Posts filed under ‘Doctor Musings’

Surgery

Surgery went well. It turns out that I rather liked the spinal anesthesia. I had been worried about it but the pain control was awesome without any noticeable effects. I woke up feeling good, no nausea whatsoever, my dear wife provided the starbucks and as far as i could tell my body ended at the belly button. The first night was rather difficult because in addition to the normal interruption for vital signs, menu  orders, etc. my blood pressure decided to drop in the middle of the night. I felt good, without any signs of low blood pressure but no matter how they took it, my systolic was under 80mm Hg and diastolic was somewhere in the 40’s. Not something they were happy with. So they decided to take it more often–every fifteen minutes in fact. that was not conducive to any sleep whatsoever.

Then the results of my post op blood draw came back and I had dropped my hematocrit by 10 points. Which is the equivalent of 3 units of blood, not an insignificant amount. Still my overall level wasn’t too low and without symptoms they decided to recheck it in an hour or so to make sure it was not a lab error. NOPE. same reading, and again in the morning when they checked it again.

The surgeon was clear I had not lost much blood so it is a mystery where it all went to. some of it could be dilution. this occurs when we give a lot of IV fluids ( in my case to raise up the blood pressure) and the blood is diluted so the reading is erroneously low, but that does not explain all of it.

Nevertheless I still got out of the hospital the next day and made it home for my snake nightmare (see prior post). I remember the surgeon asking about pain and i was still doing well. He then said that would not last and I would be having severe pain soon. Not something one likes to hear. He gave me lots of narcotics, more than i thought was called for. let me tell you, I was wrong. I am normally hesitant to take such medicines but over that past week I have overcome that preference. The pain although only occasionally severe is continuous and persistent. it wears you down, then my mood goes and I don’t want to be around anyone. it gets in the way of doing my exercises. So despite the severe nightmares that I attribute to the narcotics, I lay them out and take them on time. Like I told my physical therapist, I had to resort to my last resort: following directions.

I have had one great day, two good days and several tough days. on the good days I wonder why I can’t go to work. on my bad days I wish i had never considered the surgery. On the plus side my physical therapist says I am way ahead on my mobility. On the minus side, I have a ways to go before i can resume my aerobic activities ( a huge anxiety reducer).

Yesterday I went to the office for a meeting and to do some paperwork. I felt great getting back into my routine. I even wanted to find a patient or two to see. But soon enough the fatigue caught up with me and by the time I got home i crashed for a couple of hours. It took the rest of the day to fully recover. I guess this is going to be harder than I anticipated.

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04/04/2015 at 10:24 AM Leave a comment

Learning from the young

I just had my second root canal in two weeks. The first one was an endurance event with four roots. The significance was the skill of the endodontist at administering the lidocaine nerve block. He used a very small needle, made a gentle initial insertion with tiny bits of novocaine, then waited for that to take effect before giving the rest. Nearly painless.

From the start I worked hard at accomplishing what he does and indeed I generally am able to succeed, however… it became obvious to me that I have slacked off and have relapsed into a habit of being quick. But the experience these last two appointments was so pleasant that I will once again start over to see if I can reach the level of skill this young dentist has accomplished.

03/11/2015 at 12:47 PM Leave a comment

While speaking of fossils

Just over 26 years ago I was fresh out of Residency, ready to start my new practice, full of an arrogance to which only youth can do justice. In my defense it was not a personal arrogance but more of a training arrogance. I had just completed 7 grueling years of training (post grad school) in which I worked up to 100 weeks and the amount of material I knew was phenomenal.
So when I was introduced to one of the more established Family Doctors in the area, who had been part of the vanguard that established Family Practice as a Specialty of its own, I remember thinking how nice and laid back he was, but also how much of a fossil he was. How could someone that old have kept up all these years; with the massive amounts of evolving medical knowledge and technology?
So, just the other day I was reviewing a resume of an applicant for a receptionist position and it mentioned that she had worked for this old MD.
And it hit me, I am at this point the same age as he was when I thought him a fossil!
Actually, I looked him up and it turns out I am four years older than he was at the time.
So that is what young, newly minted docs think of me now.–Wow.
Karma waited a quarter century to send that thought boomeranging back to me.
I told my office manager that she could call me Dyno from now on, in an effort to keep me a bit more grounded.

03/03/2015 at 8:04 AM Leave a comment

laughter a multi-pronged tool

I will admit that I not only love to laugh, I particularlly love making others laugh. Specially a deep, gut, unexpected laugh. And its value in creating a good doctor patient atmosphere would be hard to overstate. However, unbeknownst to most of my patients is the  many other uses to which I put such a common human reaction. 1. humor is complicated, it requires the brain to make unexpected associations and in many cases to keep several items in memory. In this way I find it useful to determine how a patient’s brain is functioning; usually in the evaluation of dementia, depression but also post concussion and severe illness. 2. It requires lots of air to laugh which makes this very useful in my younger patients, say 2 or 3 years of age. they won’t take a deep breath on command with a stethoscope on their backs but get them giggling or laughing and you can hear how they are breathing. Going forward I find that children are not as scared of coming back if they expect ‘the silly doctor’ to interact with them. 3. If you are depressed, particularly significantly so, or if you are feeling quite miserable it takes too much energy to laugh, although by looking at their face I can tell if they ‘got’ the humor. It helps me sort out who is hurting much more than they are saying and also the opposite. 4. it is a huge distraction from whatever the current complaint is and timed appropriately it allows me to examine a joint, or belly or lump without them anticipating pain, or in other cases from amplifying the pain. 5. It makes the time that we spend together more pleasant and perceived as longer or at least as more connected (IMHO) and further compensates for any waiting time they had. 6. It softens patients perception of me in my role as a doctor with all that comes implied with that. Makes me much more approachable by both adults, elderly and as mentioned above, children. Approachableness is hard to overestimate, it allows for a much better interaction, better data collection, better patient recollection, and more willingness in the patient to remember and follow directions.

02/28/2015 at 11:56 AM Leave a comment

To be a Hero

I tell students and young providers that one of the greatest things about being in Family Medicine is that one gets to be a ‘hero’ on a daily basis.
I don’t mean ‘hero’ like: running into a burning building and rescuing a kitten-hero, but more like: significantly improving peoples daily lives-hero.
Sure, occasionally we can catch a deadly issue in time to prevent something, but more often it is convincing someone to pay attention to their diabetes, or to try an antidepressant, to give them ‘permission’ to put their health above their work, or to create an atmosphere where they patient feels comfortable enough to tell you the truth.
We occupy a place of trust and it is an amazing opportunity that sometimes I forget because it is all I know. I get to see a side of people that is not shown to others. Most of the time it is a very endearing side, occasionally a dark side, either way they allow me in to their worlds and in many cases be a minor hero in their lives.
On days that I am particularly stressed, tired, frustrated. I try reminding myself of the privilege that is given me on an hourly basis. It nearly always perks me up.

02/22/2015 at 2:57 PM Leave a comment

Surgery awaits

It has been a quarter century since I severely injured my knee during a soccer game and it will no longer be put off. Despite a significant amount of weight loss the knee is now worn out and has been impeding my exercise; now it is getting in the way of some of my daily activities. So I am now in the role of patient awaiting surgery.

It is a remarkably uncomfortable role and I find myself second guessing my decision to have a knee replacement. By all logic i have let it go far too long but I keep wondering whether I could/should put up with the pain and instability another year. I find this patient perspective rather educational. I am not worried about a poor outcome, or the anesthesia or the recovery; rather a vague fear of being vulnerable and obtusely being absent from work for the such a long time. I have not missed work for more than three weeks since I was a young man, and the prospect of being out for over a month is terrifying. I am not sure whether I am more scared of being bored or of enjoying my time off.

Being in the patient role helps me understand my patients better; there is a lot to be learned by going through the process; thing that i can use when my patients exhibit the same feelings. Nevertheless it is six weeks until the knife and I find myself conveniently ‘forgetting’ it is looming on the horizon.

Then there are the multitude of logistical issues to handle: informing patients I will be out for a month, setting up a system to run the office while I am away, making sure that patients have sufficient refills on medicines, reassuring patients that the covering doctors are just as capable, etc.

02/18/2015 at 12:18 PM Leave a comment

New Record!

For the last ten years or so the all time record for amount of alcohol consumed by one of my patients (at least what they admit to) has steadfastly remained at one case or beer a day. No, I did not have the presence of mind to ask which beer; I presumed it would be the cheapest available because we are not talking pocket change, we are talking luxury car payment money!
Last month a patient had a rather unfortunate reaction to a very common and benign medicine probably due to the unknown amount of alcohol he has consumed for the better part of his 50 years. To his credit he has not had a drink in over a week ( since his health issues reached a crisis) and he quit tobacco two months ago so he has the commitment to pull this amazing twofer off.
However, he admitted to drinking a gallon of Wild Turkey over a weekend on a regular basis. That is 128 shots of whiskey! the calories alone (9000) are off the chart. I do not know how much he drank during the work week but either way he blew away the previous record.
Considering my age I do not expect this to be surpassed.
How he remains at a healthy weight is beyond my understanding. I have to watch every morsel that goes into my mouth, exercise for an hour a day simply not to regain any weight.
Lucky for him the recuperative powers of the liver are astronomical and if he is able to abstain, he may well have a good prognosis.

02/14/2015 at 12:11 PM Leave a comment

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