Doc's Progress Notes
Week of May 1, 2000
Last Updated: 5/5/2000 at 10:55 PM PDT
The start of a new week and a new month all rolled into one. It was a long day but not hectic. There were lots of messages from the weekend and lots of phone calls to be returned. There were also lots of prescriptions to be refilled as usual.
I have one patient in the hospital, an 88 year old man who has now fallen twice within the past month suffering compression fractures in his back. He falls because he loses his balance and has the compression fractures because of osteoporosis which a pathological loss of calcium from his bones and therefore the support structure of the bone is very weak. After the first fall, I put him on a medication to treat and hopefully reverse some of the osteoporosis but it takes months and years, not a few weeks. He, and his son knows this and has been silently planning for it, needs to be in an assisted living situation not living at home alone. He is no longer safe to be home alone. Next time, it could be a broken hip and he could lay in the floor unable to move for a day or so (which I have seen before). Hopefully, the patient now has the insight to see it for himself, I did bring up that subject with him today. He will be able to be discharged from the hospital as soon as a place is available for him; the only reason he is hospitalized is because there was no other place for him when he was brought in from his apartment hurting too much to get up and around independently.
Then, during the day a patient came in who is going through menopause now. I will have the opportunity to prevent osteoporosis in her so it will not have to be treated with medication after she has a compression fracture in her spine. She will be on estrogen replacement therapy as well as calcium supplements. Calcium cannot be incorporated into the bone in women without estrogen being present so both are required to prevent osteoporosis. Vitamin D is also required to absorb the calcium from the intestine but most calcium supplements incorporate the Vitamin D into the supplement. Sunlight (ultraviolet light) produces Vitamin D in the body so if one has any exposure to the sun then they produce Vitamin D. I remember the days when we weren't sure how to prevent osteoporosis and there were very few treatments for osteoporosis. The treatments that were available were either too expensive or caused too many side effects for a lot of patients to tolerate. Today, we have medications which prevent and treat osteoporosis very effectively and are easy to tolerate.
Tonight, our worship team got together at one of the other member's house to just talk about things. We don't have a practice again until next Monday night but everyone enjoys getting together and spending time with each other. Our leader is talking about our team leading worship in some other churches some in the coming months. There are a lot of smaller churches than ours that don't have enough members to have a worship team and would enjoy having us come and help out once in awhile. Our church is blessed to have two full time teams and a youth band that leads on the fifth Sunday of those months that have five Sundays.
That's about it for tonight. Tomorrow will continue to be busy and tomorrow night is my mens group followed by our Wednesday night worship team practice. I will be trying out a new bass guitar tomorrow night. It is presently owned by another bass player in the church who is probably going to sell it since he has a brand new bass now. I will try it out and see if I am interested in buying it. If I am then I will need to sell the two I have so I can upgrade to it. See you tomorrow...
My patient went home today. He went back to his own home but with twenty-four assistance for the rest of this week then he will be going to a more permanent assisted living residence in the Portland area so he can be closer to his son. He has accepted that he will need assistance but I am not sure that he thinks it is permanent. It will need to be permanent because he is at high risk for falling more and more.
Then tonight one of my elderly patients with Alzheimer's Disease got admitted due to her agitation and aggressive behavior toward the staff and other residents in the group home where she has been living. She will need antipsychotic medication to stop her aggressive behavior before she can go back to some other sort of living arrangement. Her cognitive function is too far gone for behavior modification therapy. She doesn't know her own daughter most of the time just recognizes that she is a familiar face. She can still feed herself but cannot bathe herself or do a lot of the routine things we do every day without thinking. It is a sad thing to see but very predictable in this stage of Alzheimer's Disease. I hate to put her on antipsychotic medication but she is now a threat to harm herself, staff, and fellow residents where she is living. I had discussed this with her daughter over the last couple of years so her daughter is somewhat prepared but no family member is ever completely prepared for their parent to act like this.
Worship team practice tonight went great. I really like the new bass I am trying but have not decided whether or not to buy it. I will play with it some more and make a decision later this month. Hopefully, the owner won't need a decision right away.
My day off tomorrow looks busy. I have to go to a meeting tomorrow morning at 7:30 then I need to get some routine maintenance done on the Jeep and run some other errands. I also need to weed the garden tomorrow. Some time I need to optimize this computer again and get my office straightened up a little more. I think all the repair work is done on this house now. See you tomorrow...
Where does time go? For example, today was my day "off" so why did I not get this update done until now? Well, hop on for the ride and I will take you through my day quickly.
It began with a 7:30 meeting about possible restructuring of the Family Practice teams in our group to accommodate physicians wanting to work part time. Then, I had paperwork to catch up on from yesterday and a couple of phone calls to make to patients who I had been unable to reach yesterday afternoon. I then took the Jeep to get the tires rotated. Next I took it to get the oil changed and a lube job done. After that it was time for my haircut then lunch with my friend. I then went home and installed a roof rack on the Jeep so we can carry mountain bikes on the roof of the Jeep. Following that, I had just enough time to run before Delanae got home. I then checked my e-mail and tried to make some more phone calls to people who weren't home. Delanae and I got involved in a conversation and by the time we had finished it was time to get ready for church. After church, we came home and ate leftover pizza and salad(I was supposed to fix dinner tonight but see the above for the reason why it will be tomorrow night instead). Now you see why I am just now getting this page updated. Another reason is this is the second time I have written the above paragraphs since this program crashed about here wiping out the first attempt.
I did get to do a quick scan of the other Daynoters sites earlier today and see that Dan's Shelley is scheduled for gallbladder surgery(technically known as a cholecystectomy) Monday. In case any of you had wondered, I do agree with their decision to have the surgery. She is almost guaranteed to have further problems and there is the possibility that she would need emergency surgery in the future if she does not have the gallbladder removed when she is relatively asymptomatic. There is a greater than 90% chance that the surgery can be done through the laparoscope so a BIG operation would not be needed.
Tomorrow begins with another 7:30 meeting, then I have a patient or two to see in the hospital. It promises to be a long day as all Thursdays are. This weekend is my first weekend on call in over two years so I will have a new adventure again(actually it will be the rebirth of a bad dream). Delanae says she will spend the weekend while I am gone getting things organized for a garage sale. Until tomorrow....
Let's see if I have time for an update. Yes, I'm on call but maybe I can squeeze in a few words. Yesterday was very long and busy. It ended on a sour note when I was not called about a patient that I had asked to be updated about. That meant this morning I had to call the patient and tell her that my carefully crafted plan had broken down due to a breakdown in communication. After explaining that she accepted my apology and she is doing better. Basically, I had arranged for an ultrasound examination of a patient last night with the results to be called to the physician covering for me who would then tell the patient the results and decide whether she needed to be examined by a surgeon last night or not. The report never got called to my partner so the patient never was told anything. Luckily, she probably does not need surgery after seeing her today. Nevertheless, an investigation is being done to see what caused the breakdown in communication and to be certain it never happens again.
The corporation which we are a part of was crippled by the ILOVEYOU computer virus yesterday. All e-mail had to be shut down for up to five hours and there were still some messages bouncing around today. I got a few messages but none had the attached file with the virus in it. We got none here at home but I did not open Outlook until I had downloaded the latest virus files from Norton Anti-Virus. Now I understand that there are similar viruses being e-mailed to look like the messages come from Symantec so users will open them up without being suspicious. I was bitten by the Melissa Virus but, so far, not by these. I am much more suspicious now and will not open an attachment until I am sure that it indeed came from the source it says it came from. Delanae's radio station's computer network was also unaffected but a couple of the Portland television stations' networks had to be shut down for a while because of the virus.
Tomorrow, I will be busy from 8AM to 5PM either rounding at the hospital or working in the clinic. After that, hopefully I can do some weeding in the garden as it needs it. ......Lost my train of thought there as I was interrupted by a phone call from the emergency department. Child is fine and I will check it in the office tomorrow. Now where was I?......Tomorrow is coming so I had better try and get some sleep now. Good night everyone.
No update yet.
On call again tonight.
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