I’m one of those guys who always wanted to be a physician. It was a passion of mine.

I grew up in El Paso, graduated from Coronado High School and headed off to Baylor University where I earned my undergraduate degree. After graduation, I spent a year in a post grad program in physics. But medicine remained my goal and I enrolled in the University of Texas Medical Branch at Galveston. I graduated from med school in 1981.

After my residency in family medicine, I practiced in Fort Worth but returned to El Paso in 1989 and have been there ever since.

I’ve been practicing medicine for 35 years and still love what I do. Many of my patients have grown up with me. And now, 30-plus years later, many have stuck with me. Over time, my “family medicine practice” has morphed into geriatrics. My patients and I are aging together.

Some of my patients struggle with a variety of conditions including diabetes, hypertension, cholesterol, osteoporosis, and a surprising amount of depression. The rigors of life and family, aging and unmet expectations, loss of friends and family often trigger depression. Some older people turn to alcohol and drugs to try to ease their depression. Yet this self-medication only makes things worse.

We all must face up to some hard facts of life, me included.  I’m 66 years old. I understand as we approach 70 or so, we realize we won’t be an astronaut or fireman or a professional football or soccer player. And that, in and of itself, can be depressing.

But there is good news. Depression is treatable, often with a combination of medications and talk therapy.

The payoff for me is to see patients overcome their struggles, to regain a quality of life they thought they would never see again. Some patients are compliant. They follow their doctor’s recommendations. They take action.

But not all of them do so.

I still see patients who smoke cigarettes, and who chew and dip tobacco products. They all know the risks, and I don’t try to take their cigarettes or other tobacco products away from them. That never works.

Our nurses and I provide counseling. We try to instruct patients on the dangers of their behaviors. We encourage them to change their lifestyle, to modify behavior. We encourage them to consider a change. And sometimes that works.

For example, we know exercise is in many ways a magic bullet when it comes to treating Type 2 diabetes. So I tell my patients to “walk away from diabetes.” To get up off the couch. To get active. Walk to the mailbox. Walk in a shopping mall. Park at the rear of the lot and walk to the store.

That works with some patients. But not everyone.

I had one patient who at every clinic appointment would show me her pedometer (a device people wear to count steps). It registered 10,000 steps or more a day – confirming she had walked that far every day.

But the patient wasn’t losing any weight. She wasn’t feeling any better. I was puzzled by that until her husband told me privately she had strapped the pedometer onto her dog who wore it as he walked around the house and their yard. I gently discussed the matter with my patient – healthy dog doesn’t always equal healthy human.

Exercise is part of my life. I am a golfer, but walk the course rather than ride in a cart. I also like to hike. And I ski nearly every weekend in the winter. I do this for me, but it does set an example for my patients as well.

One final thought. El Paso and Ciudad Juárez are border cities. As a result, some of my patients cross the border and to purchase antibiotics including penicillin and Zithromax, which may be easier to obtain in Mexico. They are self-medicating. But in doing, so they are contributing to the growth of antibiotic-resistant bacteria – the so-called “Super Bugs.” I understand why patients make those purchases. But I wish they would not do so. It’s putting all of us at risk.