Doc's Progress Notes
Week of April 24, 2000
Last Updated: 4/30/2000 at 10:09 PM PST
Monday Tuesday Wednesday Thursday Friday Saturday Sunday
Most Recent Update
I'm back! Don't know where the weekend went, but I did not get anything written on this web site, obviously. Connectivity was ok unlike some of my fellow Daynoters. I see that connectivity is back for most of them now.
Anyway, on Saturday we did make it to the tulip fields here. It was raining off and on but we did manage to walk all around the fields and enjoy the many colors. The web site does not do justice to the colors and Delanae took a lot of digital pictures which she will put up on her web site in the very near future, I'm sure. If not, I will post some of them here a little later in the week. My favorite variety is the Ad Rem which you can see here. For some reason, it just struck my fancy. The mixed fields were Delanae's favorite so she will probably post at least one picture of them. Stacey just liked any of the purple varieties. Stephen was bored for most of the afternoon. There was also a variety named after me, the Jimmy. It was yellow so it was not one of my favorites.
After the tulip fields, we had dinner at Tony Roma's in Vancouver, Washington as we were driving back home. We eat ribs very seldom but do like them so we pigged out Saturday night. Actually Delanae and I pigged out, Stephen had a burger which is his favorite thing to order at any restaurant. Something about they can never mess that up. I don't think Tony Roma's can mess up ribs but he will take some convincing. Stacey decided she didn't want anything so she ate bread and a couple of french fries and kept pestering us to tell her where the ribs came from. We did not for fear of ruining Delanae's appetite. Her birthday dinner was topped off by key lime pie which I did not help her eat since I was too full after eating all of my Tony Roma's Sampler Plate.
Sunday morning we had a great service at church. After eating lunch we came home and I watched the last quarter of the Portland-Minnesota game which Portland won, as expected. After that, I worked in the garden for a little while, mostly hoeing. I do have lettuce coming up but that is all that is sprouting above ground at the present. It has been too cold at night for a lot of it to sprout yet. It got down to 35 degrees(F) here last night so it may be a while yet before anything else comes up. The lettuce will have to be thinned since it looks like every seed sprouted. My mother called tonight and told me how to thin it when the time comes. I promise pictures when more things are actually growing.Delanae is currently wallpapering our bathroom so the moulding can be put back down. She does the papering, I do the moving of the mirrors, towel racks, etc. It was interesting showering and shaving this morning without my usual mirror, I used her makeup mirror which meant I had to get up close to it to see. We did manage to get dressed and made up (Delanae made up, not me) this morning without any major problems.
Today at the office was steady but not as busy as some of the past Mondays this year have been. My stack of paperwork was not smaller, however. I don't have anyone in the hospital at the present time so I will use the time before office hours to get my hospital charts signed tomorrow. Early today was occupied by a Leadership Council Meeting starting at 7 AM.
I did diagnose a new diabetic today. He will be started on diet and exercise then we will see if he will require medication or if he can be compliant on the diet and exercise regimen to get by without medication for some time. Most diabetics can, if they have Type II diabetes which most adult onset diabetes is. It will be interesting to see if he can take charge of his own disease so I can just be a consultant for him. I try and get all my diabetics to do that. I want them to learn as much about their diabetes as I know so mutual goals can be set.
I better end this now and get the new week's files updated so I can help Delanae again. See you tomorrow.
Short update tonight since it is so late. Wallpapering in our bathroom is done enough now so the moulding can be put down either tomorrow or Thursday. We have someone coming to do that. Delanae did all the wallpapering, I just helped tonight after falling asleep on the couch last night. The mirrors and towel rack are back up as well as the shower curtain.
Today at the office was one confrontation after another. Today was the day that it seemed all my patients with chronic pain decided to increase their dose or say they had lost their medication for the umpteenth time. They all sign contracts saying they will not increase their medication without first letting me know but the ones today simply had their pharmacy call for refills when they ran out of their medication earlier than they were supposed to. We had to call them and say they had violated their contract with me and I would not refill their medication until the date we had both agreed on earlier. I do not like conflict or confrontation but I have to be firm in situations like this. If they uphold the terms of their contract then I am very easy to work with, I think. I have increased doses of pain medication early if they will simply call me and let me know what is going on.
Tonight made up for the day. First, we had a very good meeting of our men's group with a good prayer time afterward. Then it was time for our Wednesday night worship band to practice. We were joined tonight by a member of another church's worship band at the invitation of our leader. We had a great time playing music and worshipping and he fit in with us like he had been playing with us for months. Afterward, he asked if he could join us on a more regular basis and maybe even find us a drummer. We said that would be great and invited him to come back on a regular basis. Now, I need to practice my bass more if we might expand our playing some more.
Tomorrow is my day off. I will be rounding on my nursing home patients and attending a meeting at the office at noon. Hopefully I will get time tomorrow afternoon to fertilize the garden and plant some celery seeds as well as garlic. See you tomorrow...
Today did not go exactly as planned. It went as planned through the making nursing home rounds part. But, while at the last nursing home, Delanae paged me to tell me that the Jeep would not start. Not only would it not start it would not even turn over and the lights along with all other electrical devices were dead. Being the rational thinker that I am, I decided it was a dead battery so we drive under the freeway to the local Sears store, pick up a new battery, and head back to the Jeep which is parked in a local motel parking lot. I put in the new battery, the lights and electrical devices come on, the Jeep starts, then dies and all electrical devices are dead again. I then try the old battery again and again all electrical devices come on but no engine turning over when the ignition is turned. New battery again, and the same behavior. By now I realize the problem is not the battery but some other device or devices. I had previously checked all the fuses and cables and all look intact. Now there is nothing else to do but call the tow truck and take it to the local Jeep dealer.
Delanae has left long before this to make her appointments which are scheduled in the afternoon and now I have missed my noon meeting which is really no big deal. The Auto Club office dispatches a truck to haul the Jeep in to the dealer with no problem. Once there, a dealership employee gets in it and, of course, it starts right up with no problems. They did believe me when I said I was not bringing it in on the back of a truck just for the dramatic effect. It helped that the service rep I was talking to is a member of the church that we attend and knows us both personally as well as Stephen. Anyway, they are keeping it to try and find out what the problem is. In the morning we will have only one vehicle so Delanae will keep the car after she drops me off at the hospital.
I did get home in time to run this afternoon but no gardening got done. Now it will have to wait until this weekend but it is supposed to be a very nice weekend, especially Sunday. On Saturday, Delanae and I are attending a marriage seminar sponsored by the local ministerial alliance. After that, Stephen and I are helping our pastor move into a new house although Stephen does not know this yet. So Sunday will be the day to work outside in the yard, garden, and plant flowers, after church of course.
That's how my day went. Stacey asked me tonight why I worked on my "day off". I tried to explain to her why it is never really a day when I can stay home and nap or do whatever. She doesn't understand yet, she gets to stay home when she doesn't have school so doesn't understand the concept of having things to do other than the routine work mandated tasks. One day she will understand. See you tomorrow.
First, let me set the record straight. It has been pointed out to me that in yesterday's post I made it sound like Delanae was hanging out in the parking lot of a motel or something worse. Actually, she had met the manager of the HOTEL who was sponsoring some commercials for the marriage seminar this weekend. After securing a contract for them, she went back out to the Jeep to leave and that is when the misadventure began. The end of the story is that the dealership says it was a bad battery after all, that when I put the new battery in the ground connection wasn't tight enough until they tightened it at the dealership. Any way, we have the vehicle back now and it is running fine. It still has the correct time on the digital clock even after having the battery changed.
Today at the office was pretty uneventful. We were steadily busy but I was finished by 6 PM tonight which is on time for me. No interesting stories today so it must have been pretty routine. I did get to run again tonight which means I am getting back into my routine again. We did some more furniture moving at home tonight so things are coming together still. Stacey is cleaning up some of her mess which is a never ending process for her.
One last thing, the Washington Family Physician Journal came out today and has my article in it. It is not posted on the Internet yet though so I can't give you the URL but will later. If you can find a print copy of the journal then it is the Spring 2000 issue. It was not changed any by the editor but my picture did not make the journal. It seems that electronic photos can't be used and what I sent them was a scanned photo. They did not tell me this until it was too late to send an actual photo. Maybe next time.
The Jeep is still running and starting so I guess it is fixed. Hopefully it will not exhibit the behavior it exhibited on Wednesday again. There are few things worse than being stranded somewhere with a vehicle that has no electrical power.
Today was busy. I spent my lunch break admitting a patient to the hospital where he underwent an appendectomy later in the afternoon. He is a 22 year old male who started having abdominal pain Tuesday night. He was seen in our office by the physician assistant Wednesday evening late sometime. His pain at that time was mostly upper abdomen with some lower abdominal pain I think. I didn't have the dictation back yet today when I saw him so I do not know for sure and the patient could not remember. Anyway, his white blood count Wednesday night was 15,300 with normal being up to 11,000. An elevated white blood count like that can be a marker for early appendicitis but can also be elevated by other processes going on in the body. He was sent home and came back to see me today with his abdominal pain worse and now more concentrated in the right lower quadrant. His white blood count was now 19,300 so I admitted him and the surgeon operated on him later this afternoon. I presume he found acute appendicitis but I have not heard for sure yet. I will need to find out Monday what our physician's assistant thought about him Wednesday night when he examined him. Early in the course of appendicitis it can be very hard to diagnose; remember my patient from a few weeks ago who had chronic appendicitis? His pain started in the right upper part of his abdomen, not in the right lower quadrant where the appendix is supposed to be anatomically. What is bothersome to me is that with the elevated white blood cell count, this patient should have been evaluated the next day.
Tonight, Delanae and I joined some of my associates and their wives at a local restaurant for an educational program sponsored by the hospital. We had a great dinner and heard a good presentation about cholesterol and its relationship to high blood pressure and diabetes. The spouses probably didn't think it was a good presentation, I am sure they were bored. Us medical geeks though, we enjoyed it (well, some of us anyway). Now, we are home and both sleepy so I am going to wrap this up and go to bed. Tomorrow we are going to the marriage seminar then Stephen and I are going to help our pastor move. Stephen now knows about it and is hiding his excitement well. Stacey has more mess to clean up which will take her all day tomorrow if not longer. See you tomorrow.
No update.
OK, so I did not get a post up yesterday as I thought I would. Where did yesterday go, by the way? Let's see, Delanae and I attended a marriage seminar that lasted until 3 PM. She did not enjoy it as much as I did since she was suffering from severe back pain due to sleeping wrong Friday night. She is much better today, thank God. Then, Stephen and I went and helped our pastor move until 9 PM or so. When we got home, I was too tired to do anything more strenuous than watch a movie (it also did not require any thinking which was another prerequisite). Then, we went to bed and that is why this page did not get updated yesterday. It seems like I have less time on the weekend any more to update this page. Today's will be short also.
After church, we worked in the yard, garden, and flower beds all afternoon. I have peas, lettuce, and broccoli coming up and I planted celery and garlic today. I am waiting for it to get a little warmer before putting out tomato plants. It is supposed to rain tonight and the temperature is consistently still getting down into the low 40's to high 30's so I will wait a little longer before planting tomato plants. The tomato seeds have not come up yet.
Tonight, I am getting ready for tomorrow as well as doing this update quickly. I also worked on paying some bills and updating my Quicken file to just the current year. I usually wait to do that until the taxes are sent in so now hopefully my current file will load more quickly. Tomorrow begins with our monthly group meeting at 7:30 and ends with a get-together for our worship team at one of the members' house in Clatskanie, Oregon which is across the Columbia River from here. We have never been to this particular house before so we have a map. It promises to be a long day. I will TRY and get an update up tomorrow but no promises.
