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Doc's Progress Notes

Week of December 13, 1999

Last Updated: 12/19/1999 at 6:44 PM PST

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Monday December 13, 1999

Weather report thus far today is good. We had a little snow mixed with rain overnight but no accumulation and now it is all rain. Actually, during the day today there have been times when the sun has been shining through cloud breaks. Tomorrow the rain is supposed to be back and heavy at times with rain forecast for the rest of the week. Rain, of course, is what keeps the Pacific Northwest green and makes it so beautiful here when it is not raining.

The iguanas are biting. Actually, only one and it belongs to a patient. The patient is not mine but was seen by one of my colleagues today with the complaint that her iguana bit her on the finger and she is now concerned that the bite was infected. It seems that the owner of the iguana woke up the animal and the animal not happy about being awakened before it was ready bit her (I can understand the anger, living as I do with people who also do not like being awakened early; I have no bites yet, however). We were concerned about infection in the bite also with the appearance of the finger so, not knowing what organisms reside in an iguana's mouth, called a local veterinarian. She promptly replied with a list of possible organisms which helped us know what antibiotic to place the owner on.

Different animals have different organisms that normally reside in their oral cavities (mouths). Human bites are among the worst with a significant number of human bite infections of the hands requiring hospitalizations and extensive surgical treatment. The classic story is the person who got drunk on Saturday night, traded punches with one or more persons, then Monday morning has a swollen hand and cannot recall why. He(or she) cut their hand on a human tooth and the resulting infection has spread deeply and quickly. (It's also possible they may have a fracture of their hand from the punch but that is another story) Luckily, the iguana bite should not be as serious.

Another patient this morning helped remind me about why I went into family medicine. He was a new patient who wanted a complete physical for health maintenance reasons. Before he left he mentioned having shoulder pain related to a workplace injury. He asked if I could take care of that too and I was pleased to tell him yes I could. He had expected to be referred to someone else as that was what he was used to. Family physicians can care for more than 80% of the medical problems they are confronted with according to national statistics. Now, this patient may have a problem that I will need orthopedic consultation with but there is a very good chance that I won't. He is very grateful that he doesn't have to find another physician to take care of his shoulder problem, at least right away.

I see that Dan Seto mentioned the Honolulu Marathon in his post today. He has a story about the time he finished that race and coincidentally so do I. It was in 1985 when I was much younger and in much better shape. It was to be my first of hopefully several marathons so I escalated my training mileage for six months to prepare for the race. My training plan was going great until the Saturday before my last 20 mile training run scheduled on Sunday, three weeks prior to the marathon. At the end of the relatively easy run that day, I felt pain in my right hamstring which only got worse overnight. I was unable to run even a mile the next day and could not run at all for almost a week, then could only do runs up to 5-6 miles prior to the marathon.

We flew to Oahu as scheduled and had a great time for 4-5 days prior to the marathon. I managed to run 3-4 miles a day hoping for a miracle at the start of the marathon that would allow me to complete the race somewhere close to my goal of three hours which would qualify me to run in the Boston Marathon. Race day dawned with a light rain which all competitors hoped would continue throughout the race to keep the temperature down. It did not, however.

I ran the first twenty miles very near the pace I had planned to be on thanks to the excitement of being in such a marvelously run race with fans all along it and aid stations very close together. After twenty miles my missed training caught up to me and I had to slow to a jog several times in the last six miles. I finished in a little over three and a half hours, number 1000 out of somewhere near 20,000 runners. Immediately after the race, I swore to never try another marathon and have not attempted one since. I forgot the pain after a time but I have never had the time to properly train for another one and it doesn't look like I ever will. I still look back on that race with fond memories and recommend to anyone who wants to try a marathon and doesn't mind crowds. I also still have my souvenirs from that race including my official certificate of finish.

This post is so late because I was helping put the stage back together at church. We redid the monitors and cabling to and from the mixing board to make it more simple and reproducible as well as to eliminate some of the extra cabling which was in the way. Everything should sound better now and it certainly is easier to tell what goes where. Plus, there is some satisfaction from putting things back together, especially if it involves wiring and cables. I'm sure the other Daynoters understand that last statement and will agree.

Enough for today. Must go and get ready for tomorrow. Good night all.

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Tuesday December 14, 1999

Another potential obstacle cleared in the path to obtaining hospital privileges again after my sabbatical. In today's world, physicians have to reapply for hospital privileges at not greater than two year intervals even if they have been on staff at that hospital for 25-30 years. The hospital must check their credentials including querying the National Practitioner Data Bank to find out about any malpractice judgments not reported to the hospital previously and possible staff sanctions at other hospital where they may be on staff.

Today I met with the Credentials Committee at my local hospital. This committee is made up of physicians on staff here who review a prospective staff member's application to be certain there are no potential problems with their credentials and interview you also. This went without incident so next my application goes to the full medical staff for approval and finally to the hospital board for final approval. Of course, the hospital board is made up mostly of lay people, not physicians, so there is always a question about how a person who is not a physician can judge the ability of a physician to deliver care to hospitalized patients without having actually met that physician or seen any of his "work". Normally, hospital boards just "rubber stamp" the recommendations of their medical staffs.

I must admit I have mixed feelings about returning to the hospital staff. On the one hand, I look forward to again being able to follow patients through all their illness be it inpatient or outpatient; but, I don't look forward to taking call with the lost sleep and weekends in the hospital. I have come to enjoy having weekends off and being able to plan activities such as worship band rehearsals. I do need to do this at this point in my life. Someday, I look forward to not having to take call again.

The chronic pain patient I told you about last week who had allegedly called other physicians and they had called in narcotic pain medications for her without me knowing about it, was back in today with no documentation that it was not her picking up the extra prescriptions. I confronted her on this and the additional evidence from another pharmacy and she told me it was her sister who had done this. She says her sister looks just like her but has a drug abuse problem. I told my patient that I did not know who to believe and that I needed documentation from the pharmacies and the police department that there was illegal diversion going on. At the time she seemed calm about it and seemed to understand but called back later to say since I was questioning her honesty she would find another physician. This is probably the best end to this dilemma for me but I still am left wondering if she actually called the other physicians and picked up the prescriptions or was it really her sister who had done this type of thing before.


Great practice tonight. The new setup worked great on stage tonight. Everyone could hear very well and had fun making music and worshiping. It was an interesting mix tonight with a twenty year old drummer, his parents on rhythm guitar and keyboard, me, a beginner still, on bass, and an ex-80's rocker on lead guitar. We were LOUD and enjoyed playing together. It is quite often amazing who the Lord can bring together to worship Him!

My e-mail inbox was full of messages being exchanged among members of the Gang when I got home tonight. The messages were about home networks, LAN's, and various other acronyms that only OLD computer users would know about. Since I am still fairly young as far as computer knowledge goes, I did not understand most of what was being talked about. I must add to my O'Reilly collection so I can understand a little more of what they are talking about. I can read them while on call and up all those nights again in the future. So much to look forward to.

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Wednesday December 15, 1999

What happened today? It all started when I was not able to force myself to get out of bed at 5:30 AM to run in darkness in the pouring rain. Since that is normal weather here this time of the year, I can't use the excuse that today was just a bad day and tomorrow will be better. I must get motivated again because it is too easy to slip into the couch potato mode. I don't have enough hours in the day to be able to come home at night and run, especially this time of the year.

At work today the keyword was PAIN. Everyone seemed to be suffering in some form or fashion from pain. There were multiple cases of back pain, there was abdominal pain, there was hip pain, there was shoulder pain, and there was heel pain. I have probably forgotten some of the others by now but it was a frustrating day at the office to say the least. Because of the stress of the season on people their pain is magnified especially if it is chronic in nature. A woman I saw today with abdominal pain and back pain is a real diagnostic challenge and I will tell you about her when I know a little more. I think I have blocked out the details on the rest of the people.

Worship tonight was great. Our patched together worship team that I talked about last night did a great job. Our regular drummer was back tonight but we had a different leader than usual and the keyboard player was his wife. This was the first time that she had played with us and the first time I had seen her play. Next week will be different so we will play it by ear.

This post will be short. Delanae and I have to have a talk about what we have spent on Christmas so far and who is left and what can we afford to get them. I sometimes get to be a Scrooge at this stage and say no more presents for anyone and then feel real guilty after saying it. Delanae has an unexpected Christmas bonus which will help. I foresee no new computer equipment for quite a long time. See you tomorrow.

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Thursday December 16, 1999

Monsoon weather continues here in contrast to what Tom Syroid is living in up in the Far North. We just have rain, no freezing weather except up in the mountains. There is supposed to be a break in the pattern this weekend but I will believe it when I see it.

Today was busy, especially the morning. One of our physicians was home sick so we were short-handed today. When that happens, invariably that means we are going to much busier than what is expected. This morning, I had a woman who had sustained a nasty blow to the head last night courtesy of a cupboard. She had been fine throughout the night but this morning was harder to arouse than normal and was more uncoordinated than normal for her. Her husband brought her in and I felt that her change in symptoms after the blow to the head warranted a CT scan of the brain to be certain there was no bleeding in or around the brain. Thankfully the CT was normal but it is so nice to have CT scanning readily available when there is any question. The "good old days" before CT scanning was readily available were not so good, there were a lot of worried hours to see if a patient was going to improve after a head injury when you were unsure if there was a bleed or not. Yes, Medic Dan, I did look her over for other injuries and did question her about possible spousal abuse.

Also, during the morning, I saw a seventeen year old girl who told her boyfriend last night that she would be better off dead. She had no real plan to kill herself and her boyfriend and his parents were able to talk her out of any attempt last night. What is worrisome is that she has had two attempts in the past. She is currently in treatment which is being coordinated by a local psychologist who her and her mother have lost confidence in. She has real mood swings which may partially be menstrually induced. She told me that she had heard of a couple of teen suicides which we have had here locally lately and thought that sounded nice, not having to worry about mood swings ever again. She really wanted to vocalize her problems and frustrations which is encouraging and hopefully means she really isn't serious about committing suicide. I talked to a local adolescent psychiatrist who was going to see her this afternoon. Hopefully, now she has gotten the help she needs and she won't be another teen suicide.


I got to run tonight. Delanae and I were up late last night talking so I was unable to drag myself out of bed this morning and run. We thought Stacey was going to be playing in another orchestra concert tonight at one of the two local malls but she did not have to so I had time to run after I finished at the office. I always feel better after doing that as it helps me get rid of frustrations that build up during the day. I've always much preferred running in the evening and there is some research out there that suggests to lose weight quicker one should run late in the day rather than early in the day. Of course, now that I am doing this daily update I get rid of a lot of frustration through writing and also some dead weight (think about for a little while and you will get it). <grin>

We have to go shopping this weekend. Yes, there are still a couple of things we lack getting for people including our son Stephen. That means we have to brave the stores the Saturday before Christmas (think sad organ music in background). I have convinced Delanae to go early before ALL the rest of the people can get there but I do not look forward to the experience. Luckily, we pretty much know what we are after.

After that, Saturday night, is the Christmas party for all hospital employees that will include our clinic staff and clinicians. It is a casual affair with a lot of people who don't necessarily know each other so it should be an interesting time. Our clinic will have a reserved table there. All in all, Saturday will be a busy day. See you tomorrow.

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Friday December 17, 1999

Connection problems dominate the news today. I usually read the rest of the Daynoters journals during breaks at the office since we have a T-1 connection there but have not been able to load all of Brian Bilbrey's current journal page there today. The best I was able to load was part of Monday's post. We have e-mail filtering at the office and usually his page loads slower than over my home dialup connection, which I hope someone can explain sometime, but I have never had this problem before. Now at home I can't connect to my ISP. Don't know what time you will be reading this. Hopefully today.

The patient I told you about Tuesday who had "fired" me was back in the office today. She brought with her a letter from her daughter confessing to calling the other two physicians and impersonating her mother to ask for pain medication. She then says she went to the pharmacies and told them she was picking them up for her mother. The dates on the letter match the dates the pharmacies dispensed the extra pain meds but I have asked for the copies of who signed for the narcotics at the pharmacies. The daughter says she has left to enter an inpatient drug treatment program in central Washington and is very sorry for all the trouble she has called. The mother says she wants to continue seeing me and called Tuesday because she was afraid to face the truth that it was her daughter who had done this. I am awaiting the copies of the signatures from the pharmacies before I accept this story as the truth, the whole truth and nothing but the truth. The mother certainly seemed upset enough in the office today for this to be the truth or she deserves an Oscar for her performance.

If you detect a little cynicism here, you have heard right. I hope I am wrong but in today's world one has to be very careful. I have had an entire family (father, mother, and daughter) stand together in an exam room and lie to me about not going to anyone else to get pain medication. Of course, the other physician they had been going to had just talked to me on the phone before I walked in the room and confronted them.

We don't have to go to Portland tomorrow. I called a music store there this morning to see if they have the guitar effects pedal Stephen wants and they are out but have them on order. Their price is cheaper than what I can get one for on the Net and delivery isn't guaranteed before Christmas by any of the Internet stores so we will just buy it in Portland when it comes in. We may have to let Stephen open a wrapped picture of the pedal on Christmas morning. The rest of the things we need we can get locally.

Still can't connect. I am off to eat a pizza and watch a movie with Delanae. I'll get this posted when my ISP lets me connect. Talk to you again tomorrow.

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Saturday December 18, 1999

Connection restored. As you can see, I can now connect to the Internet again. That more than eighteen hour period without being able to connect through our ISP is the longest we've had in more than a year. For about the past year, since upgrading their modems and installing more telephone lines, we've had few connection difficulties and none that long. Hopefully, we will have no more. More posts throughout the day now.

Plans changed again. We did not go shopping today. We are taking the kids to the mall across the street from the party to spend some of their Christmas money. Every year they get to open one Christmas gift early and this year the gift contained money. Being American kids they cannot keep the money in their pockets otherwise it would burn a hole in the pocket. They must go out and spend it as quickly as possible. We will let them stay in the mall for a couple of hours and then will pick them up. This gives us a convenient excuse to leave the party early if it is boring, if it is not then we can go back after taking them home.

I have been working on a Christmas greeting for everyone today. I have sent it to our friends already; now I would like to include you my readers. The Christmas greeting is here. The poem, by the way, is not original, it was from a Hallmark Christmas card that we used this year. There is no author credited, otherwise I would have done the same. We truly hope you have a wonderful and safe holiday season.

Now, off to the party. Depending on what time we get back there may be another update tonight, if not I will see you tomorrow.

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Sunday December 19, 1999

This update is being done to music. Actually, Rebecca St. James' "Christmas" is playing in the background from the living room where the stereo is cranked WAY UP. I'm home by myself at the present time so I can crank it up to a glass breaking level and hear it in here (the cats are running too). If you like BASS and are open minded enough to like different arrangements for traditional Christmas carols this CD is HIGHLY recommended. </music critic mode>

The party last night ended early for us at least. I don't know how late everyone else stayed but we left to get the kids around 8:30 and didn't go back. Not that it was bad but Delanae wasn't feeling in the party spirit, which is unusual for her, so we ate dinner there, which was good, and then left. We got most of the Christmas shopping we still had to do between 8:30 and 10 PM last night which turned out to be a great time to go to the mall. There were no crowds. Must keep this in mind for the future.

The last packages go in the mail tomorrow. Yes, I know they won't get to where they are going before Christmas but at least we tried, we got everything mailed before Christmas which is the important thing, right? They are going to my brother and his family and there is a tradition of either their gifts or our gifts being late. I almost forgot, my mother's gift won't be ready in time for shipment before Christmas so we haven't sent out the last package after all, darn. <Lost my train of thought there while playing air drums along with Rebecca's band. I play air bass and drums, sometimes pick up my bass behind me and play it too.>

Delanae and Stacey are going to be addressing Christmas cards to go out to Delanae's clients tomorrow. Stacey is being bribed with cheeseburgers from McDonald's. We tend to buy twenty or so on Sundays when they are thirty nine cents apiece so the kids have something to snack on during the week (I know they are not the most healthy food but the kids will eat them and they are easy to fix, so get off my case already). <Here comes Rebecca's version of "O Holy Night", can't type and play air bass and percussion at the same time. Excuse the interruption. The subwoofer really makes the house vibrate on that song.> Anyway, Delanae and Stacey will be up very late tonight finishing those cards. They are night owls anyway and do their best work after 10 PM.

This coming week should be interesting. This week tends to be slow as far as routine appointments but with several people gone on vacation we will be busy seeing the acutely ill. Everyone wants to be well for Christmas for some reason. That means we get a lot of people who want an antibiotic for their cold and have a hard time believing us when we tell them they won't get well any quicker since antibiotics don't work against viruses. Then on Thursday and Friday we will have the people who come in and have to be well tomorrow. They tend to not believe us when we say there is no human way we can guarantee they will be aware, they think we are holding back on giving them that magic pill that will get them well in twenty four hours. Our patients will be much less stressed starting next week.

My day will start early tomorrow morning with my first Leadership Council meeting beginning at 7 AM. The rest of the week is busy at noon with Christmas lunches or staff meetings. Then, I am off Christmas Eve since we will staff that day like a Saturday and just see people who really need to be seen that day because of an urgent medical problem. I am not on call so I won't have to work that day or New Year's Eve. This is two years in a row not having to be on call either Christmas or New Year's, I like it. Plus, our anniversary is New Year's Eve so in the past I have always worked Christmas to get New Year's Eve off. All this will catch up with me, I know, probably next year.

Must get ready for tomorrow. I also have to do my weekly full backup on my data and practice my bass some also. We are doing Christmas carols Wednesday night and out worship team is practicing tomorrow night. I always enjoy doing different arrangements of the traditional carols but tonight we will be listening to the traditional arrangements while the cards are being addressed by the girls. Until tomorrow.........

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