Allan Block, MD

I don’t write many checks anymore.

When I started my practice in 2000 I wrote a lot. Paychecks for my staff, my rent, insurance, IRA contributions, federal & state withholding, payments on my EMG machine, pretty much everything.

Checks are old. We’ve been using them in some form for roughly 2000 years.

But the online world has changed a lot of that. Now I write maybe 2-3 a month. I could probably do fewer, but haven’t bothered to set those accounts up that way.

I recently was down to my last few checks, so ordered replacements. The minimum order was 600. As I unpacked the box I realized they’re probably the last ones I’ll need, both because checks are gradually passing by and because there are more days behind in my neurology career than ahead.

The checks are a minor thing, but they do make you think. Certainly we’re in the last generation of people who will ever need to use paper checks. Some phrases like “blank check” will likely be with us long after they’re gone (like “dialing a phone”), but the real deal is heading the same way as 8-Track and VHS tapes.

As my 600 checks dwindle down, realistically, so will my career. There is no rewind button on life. I have no desire to leave medicine right now, but the passage of time changes things.

Does that mean I, like my checks, am also getting obsolete?

I hope not. I’d like to think I still have something to offer. I have 30 years of neurology experience behind me, and try to keep up to date on my field. My patients and staff depend on me to bring my best to the office every day.

I hope to stay that way to the end. I’d rather leave voluntarily, still at the top of my game. Even if I end up leaving a few unused checks behind.
 

Dr. Block has a solo neurology practice in Scottsdale, Arizona.

I don’t write many checks anymore.

When I started my practice in 2000 I wrote a lot. Paychecks for my staff, my rent, insurance, IRA contributions, federal & state withholding, payments on my EMG machine, pretty much everything.

Checks are old. We’ve been using them in some form for roughly 2000 years.

But the online world has changed a lot of that. Now I write maybe 2-3 a month. I could probably do fewer, but haven’t bothered to set those accounts up that way.

I recently was down to my last few checks, so ordered replacements. The minimum order was 600. As I unpacked the box I realized they’re probably the last ones I’ll need, both because checks are gradually passing by and because there are more days behind in my neurology career than ahead.

The checks are a minor thing, but they do make you think. Certainly we’re in the last generation of people who will ever need to use paper checks. Some phrases like “blank check” will likely be with us long after they’re gone (like “dialing a phone”), but the real deal is heading the same way as 8-Track and VHS tapes.

As my 600 checks dwindle down, realistically, so will my career. There is no rewind button on life. I have no desire to leave medicine right now, but the passage of time changes things.

Does that mean I, like my checks, am also getting obsolete?

I hope not. I’d like to think I still have something to offer. I have 30 years of neurology experience behind me, and try to keep up to date on my field. My patients and staff depend on me to bring my best to the office every day.

I hope to stay that way to the end. I’d rather leave voluntarily, still at the top of my game. Even if I end up leaving a few unused checks behind.
 

Dr. Block has a solo neurology practice in Scottsdale, Arizona.

I don’t write many checks anymore.

When I started my practice in 2000 I wrote a lot. Paychecks for my staff, my rent, insurance, IRA contributions, federal & state withholding, payments on my EMG machine, pretty much everything.

Checks are old. We’ve been using them in some form for roughly 2000 years.

But the online world has changed a lot of that. Now I write maybe 2-3 a month. I could probably do fewer, but haven’t bothered to set those accounts up that way.

I recently was down to my last few checks, so ordered replacements. The minimum order was 600. As I unpacked the box I realized they’re probably the last ones I’ll need, both because checks are gradually passing by and because there are more days behind in my neurology career than ahead.

The checks are a minor thing, but they do make you think. Certainly we’re in the last generation of people who will ever need to use paper checks. Some phrases like “blank check” will likely be with us long after they’re gone (like “dialing a phone”), but the real deal is heading the same way as 8-Track and VHS tapes.

As my 600 checks dwindle down, realistically, so will my career. There is no rewind button on life. I have no desire to leave medicine right now, but the passage of time changes things.

Does that mean I, like my checks, am also getting obsolete?

I hope not. I’d like to think I still have something to offer. I have 30 years of neurology experience behind me, and try to keep up to date on my field. My patients and staff depend on me to bring my best to the office every day.

I hope to stay that way to the end. I’d rather leave voluntarily, still at the top of my game. Even if I end up leaving a few unused checks behind.
 

Dr. Block has a solo neurology practice in Scottsdale, Arizona.

Phoenix has only a few months each year to use my hot tub, so winter is when I catch up on a lot of my reading. Recently I was reading the November Lancet, which had some interesting statistics about migraine.

• It’s the second leading cause (behind back pain) of years lived with disability.
• There are 10 million people with migraines in the United Kingdom (population roughly 70 million).
• In the last 5 years, migraine use of emergency rooms has increased 14%.
• According to the U.K. National Health Service, over 16,000 ER visits for migraine could be avoided.

These are compelling statistics, and probably (taking into account population differences) similar to numbers here in the United States or Canada.

Like all neurologists, I see my share of migraine.

Like many neurologists, I also get migraines. Not many, maybe 2-3 per month, effectively treated with a triptan. So I have a decent understanding that they aren’t pleasant.

Fortunately, migraine advances have been impressive, with seven new CGRP drugs in the last 3 years, bringing successful treatment closer for many.

But the problem is far from solved, a point that was driven home yesterday.

I awoke early yesterday morning with a migraine, and took an Imitrex. But instead of feeling better in an hour, it kept worsening until I was literally disabled by it. I took some Excedrin Migraine. The last time I had a migraine this bad was in 1998, during my fellowship, and my attending had to drive me home (thanks, Joe).

It was showing no signs of letting up. I thought about going to emergency department. After all, aren’t we trained for that when we hear “worst headache of my life?” but figured it was more likely just a migraine, and didn’t want to bog down my ED colleagues in the midst of another COVID-19 wave.

I took another Imitrex. I found a sample of Ubrelvy that I’d brought home out of curiosity, and took that, too. I think I have an old, nearly empty, bottle of Norco, somewhere, from a 2014 dental surgery, but was too photophobic to go looking for it (if I still have it at all).

I lay down in bed under the ceiling fan, and somehow fell asleep.

When I woke about 90 minutes later it was gone, like a switch had been flipped. Maybe it was all, or just one of, the meds I’d taken. I’ll never know. I could now resume my regularly scheduled program.

The migraine had cost me 7 hours. Like most small business owners, I’m trying to get all the year-end paperwork wrapped up, in addition to reviewing cases, writing up reports, and spending time with my family. So none of that happened that Saturday morning. If I’d had to see patients that morning there’s no way I could have done it.

Fortunately, as I said, that’s only the second time that’s happened to me, and it’s been 25 years since the last one.

But I’m lucky. There are those who have them far more frequently, limiting their ability to work, raise families, spend time with friends. … Have a life.

Migraine is far from a deadly disease. In neurology we treat far worse conditions. But in sheer numbers migraine affects far more people, and (indirectly) an even larger group of coworkers, parents, friends, and children who have to cover unpredictably when the other person is out with one.

For all of them, improved migraine treatment approaches can’t come soon enough.

Phoenix has only a few months each year to use my hot tub, so winter is when I catch up on a lot of my reading. Recently I was reading the November Lancet, which had some interesting statistics about migraine.

• It’s the second leading cause (behind back pain) of years lived with disability.
• There are 10 million people with migraines in the United Kingdom (population roughly 70 million).
• In the last 5 years, migraine use of emergency rooms has increased 14%.
• According to the U.K. National Health Service, over 16,000 ER visits for migraine could be avoided.

These are compelling statistics, and probably (taking into account population differences) similar to numbers here in the United States or Canada.

Like all neurologists, I see my share of migraine.

Like many neurologists, I also get migraines. Not many, maybe 2-3 per month, effectively treated with a triptan. So I have a decent understanding that they aren’t pleasant.

Fortunately, migraine advances have been impressive, with seven new CGRP drugs in the last 3 years, bringing successful treatment closer for many.

But the problem is far from solved, a point that was driven home yesterday.

I awoke early yesterday morning with a migraine, and took an Imitrex. But instead of feeling better in an hour, it kept worsening until I was literally disabled by it. I took some Excedrin Migraine. The last time I had a migraine this bad was in 1998, during my fellowship, and my attending had to drive me home (thanks, Joe).

It was showing no signs of letting up. I thought about going to emergency department. After all, aren’t we trained for that when we hear “worst headache of my life?” but figured it was more likely just a migraine, and didn’t want to bog down my ED colleagues in the midst of another COVID-19 wave.

I took another Imitrex. I found a sample of Ubrelvy that I’d brought home out of curiosity, and took that, too. I think I have an old, nearly empty, bottle of Norco, somewhere, from a 2014 dental surgery, but was too photophobic to go looking for it (if I still have it at all).

I lay down in bed under the ceiling fan, and somehow fell asleep.

When I woke about 90 minutes later it was gone, like a switch had been flipped. Maybe it was all, or just one of, the meds I’d taken. I’ll never know. I could now resume my regularly scheduled program.

The migraine had cost me 7 hours. Like most small business owners, I’m trying to get all the year-end paperwork wrapped up, in addition to reviewing cases, writing up reports, and spending time with my family. So none of that happened that Saturday morning. If I’d had to see patients that morning there’s no way I could have done it.

Fortunately, as I said, that’s only the second time that’s happened to me, and it’s been 25 years since the last one.

But I’m lucky. There are those who have them far more frequently, limiting their ability to work, raise families, spend time with friends. … Have a life.

Migraine is far from a deadly disease. In neurology we treat far worse conditions. But in sheer numbers migraine affects far more people, and (indirectly) an even larger group of coworkers, parents, friends, and children who have to cover unpredictably when the other person is out with one.

For all of them, improved migraine treatment approaches can’t come soon enough.

Phoenix has only a few months each year to use my hot tub, so winter is when I catch up on a lot of my reading. Recently I was reading the November Lancet, which had some interesting statistics about migraine.

• It’s the second leading cause (behind back pain) of years lived with disability.
• There are 10 million people with migraines in the United Kingdom (population roughly 70 million).
• In the last 5 years, migraine use of emergency rooms has increased 14%.
• According to the U.K. National Health Service, over 16,000 ER visits for migraine could be avoided.

These are compelling statistics, and probably (taking into account population differences) similar to numbers here in the United States or Canada.

Like all neurologists, I see my share of migraine.

Like many neurologists, I also get migraines. Not many, maybe 2-3 per month, effectively treated with a triptan. So I have a decent understanding that they aren’t pleasant.

Fortunately, migraine advances have been impressive, with seven new CGRP drugs in the last 3 years, bringing successful treatment closer for many.

But the problem is far from solved, a point that was driven home yesterday.

I awoke early yesterday morning with a migraine, and took an Imitrex. But instead of feeling better in an hour, it kept worsening until I was literally disabled by it. I took some Excedrin Migraine. The last time I had a migraine this bad was in 1998, during my fellowship, and my attending had to drive me home (thanks, Joe).

It was showing no signs of letting up. I thought about going to emergency department. After all, aren’t we trained for that when we hear “worst headache of my life?” but figured it was more likely just a migraine, and didn’t want to bog down my ED colleagues in the midst of another COVID-19 wave.

I took another Imitrex. I found a sample of Ubrelvy that I’d brought home out of curiosity, and took that, too. I think I have an old, nearly empty, bottle of Norco, somewhere, from a 2014 dental surgery, but was too photophobic to go looking for it (if I still have it at all).

I lay down in bed under the ceiling fan, and somehow fell asleep.

When I woke about 90 minutes later it was gone, like a switch had been flipped. Maybe it was all, or just one of, the meds I’d taken. I’ll never know. I could now resume my regularly scheduled program.

The migraine had cost me 7 hours. Like most small business owners, I’m trying to get all the year-end paperwork wrapped up, in addition to reviewing cases, writing up reports, and spending time with my family. So none of that happened that Saturday morning. If I’d had to see patients that morning there’s no way I could have done it.

Fortunately, as I said, that’s only the second time that’s happened to me, and it’s been 25 years since the last one.

But I’m lucky. There are those who have them far more frequently, limiting their ability to work, raise families, spend time with friends. … Have a life.

Migraine is far from a deadly disease. In neurology we treat far worse conditions. But in sheer numbers migraine affects far more people, and (indirectly) an even larger group of coworkers, parents, friends, and children who have to cover unpredictably when the other person is out with one.

For all of them, improved migraine treatment approaches can’t come soon enough.