Clinical Skills (1), (2) And (3): Measuring Body Temperature, Blood Pressure: Fill & Download for Free

I was very arrogant about my health until recently.At 59, I had never been sick, I’m very fit, and look quite a bit younger than my age. My father is 90 and lives the same lifestyle now as 30 years ago, living in his own home in the Texas Hill Country.I’m a physician and have almost daily occasions to offer health advice, and I have a healthy, thriving practice.I am a fan of Nortin Hadler, MD, who writes extensively on intelligent, informed healthcare, offering facts and studies a healthcare consumer should be aware of before giving or refusing consent to commonly recommended medical screenings and treatments for conditions such as high cholesterol, blood pressure, or glucose; colonoscopy; mammography; PSA screening and more. Lest you think he’s fringy, he’s Professor Emeritus of Medicine at UNC School of Medicine at Chapel Hill, and Harvard and Yale educated. You can see his brilliance and relevance in this PBS interview.For 20 years or so, I’ve seen a wonderful internist yearly, but, would abdicate responsibility for this behavior, saying. “The only reason I have a doctor is I have a wife.”Thank goodness I have a wife.September, the year before last, 2018, I had previsit labs for my annual visit with Rick Earnest, who was Chief Resident during his internal medicine residency at Emory, he’s top notch.My white count was low. Rick’s nurse called and said he wanted another CBC and a folate. White count low; folate normal.Then, I saw Rick in his office and we chatted dispassionately about the neutropenia… WBC was around 2, with 4–12 being normal.He told me he had talked to a local heme/onc that morning and then, he shrugged his shoulders and said, “Looks like you need to see a hematologist…” I agreed.About a month later, I had extensive labs at the local oncology center; met the delightful hematologist, Kavita Nirmal, who recommended a bone marrow biopsy.I knew this was coming and, once again, being very healthy and having no signs or symptoms, I thought serial CBC’s would do.However, after my consult with Kavita, I had no urge to refuse the bone marrow biopsy, and it was done that day.Things moved quickly from there.The next day, Kavita called and said I needed to see a specialist at Baylor. Five minutes later, she called back and said, “You could also go to MD Anderson.”Baylor is two hours, MD Anderson is four.Initially, I balked at accepting an MD Anderson referral, as this meant, in my mind, saying, “This is serious.”Over the next 24–48 hours, I had the strong intuition I should go to MD Anderson.I responded to Kavita’s phone call about my treatment choice in a way I found funny/odd… I said, “I owe it to my family to go to MD Anderson.” I thought, “Wow, Dude, you can’t even take responsibility for your choice to go to MD Anderson.” (It wasn’t a big deal… but, interesting.)My records and actual marrow specimen were Fedexed to MDA; I went there for labs and another bone marrow biopsy; and met with a national leader in leukemia, Naveen Pemmaraju.All this occurred in a very compressed period of time and in a context of general surreality, punctuated by briefs periods of extreme surreality.I had accepted there was something wrong with my bone marrow. I had actually been aware I was neutropenic as far back as August 2016; but, again, arrogant invincibility had me ignore it.In Longview, I was told, based on microscopic evaluation of my marrow, and an estimated 13% blast count, I had myelodysplastic syndrome (MDS), something I was familiar with when a fellow staff psychiatrist told me he had it. It was a significant health scare for him, but that was in the 90’s and he and I were in touch for at least 10 years after that, and to my knowledge, he’s still fine today… (we both moved on from that mental health center years ago).Then, as I was going through the process leading up to seeing Dr. Pemmaraju, a nurse who was checking me in and reviewing my chart, was reading out loud to herself… as I listened, it was all quite routine to me as a health care provider, until the letters “AML” came out of her mouth.They weren’t intended for me; she was just one of those people who reads out loud when they read. Perhaps she thought I knew. Perhaps she didn’t know she was reading out loud. It is a cancer center…I can’t think of an adequate adjective to put in front of “stunned” and “frozen” to adequately express that instant as the biggest WTF! of my life rang out in my mind…“It’s leukemia?! I have leukemia?!!!” My mind was reeling with that shock…It was quite a mental shift, in an instant, unsuspecting, unprepared, from MDS to AML.I suppose it was helpful to have the time to be past that initial reaction later, as I sat in one of Dr. Pemmaraju’s exam rooms, waiting to see him. He burst into the room almost as enthusiastically as Kramer on Seinfeld. He was young, energetic, positive and extremely enthusiastic.There I was, sitting face to face with one of the finest allopathic physicians… a hematologist/oncologist who only treats two types of leukemia and MDS.It was a briefly challenging/confronting situation on a philosophical level.You see, I’ve been writing, Power Without Pills: A Curious Psychiatrist’s Guide to Healing and Growth in the Modern World since Googling John Sarno, MD in February 2006. And, I have talked some trash about modern medicine. Not irresponsibly or inappropriately… but, trash talking nonetheless.I was challenged with substantial, in-my-face cognitive dissonance.I resolved it for myself quickly.I had been throwing the baby out with the bath water.I had been all “mindbody medicine is where it’s at!” and, then and there, I realized I had been going to an extreme.I once heard a man say, “You’re just as half-assed no matter which cheek you got.”So, I decided, “Alright... I like this guy... I trust this guy... I’m going to roll with this, and I’ll handle the mindbody part... and he’ll handle the traditional medicine part…”Both cheeks were suddenly firmly in place.He told me they have a clinical trial, using the CLIA protocol, where they’re getting upwards of 90% complete remission rates in frontline AML.All three drugs are FDA-approved for AML, but no one is using all three together. “We are gonna rock this thing! We are going to crush it together!”, he said, beaming.He told me I’d need some preliminary tests, like an echocardiogram, to qualify for the study... a formality.Then, I would be admitted, given five days of chemo, be in isolation, and have a total of around 28 days inpatient before being discharged to outpatient treatment where I would receive five consolidation rounds of the same three chemotherapy drugs every 28 days.He said I’d be in complete remission by Day 28.That conversation was on the Friday before Thanksgiving. He told me to go home and spend time with family... my wife was there in that initial consult and throughout, but I hadn’t seen my father in Austin in a while... it was a wonderful, deeply meaningful break/visit with close family before I went inpatient… ostensibly 28 days, in isolation.On the eve of Thanksgiving Day, I was admitted to the Leukemia Specialty Care Unit at MDA, at around 7 pm, and began chemotherapy that night.How I’ll be bathing in isolation for the next 3–4 weeks…My wife and father-in-law visit me in the square bubble…This woke me up in the middle of the night, tickling my nose…Going…Gone. My hair didn’t survive.It went exactly as he said; except I had a Day 21 bone marrow biopsy in the hospital. The next day, the attending on the service strode briskly into my room, smiling, and said, “Go home. You don’t need to be here any more.”My blast count had gone from 30% to 4%, complete remission, in 21 days.I said, “Uh… I’m not ready.” (My wife was four hours away and expecting me to be discharged in about a week).I went home the next day, six days early, for good biological behavior.I was in complete remission.There was suspense though. I was told through some magic called flow cytometry, they could give a measure of prognostication, MRD, Measurable Residual Disease. With MRD, they could find traces of leukemia, the presence of abnormal blasts, “down to levels of 1:10,000 to 1:1,000,000 white blood cells (WBCs), compared with 1:20 in morphology-based assessments.”[1]A few nervous days later, at my first outpatient follow up, I was given the news, “You are MRD negative.”A Senior Coordinator of Clinical Studies, Department of Leukemia, MD Anderson Cancer Center, Rabiul Islam, who’s worked there since 2003, gave me that wonderful news, and he added, “I have never seen an MRD negative patient at Day 21.”As I have said, I highly value and practice mindbody medicine; parts of that are a positive mental attitude and faith in the healing propensity of the body and the intelligence of life.And my positivity and faith had been rewarded at every turn (even developing leukemia, which I would not have consciously asked for); but it was never the kind of faith and positivity that produced a reaction to, “You are MRD negative,” of, “Well, of course, I’m MRD negative.”I cried when he told me and it brings tears to my eyes now as I write this. I am deeply grateful.And, along those lines, I have taught mindbody medicine concepts for over 20 years and was pleased to find nothing changed with being diagnosed with an illness that has a 25% five-year survival rate. I found, not surprisingly, I walked the talk. Yet, you don’t know how solidly your ship is moored until there’s a storm.As interesting foreshadowing, for years, as one approach to mindbody medicine, I would discuss the hypothetical situation in which someone was diagnosed with a type of cancer that had their physician say, “The 5-year survival rate is 5%.” I would then say, “I wouldn’t say, ‘Oh, no! Those are terrible odds!’ I would say, ‘What did the 5% do?’’’ (My apologies for the complex, and possibly incorrect sentence structure.)I have had many profound blessings in the powerful life lesson leukemia brought to me.To address the question:The leukemia was caught on a yearly routine blood test before I was symptomatic.I am young and healthy, with no comorbid illnesses, and I really stood out on the Leukemia Specialty Care Unit because of my youth, fitness, and lack of comorbid illness.I got the best cancer treatment in the world, I assert.I’ve had an excellent attitude throughout.I never fought the leukemia. I was never inclined to. At the local cancer center, the narrative was everywhere about fighting cancer; even the wifi password had that rhetoric… yet, I could not abide by that narrative.I’m not suggesting that people not adopt that narrative; it’s fine with me if they do; it’s just not for me. I’m not going to start a “Fight Fighting Cancer!” campaign.I do want people to know there’s more than one narrative to adopt in the face of cancer. Pick according to your gut.I’ve said thousands of times: “What you resist persists.” I would not fight. I would listen.I viewed the leukemia as a messenger, and my job was/is to get the message.I have enjoyed Louise Hay’s work, and was aware of the fact she gave meaning to particular illnesses.I thought, “Leukemia is a childhood disease…” Hmmmmmmm…I had started guided journaling at What is Self Authoring? many months earlier, and had started with the Past module (there are also two for the present and one for the future… starting with the past made the most sense to me…) but, I quickly fell into procrastination…One obvious message was, “I wouldn’t do that if I were you…”, meaning, I got one message as, “Don’t keep putting off deep work.”Now, acute myeloid leukemia is relatively rare with about 20,000 newly diagnosed cases a year. That’s an incidence of 0.006%. It’s rare.But, things would likely be much darker (which sounds weird to write, because I can’t say they’re dark (though I can admit if one looks at the five year survival rate for AML, one would be inclined to say they’re dark… but, that’s a statistic, and part of good mindbody medicine is not being negatively influenced by stats…)) if I hadn’t been getting yearly routine labs.TLDR:Get yearly routine labs like a CBC and complete metabolic panel.The risk/benefit ratio argues for it.Think of it as insurance… you definitely want to have it, even though you don’t want to use it.Extra credit edit:So as to exclude as few readers as possible, I am adding an important point…I have used the word, “blessing” more than once, and said that there is meaning in this life challenge/lesson, thereby asserting/strongly implying it’s not random; we don’t live in a strictly mechanical Universe, in which we humans are machines that break and consequently go to doctors that intervene on our behalf and restore us to health.I was ultimately convinced of that mechanistic worldview until the age of 23. I no longer believe in or inhabit that worldview… but no matter…I’m working on a reply to the gentleman’s comment in which it’s asked what I think caused the leukemia.My reply involves logic I learned from my mother, an adept at logic. She changed her worldview late in life with logic.She told me one day, she had done a thought experiment in which she made a matrix of cells… the particulars will be in the reply when I post it.It is the particular thought exercise that’s relevant here:Let’s say you can’t abide by the notion of an actual blessing, or the idea there’s meaning to be mined in a disease, especially a life-threatening one like leukemia, you can still potentially get the value of that system/belief through this exercise:Let’s construct a matrix of four cells: 2 rows, 2 columns…I’m blessed really/I’m not actually blessedI believe I’m blessed/I reject the possibilityThen stand in each cell and look out at the world as if those conditions are so… what do you see? Is that possibility empowering?You see, it isn’t the truth that I was blessed and it isn’t the truth there is meaning, not randomness, in the leukemia… it’s a powerful place to stand.For the strictly “If I can’t see it in a lab, it doesn’t exist,” Do you want to be empowered, or do you want to be right? Or, if your health isn’t good, do you want to be healthy, or do you want to be right?Consider everyone is a house with four rooms: physical, mental, emotional and spiritual.In the modern world, you risk falling prey to the paradigm, the physical level of reality is all there is… It’s all matter and energy… if you can’t see in the lab it doesn’t exist.That worldview may be true, and obviously, it may not be.If you hold yourself as a house with only one room, physical, which gives rise to the illusion of the other three rooms and that’s not the case, there may be a dear price to pay.EDIT (April 16,2019):I can’t say I’m about to add materially to my answer of the question; however, I can see how the reader might be curious as to what’s up as of today… I don’t remember when I wrote this; I see my last update was February 16th.There have been three excitements and one very sad loss since I last updated. I’ll end with the loss.About six weeks ago, after receiving a unit of red blood cells, an infusion which took about two hours, I drove home and sat on the couch. I started to feel cold and hot at the same time. Cold won out and I got underneath an electric blanket and turned it on. Very shortly I was having hard chills.My instructions from MDA since my December discharge were, “Go to the ER if your temperature hits 101 or more.” I didn’t have to take my temperature. My wife drove me to the ER. It was a Friday afternoon and the ER was packed. Getting into the ER was fun; because I have staff privileges there, but the staff up front and the triage nurse don’t know me from Adam. So, I went in the back doors of the large ER, bald, with an overnight bag slung over my shoulder and said, “I’m Dr. Murphy. I’m in treatment for leukemia and I have a fever.” Most of the dozen or so doctors, nurses, technicians and unit clerks behind the counter stopped what they were doing to stare at me. I stared back at them. Eventually, a nurse broke the deadlock. “17 is open,” she said stepping out to escort me.I was deathly ill. All the routine things… blood cultures, chest xrays, etc. were done, looking for a possible source of infection.For the next three days I lay in the dark, sleeping as much as I could. They left me alone, which I thought was odd, but appreciated. At MDA I don’t think they would have let me lay in the bed 24/7, and didn’t even when I had RSV (another story).Monday rolled around; nothing had grown in the blood cultures; and, I had started to feel better. About 11 am, having enjoyed a great rapport and relationship with everyone there, I said politely to the nurse, “Um, I’m going to be discharged. I just need to know whether it will be AMA or not.” 10 minutes later I was signing routine discharge orders, and I went home. I felt like crap.In retrospect, the most likely explanation was a non-hemolytic transfusion reaction, something that occurs in about 1 out of every 1,000 RBC infusions. This can occur if WBC’s stow away in a batch of inadequately washed RBCs. They cause a cytokine reaction, the kind of thing that makes you feel awful when you have the flu.Gradually, over the next few days, my energy came back.The second excitement was going back to MDA on a Friday, my chemo rounds always start on Friday, and had labs in the morning to prep to see Dr. P, who would then order the 3-day round of chemo.My WBC was below 1,000, even though, due to circumstances, I was on Day 35 of a cycle. Being in a clinical trial at MDA, there are protocols and guidelines and chemo was off; it couldn’t proceed.Once again, Dr. P predicted the future. He said, “We’ll do a bone marrow biopsy; you’ll still be in remission. You’ll go home. Have a great weekend. Come back Monday morning. We’ll do labs and give you a shot of Neupogen Monday and Tuesday mornings, and we’ll restart your chemo on Wednesday.”That was an exciting weekend; because, while the blast count was likely ready Friday afternoon, no one was there to read it. And, while I mentioned a couple of potentially arrogant sounding behaviors around febrile neutropenia hospitalization; I’m not the type to be inclined to try and get the results before Monday.I was able to think positively throughout most of the weekend. I did allow my mind to think about a recurrence, but not to dwell on that possibility. I wasn’t in denial; I knew the results of the biopsy could be bad news staying alive-wise. But again, I mainly stayed in positivity and continued to visualize my 90th birthday party (my father, Stu’s 90th birthday party is next month) and to affirm, “I am so happy and grateful now that I’ve released the patterns that gave rise to the leukemia.”Monday morning, after having had my labs, I was sitting and waiting in the 8th floor leukemia waiting area, waiting to be called back for an injection of Neupogen, my cell phone rang. It was Dr. Islam. “Your blast count is 2%.”I cried with joy, once again, as I did when he told me, “Your MRD is negative. I have never seen an MRD negative patient at Day 21,” months before.To be continued… fatherhood calls at the moment…there’s more coming… and… 95% of what I write on Quora is via iPhone… somewhat constraining…My two older sisters and I with our father at his 90th birthday party last month, May 2019. He’s a huge inspiration, and not just because that’s his house we’re visiting and he’s had CLL for ten years and has only accepted monitoring of it.I’m coming up on 6 months complete remission. There’s much more to write; and, my commitment is that what I write make a difference for you.And, as promised above, there’s more to the story and I will flesh out what I believe made the difference in the face of a potentially terrifying disease…Today, my hair, like springtime blossoms, is sprouting again… a sign of the life force, irrepressible, pushing up through the cracks in the sidewalk…Here’s to New Life……and again, more to come…Edit: July 4th, 2019Today, the 4th of July, enjoying Life. I’m 60 now… my hair’s sprouting… the sprouting started this Spring after the chemo was finished… I gave that timing meaning… Springtime… new life…I intend to share more about this experience, and yet, I’m not sure this is the place to do that given the original question.So far, it has been a pleasure to have this forum to share my experiences with leukemia and everything related. If you have a suggestion as to a better forum/platform to share my knowledge, experience and hope with regard to leukemia, let me know.EDIT Saturday, July 27, 2019:I had surgery Thursday to have a myringotomy and tympanostomy tube placed in my left ear. It went perfectly.Fluid filled my left middle ear during my last hospitalization (for febrile neutropenia) in April. There were two complications from that hospitalization, I presume from high dose IV vancomycin and cefipime… a sudden and persistent left ear effusion and neuropathy of my distal feet bilaterally.The tube has all but resolved the effusion (it’s present in the morning, but drains within and hour or two). And the neuropathy, which consists mainly of the sensation my socks, no matter what their fabric, are filled with sand in the toes, and there is pain at times, increased initially with hard shoes and jogging. However, the jogging actually seems now to be a force for its resolution.I set a goal of running a 10K by September 29th, a goal RunKeeper helped me to decide on. Thanks to my varsity tennis playing son, Elliot, for that app tip.I had preop labs Tuesday, and coincidentally, two month followup labs for my heme/onc, Kavita Nirmal, on Wednesday. Not surprisingly, they were both very close…WBC 4.1Hgb 16Platelets 157,000It’s all good.EDIT Thursday, September 12, 2019:Reporting in for the curious…My post above starts with the yearly routine labs I had done September of last year, 2018. That’s cool, and relevant to the question.I’ve had two haircuts since my nuked hair decided it was OK to start growing again. Gone is the childhood fear of the barber or stylist getting it too short.I’ve run 5 days a week since July 21st, and I am registered in Texas Oncology’s Celebrate Life Survivor’s 5K on the 28th.There are two big benefits of running 5 days a week.One is the health and fitness benefit which is enough on its own.The other is, who I am for myself today is larger than who I was when I was saying, “I need to start running again,” for SEVEN years. (I was shocked about 4 months ago, in a moment of self-clarity, I caught myself running that line of bullshit past myself, and I stopped and asked myself, “When was the last time I exercised regularly?” …2012. Damn, Dude. You’ve been saying that to yourself for SEVEN years.)About 3 months ago, I started making the bed if I were the last one out. I’d heard Dr. Jordan Peterson recommend this one before solving any of the world’s problems. “Make your bed.”About a month later, during breakfast with my varsity tennis playing son, I downloaded an app, RunKeeper, he’s using to log his many runs.It started pressuring me to run a 10K in a month. I reacted, “I’m 60 years old. I’m not running a 10K in a month… I’ll run one in two months,” and on July 21st, I started running 5 days a week.Another recent shift in who I’m being in the world is manifested by the fact that I’m writing again.UPDATE: September 30, 2019I beat my oncologist in a 5K this weekend! Sorry, Dr. Nirmal. Good run!Not that long ago, my hemoglobin was 7 and I got winded climbing a flight of stairs. Now it’s 17 and I can run a 5 kilometers!UPDATE: October 25, 2019:It just occurred to me it is getting close to the one year mark that I went to MD Anderson for the first time and I don’t think I’ve adequately acknowledged them.To me, and probably by objective measures, MD Anderson is the best cancer treatment center in the world. It must be one of the largest with over 20,000 employees and over 15,000,000 sq ft of space. Yet, it is one of the best run organizations I’ve ever seen of any size. That’s important. But, not as important as the care and concern I saw everywhere. The ethos there is healthy, upbeat, nourishing and inspiring.In particular, I want to acknowledge and thank to a depth appropriate to one given to someone who participates in literally saving a life. Naveen Pemmaraju, thank you for saving my life. I am the father of a now 3-year-old, precious boy. I am also the father of two other boys, 19 and 17, who shouldn’t lose their father, either; yet, the biggest save was saving the life of the father of this precious 2-year-old boy.December 13, 2018 - Just discharged from MD Anderson’s Leukemia Specialty Care UnitThis is what I’m talking about, Naveen. This is such a huge gift. Words aren’t adequate to express the depth of my gratitude. Thank you.Rabiul Islam, thank you for your relentless close support and encouragement. You repeatedly went above and beyond calling me on my cell and keeping me informed. And, the moment you told me I was MRD negative is one of the happiest moments of my life. You didn’t have to add, “I have never seen an MRD negative patient at Day 21.” But, you did and that made a deep, profound positive impact. It has been some of the best medicine mentally and emotionally, and probably physically and spiritually. All boats rise with the tide. What a profound gift. Thank you.Michael Andreeff, thank you for who you are personally and professionally. You were my first inpatient physician contact, and it was, interestingly, on Thanksgiving Day. You walked into my room with an entourage of residents and fellows and said, “Who are you, and vot are you efen doing here?” (Sorry, that’s my recollection of your delightful German accent.) I loved our banter. When I told you I was a psychiatrist, you told me, “I vanted to be a psychiatrist, but I vound up being this.” You were part of the development of flow cytometry in the early days in Heidelberg. Flow cytometry told me the leukemia was gone down to a resolution of 1:1,000,000 WBC’s compared to 1:20 resolution possible with a microscope alone. Thank you for the quintessential physician that you are; and, thank you for having me look forward to witty banter every morning at morning rounds. What a delight.Zeev Estrov, thank you for who you are. Two memories stand out. You came into my room the morning after my Day 21 bone marrow biopsy and said, “Go home. You don’t need to be here anymore.” And, after I started to recover from the seeming near death experience from RSV, I perked up for your morning rounds; and, you and your entourage of residents and fellows came in. I had finally had a good night’s sleep and told you so. You turned to your students and said, “That! will tell you more than any lab test.” To me, such a brilliant moment of teaching. In medical school, I remember the lesson of one of my professors, “You treat the patient, not the labs.” You are another star in the MD Anderson firmament.To the staff of the 12th floor Leukemia Specialty Care Unit and to the nurses who inserted my PICC line, I cannot say enough to thank you and express the gratitude I have for my treatment there. It is a difficult thing to be a young man, otherwise healthy, diagnosed with a life threatening disease and facing an uncertain future, knowing it included, at the least, chemotherapy and weeks of isolation. I don’t think I’ve told anyone this because it sounds weird. When Dr. Estrov told me to go home on Day 22, I was disappointed. That’s partly your fault. Good job. I’d say, “Keep it up,” but that would be silly. It’s who you are.To the 8th floor Leukemia Clinic and staff, thank you for always being friendly, upbeat, professional but not dry or stiff, and always being a well-oiled machine. Wow. You and your clinic and lab are part of the reason that the thought occurred to me, “This is the best run organization I’ve ever seen of any size.” Amazing. Thank you.To my individual nurses, inpatient, outpatient and chemo, because all of you were so extraordinary in skill, compassion and presence, I got to be right every time about how great MD Anderson is, every time. Every contact. Thank you.To the nurse who put in my PICC line, when I was the most alone and scared, Wednesday night, alone before Thanksgiving Day, thank you for your flawless insertion of a central line, your calming bedside manner, and thank you for telling me you had multiple myeloma years before and remain disease free. (The only thing that could have made the whole experience better, for the next patient, consider leaving out the part about your PICC line getting infected. :) ) Thank you.There are so many people to thank. Right now I am acknowledging you, MD Anderson. Thank each and every one of you. I am weeping now in gratitude as I get in touch with the magnitude of the gift and how you gave it. Jackson just turned 3. He will thank you one day. For now, I thank you on his behalf.Oh my! There are so many people to thank!To be continued…EDIT: January 7, 2020An interesting “problem” is arising here… the longer I live, the less appropriate the word “recently” in the opening line of this answer is… in December, less than a month ago, I went back to MD Anderson for my first checkup since July. All is well and my MRD continues to be negative over a year after entering remission. Thank you, Dr. Pemmaraju and all of you at MD Anderson.And, as I mentioned above, there are many more to thank. I will address two of you now:To Nortin Hadler, MD, of UNCSOM. Nortin, your startlingly deep compassion and ability to read between the lines of what I was saying moved me to tears. You heard me asking things I didn’t know I was asking. Your clinical acumen and profound compassion were so intense at times it was hard to be with. You encouraged me at a deep level. Not long before I was diagnosed with AML, I wrote you to thank you and tell you how much your work has meant to me as a physician and reader. I didn’t expect a reply, let alone one of such thoughtfulness. Then, during my struggles with leukemia, you shined as a lighthouse of steadfast personal and clinical wisdom. Thank you for hearing what I didn’t even know I was expressing and addressing it.To Steve Derdak, DO. My sister, one of the finest physician’s I know, refers to you as the smartest physician she knows. That’s quite an endorsement. I still remember visiting you when you were in medical school and thumbing through your Harrison’s Principles of Internal Medicine to find it thoroughly highlighted. Years later as an intensivist at Brooke Army Medical Center you brought your vast clinical experience to me personally in a very frightening and challenging time. Thank you for being there. And thank you for your sweet, personal bedside care of Marty at our home during her final days.And thank you Quorans for your views and upvotes. I deeply appreciate it!More to come.Edit: June 21, 2020Went back to MD Anderson a couple weeks ago for a routine followup. Results were all good except MRD.CBC great. Bone marrow aspirate showed 1% blasts (normal is < 5%). All very exciting. 6 days out a notification popped up on my phone that Dr. Pemmaraju wanted a telephone appointment with me.That was not welcome news, and I couldn’t wait until the next day to find out why. I called his PA, Rodney, and learned the news. My Measurable Residual Disease is now positive. I am in morphological remission, but not at the level of resolution provided by amazing technology.Dr. Pemmaraju’s recommendation is 3 rounds of venetoclax and azacitidine (VEN/AZA). Mild chemo… he used the analogy that the previous chemo is like a bomb and the VEN/AZA is like a Predator drone strike.He said my MRD will turn negative again. And he referred me back to the Stem Cell team.No problem seeing the Stem Cell team again for a consult but I was dead set against it.My thinking was why would I sacrifice feeling great for the devastation SCT is?And I’ve already created this narrative of how powerful mind/body medicine can be…It wasn’t an easy choice at all. And at one point in the last 16 days of wrestling with my circumstances I decided to do SCT but from a place of fear. (There’s a powerful distinction between choosing and deciding worth taking a look at.) Then I decided against it.At some point I looked at the scientific research and statistics on it; then I watched some inspirational videos by successful recipients and using the rhetoric from one of those people, switched to viewing SCT as an investment in my future. And I went back to my matrix of 4 cells and considered each possibility it boiled down to which mistake I would rather make…Have a stem cell transplant when I could’ve done well using mind over matter after allorNot have a stem cell transplant when in fact I needed one to prevent death by AML progression?Decision is derived from the root word “cide” or to kill off. In a decision the circumstances and considerations determine the selection… you have a pro list and a con list and the selection is based on which list is longer. The alternative is killed off by the considerations.Choice: To select freely and after consideration.Initially I decided no. Then I decided yes. All of that occurred in a field of fear and suffering.At some point I chose SCT and a feeling of peace came over me.I am at peace with the choice and the outcome.Once again, I think I will fare exceptionally well and I know that isn’t a given.I realize one outcome is death by overwhelming infection, organ failure or graft vs host disease.That is out of my hands. I accept my fate. I choose it.And I am happy to share the journey ahead.Edit: August 3, 2020Day 1 Cycle 2 of venetoclax and azacitidine. Mild chemo. The first cycle of this had few side effects and no hair loss. It was surprisingly hard on my kidneys… the cycle is Monday through Friday every 28 days (if possible) and my creatinine spiked to 1.5 on that Friday. It returned to normal and a nephrology consult concluded it was a reaction to the venetoclax. Dr. P concluded it was an idiosyncratic reaction and doesn’t think it’ll happen again.Edit: November 3, 2020Getting Busulfan at MD Anderson this morning in preparation for a stem cell transplant.I am quite well and continue in morphological remission. My MRD turned positive in June for the first time since December 2018. I’ve accepted MD Anderson’s recommendation for a SCT. It’s been their recommendation all along, but until June insurance wouldn’t pay for it and I didn’t want it. However, confronting a dead canary down here in the mine, two thoughts persuaded me.I have three boys, the youngest is four. In that context I look at this as an investment in the future; and, I’d rather have it and not need it than need it and not have it… I met a wonderful man in his early 70’s, John, in an infusion room last year. Delightful. I got to talk to him at length twice. Delightful man. He looked well to me. However, his chemo had never gotten him into remission and he died very quickly. His death hurt deeply. I grieved his death and I could feel the pain of it much more acutely than my mother’s 8 years ago, something I think odd. Perhaps it was the reminder of my vulnerability.I remain optimistic and grounded in my choice and commitments.Today is the first day the thought, “I am a writer” occurred so consonantly. Perhaps the dawning of the reality of death, not necessarily of its immanence, but of its ultimate reality, shifted my audience from what others think to what I think. I’ve a story to tell. It’s for me and that others may benefit.“The ill person who turns illness into story transforms fate into experience…” —Arthur Frank, from The Wounded StorytellerFootnotes[1] Minimal/measurable residual disease in AML: a consensus document from the European LeukemiaNet MRD Working Party

Any boxer can be beaten. On any given night, a lucky punch, a slip, anything can happen.But if you are asking, on his best day, would any heavyweight in history be favored over Ali, the answer is “NO.”The modern heavyweights are in the worst era ever for heavyweight boxing, according to virtually every observer, including Mike Tyson and Lennox Lewis. None of them would have a prayer of defeating Ali at their respective best.Nor could any fighter from days gone by, with the toughest test in such a mythic bout being offered by a young Sonny Liston, who Ali said was the best fighter in history except for him. Equipped with incredible power, great fundamental skills, and an incredible reach which enabled him to control distance as well as any heavyweight in history, Liston would have offered the best challenge but it would have fallen short.Before his 1.314 days of enforced exile from boxing, Muhammad Ali, was as close to an unbeatable heavyweight as any who ever lived. NO heavyweight, past or present, would be favored by anyone with a brain to defeat the Ali of 1967. He was too fast, and just that damn good.Who says so?Other fighters, past and present, including every fighter who faced him, trainers, boxing writers and historians."You can't hit him," said Cleveland Williams, "you just cannot hit him!" According to CompuBox, Williams landed only 10 punches the entire fight with Ali. Williams said "I threw hooks, I threw uppercuts, I missed them all! Hell, I couldn't even land a jab!"“I didn’t realize he was that good, or could hit that hard,” Sonny Liston after their second fight.Zora Folley, after facing Ali, said "you can't hit him! But he sure can hit you."Bob Foster: "Muhammad Ali. He was the man. He was big, fast; he was smart and never did get hit easy. Man, was he fast and slick in the ring"Or Joe Bugner, asked who was the best fighter you ever met, including Ali and Frazier? Joe Bugner responded: "Best overall was Muhammad Ali, who was the greatest of all time in my opinion."What about George Foreman, who faced fighters in two generations, who was the best fighter you ever faced or saw? Foreman said: "It's clear that “The Greatest” remains exactly that. Ali has the vastly superior record and his accomplishments are beyond reproach."What did Ken Norton say, about the man he fought three closely contested bouts with? In an interview with boxing writer and historian Frank J. Lotierzo on ESPN radio 1490, he said: Frank: In your book you say Ali is the best ever. Do you believe that? Norton: "As far as I’ve been around, yes." Frank: "Is Ali the best fighter you ever fought?" Norton: "Yes."In his book, "Going the Distance," Ken Norton described Ali's later career and defense as "he didn't have the lightning speed he had in the 60's, but he was still one hell of a fighter, and man, could he slip punches! Even then, he remained the best i ever saw, and I believe the best ever, period."Ernie Shavers, said in his book "Welcome To The Big Time" by Earnie Shavers, that the best fighters of that era were Ali, Foreman and Frazier. He said "even an old Ali was still the greatest."Rocky Marciano, who filmed the "computer fight" with Ali in 1969 while Ali was banned from boxing, said of Ali "the fastest man on wheels, no fighter who ever lived was that fast." Rocky, when asked how good he thought Ali was, said "most would make the guy before they made him stop fighting – the fighter that destroyed Cleveland Williams, before time off took so much of the skip and slip from his legs – a strong favorite over anybody, anytime, anywhere, including me."Canadian heavyweight George Chuvalo said of Ali, "my plan for the fight was simple: as the shorter guy, I wanted to stay close to Ali, nullify his speed and prevent him from using the whole ring. I also wanted to make it rough. The rougher, the better. But it took all of about 30 seconds for me to realize he was the fastest fighter I’d ever seen. It’s one thing to expect it; it’s another thing to feel it, live it."Chuck Wepner, beaten by Ali in 1975, said, "The day of the Ali fight I bought my wife a powder blue negligee and told her 'wear this tonight, 'cause you'll be sleepin' with the heavyweight champion of the world'. That night, when I got back to the room, she said: 'Do I go to his room or will he be coming to mine?'"Jerry Quarry, after fighting Ali in his first fight back after Ali's 1,314 day exile - an exile during which he did not spend one day in the gym - said of Ali the fighter, "man if this cat is this damn good after three years out of the game, no damn body could have beaten him back in the day!"Let's ask Mike Tyson to evaluate Ali as a fighter: Mike Tyson, a student of boxing to this day, and a guy who has probably watched more boxing film than any other boxing historian, said of Ali:“Nobody beats Ali,” he said when asked if he’d have beaten him, prime against prime. And he explains that those who grew up in the ’80s and ’90s and perceived Tyson as the winner just because he hit harder and had bigger muscles let themselves be fooled by Ali’s physical appearance. “Ali is a fuckin’ animal,” Tyson said. “He looks more like a model than a fighter, but what he is, he’s like a Tyrannosaurus Rex with a pretty face. And fast, Lord God he was fast!”Asked who the best ever was, Mike again said simply “Nobody beats Ali.”What about Lennox Lewis? "Ali was the greatest heavyweight EVER in my opinion.... I would never put myself in his class...and never have."Max Kellerman says "From 1970, when Ali came back from his forced exile, to 1978, when Ali won back his crown for the final time (against Leon Spinks), Ali shared the very top shelf with Joe Frazier and George Foreman, and the three of them were supported by Ken Norton and Joe Bugner and, in the beginning of the decade, Oscar Bonavena, Jerry Quarry and Jimmy Ellis, and at the end of the decade Ernie Shavers, Ron Lyle and Jimmy Young. Ali fought them all, and many of the others fought each other. The greatest heavyweight era ever."Max also said, "if you count from the day he dethroned the most feared boxing champion ever, he dominated his sport for 14 years! NO one else ever did that, EVER."Muhammad Ali. Ali, was and remains, the first World Heavyweight Champion to come back from retirement and regain the undisputed title.He beat 14 world champions, from the years 1962 to 1978, over an incredible 16 year period.Ali won twenty-two World Heavyweight Championship fights over a 14 year period.Ali made a total of nineteen successful title defenses of the undisputed title, nine during his first reign and ten during his second reign. Another record he set which stands today, he has a record of 11-0 in rematches.Ali faced a heavyweight record of 8 Hall of Fame fighters, winning all but one, and making 11 total fights against Hall of Famers, of which he won 10, and his only loss came when he was 39, had been retired for two years, and had Parkinson’s.Ali is the only boxer to be selected by Ring magazine as Fighter of the Year six times. Ali was also ranked as the greatest athlete of the 20th century by Sports Illustrated. He was also the Sports Personality of the Century by the BBC. He was named the third greatest athlete of the 20th century by ESPN Sports Century.Ali is generally ranked as the best heavyweight ever, by virtually every expert in the field, and is in the top five pound for pound fighters ever.Boxrec’s computer ranks Ali as the best heavyweight of all time, PERIOD.BoxRec: RatingsThe only two fights he lost and did not avenge he was nearly 39 for the first, going on 40 for the second, and already ill with Parkinsons.Of the eight Hall of Famers he faced, all eight said he was the best heavyweight who ever lived. Joe Frazier, in his autobiography "Smokin' Joe: The Autobiography of a Heavyweight Champion of the World" listed the best fighters of the 60's and 70's as Ali, Foreman, Norton and Holmes. Joe said Ali was "probably the best ever, but I managed to beat him!"Ali would be favored against not just modern fighters, but any fighter, in his prime, is not just my opinion, but that of real experts, all of the guys who fought him: "I came to love Ali,” two-time foe Floyd Patterson told David Remnick for his book King of the World. “I came to see that I was a fighter and he was history." Patterson went on to say. "Before they took boxing away from him for three years, he was the best fighter who ever lived, period.”Angelo Dundee, Ali's and Sugar Ray Leonard's trainer, said; "look at Ali’s quality of opposition. He shook up the world against Liston, then did it again. He shocked the world against Foreman. He won two out of three against Frazier. Same against Ken Norton. He beat Patterson twice. The also-rans on Ali’s record—Jerry Quarry, Ron Lyle, Zora Folley, Oscar Bonavena, Bob Foster, Ernie Terrell—were as good as all but two or three opponents Joe Louis beat during his 11 years as champ."Legendary American boxing historian and writer Bert Sugar, said of Ali, "True greatness comes from within as well as the physical, and Ali had it all. On his best night, he beats any fighter who ever lived."BBC boxing writer and historian Ben Dirs said of Ali compared to Wlad Klitschko and other fighters of this generation, "Ali reigned in the most talent-rich era of heavyweight boxing, winning the title from the fearsome Sonny Liston in 1964, winning it again from the even more fearsome George Foreman 10 years later and beating greats such as Floyd Patterson, Joe Frazier and Ken Norton in between."Much of Ali's technique depended on speed, and even old Ali had speed - Foreman said after Zaire "I thought he was 34, he couldn't be that fast, but man, he hit me with shots I couldn't even see!"In his pre-exile form, he was the fastest heavyweight, perhaps fastest fighter, of all time. How fast was Ali? The Muhammad Ali pre-exile was the fastest heavyweight ever. In the May 5, 1969 issue of Sports Illustrated, Ali’s jab was measured with an omegascope. Ali’s jab, it was found, could smash a balsa board 16.5 inches away in 19/100 of a second. It actually covered the distance in 4/100 of a second, which is the blink of an eye. (and a lot faster than Floyd "beat up your Grandma" Mayweather)Jimmy Jacobs, who owned the world’s largest collection of fight films, said that on film tests with a synchronizer Ali’s jab was faster than that of Sugar Ray Robinson, or any middleweight, welterweight, or lightweight, he could measure. Jacobs contended that Ali was not only the fastest heavyweight, but also the fastest fighter he ever saw on film.Marv Jenson, who managed Gene Fullmer, concurred saying, “Ali has the fastest hands on any heavyweight I have ever seen, hell, he has the fastest hands, period."Asked about Ali, and his technique as a boxer, Howard Cosell summed it up best: "The greatest Ali ever was as a fighter was against [Cleveland] Williams in 1966. That night, he was the most devastating fighter who ever lived." Cosell went on to say "no fighter ever lived could beat that version of Ali, no one."I must say, when I read some of these answer to mythic fights, that there are writers on here, who confuse size with skill.Boxing writer and historian, Frank Thomas, explains the difference between size and skill:"In the minds of some, size trumps all. Ergo, the Klitschkos [or Joshua] should defeat any other heavyweight who is not of similar stature. This gravely misunderstands the role of size in boxing, as amply demonstrated by yesteryear’s Primo Carnera, the Golden Age’s own Ernie Terrell, or modern fighters such as Nikolai Valuev and Lance Whitaker. In addition to height, it also misreads what “size” is.Many modern heavyweights are the same height as their 1970s counterparts, but pack twenty pounds or more of extra mass. Yet does that mass make them a better fighter? If it was earned by lifting weights, [or PED's] as is all too often the case, then the answer is no.Bulky muscles look impressive, but they do not help a fighter hit harder. Instead, they slow a fighter down and serve as useless bulk which must be hauled around the ring all night. Anyone who has trained using old school boxing methods is familiar with just how difficult it is to build good boxing muscle through weight lifting."Because fighters today are bigger, does not mean they are better. A physique like AJ's is useful if he is posing on a stage for Mr. Universe, and not a bit of help in the ring while a fat Mexican is pounding his huge posterior. His size helps him against boxers without the skill to actually box him.Emmanuel Steward said of today’s bigger fighters, "they are nowhere near as skilled as the old fighters. All the good big men are in the NFL or NBA!"Angelo Dundee said before he died, "the great heavyweights are gone. Lennox Lewis was the last great heavyweight you will see in your lifetime. These guys coming up just can't box!"Fighters today fight far fewer rounds, box less in the gym, and simply do not learn the fundamentals of the game. Tyson Fury and Luis Ortiz are the only heavyweights in the top ten who actually can box! And Fury is coming off a near 4 year drink and drug binge, and Ortiz is at least 40! Oleksandr Usyk can actually box, but he is unproven as a heavyweight at this time.Second, the difference modern nutrition and training would make to older fighters.You have to assume in mythical fights that both fighters would have the advantages of the modern era. Muhammad Ali in 1967 trained to go 15 rounds non-stop, and lost weight to be able to do it. In a 12 round era, with modern nutrition and training, the Greatest would come in around 220, his natural weight, with the same matchless speed and peerless reflexes.I will close with my favorite Muhammad Ali stories: first, when he was a fighter, on the night he stunned the world and beat George Foreman, sensing the mood in his dressing room he asked: “What’s wrong around here? Everybody scared? Scared? A little thing like this? This is like another day in the gym.”Second, is a sad story. A tale of how an old and sick fighter faced defeat.Ali's tale in defeat comes against Larry Holmes, in his second to last fight, when he was already desperately ill.Ali retired for the first time - we are not counting his forced, 3 1/2 year "retirement" from 1967 to 1970 when he was barred from boxing - on September 15, 1978 after he regained the title from Leon Spinks. He was almost 37 when he retired, had been in 59 fights, 56-3, with losses only to Joe Frazier, Ken Norton, and Leon Spinks.Two years later, King offered the almost 39 year old Ali $8 million dollars to come out of retirement, the largest amount of money he was ever paid, and face Larry Holmes, who by then had defeated Ken Norton, and become the WBC champion.Ali, already badly ill with Parkinson's, could not pass the standard fight physical and the Nevada State Athletic Commission had the former champion examined at the famed Mayo Clinic as a pre-condition to being granted a boxing license.Ali checked into the clinic on July 23, 1980. His neurological exam was conducted by Dr. Frank Howard, whose tests and examination recorded: Ali literally could not touch his finger to his nose, (he could not get closer than an inch to his nose), he had difficulty in coordinating the muscles used in speaking, and he did not hop on one foot with even standard agility for a man his age.Nonetheless, incredibly, Dr. Howard found no specific condition to prohibit Ali from fighting. The Mayo Clinic report was given directly to the Nevada State Athletic Committee, but it was not made public. Based on the report, Ali was granted a boxing in Nevada.In addition to being unable to touch his nose, speak normally, or hop up and down the way a man his age should, the champ was vastly overweight, and had to starve himself down to be presentable for the fight.And not only should the Parkinson's have stopped the right, his own medial team nearly killed Ali. Dr. Charles Williams, who was a member of Ali's medical team, believing that Ali had a thyroid imbalance, had prescribed one tablet of Thyrolar per day.Thomas Hauser, in his book Muhammad Ali: His Life & Times, wrote: "Thyrolar is a potentially lethal drug, and no one on Thyrolar should engage in a professional fight." Incredibly, Ali doubled the dosage with his team's knowledge because he "thought the pills would be like vitamins."Known side effects of Thyrolar include fatigue, sluggishness, headache, increased blood pressure, tremor, nausea, increased heart rate, frequent urination and weight loss. The drug also can impair the body’s ability to cope with heat, causing dehydratation then heat stroke.Against Holmes, Ali on fight night was weak, fatigued and short of breath from round one on. His body wasn't able to cool itself properly, and his temperature rose. That, Dr. Williams would later acknowledge, "led to heat exhaustion that went into heat stroke with an immediate period of slight stupor and maybe delirium." He added, "I may have placed him in jeopardy inadvertently."Ali's former physician, Dr. Ferdie Pacheco, told Hauser: "Ali was a walking time-bomb in the ring that night. He could have had anything from a heart attack to a stroke to all kinds of bleeding in the head."Four days after losing to Holmes, Ali checked into UCLA Medical Center. Dr. Dennis Cope, who supervised Ali's stay, determined "that prior to medical intervention, Muhammad's thyroid gland was functioning properly." In other words, Dr. Williams had almost killed Ali for a thyroid problem which did not exist.Dr. Cope found it beyond belief he had actually tried to fight in his condition.In a fight he never should have been allowed to make, Ali's corner threw in the towel with him on his stool, suffering heat stroke symptoms, but wanting to continue and finish the fight. Ali argued to continue, but Herbert Muhammad overruled him from ringside and Dundee threw in the towel. Though Holmes had won every round, he never succeeded in knocking Ali down or out.And now the story of the greatest heavyweight ever, old and sick, in defeat.Angelo Dundee, till his dying day, said the most courage he ever saw a fighter exhibit was Ali getting off the stool, in heatstroke, unable to even lift his arms enough to ward off punches, and trudging forward, defenseless, round after round, because, as he whispered to Dundee after round one, "I can't quit, man, I can't quit. I got to try."After the fight, Holmes and his brother visited Ali in his room, to make sure he was well. As they got ready to leave, Holmes said he heard this voice come from under the mound of ice packs on Ali’s face raising in volume, louder and louder, “I want Holmes! I want Holmes!”Larry said “there was only one Muhammad Ali.”That incredible courage, and iron will, coupled with his talent in his prime, made him unbeatable on his best night.

Ali is, in the opinion of almost all boxing historians, in his prime, the very best heavyweight who ever lived. In addition, he is ranked in the top three or four all time pound for pound.CREDIT PICTURE BRITTANICAAli fought everyone and anyone who was a contender, with no reservations. In contrast to today's fighters who cherry pick, Ali fought everyone.There were 17 top 100 all time heavyweights active during Ali’s reign - he faced every one.Ali faced those 17 top 100 heavyweights, and beat all but one, and when he was 39 and ill; he faced and beat 21 of 22 top 150 fighters, the best of any heavyweight, ever.Ali himself quoted in “The Greatest” said:“When people ask me about who was the greatest of all time, I say look at the records. I fought better competition, over a longer period of time than any other fighter in history.”Ali faced the best of the best:#2 Archie Moore (ranked as light-heavyweight but fought for heavyweight title twice)#4 Sonny Liston#13 Joe Frazier#14 Larry Holmes#15 Floyd Patterson#19 George Foreman#20 Bob Foster (ranked as light heavyweight but fought for heavyweight title twice)#22 Cleveland Williams#34 Ken Norton#36 Zora Folley#43 Henry Cooper#44 Ernie Terrell#48 Jimmy Ellis#51 Karl Mildenberger#57 Oscar Bonavena#67 Jerry Quarry#68 Ron LyleAli faced 17 top 100 all time heavyweights in 26 fights, he beat 16 of the 17 at least once, 5 of them twice, for a 94% victory rate against all time top 100 competition!In addition, Ali beat five fighters ranked between 100 and 160, to wit:#116 Joe Bugner#118 Doug Jones#124 Jimmy Young#131 Mac Foster#141 Earnie Shavers,and Ali faced 23 fighters in the top 150 and beat 22 of them at least once in 31 fights.That meant more than half of his fighters were against top 150 competition, the best percentage in any weight class in boxing history!And his ring accomplishments stand the test of time…For 14 wonderful years, Ali dominated boxing in a way no other has before or since. He because the only heavyweight to retire and return almost 4 years later to regain the UNDISPUTED title. He is the only 3 time lineal undisputed heavyweight champion. He fought every single contender of his age.Max Kellerman says:“From 1970, when Ali came back from his forced exile, to 1978, when Ali won back his crown for the final time (against Leon Spinks), Ali shared the very top shelf with Joe Frazier and George Foreman, and the three of them were supported by Ken Norton and Joe Bugner and, in the beginning of the decade, Oscar Bonavena, Jerry Quarry and Jimmy Ellis, and at the end of the decade Ernie Shavers, Ron Lyle and Jimmy Young. Ali fought them all, and many of the others fought each other. The greatest heavyweight era ever."Max also said:“If you count from the day he dethroned the most feared boxing champion ever, he dominated his sport for 14 years! NO one else ever did that."Ali’s physical ability was unmatched by any heavyweight everIn his prime, before his exile in 1967, Cleveland Williams said of Ali:“You can't hit him, you just cannot hit him!"According to CompuBox, Williams landed only 10 punches the entire fight. Williams said:“I threw hooks, I threw uppercuts, I missed them all! Hell, I couldn't even land a jab!"Zora Folley, after facing Ali, said:“You can't hit him! But he sure can hit you."His technique in his prime was a reflection of simply unrivaled physical ability. He adapted as he got older, and after almost four years of his prime were taken away. He worked on adapting his decreased physical abilities to better technique, and the results speak for themselves:His record stands the test of time as the greatest heavyweight everAli was and is the first and only three-time lineal World Heavyweight Champion. He was and remains the first World Heavyweight Champion to come back from retirement and regain the title. He beat 14 world champions, from the years 1962 to 1978, over an incredible 16 year period. Ali won twenty-two World Heavyweight Championship fights over a 14 year period. Ali made a total of nineteen successful title defenses of the undisputed title, nine during his first reign and ten during his second reign.Another record he set which stands today, he has a record of 11-0 in rematches. Ali faced a heavyweight record of 8 Hall of Fame fighters, winning against all but one, and making 11 total fights against Hall of Famers.Ali was named Ring "Fighter of the Year" for 1963, 1966, 1972, 1974, 1975 and 1978. Ali was named the Boxing Writers Association of America "Fighter of the Year" for 1965, 1974 and 1975. Ali was named Sports Illustrated "Sportsman of the Year" for 1974. Ali was named The Ring "Fighter of the Decade" for the 1970s.Ali was inducted into the U.S. Olympic Hall of Fame in 1983. He received the Boxing Writers Association of America James J. Walker Memorial Award for 1984. Ali was inducted into the World Boxing Hall of Fame in 1986. He was inducted into the The Ring Boxing Hall of Fame in 1987. Ali was inducted into the International Boxing Hall of Fame in 1990. Ali was named "Athlete of the Century" by GQ magazine in 1998. He was named "Sports Personality of the Century" by the BBC in 1999, and "Sportsman of the 20th Century" by Sports Illustrated.Perhaps his ability was best summed by Archie Moore, who tried to train him, and who faced him in the ring in 1962:“He won't listen, he does everything he ain't supposed to do, but damn, he is so good he wins against anybody they put in with him!"Ali in his prime was a master at slipping punches, and his defense was sublime.But let us go to the real experts, the fighters, in this case, the ones who fought Ali, and who studied Ali's career as part of their own training:Bob Foster:“Muhammad Ali. He was the man. He was big, fast; he was smart and never did get hit easy. Man, was he fast and slick in the ring"Or Joe Bugner, who was the best fighter you ever met, including Ali and Frazier?Joe Bugner:“Best overall was Muhammad Ali, who was the greatest of all time in my opinion."What about George Foreman, who faced fighters in two generations, who was the best fighter you ever faced or saw? Foreman said:“It's clear that “The Greatest” remains exactly that. Ali has the vastly superior record and his accomplishments are beyond reproach."What did Ken Norton say, about the man he fought three closely contested bouts with? In an interview with boxing writer and historian Frank J. Lotierzo on ESPN radio 1490Frank:“In your book you say Ali is the best ever. Do you believe that?Norton:“As far as I’ve been around, yes."Frank:“Is Ali the best fighter you ever fought?"Norton:“Yes."In his book, "Going the Distance," Ken Norton described Ali's later career and defense as:“He didn't have the lightning speed he had in the 60's, but he was still one hell of a fighter, and man, could he slip punches!"Ernie Shavers, said in his book "Welcome To The Big Time" by Earnie Shavers, that the best fighters of that era were Ali, Foreman and Frazier. He said:“Even an old Ali was still the greatest."Rocky Marciano, who filmed the "computer fight" with Ali in 1969 while Ali was banned from boxing, said of Ali "the fastest man on wheels, no fighter who ever lived was that fast." Rocky, when asked how good he thought Ali was, said:“Most would make the guy before they made him stop fighting – the fighter that destroyed Cleveland Williams, before time off took so much of the skip and slip from his legs – a strong favorite over anybody, anytime, anywhere, including me."Canadian heavyweight George Chuvalo said of Ali:“My plan for the fight was simple: as the shorter guy, I wanted to stay close to Ali, nullify his speed and prevent him from using the whole ring. I also wanted to make it rough. The rougher, the better. But it took all of about 30 seconds for me to realize he was the fastest fighter I’d ever seen. It’s one thing to expect it; it’s another thing to feel it, live it."Chuck Wepner, beaten by Ali in 1975, said, "The day of the Ali fight I bought my wife a powder blue negligee and told her 'wear this tonight, 'cause you'll be sleepin' with the heavyweight champion of the world'. That night, when I got back to the room, she said: 'Do I go to his room or will he be coming to mine?'"Joe Frazier, who truly hated Ali, said after their third fight, the Thrilla in Manilla:“Man, I hit him with punches that'd bring down the walls of a city. Lordy, lordy, he's a great champion."Jerry Quarry, after fighting Ali in his first fight back after Ali's 1,314 day exile - an exile during which he did not spend one day in the gym - said of Ali the fighter:“Man if this cat is this damn good after three years out of the game, no damn body could have beaten him back in the day!"Mike Tyson, a student of boxing to this day, and a guy who has probably watched more boxing film than any other boxing historian, said of ranking the great heavyweights:Mike said when asked if he’d have beaten him, prime against prime:“Nobody beats Ali”.And Mike explains that those who grew up in the ’80s and ’90s and perceived Tyson as the winner just because he hit harder and had bigger muscles let themselves be fooled by Ali’s physical appearance:“Ali is a fuckin’ animal, he looks more like a model than a fighter, but what he is, he’s like a Tyrannosaurus Rex with a pretty face. And fast, Lord God he was fast!”But could you have beaten him on your best day, the reporter said? Mike emphasized, saying Ali was simply too fast, and too skilled, saying again:“NOBODY beats Ali.”What about Lennox Lewis:“Ali was the greatest heavyweight EVER in my opinion.... I would never put myself in his class...and never have."Asked about Ali against modern fighters, Joe Frazier laughed and said:“You got to be kidding me!"That Ali would be favored against not just modern fighters, but any fighter, in his prime, is not just my opinion, but that of real experts, the guys who fought him:Two-time foe Floyd Patterson told David Remnick for his book "King of the World:“I came to love Ali. “I came to see that I was a fighter and he was history. Before they took boxing away from him for three years, he was the best fighter who ever lived, period.”Angelo Dundee, Ali's and Sugar Ray Leonard's trainer, said:“Look at Ali’s quality of opposition. He shook up the world against Liston, then did it again. He shocked the world against Foreman. He won two out of three against Frazier. Same against Ken Norton. He beat Patterson twice. The also-rans on Ali’s record—Jerry Quarry, Ron Lyle, Zora Folley, Oscar Bonavena, Bob Foster, Ernie Terrell—were as good as all but two or three opponents Joe Louis beat during his 11 years as champ."Legendary American boxing historian and writer Bert Sugar, said of Ali:“Ali did all kind of things fighters are not supposed to do, lean back, kept his hands down, and more. But true greatness comes from within as well as the physical, and Ali had it all. On his best night, he beats any fighter who ever lived."BBC boxing writer and historian Ben Dirs said of Ali compared to Wlad Klitschko and other fighters of this generation:“Ali reigned in the most talent-rich era of heavyweight boxing, winning the title from the fearsome Sonny Liston in 1964, winning it again from the even more fearsome George Foreman 10 years later and beating greats such as Floyd Patterson, Joe Frazier and Ken Norton in between."Much of Ali's technique depended on speed, and even old Ali had speed - Foreman said after Zaire:“I thought he was 32, he couldn't be that fast, but man, he hit me with shots I couldn't even see!"In his pre-exile form, he was the fastest heavyweight, perhaps fastest fighter, of all time. How fast was Ali? The Muhammad Ali pre-exile was the fastest heavyweight ever. In the May 5, 1969 issue of Sports Illustrated, Ali’s jab was measured with an omegascope. Ali’s jab, it was found, could smash a balsa board 16.5 inches away in 19/100 of a second. It actually covered the distance in 4/100 of a second, which is the blink of an eye. (and a lot faster than Floyd "beat up your Grandma" Mayweather)Jimmy Jacobs, who owned the world’s largest collection of fight films, said that on film tests with a synchronizer Ali’s jab was faster than that of Sugar Ray Robinson, or any middleweight, welterweight, or lightweight, he could measure. Jacobs contended that Ali was not only the fastest heavyweight, but also the fastest fighter he ever saw on film.Marv Jenson, who managed Gene Fullmer, concurred saying:“Ali has the fastest hands on any heavyweight I have ever seen, hell, he has the fastest hands, period."Asked about Ali, and his technique as a boxer, Howard Cosell summed it up best:“The greatest Ali ever was as a fighter was against [Cleveland] Williams in 1966. That night, he was the most devastating fighter who ever lived." Cosell went on to say "no fighter ever lived could beat that version of Ali, no one."I think also, when you assess a fighter, you also have to assess how they functioned in defeat - because almost all great fighters taste defeat if they meet enough other great fighters and stay around long enough.Ali's tale in defeat comes against Larry Holmes, in his second to last fight, when he was already desperately ill.Ali retired for the first time - we are not counting his forced, 3 1/2 year "retirement" from 1967 to 1970 when he was barred from boxing - on September 15, 1978 after he regained the title from Leon Spinks. He was almost 37 when he retired, had been in 59 fights, 56-3, with losses only to Joe Frazier, Ken Norton, and Leon Spinks.Two years later, King offered the almost 39 year old Ali $8 million dollars to come out of retirement, the largest amount of money he was ever paid, and face Larry Holmes, who by then had defeated Ken Norton, and become the WBC champion.Ali, already badly ill with Parkinson's, could not pass the standard fight physical and the Nevada State Athletic Commission had the former champion examined at the famed Mayo Clinic as a pre-condition to being granted a boxing license.Ali checked into the clinic on July 23, 1980. His neurological exam was conducted by Dr. Frank Howard, whose tests and examination recorded: Ali literally could not touch his finger to his nose, (he could not get closer than an inch to his nose), he had difficulty in coordinating the muscles used in speaking, and he did not hop on one foot with even standard agility for a man his age.Nonetheless, incredibly, Dr. Howard found no specific condition to prohibit Ali from fighting. The Mayo Clinic report was given directly to the Nevada State Athletic Committee, but it was not made public. Based on the report, Ali was granted a boxing in Nevada.In addition to being unable to touch his nose, speak normally, or hop up and down the way a man his age should, the champ was vastly overweight, and had to starve himself down to be presentable for the fight.And not only should the Parkinson's have stopped the right, his own medial team nearly killed Ali. Dr. Charles Williams, who was a member of Ali's medical team, believing that Ali had a thyroid imbalance, had prescribed one tablet of Thyrolar per day.Thomas Hauser, in his book Muhammad Ali: His Life & Times, wrote:“Thyrolar is a potentially lethal drug, and no one on Thyrolar should engage in a professional fight."Incredibly, Ali doubled the dosage with his team's knowledge because he "thought the pills would be like vitamins."Known side effects of Thyrolar include fatigue, sluggishness, headache, increased blood pressure, tremor, nausea, increased heart rate, frequent urination and weight loss. The drug also can impair the body’s ability to cope with heat, causing dehydratation then heat stroke.Against Holmes, Ali on fight night was weak, fatigued and short of breath from round one on. His body wasn't able to cool itself properly, and his temperature rose. That, Dr. Williams would later acknowledge:“Led to heat exhaustion that went into heat stroke with an immediate period of slight stupor and maybe delirium." He added, "I may have placed him in jeopardy inadvertently."Ali's former physician, Dr. Ferdie Pacheco, told Hauser:“Ali was a walking time-bomb in the ring that night. He could have had anything from a heart attack to a stroke to all kinds of bleeding in the head."Four days after losing to Holmes, Ali checked into UCLA Medical Center. Dr. Dennis Cope, who supervised Ali's stay, determined:“That prior to medical intervention, Muhammad's thyroid gland was functioning properly."In other words, Dr. Williams had almost killed Ali for a thyroid problem which did not exist.Dr. Cope found it beyond belief he had actually tried to fight in his condition.In a fight he never should have been allowed to make, Ali's corner threw in the towel with him on his stool, suffering heat stroke symptoms, but wanting to continue. Though Holmes had won every round, he never succeeded in knocking Ali down or out.Angelo Dundee, till his dying day, said the most courage he ever saw a fighter exhibit was Ali getting off the stool, in heatstroke, unable to even lift his arms enough to ward off punches, and trudging forward, defenseless, round after round, because, as he whispered to Dundee after round one:“I can't quit, man, I can't quit. I got to try."That incredible courage in the face of defeat has to count.But there is yet more. I think, in assessing any fighter's place in history, you have to also assess their impact outside the right. Joe Louis, for instance, whom I would rate second to Ali, was a huge influence in the 1930's and 1940's in this country.And then came Ali. When he resisted induction into the Army, and stood up to the racial inequity so blatant at that time, emphasizing the unfairness of the draft, and the racism so casually prevalent in America at the time, many people were angered. But most came to respect the fact that a man who could have fled the country, made tens of millions of dollars in exile while living in adulation and comfort, instead stayed, risked prison, to fight for change.And the Supreme Court said that the Government was wrong, that he was improperly drafted and President Obama said best how the vast majority of Americans came to feel about Ali and the draft: “At the time it would earn him enemies on the left and the right, make him reviled, and nearly send him to jail,” Obama said:“But Ali stood his ground. And his victory helped us get used to the America we recognize today.”Joe Louis, who served during WW2, said about Ali resisting the draft:“At first I didn't understand, but as time passed I did. He was right, you know, and it cost him a lot."Floyd Patterson, who opposed Ali's stance on the draft at first, said later on:“People, including me, know he was right, right then, and right now, on the draft and Vietnam."The New York Times, after Ali rescued 19 hostages in Iraq in 1990, said:“However great he was in the Ring, Ali is greater as a human being. Despite being ill, the Champ has given millions of his own money, raised tens of millions more for charity, to feed people, for medical treatment, and perhaps most importantly for a man who is ill, he donates his time to help others. His recent trip to Iraq to rescue hostages held there, during which he ran out of medications he must take, and which caused him considerable suffering, is an example of one man reaching out to help others with no regard for his own health or safety."After retiring from boxing in 1981, at age 39, Ali focused on religion and charity, until his declining health prevented him from public appearances. Ali donated millions to charity organizations and disadvantaged people of all ethnic, racial and religious backgrounds. He helped raise tens of millions more.Ali helped to feed more than 22 million people afflicted by hunger across the world. He never asked for, or wanted, praise for these efforts.Among his many charitable efforts, Ali worked with the Michael J. Fox Foundation for Parkinson's Disease to raise awareness and encourage donations for research. In 1987, the California Bicentennial Foundation for the U.S. Constitution selected Ali to personify the the U.S. Constitution and Bill of Rights. Ali rode on a float at the following year's Tournament of Roses Parade, launching the U.S. Constitution's 200th birthday celebration.In 2012, Ali was awarded the Philadelphia Liberty Medal in recognition of his lifelong efforts in activism, philanthropy and humanitarianism.On a personal note, on January 19, 1981, in Los Angeles, Ali was in Los Angeles when a man out on 9th floor ledge talking about jumping mentioned the champ. Ali was notified, and rushed to the scene, and talked the suicidal man down from jumping off a ninth-floor ledge, an event that made national news.Ali simply said he was glad he could help and said the first responders should get the credit and were the real heroes.But perhaps nothing sums up Ali's life, and who he was, than what he did in 1990. That year, Ali went to Bagdad as the first Gulf War was looming, to try and free 15 American hostages being held by Saddam Hussein. Ali, already significantly disabled with Parkinson's, ran out of his medications while in Bagdad, and endured very real suffering, yet refused to leave, and persevered until Saddam allowed him to take all 15 American hostages home to their families.On Dec. 2, 1990, Ali and the hostages flew out of Baghdad, headed for JFK.The men remain overwhelmed to this day:“You know, I thanked him,” said former hostage Bobby Anderson. “And he said, ‘Go home,’ be with my family . . . what a great guy.”Ali asked the media not to make the story about him, but about the hostages and their reunited families.All fighters who hit the big time are generous with their friends and family. The only ones notable for charity to people they do not know are Ali and George Foreman.Can there be any doubt that Ali was the greatest fighter ever in terms of his impact on national and world consciousness? No, there can be no doubt.Who said so? The New York Times, among others.Can there be much doubt he was the greatest heavyweight boxer of all time? NO, to practically everyone who knows boxing.I will close with my favorite Muhammad Ali stories: when he was a fighter, on the night he stunned the world and beat George Foreman, sensing the mood in his dressing room he asked: “What’s wrong around here? Everybody scared? Scared? A little thing like this? This is like another day in the gym.”And on September 10, 1966, a young Ali defended his title in Frankfurt Germany against Karl Mildenberger as part of his "European tour." He was tired and stressed by a return to the USA to continue his fight against the military draft, but he won the fight nonetheless. In the 12th round, with Mildenberger on the ropes, referee Teddy Waltham stopped the fight.At the airport the next day, Waltham’s fee of 1,000 pounds was stolen. Waltham, who was counting on the money to pay his mortgage and bills, was distraught. When Ali heard, he gave Waltham the money from his own pocket.When asked about the incident, Ali shrugged it off, saying:“Man, don't make this a story, he needed the money more than I did."He really was the greatest, both in and out of the ring.And those are the real facts!CREDIT TO:Ali: A Life by Jonathan EigCox’s Corner and Monte CoxMuhammad Ali: A Life by Thomas HauserMuhammad Ali: A View From the Corner by Dr. Ferdie PachecoThe Greatest: My Own Story by Muhammad AliThe Los Angeles Times’s accountThe Real Ali by Rahman AliWhen Muhammad Ali Met a Man on a Ledge