now a new fear – the ticktock of the clock — squashed the pecuniary one, and the decision to leave my job seemed like a Gladwell no-brainer.

Anyway, my plan wasn’t to spend the rest of my life traveling the world. First of all, that rainy-day fund isn’t that big. And as short as 18 years sounds, that’s a heck of a lot of days and weeks (and yes, seconds) not to fritter away. Rather, my plan was to do what I’d been doing in bits and pieces, in between jobs, on vacations, before the work day and after hours: Be a full-time writer.

Fortunately, I had some role models in making this leap. My friend Peter, 53, a documentarian, had left his full-time job 18 months earlier to take what he then called a sabbatical to write a play. He explained to me: “I realized it was a myth to think there would be a time when I don’t have any financial worries. If not now, when?” He then added that his 52-year-old best friend who died of a malignant brain tumor “was a very real accelerator of my decision.”

Similarly, my friend Tom, 56, told me over coffee he’d come to the realization, “I only have so many years left.” A photographer and writer, he’d recently stepped down from a university directorship after watching two of his closest friends die, “guys that I thought were bulletproof,” he explained. “I want to quit talking about doing my own work – and do my own work.”

The week after getting my doctor’s “good luck” e-mail, I gave notice. I told a good story but what I didn’t say was this: “I’ve got only one life to live, and if I don’t do it now, when?”

I couldn’t sleep the next few nights, the loud echoes of my naysayers circling through my head. But over the weeks that followed, things began to shift. I started to get new assignments and finished up a book proposal. I’d get up at 5 a.m. as excited as a kid on Christmas morning. I felt a new sense of ownership, joy and meaning to my days. This wasn’t my work, it was my life. And I didn’t just like it – I loved it.

Of course, I know I won’t spend the rest of my days in this state of euphoria. I will struggle with blank pages and intermittent paychecks. But I will appreciate each day more. I understand now what my friend Tom was telling me when he sent me a short passage from Wendell Berry’s novel “Jayber Crow,” in which the namesake main character reflects on the passage of time. “Back at the beginning, as I see now, my life was all time and almost no memory … And now, nearing the end, I see that my life is almost entirely memory and very little time.”

I know too well the feeling that my life is now more memory than future. As I finish these pages, I see that my clock is down two million seconds from when I started. Call me crazy, but I have to say I love the ticktock of the Death Clock. Without it, I might not be living.”



I am now just a few short years away from 60 (how is that possible?), inciting me to wax philosophical about the aging process.  The numbers are concrete and I view and interpret them through a surreal prism of disbelief and astonishment, still appearing reasonably young and internally feeling no different than 20 or 25 or 30. Factually, the average life expectancy for a male in the USA is 75.5 years.  So the truth of the matter is that if I am fortunate enough to achieve average longevity, I have already lived 75% of my life. And generally speaking, the last 25% of one’s life are not the best years in terms of one’s health, as I can attest to as a physician.


Somehow and some way, humans are imbued with a powerful mechanism of denial that allows us to isolate realities such as these and store them on some imaginary shelf, bottled in some imaginary can to be sequestered and quarantined and not to be contended with.  If we did not have this ability, the psychic pain would be unbearable and thanks to this artifice, we manage to endure emotional burdens. This allows me to proceed under the delusion that I am still “young” and have my whole life in front of me and I remain hopefully optimistic about what the future will bring, and my optimism is self-fulfilling.


I completed my fellowship at UCLA and continue to receive mailings and updates from this superb medical institution.  I just received their publication “Vital Signs,” which has a section for my demographic advertising their “Fifty Plus” program, which offers educational lectures, a walking program, information on community and health resources, membership amenities, a free community flu shot clinic, and special events. In the Spring 2013 edition, the following classes were offered: Senior

Scholars; Memory Training Course; Brain Boot Camp; Vision Problems in Older Adults; Health Maintenance and Disease Prevention; Tai Chi Workshop; Introduction to Dementia; Senior Health Fair; Vaginal and Bladder Mesh Surgery; and Dizziness. Oy Veh…woe is me!


The aging process is insidious. The years creep by, seemingly slowly at first; then, ever so gradually, the wheel of time starts to crank faster and faster with greater and greater momentum, until the weeks and months roll past at a dizzying and frightening warp speed. Before you know it, you are at the summit of the mountain, looking down at the back face or, for you golfers out there, you’re on the back nine.


The older one gets, the faster one’s perception of the passage of time. When I was a child, a single summer seemed to represent an eternity; now, in midlife, the summers blur by at a rate that challenges my sanity. Family events that are initially scheduled on the calendar for a few years from now seem to approach at an uncomfortably rapid pace and, suddenly, are here. Part of this may be explained on a strictly mathematical basis—for a five-year-old, one year represents 20% of his or her life, whereas for a 50-year-old, it represents a mere 2%. Another factor in the perception of time racing faster and faster is our pursuit of a career—being productive and busy does not necessarily lend itself to the awareness of time: time consciousness, if you will. Many of us are ever increasingly focused on our day-to-day activities, too caught up in maintaining our routines to take notice of the hours, weeks, and years speeding by.


The lightness of being is an additional factor contributing to the perception of the rapid passage of time—we float around the planet consumed by a variety of roles that we play, always in a hurry, constantly on the move, existing without giving a great deal of thought to actual existence—as a result, existence seems to lose its substance, weight, meaning, and time framework. We are so consumed by our numerous mundane daily destinations, working, traveling, living in our oftentimes insular circles, that we are remiss in attending to the real journey, the true process, life in its entirety. It is a Zen precept that life is to be found in the present moment, and not the future. Lack of focus on the here and now with too much attention to the next moment can be a factor in the perception of time passing at warp speed.


The bottom line is that the future is approaching in a fast and furious fashion and most of us hopefully desire to maximize our time—irrefutably one of our most precious commodities—that we spend occupying space on our planet. And we really do have precious little time here—to paraphrase Hart Crane: “Our earthly transit is a brief wink between eternity and eternity.” To quote Ben Stein, “Time is overwhelming, omnipotent, and ubiquitous in its power…it may never be conquered or defeated.”


As my former golf instructor-cum-philosopher Hank related to me, every opportunity we have to swing a golf club at a ball is a unique moment in space and time—a different day, a different course, a different ball, a different lie, a different mood, a different weather forecast—a moment that will happen once and only once and then will be gone forever. So, since you have one and only one chance at making the most of this unique slice (pardon the pun) of eternity, why not give it your all

and make it count to the best of your abilities. This concept is a useful metaphor when extended to life in general.


 So what is one to do in the face of this seemingly harsh reality? The answer is to appreciate every moment, put your best effort into every endeavor, and relish the journey because the inevitable destination for ALL of us is exactly the same. This is essentially an expansion of Tony Horton’s “BRING IT” concept (regarding exercise) to life overall.


“We see life through a screen of thoughts and concepts, and we mistake those for reality.  We get so caught up in this endless thought-stream that reality flies by unnoticed.  We spend our time engrossed in activity, caught up in an eternal pursuit of pleasure and gratification and eternal flight from pain and unpleasantness.  We spend all of our energies trying to make ourselves feel better, trying to bury our fears, endlessly seeking security.”

Bhante Henepola Gunaratana


“Life is a fatal adventure. It can only have one end.

So why not make it as far ranging and free as possible.”

Alexander Eliot (author/critic)


“We are living on borrowed time.”

Father Americo Salvi, my patient

“Do stuff. Be clenched, curious.  Not waiting for inspiration’s shove or society’s kiss on your forehead.  Pay attention.  It’s all about paying attention.  Attention is vitality.  It connects you with others.  It makes you eager.  Stay eager.”

Susan Sontag

“Don’t betray time with false urgencies.” 

Jack Kerouac

“For of all sad words of tongue or pen, the saddest are these—it might have been.”

John Whittier

“The miracle is not to walk on water.  The miracle is to walk on the green earth, dwelling deeply in the present moment and feeling truly alive.”

Thich Nhat Hanh

“Life moves pretty fast.  You don’t stop and look around once in a while,

you could miss it.”

Ferris Bueller

“Learn as if you were to live forever. Live as if you were to die tomorrow.”



“….Time is passing faster and faster every day.  Day to day I have to make all sorts of choices about what is good and important and fun, and then I have to live with the forfeiture of all the other options those choices foreclose.  And I’m starting to see how as time gains momentum my choices will narrow and their foreclosures multiply exponentially until I arrive at some point on some branch of all life’s sumptuous branching complexity at which I am finally locked in and stuck on one path and time speeds me through stages of stasis and atrophy and decay until I go down for the third time, all struggle for naught, drowned by time.  It is dreadful.  But since it’s my own choices that’ll lock me in, it seems unavoidable—if I want to be any kind of grownup, I have to make choices and regret foreclosures and try to live with them.”
David Foster Wallace

“The first half of life is orderly, a miracle of detailed harmonious unfolding” beginning with the embryo.  What comes after our reproductive years is “more like the random crumpling of what had been neatly folded origami, or the erosion of stone.  The withering of the roses in the bowl is as drunken and disorderly as their blossoming was regular and precise.”

Jonathon Weiner


“What surprises me most about humanity is man. Because he sacrifices his health in order to make money. Then he sacrifices money to recuperate his health. And then he is so anxious about the future that he does not enjoy the present; the result being that he does not live in the present or the future; he lives as if he is never going to die, and then dies having never really lived.”

The Dalai Lama, when asked what surprised him most about humanity.

“Maybe it’s not metaphysics. Maybe it’s existential. I’m talking of the individual US citizen’s deep fear, the same basic fear that you and I have and that everybody has except nobody ever talks about except existentialists in convoluted French prose. Or Pascal. Our smallness, our insignificance and mortality, yours and mine, the thing that we all spend all our time not thinking about directly, that we are tiny and at the mercy of large forces and that time is always and that every day we’ve lost one more day that will never come back and our childhoods are over and our adolescence and the vigor of youth and soon our adulthood, that everything we see around us all the time is decaying and passing, it’s all passing away, and so are we, so am I, and given how fast the first forty two years have shot by it’s not going to be long before I too pass away, whoever imagined that there was a more truthful way to put it than “die,’ “pass away”, the very sound of it makes me feel the way I feel at dusk on a wintry Sunday—’

And not only that, but everybody who knows me or even knows I exist will die, and then everybody who knows those people, and might even conceivably have even heard of me will die, and so on, and the gravestones and monuments we spend money to have put in to make it sure we are remembered, these’ll last what—a hundred years? two hundred? – and they’ll crumble, and the grass and insects my decomposition will go to feed will die, and their offspring, or if I am cremated the trees that are nourished by my windblown ash will die or get cut down and decay, and my urn will decay, and before maybe three or four generations it will be like I never existed, not only will I have passed away but it will be like I was never here.

That everything is on fire, slow fire, and we’re all less than a million breaths away from an oblivion more total than we can even bring ourselves to even try to imagine, in fact probably that’s why the manic US obsession with production, produce, produce, impact the world, contribute, shape things, to help distract us from how little and totally insignificant and temporary we are.”

David Foster Wallace, from “The Pale King”

“Life is tough.  It takes a lot of your time, all your weekends, and what do you get at the end of it?  Death, a great reward.  I think that the life cycle is all backwards.  You should die first, get it out of the way.  Then you live twenty years in an old-age home.  You are kicked out when you are too young.  You get a gold watch, you go to work.  You work forty years until you’re young enough to enjoy your retirement.  You go to college, you party until you’re ready for high school.  You become a little kid, you play, you have no responsibilities, you become a little boy or girl, you go back into the womb,  you spend your last nine months floating.

 And you finish off as a gleam in someone’s eye.”

Jack Kornfeld
“Reverse Living”

Bottom Line: The reality is that the “end of the line” comes far too quickly. So, enjoy and protect in every way possible what you have today. Carpe Diem!


Andrew Siegel, M.D.

Author of Promiscuous Eating: Understanding and Ending Our Self-Destructive Relationship with Food:

Available on Amazon in paperback or Kindle edition

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