Friday, September 30, 2011

Tell me what you really think?

This is an actual quote from an 83 year old male ( 83 year old) with a thick New York accent (the word "frickin" will be substituted for the actual word used):

"I have a frickin problem. The fricken 60 mg heart pill that I take twice a day has taken away my frickin ability to have sex. I looked it up and it's a blocker (a calcium channel blocker). It's blockin my ability to get one (he then raises his arm with a fist to simulate what he can't get anymore). I'd rather be frickin dead. I basically live for sex and food. I love my gal so much and like to have sex twice a day, everyday. I even took Viagra but all it did was give me a frickin headache. You gotta change that frickin medication. I need to frickin get back in action."

I let him know I would do my frickin best to help (actually, everything except the frickin part).

Thursday, September 29, 2011

Both socks before shoes?

A 51 year male was depressed.

He had gone to see a psychologist and declined to ever go back.

He was upset.

He finally filled me in on why he was so upset.

Patient: He (the psychologist) asked the stupidest questions. I went along with him for the most part but finally got up and left when he wanted to know if I put both socks on before I put on my shoes or if I did one side at a time.

His wife confirmed his statement. She was with him at the time.

Patient: What did that have to do with me being depressed?

Me: No clue. I think I would have gotten up and left as well.

Of course, I thought about it for the rest of the day. I'm pretty sure I've done it both ways in the past. I'm sort of afraid to ask a psychology colleague what it means.

I'll pass.

Wednesday, September 28, 2011

Just fine the way he is

Mr. C., a 62 year old, came in for a physical exam.

When I asked him to drop his underwear so I could finish his exam he stated:

"There ain't much there to check but I've always thought I've had such a good time with what little I've got I don't think I could stand to be any larger."

He laughed and so did I.

Well stated, I thought.

Tuesday, September 27, 2011

His Vow

I've seen Mr. R., a 51 year old, three times for medical visits.

The first two visits were for acute problems.

The third was for a full history and physical.

He's always worn all white (a white shirt, white pants, white belt, white socks, and white shoes).

Finally, on our third encounter, I had time to ask the obvious:

Me: I've noticed you always wear white (I figured he would be impressed by my astute skills of  observation).

Mr. R.: Almost ten years ago my daughter was diagnosed with leukemia. I prayed and asked GOD to cure her. I also vowed to wear white for the rest of my life, as long as she was still alive. She's still doing well.

Me: That's great news. Thanks for filling me in (I had no idea his reason for wearing white would be so impressive).

Monday, September 26, 2011

Best choice

The single most best choice, I've ever made, was getting married exactly 19 years ago.

I'm a lucky man.

Sunday, September 25, 2011

His good name

Darrell P. is 52 year old male who just moved to Florida, from New Jersey, to be closer to his daughter and grandchildren.

He let me know he was going to start a business down here.

He had a heating/air conditioning business up north.

He was studying for the state licensing exam since every state has slightly different rules and regulations.

Me: What are you going to call your company?

Darrell P.: Darrell's Heating and Air Conditioning, just like it was up north.

Me: How did you come up with such an original name?

Darrell P.: Oh, I just (he then saw me smiling)'re busting my chops aren't you (he then smiled)?

Me: Actually, I can't think of a better name.

Darrell P.: Thanks. You know, I've never had to advertise. I've always had such a good reputation that all my business comes from referrals. I know I'll just need to get my first job down here and then my business will start rolling. My motto has always been "we will make you smile." My customers knew I would always take care of them and always make things right. I'm proud to have my name on my company.

Me: You should be. Thanks.

Saturday, September 24, 2011

Spoken (unspoken)

Nurse: Your 8 AM patient is ready to see you now.

Me: That's great (since it's almost 9 AM).

A little later...

Nurse: I just roomed your third 9 AM appointment.

Me: OK (too bad we don't have more folks to put in the same time slot).

A little later...

Nurse: Are you ready to see your 10 AM appointment?

Me: Sure am (especially since it's 10:55 AM).

A little later...

Nurse: Doctor ___ had to leave urgently on a family emergency. Can you see his patients for him?

Me: No problem (just let me check to see if my clone is available to help).

A little later...

Nurse: I need you right away in the treatment room; Mr. ___ is complaining of crushing chest pain. He didn't call 911 as he was advised to when he called from home.

Me: I'm coming (so I can do my best impersonation of an ER doc).

And so starts the beginning of another week seeing patients.

Over the years, I've always just tried to operate under the assumption that most days in the office are going to be controlled chaos.

When it's not, it's a bonus.

No one ever said being a primary care physician would be easy.

Just try to limit your sarcasm (to under your breath, unspoken, comments) and always pack a lunch to eat between seeing scheduled and unscheduled patients.

No matter how crazy things are, it still gives gives me a lot of satisfaction and job security (and also gives me plenty of ideas for this blog).

Friday, September 23, 2011

What's next?

I have an 86 year old patient who is always brought to appointments by his 64 year old daughter.

She's a beautiful women but always seems to have had some more "work" done on herself every time she brings her Dad to see me.

She had a face lift a few years ago.

She has fake eyebrows as a result of the face lift.

She then had her neck done since it looked odd next to her perfectly smooth face.

Her large breast implants are usually accentuated by her choice of shirts.

Recently she came in with new, bright white, perfect teeth.

Even more recently she came in wearing post-op boots on both feet.

She had some of her toes straightened.

She has made comments about not being sure what she is going to have done next.

These comments are usually intermixed amongst statements made about her Dads medications being too expensive.

I usually just nod my head but, honestly, I'm quietly wondering what's going on in her personal life.

I haven't asked her since she isn't my patient.

I haven't told her she was a beautiful women before she started having all her work done since it might be deemed inappropriate.

I'll just wait until she brings her Dad in for his next visit to look for the new bandages.

Thursday, September 22, 2011

Guilt free results

A 63 year old male was having a problem.

He met his new girlfriend on the Internet months ago and they had already shared many great weekends.

They hadn't attempted to be intimate until recently.

When they did he wasn't able to perform.

"It" had NEVER happened to him before.

He wanted a prescription for Viagra.

He reported being attracted to her.

He reported respectful communication.

He didn't feel threatened or intimated by her.

I finally asked if he felt guilty about anything (I couldn't think of any other questions to ask).

He said she's 53 years old and she thinks he's 53 years old.

He lied to her the first time they communicated on the Internet and hadn't come clean since.

He actually could have passed for 53 years old.

I told him that.

I let him know he didn't need Viagra.

He just needed to tell her the truth.

He stopped by three weeks later to briefly talk.

He was able to tell her and his apology was graciously accepted.

They were still together.

He also let me know that all was back to "normal."

He did not need Viagra.

Wednesday, September 21, 2011

An attitude adjustment

Mr. T. is a 65 year old male who seems to really enjoy life.

His hobbie is wood working and he shows his products at a number of different craft shows in our area.

He seemed to be in a particularly good mood when I saw him recently and commented to him about it.

Mr. T.: I just had a great weekend. You should've seen the joy on the face of these two kids when their parents bought a Fort I had made.

Me: How did you make it?

Mr. T.: I had a couple of bags of Popsicle sticks that I wasn't using for anything and decided to try and build a Fort. I didn't have any plans, just started building it. By the time I was finished it was complete with a wall around it, watch towers, walkways and even swinging gates. I went to the dollar store and was able to get some toy soldiers to glue at different spots. It looked great when it was done.

Me: Did you take a picture of it before you sold it?

Mr. T.: No, I should have.

Me: How long did it take to build?

Mr. T.: Just a few days. Almost cut off the end of my fingers a few times with the Exacto knife. It's a lot harder to cut the Popsicle sticks than you would think just looking at them.

Me: How much did you sell it for?

Mr. T.: $20. It was my only sale for the day but it helped to pay for the booth for the weekend.

Me: That's great.

You know, it had been a hectic day and I was in sort of a bad mood before spending time with Mr. T.. Seeing the joy he experienced with his $20 sale sure helped give me an attitude adjustment.

Tuesday, September 20, 2011

Three balls

It was a lot of fun to meet Dr. R., a 74 year old dentist, who still saw patients three days a week and still had a great sense of humor.

Prior to going into private practice he had a 27 year military career.

During the medical history he noted that his only past injury was when he got kicked in the testicles as a teenager.

Dr. R.: Ever since then I've had three balls (of course one was an organized hematoma). In college my frat brothers always called me quarter dozen (he laughed).

Quick math: A quarter of a dozen is three.

It took me a second to do the math.

Me: How did they find out? What were they doing checking out your scrotum?

Dr. R.: I had a little too much to drink one night and let it slip.

During the review of systems he remarked that he was finally ready to be evaluated for hearing aids.

Me: Is it bothering your wife (often it's the spouse that seems to "encourage" men to get hearing aids)?

Dr. R.: No, she has bad hearing also. We just now think each others name is What.

He laughed.

So did I.

Monday, September 19, 2011

To shave or not to shave, that is the question

Lately, it seems that a lot of the younger men who come in for a physical exam have shaved all their pubic hair.

Initially, it sort of surprised me.

Now, I've sort of come to expect it.

Here's some potential reasons I've come across:

1. Religious reasons: all the male nudes on the ceiling of the Sistine Chapel are hairless below the waist.

2. Aesthetic reasons: a cleaner, more contained aesthetic look is in vogue for pubic hair.

3. Cleanliness reasons: the crotch is a focal point for heat, sweat and bacteria.

4. Health reasons: to make sure you don't have a rash or other unwanted critters and to make testicular self exams easier (yep, most are also shaving their testicles as well).

5. Self esteem reasons: the penis will appear longer due to removing the hair that often goes at least part way up the shaft.

Although I suspect I know the main reason, from the list above, why many choose to shave, I think I'll just continue to be "old fashioned" concerning that aspect of my own body.

Sunday, September 18, 2011

Some one liners from the past week of patient care

An 87 year old male: I think I'm still doing quite good; I've still got my teeth, no hearing aids and my mind.

A 53 year old male, when asked if he still smokes: Not no more so much (he finally admitted to smoking less than 5 cigarettes a day).

A 36 year old male, with a BMI of almost 50 (ideal is less than 25), when asked how everything went with his visit to the nutritionist: She basically told me I needed to drink water and eat lettuce and carrots, so I told her this conversation is over because I don't have big ears, a fluffy tail and my name isn't Bugs Bunny.

When I asked a 76 year old widower, who was requesting Viagra, if he had a new girlfriend: No, but I do rent one every once in awhile.

Saturday, September 17, 2011

Strong ties

I had a nice visit with my Mom recently.

She will celebrate her 80th birthday this year.

My parents always made sure we (my 2 brothers, sister and I) recognized the importance of our immediate and extended family.

As the youngest child, I had the opportunity to get away with a lot more than my siblings.

Looking back, I was able, for the most part, to make good choices when a lot of other kids did not.

It wasn't that I didn't want to try something that might be illegal or risky.

It was because I always worried that if caught, it would bring shame upon my family.

Having a strong family bond usually allowed me to make good choices.

I hope it will do the same for my kids.

Friday, September 16, 2011

Bet that hurt

A 50 y/o male had a concern about a very sensitive private part of his body.

He was embarrassed to show me and even more embarrassed to let me know how it occurred.

After he confided in me, we did laugh together.

He, in fact, did have a significant superficial abrasion and would benefit from an antibiotic to prevent an infection.

Without revealing too much information, he was advised to encourage his partner to fix the jagged edge of the denture (that had fallen into his lap while they were being intimate) or to just keep it out altogether in the future.

He agreed with my expert medical advice.

Thanks again Dad

My Dad would have been 83 years old today.

He was a great role model (as a husband and father).

I'm very thankful.

Thursday, September 15, 2011

Made my day

I saw Mr. B., a 64 y/o male, for the first time while covering for a partner who was out. He came for medication refills.

Me: I see you have a bag with your pill bottles. What do you take?

Mr B.: A nerve pill, a sleeping pill and a pain pill (said with a deeeeeep southern accent).

Me: Now that's a southern accent. Where are you from?

Mr. B.: I've lived here (in Florida) for the last 40 years but I'm from L, A...lower Alabama (he then laughed).

I quickly determined that this visit could be a lot more interesting than just a medication refill.

Me: Can you tell me a little more about yourself?

Mr. B.: You bet doc. I'm just a country boy from L, A, lower Alabama (he laughs again). When I got drafted I joined the Army and was a Quartermaster in Vietnam. One day in '67 I was working on the laundry and supplies and heard a "whee" sound and the next thing you know my guts were hanging out (puts his hand over his right lower quadrant) and I had a terrible stinging in my left shoulder. I was already on my second tour and only had about a month to go but those wounds got me sent home (he unbuttons his shirt to expose a severely scarred right lower quadrant and a large keloid on his left shoulder). I've still got a lot of the shrapnel inside.

Me: Did you get a Purple Heart?

Mr. B.: Sure did. The commanding officer was real good about looking out for us.

Me: How long did it take for you to recover?

Mr. B.: Almost 5 months.

Me: What did you do after that?

Mr. B.: I just worked for one company since I left the Army; a citrus and juicing plant. I've been a foreman and then became a fork lift operator. I retired last year.

Me: Married?

Mr. B.: Yep, 42 years, three children, 7 grandchildren, no greats yet.

Me: How's your wife doing?

Mr. B.: Fine, but she had a little setback having to get her glowbladder (gallbladder) out a few weeks ago.

I was running late seeing scheduled patients, as usual, but choose to continue. This "interview" went on for almost 25 minutes.

He had another bout of laughter when he told me about getting his teeth out before he got dentures.

Mr. B.: I had 17 teeth pulled out at the same time. That there dentist said how are you gonna get home. I said what do you mean, I drove here so I'm gonna just drive myself home. A little while later my phone rang and that there dentist called me and said are you home? I said what kind of question is that? You called my house and I answered. Doesn't that mean I'm home?

Unfortunately I needed to get on with my day. I thanked him for his service to his country. I let him know it was a privilege to spend time with him.

Luckily, I also remembered to refill his medications.

Wednesday, September 14, 2011

Catching up with my hair

Today is my son's 17th birthday.

Man, I'm getting old.

He was born when I was 34 years old.

He has grown into a responsible, respectful young man that does great in school and sports.

My kids (my daughter is 15) are finally catching up with my hair.

I've had white hair since my late thirties.

When they were younger, a lot of folks thought I was their grandfather.

Now, I get to go to school related meetings and activities and look around at all the other parents with grey and white hair.


Tuesday, September 13, 2011

A frustrating joy

 Mr. R. is a 69 y/o male with poorly controlled diabetes.

He has fired or been fired by two endocrinologists, as well as three different diabetic educators.

The most upset I have ever seen him was after seeing the last diabetic educator.

He reported the person (it was a male) was so rude he "just wanted to reach across the desk and punch him!"

I have been his primary care physician for the last 8 years.

The entire time, his A1C has been greater than 10 (for non-medical folks this means very poor diabetic control).

He's very well read.

Despite multiple long conversations about diabetes, the pancreas, insulin production, gluconeogenesis, the need to take oral medications and insulin, etc., he continues to have his own strongly seated beliefs about how he wants to take care of his diabetes.

His most recent A1C was 14.2.

Amazingly, he does not have retinopathy, his blood pressure is well controlled, his renal function is normal, he does not have proteinuria and has no symptoms of neuropathy.

It's a frustration to have his as my patient.

He's also evangelical, spirit filled, loves life, walks two miles twice a day, doesn't drink or smoke, always verbalizes his thanks to the LORD for his health and always ends visits by thanking me for being his doctor and asking for an update on my family.

It's a joy to have him as my patient.

He's a frustrating joy.

Monday, September 12, 2011

An unwelcome visitor

I've been in the process of a transition in my professional life.

I accepted another clinical position 6 months ago, but due to many issues, have not been able to make the change as of yet.

Lately, I've been having a recurring dream.

I keep dreaming a male is in my bedroom, staring down on me, while holding a large knife in his hands.

Every time this has happened, I've either fallen or jumped up out of bed.

My wife thinks I'm a nut case.

She always makes sure I'm alright but she's also a little irritated since the crash from falling or the jolt of the mattress always wakes her up.

My kids, when given an update on my sleep visitor, just think it's funny.

Many psychologists have pondered, "what do dreams mean?"

I'm sort of afraid to see a dream specialist to get his/her interpretation of this recurrent dream.

I think I'll just hang in there and look forward to finally making the transition to see if it stops.

In the meantime, if you see me with a black eye or a contusion on my head, it's probably just from hitting my bedside table on the way to the floor.

Sunday, September 11, 2011

I remember

I was in the midst of seeing patients when informed, by a Nurse Practitioner I worked with, of the terror attack of 9/11/01.

We were still watching the TV in the waiting room when the 2nd plane hit.

Patient care continued for the day but everyone knew that our way of life would never be the same.

We remember and we should never forget.

That's why

As a kid, my parents always made sure to "be there" for all my sports and activities.

It was always great to have them there, but I noticed they, especially my Mom, would always be looking at me whenever I happened to look their way.

I never understood why.

Sometimes being watched was unwanted, especially at, for instance, a high school dance in which they volunteered to chaperon.

Every time I would just start to get up some nerve to ask a girl to dance, I would look over and see my Mom smiling at me and then lose the nerve to follow through.

It wasn't until I became a parent that I was able to answer why I was always on their radar.

I do the same thing when my kids are in the midst of a sport or activity.

I just try to anticipate when they might look my way.

I'm then sure to divert my eyes.

I don't want my kids to feel like they are always under my constant line of vision.

As parents we have an excuse; we just can't help it.

Saturday, September 10, 2011

Re-programing at the fork

My 2 PM appointment was a "no-show."

The "no-show" arrived at 4:30 PM.

Even though the "no-show" actually allowed me to get back on time seeing my other appointments and walk-ins, I was still annoyed he arrived so late.

He declined to re-schedule when asked by my nurse.

He wanted to be seen.

Patient (when I abruptly walked into the exam room): Sorry I was late but my supervisor wouldn't let me leave on time.

Me: I understand but you could have called to re-schedule.

Patient: No, that's OK. I figured I'd just wait to see you since I had an appointment.

Me: You can ask for a later appointment time in the future if it would work out better for you.

Patient: Oh, I don't need to do that. The 2 o'clock appointment is fine.

Me: You came 2 and 1/2 hours after your appointment time.

Patient: I didn't mind waiting to see you since I had an appointment (he had been waiting an entire 14 minutes).

Me: I'll try to help with whatever acute needs you have then.

Patient: That's great, I have a bunch of things to discuss with you during this appointment...

He either had no idea where I was trying to go with my conversation or he was doing a great job of pretending not to know.

I was at the fork in the road.

Luckily, I opted for the appropriate, professional response instead of listening to the evil voice in my head.

Me: Sure thing, lets go over your concerns.

We reviewed his health concerns and had a long discussion on the emotional turmoil he was experiencing with his ex-wife.

I was able to offer some advice.

I'm glad I was able to re-program at the fork.

It turned out to be a great visit.

Friday, September 9, 2011

I Autta

I met Mr. D. for the first time recently.

He's a widower for the last 7 years.

When reviewing his diet he offered the following information:

"I eat the same thing everyday. I have breakfast at the Waffle house, have a salad at The Golden Corral for lunch and get the Colonel's's chicken pot pie (at KFC) for dinner. The Colonel makes a great chicken pot pie you know. It's packed full of vegetables."

When I acknowledged the pot pie does sound great he let me know that I "autta get some."

I think I autta.

It appears to be an amazing recipe for health, except for maybe the Waffle house part.

You can't argue with the results.

He's 91 y/o, cognitively and functionally intact, still drives, still has his teeth, denies falls, incontinence and works part time for his church.

Thursday, September 8, 2011

A little; no, an occasional; no, all day long

An 81 y/o male was seen last week.

His cardiac exam was abnormal and an EKG confirmed he was in atrial fibrillation with a heart rate in the 130-140 range.

He was asymptomatic.

Recent labs were normal.

Me: Do you drink alcohol at all?

Patient: A little; only an occasional glass of wine. I don't drink any hard stuff or beer.

Me: Really, that's all?

Patient: That's all.

I decided to control his heart rate with medication and start warfarin as an outpatient.

An echocardiogram was ordered.

He returned 48 hours later and was doing well with a heart rate in the 80's.

He would be referred for an elective cardioversion (to try to convert his heart into a regular rhythm) once his INR (blood thinning level) was within a therapeutic range for a few weeks.

He returned last evening (3 days after his last visit), as I was about to "walk out the door."

His wife was with him.

He was tremulous, shaking and his heart rate was 180-220.

His wife let me know he stopped drinking after our last visit 3 days ago.

Me: He mentioned he had an occasional glass of wine.

Wife: Oh no, he buys a 3 liter bottle of Carlo Rossi blush wine at least every other day. He drinks all day long. He got worried about his health and decided to completely stop.

Me: Thanks, that helps to explain a lot.

He was now in the midst of some alcohol withdrawl symptoms, in addition to his new onset atrial fibrillation.

He was admitted to the hospital.

It amazes me that I remain as trusting (gullible) of patients as I do after all these years. I suppose the alternative is just too depressing.

Wednesday, September 7, 2011

A life long memory

This past Saturday night we had no plans.

We were probably just going to spend the night watching some TV.

While reading the sports section of our local newspaper, I saw that our local professional soccer team was playing in the championship game in a few hours.

I had completely forgotten it was a "home" game.

"Anyone want to go?" I asked.

"Sure," came replies from my wife and son.

We got there just before the game started.

Tickets were still available.

It was an awesome game.

The crowd was great.

It was tied after regulation 1-1.

It was tied after the two overtime periods 2-2.

We won on the last penalty kick, 3-2.

We all couldn't stop talking about the game on the way home.

The quick decision to go turned into a life long memory!

Tuesday, September 6, 2011

An expensive trim

My mother-in-law called us at about 6 am to let us know my wife's brother was admitted to a local hospital at approximately 2 am for chest pain.

He's 38 y/o and smokes 1 pack a day.

I stopped by the hospital on my way to the office but he was off having tests done.

The hospitalist who had admitted him had left for the day.

I called during the day but he was off having tests done.

I finally saw him at about 6 pm.

He had just recently gotten back to his room.

Every time he would move in bed his chest would hurt.

Me: Did you do anything yesterday to strain yourself?

Brother-in-law: Not that I can remember.

Mother-in-law: Don't you remember, you trimmed the palm tree in the front of the house yesterday.

Me: You did? Did you use a power saw?

Brother-in-law: No, I used a hand saw.

He then imitated the cutting motion and experienced the same chest pain.

Me: Did you tell anyone that?

Brother-in-law: No, they just kept saying that because of my age and since I smoke, they need to make sure my heart is OK.

Shortly after, another hospitalist came by. He reviewed the normal findings from the labs that were done over the course of the day, the serial ekg's, the chest x-ray, the CT angiogram, the echocardiogram and the nuclear stress test.

When given the added information about the palm tree trimming, he agreed that my brother-in-law probably had irritated the serratus anterior chest wall muscle.

He was advised to take a medication called ibuprofen (wow!) and apply topical heat.

I'll never look at the palm tree outside their house in the same way.

Its last trimming cost about $20,000.

Another good reminder to all health care providers: A cook book work-up should never replace a good history.

Monday, September 5, 2011

Have a great Labor Day!

Labor Day stands for America's greatest natural resource-not its minerals, its timber or its farmland, but its people: Americans who get up early everyday and go home tired every night, quietly creating a better life for their families and fellow citizens (Gerald Ford).

Sunday, September 4, 2011

A good reminder

An 84 y/o male, retired pastor, just doesn't feel well.

He reports decreased energy, feeling more fatigued, decreased get up and go, and a decreased desire to be with others.

He came to see me for another medical opinion.

He was cognitively intact.

He reported he went to another primary care physician who did a "boat load" of blood tests and sent him for a total body CT scan. He also had an MRI of his brain. He reports that nothing abnormal was found.

He reports that he saw a cardiologist who put him through a bunch of tests. Everything turned out fine.

A pulmonologist had him get pulmonary function tests and a sleep study. Both did not show any significant findings.

Me: What are your symptoms again?

Patient: I just don't feel well, I tire easily, I have no energy, no desire to socialize; I even stopped writing which has always been a joy of mine.

Me (and I don't pretend to be the smartest guy around): It sounds like you might be depressed.

I then went on a discussion of possibly trying an anti-depressant that would increase brain neurotransmitters, including serotonin.

I actually couldn't think of anything else to do that already hadn't been done by the other physicians.

Patient: You know my son has been using a medication that increases serotonin for awhile and has been doing great since he started taking it.

On phone follow-up three weeks later he reported he was starting to feel a lot better.

I'll be the first to admit that I've often made depression a diagnosis of exclusion after ruling out other medical conditions.

I'm not sure, but I suspect since he was a retired pastor, the other physicians didn't think he could be susceptible to depression.

Fear of litigation is often used as an excuse for so may tests being done.

It was clear that this man was not a litiginous person.

In hind sight, it obvious that depression should have been considered earlier in his medical work-up given his presenting symptoms.

One SSRI is on the Wal Mart $4/month ($10/3 month) plan.

He had over $10,000 in tests before this option was considered.

It's a good reminder to all, including myself!

Saturday, September 3, 2011

Feeling new

Mr. A. is an 87 y/o man who has a great outlook on life.

I've known him for about 7 years.

He has a standard response when asked how he feels.

"Brand new," he always replies.

For a number of years now he has been followed every 6 months for an abdominal aneurysm.

He's had two different opinions from vascular surgeons.

One advises to operate and the other advises to monitor.

Both are well respected specialists but it's obviously caused much discussion over the last few years with the patient, as well as with his extended family members.

For now, he continues to feel comfortable monitoring it.

I noticed yesterday that he was sitting sideways, looking at me with his head turned while we were reviewing his latest study that showed no change in the size of the aneurysm.

Me: Why are you sitting that way?

Patient: I just figured I would point my belly away from you in case it ruptures while we're talking.

He laughed first and then so did I.

It was such a hearty laugh that I let him now the anuerysm must still be pretty strong to withstand such pressure.

"I'm brand new, doc, brand new."

Friday, September 2, 2011

A 3 month follow-up surprise

The nursing note stated, "here for follow-up."

My next patient was a 35 y/o male who was usually followed by a partner who had to leave on a family emergency earlier in the day.

I quickly reviewed his medical record.

He was being followed for hypertension and diabetes, was recently started on a cholesterol lowering medication, and was being brought back for a follow-up appointment.

Cool, I figured, should be straightforward.

I opened the door to the waiting room and called out his name.

A male with a complete cervical halo, including the skull bolts, arose from a chair and walked to me.

Obviously, I was surprised.

After confirming his identity and a quick greeting, I brought him to an exam room and excused myself.

I sprinted back to the privacy of my office for a more thorough chart review.

He had just been seen three months earlier.

The note from that visit was incredibly complete (I'm always amazed by this one partners office notes).

No where did I find mention of a cervical halo, previous neck injury, phone calls to our office about an accident, consultation notes, etc..

I went back to the exam room and just decided to say, "so, how is everything going?"

Luckily he was able to fill me in without having to ask any other questions.

He had, since last here, sustained severe chemical burns to the back of his neck and undergone three skin graft procedures. Due to the severity of the burns and location of the grafts, he was placed in the cervical halo in order to prevent any neck movement to give the grafts the best chance of taking.


Had never seen that before.

Me: You've had quite an interesting three months since you were last here.

Patient: I sure have.

His blood pressure and diabetes were well controlled. I totally forgot to check on how his cholesterol was doing, however.

Thursday, September 1, 2011

I bet...

A 61 y/o man came in for an exam and his wife was with him.

She introduced herself as "his second wife."

When he took off his shirt he had a tattoo that spanned his entire back.

I was able to get a good look at it while listening to his breath sounds.

The tattoo was a naked woman, standing, with her hands on her hips, wearing high heels.

On the tattoo, over the left breast, there was a tattoo of man's face over top of the Air Force insignia (it was a tattoo on the tattoo).

Under the entire tattoo was the name "Mary."

The tattoo and the tattoo on the tattoo (confused yet?) had a remarkable resemblance to the folks with me in the exam room (the patient and his wife).

Me (looking at his second wife): I bet your name is Mary and that you have a tattoo on a private part of your body and (looking at the patient) thanks for your service in the Air Force.

Both laughed after confirming my statement.