Posts filed under ‘true story’

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

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

Difficult success

This elderly lady came in after recent back surgery. More than that, after her 6th back surgery!! For any one that knows about medicine that is a daunting thing. The success rate of back surgeries drops exponentially with each surgery and after the second or third the success rate is hardly measurable. At any rate that was not the problem. The problem was overwhelming pain two weeks after surgery. Pain so bad that she could hardly survive, could not rest, was in constant misery and nothing gave her any relief.

I entered the situation when the significant efforts of her surgeon became pointless and he sent her to my office. I was shocked (and it is hard to shock me) that she was already on oxycodone 15 mg and she was taking them every 2 hours! That is a hefty dose for someone as big as me, much less a 77 year old lady. Moreover it was barely helping at all, it was not even sedating her. She could not sleep, could not eat, and the pain was effecting her thinking. It took significant effort for her focus on questions, the pain was so intrusive.

I talked with the surgeon to make sure I was up to speed on what he had done and discovered that this was the upteenth surgery on her spine! Ouch! I had the huge advantage of knowing the patient and her husband for decades. They worry enormously about each other and in fact her husband has lost nearly thirty pounds because he cant eat, he is so worried ( and he is very thin to begin with). She constantly worries about his heart and that he will not be able to handle the stress of her problems.

Knowing that narcotics have not helped the pain is a great help, it narrows down the scope of what could be wrong. She felt miserable and complained of pain ‘all over’ so I had to push her to focus on where the sever pain was (started). I finally found an area two inches to the left of the incision where I could feel a series of muscle spasms and she reacted to light presure with significantly increased pain– A trigger point. I decided that the problem we were not dealing with was two fold, tremendous anxiety and worry plus the muscle spasm ( imagine a charlie horse in your back, one that you cant straighten out and relieve). Muscle spasm are nearly impervious to narcotics, I dont know why but that is they way they are.

I first injected her with a hefty dose of Valium. One of the world’s best drugs. Extremely safe when used appropriately, a great anxiety reliever and a very strong muscle relaxer, all in one. I waited 10 to 15 minutes while I prepared a Cortisone injection and then I placed it all around the tender spastic area. All the while assuring her that I would do everything I could to prevent one more sleepless pain filled night.

Within ten minutes her entire demeanor changed, she was not constantly fidgeting, she stopped fretting about the pain, she began talking about how hungry she was, the turnaround, although, significiant was not complete.

There were two additional things, she was worried the pain would return and she began to focus on other issues. I realized that her overall issues were 50% enormous pain 50%anxiety and 50% insecurity. I had only dealt with the pain and some of the anxiety.

Over the next day I continued with the valium, talked to her on the phone to reasure her I was not abandoning her, saw her again the next day and injected a less tender spot that was masked initially but most importantly told her how good she was doing. I pointed out  everyone of the pain based behaviors she had stopped and the abilities that she had not regained. She was standing unaided adjusting her dress! She walked out without discomfort!

Once I got her focus on her improvement and that I would be there for her, She completely morphed into her old self. She had needed to be shown that things were better.

I am happy that she is so much better and now we have a plan of attack should the problem recurr ( and no narcotics!) but it took nearly every bit of learning and experience I have had over the past 20 years, good thing I was on my game that day.

12/20/2014 at 5:56 AM Leave a comment

The danger of Stink Bugs

Monday night an elderly man shows up with an eye problem. He is a sweet man who, despite his age, manages the entire household because his wife is debilitated.
He complains of irritation in his left eye. The story begins with the laundry. Upon removing the clothes from the dryer he notices a stink bug in the drum. He cannot see well enough to notice if the bug survived the drying cycle ( unlikely in my opinion but what do I know?) he picks it up with his hand and brings it to his face to get a good look and see if he is moving when the bug explodes! Into the affected eye.
Luckily his eye only received a little thermal damage and none to his cornea. a few drops, a patch and he was on his way.
My deduction is that the intense heat of the dryer caused steam to build up inside the bug and his shell contained the pressure until he picked it up and put stress on the exoskeleton, upon which a small steam explosion occurred.
The smell was reportedly awful.
Perhaps someone will experiment with the ubiquitous critters to confirm this theory but if so, they will have to steer clear of PETA.

12/18/2014 at 2:57 PM Leave a comment

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