Doc's Progress Notes
Week of February 14, 2000
Last Updated: 2/20/2000 at 8:24 PM PST
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Happy Valentine's Day to everyone, hope you did something special for the one you love. Delanae gave me something very special and intimate while I gave her something very special and intimate also, my heart and love. Okay, she also gave me a monkey that dances and sings "Doctor My Love".
Day one of the review course is now history. I had no problems with the buses, there was one waiting at the park and ride lot when I arrived about 6:40 this morning. I made it to the hotel, after walking about ten blocks from where I got off the bus, at 7:35 which was plenty early enough. This evening, I just missed the bus I wanted, I saw it pulling away from one block away, but still got home just after 7 PM. Tomorrow I will know where to get off and the schedule a little better. Neither bus was completely full but I don't think that I want to catch a later bus in the morning since they fill up quickly after 7 AM. All in all, a good way to travel downtown during rush hour and also a good way to find my way around downtown Portland. I look on it as an adventure. I can also see Portland since I am not driving and tonight I realized how beautiful the city is. Also, I got to drive home listening to SonicFlood first, then U2. That is a great way to end a day.
The course itself looks like it will be great, at least judging by the first day. The lectures this morning were excellent but the workshops this afternoon were even better. I heard the best presentation on chronic back pain that I had ever heard this afternoon. The speaker and I talked a little after the workshop and I am going to try and send some more patients to him for second opinions. The problem is, as he admitted, that his clinic is full and has a long waiting time for an appointment. He will be a good resource for telephone consultation even if I can't get patients in quickly.
The other workshop this afternoon was actually a two parter. The first half was about functional assessment of the elderly and the second half was on prescribing rehabilitation for them after doing the functional assessment. The speaker was anything but dry which we get a lot when discussing these topics. He was full of helpful pearls about exams and what to order for what problems. I thoroughly enjoyed all the workshops this afternoon, hope tomorrow's are just as good.
One surprise at the course today, I ran into someone I had not seen in 15 years. Hunter and I were residents together from 1983-1985, he was a year ahead of me so he was my senior resident and we would interact while we were both on call for OB and hospital medicine. He went to Fairbanks, Alaska to join a practice in July 1985 and I had not heard from him since. I was standing, talking to someone, when I heard him introduce himself to someone behind me as being from Fairbanks. I turned around and sure enough it was him. He didn't recognized me at first but, after looking at my name tag, he did. We caught up a little on what had happened to each other during a break this afternoon but we will try to spend a little more time catching up during the week.
I must go now and get ready for tomorrow as well as check out some of the other Daynoters sites. Tomorrow looks like Third Day both in the morning and evening, I can't wait. Give your loved ones an extra hug tonight from me.
No update.
I'm back tonight. I was too tired last night to put up anything after a full day in the course then a long conversation with Delanae and the kids about some family issues. As all parents know, that is the down side of being a parent, having to have serious conversations with your adolescent and near adolescent about their behavior. Hopefully, everything is settled now but my bet is that there are more conversations like that in our future.
The review course continues to be very good. Today's highlights included lectures on genetics and testing for various inherited diseases such as hemochromatosis and inherited tendencies for cancer. Also, this afternoon we had a very good discussion of diabetes which happens to be an interest of mine. I learned a lot of new information about diabetes, some of which hasn't even been published by the American Diabetes Association yet. Finally, we had a good presentation on how to move an alcoholic toward recognizing his disease and seeking treatment without having a big confrontation with him. I knew confrontation doesn't work all that often but needed to learn alternative ways to deal with the denial by the person with the substance abuse problem.
Yesterday's highlight, for me, was the lecture and workshop on somatization. Patients who are somatizing are the most challenging and frustrating for all physicians. Somatization is defined as the appearance of physical symptoms in patients having minimal, stable, or no existing biological pathology, primarily due to psychological or social problems. Somatizing patients consume a large amount of medical dollars and physician time in the office and in the past physicians had not been well trained on how to handle them. Now, this is a field of intense study and we learned a lot of new information about somatizing patients yesterday and some ways to, hopefully, help them become more functional again. The physician discussing this disorder is a psychiatrist in Seattle who is teaching in the Family Practice residency program there and consulting in the Family Practice Clinics there. Interestingly, due to the decreased reimbursement for psychiatrists by managed care companies, many are reinventing themselves as consultants in primary care clinics, especially primary care residency programs. With the high prevalence of mental health problems seen by primary care physicians, this would be very helpful to your average primary care physician in private practice too.
A little excitement this morning before the day's lectures started. I am driving to a park and ride lot, then riding the bus to downtown Portland and back every day. This morning I pulled into the parking lot, started into a parking space by braking to turn into it and my antilock system came on and the car slid a little bit toward the car next to me. I had enough forward momentum that I got into the parking space OK without hitting the car, then got out wondering what had happened. I slipped when I stepped out of the car and realized that there was black ice on parts of the asphalt parking lot and I had picked a spot with black ice. The temperature was 33 degrees(F) but the fog that was there was freezing on some surfaces causing the black ice. I will be more careful in the morning since the temperature will be about the same again.
That's about it for tonight. Tomorrow night I will be talking about Alzheimer's Disease and casting and splinting looks like. See you later....
Today's topics ranged from Alzheimer's Disease to the foot. Actually the title of the final lecture today was Foot and Ankle problems but most of the lecture was about foot problems. It was a good lecture, as most have been this week but the lecturers this afternoon this afternoon all seemed to be trying to present too much material for their assigned time. Maybe I am just getting more tired after four days of lectures almost ten hours a day. It has been great as far as reviewing and renewing my medical knowledge but I will be glad when it is over tomorrow at noon. Then maybe I can find out what is happening in the world again as well as spend some time on the Internet catching up on some sites I haven't visited all week.
I had no problems this morning with black ice. I didn't see any or slip on any or hear about any. I did catch an earlier bus this morning so saw different people and met a different bus driver. I've only been doing this for four days but it is amazing how quickly the drivers get acquainted with you and talk to you when getting onto or off the bus. Tonight, I caught a later bus also so I met another driver and different people again. This morning, an older man was explaining to a boy in his late teens what he could see if he looked in the sky tonight with his telescope. He drew him a very detailed star chart on a drawing pad and did it all by memory. They had just met on the bus and struck up a conversation about astronomy.
Nothing more interesting to write about tonight. I will therefore post this and see you tomorrow.
The review course is now over. It ended at noon today with the last lecture being about the threat of bioterrorism. Bioterrorism would be the use of a biological weapon by a terrorist group. Actually, there has been one attack on this country by a group of terrorists using a biological weapon, it happened in Oregon in 1984 when a group of Rajneeshees put Salmonella into salad bars and caused a lot of people to come down sick with vomiting and diarrhea. This is the only known bioterrorism attack on this country, up to this time. The main worry for the public health departments in this country are the agents of smallpox, anthrax, and plague. Steps are being taken to increase the supplies of vaccine for all three diseases now before some terrorist group can use one of the agents. Amazingly, one can buy cultures of anthrax and plague from several suppliers both in this country and abroad. One fact that I learned today which will stick with me now is that anthrax causes a widened mediastinum on chest x-ray (this fact may be useful on a board recertification exam in the future).
All in all, it was a very good course but I am glad it is over. I got about 40 hours of continuing medical education this week and am now ready to go back to seeing patients again. My batteries have been recharged and I am ready to apply some of my new knowledge. That is the exciting part of learning, getting to apply the new knowledge and REALLY learning it.
Tomorrow, we are picking out the new carpet for downstairs. The insurance company finally came through with most of the money to replace the old carpet this week so now maybe we can get this house back in order within the next two weeks or so. I know Delanae is anxious to have her office back so her computer is easier to use and not in the way like it is now. More tomorrow after I get caught up on some of my missed sleep tonight.
Today was "catch-up day". I started this morning by catching up on the other Daynoters sites that I had not been able to read all week due to my long days and short nights. I am now caught up on what has happened all week and see that Dr. Keyboard's better half Wendy has also started a journal. Welcome Wendy and it will be nice to hear how Dr. K really lives.
This afternoon, Delanae and I went to the carpet and flooring store to pick out carpet to go downstairs and in our upstairs "mud room". We were pleasantly surprised to find that it appears that the insurance company has actually calculated our rooms as bigger than they really are so we have more money coming than we thought. Our installer drew detailed drawings for the carpet but the total square yardage is less than what the insurance adjuster calculated so, if his figures are right and we will check with him again before actually installing the carpet, then we can purchase a higher grade carpet than we had thought we could and also carpet the bedroom downstairs that is not presently carpeted as it appears that the adjuster included it in her figures. The carpet is now on order and Delanae is very happy because it is a light green and because I let her pick the color. Also, it appears that we will have enough money left over to have the walls painted rather than she and I having to do it. The painting will start this coming week and the carpet should be in in about two weeks.
Later in the afternoon, we went to our local racquet club so I could start a new weightlifting program. It is called High Intensity Training and involves doing very high weights with a relatively low number of reps and working out only twice a week. The results, increased strength and muscle mass, compare very favorably in all the studies I have seen to the more traditional programs which call for more reps and workouts 4-5 days a week. I had been on a more traditional program 4-5 years ago and really liked the results but no longer have the time to work out like that now (I didn't really have the time then). The HIT model stresses lifting to concentric failure, meaning you cannot lift the weight one more time, achieved in only 8-10 reps then move on to the next lift. The whole workout should not take more than one hour, should include the entire body each time, and should be done no more than three times a week, twice being the ideal number. I will keep you updated on how I do but right now I know I will be very stiff tomorrow, not having done any weightlifting in at least four years. I am using Nautilus machines, by the way, which are supposed to work as well as free weights, we'll see. I always have the option of going back to free weights to augment what I am doing on the Nautilus machines if I don't see the results I am looking for. Since I am off on Wednesdays now, I'll be able to lift Wednesdays and Saturdays which means I won't have to be away from my family any more often at night than I already am.
Stacey now wants to move her bedroom upstairs. While we were gone looking at carpet and working out, she measured the room that is now my office and decided that she could get rid of some of the stuff in her room and fit everything else into my office. That would give her a new bedroom, Delanae could move her office into what is now Stacey's bedroom, and I could then move back into my old office downstairs. I am not sure why Stacey wants to move upstairs into a smaller room other than that would mean she would be right next to the bathroom where her new dwarf hamsters are living. She brought these hamsters home Thursday and is learning about taking care of them now. Stephen has gerbils and she has hamsters so the cats are dreaming of chasing rodents of all types. We keep stopping those dreams from becoming reality by closing the doors to the rooms they are in and keeping the lids of their cages on very tight. Delanae and I have not decided if the move is a good idea yet but there may be more moving of computers and furniture than I thought after the new carpet goes in.
Bob Thompson mentioned that memory prices are down, and now is a good time to buy that memory you have been waiting to buy, in his update today. Tonight, I thought I would go to the Crucial web site and look at the price since I need to upgrade Delanae's computer with more memory but I could not log onto the web site. Don't know if their server is down or if so many of Bob's readers went there that they overwhelmed the server. I will keep trying tonight and the rest of the weekend.
I'm having some weird computer behavior here. My system clock keeps losing time until I reboot, then it shows the correct time for a few hours then slows again. Rebooting always solves the problem for a few hours but I really don't want to have to reboot three of four times a day. I had thought, when it first started doing this, that the problem was the CMOS battery needing replacing but if that was the problem then why would it correct itself to the correct time with rebooting. It should stay slow, no matter whether the system is rebooted or not. Suggestions are welcome.
I feel better, now. I had looked back at my posts this week and felt they were all very short and rushed, which they were. I was afraid I had lost my ability to write more than a few words but tonight I proved I have not. Things should be back to normal next week, or at least as normal as they get here. Until tomorrow....
I now have an answer to why the system clock slows down. It seems there is a conflict between Norton Anti-Virus and Windows 9x which causes this behavior. It was covered on the Microsoft web site and was graciously sent to me by a reader this morning. To be sure that the battery was OK, I did as the article mentioned, I brought up a MS-Dos Prompt and typed TIME giving me the system time, which matched with the time shown on the system clock in Windows 98SE. This proved the battery was OK, as I had suspected. The only cure for the problem is to disable NAV which I do not want to do. I will have to live with the problem and remember to reset the Windows system clock every so often.
It is looking more like Delanae and I will have our offices downstairs once the new carpet is in. Stacey has agreed to all the conditions of having her bedroom upstairs and Stephen doesn't want to move out of his present bedroom. If this all goes through, it will make it much easier to network our two computers so we can share one Internet connection and won't have to have both phone lines tied up at times. This way, I could add memory to Delanae's computer, add a larger hard drive to mine, buy one new modem, and buy the appropriate NIC's and cable and we would be set to go since our computers will be physically much closer. I would not have to drill any holes in walls to try and run cable through them. Right now, Delanae's stuff is in Stacey's bedroom while the carpet is being replaced so we would not have to move it back, this way.
I made the mistake of going by my medical office for a little while this afternoon. There are two stacks of charts and other paperwork on my desk that I will have to deal with tomorrow. I am so looking forward to it. I did deal with the e-mail and voice mail this afternoon so I won't have those to deal with tomorrow but there is plenty of work to do before I see patients. My schedule looks packed tomorrow already, it will be a long day. I have worship team practice after that so I won't be home until probably after 9 PM tomorrow. All in all, a long day. See you LATE tomorrow....
