Doc's Progress Notes
Week of May 15, 2000
Last Updated: 5/21/2000 at 8:40 PM PDT
It's Monday again. Today was a typical Monday with me running behind trying to catch up on everything. Actually I was not as behind as I am some Mondays. I did admit one patient from the office today. He came in with nausea and diarrhea and generally feeling bad. I thought it was probably because one of his medications, Digoxin which is used for heart problems, had built up in his bloodstream. Sure enough, it had but why? The rest of his bloodwork showed that his kidney function was dangerously low but he had no history of kidney problems. So, why? What would cause a sudden drop in kidney function to dangerously low levels. Obstruction of his bladder outflow of urine could do this and that could be caused by an enlarged prostate. He had had surgery on his eye a couple of months ago, then postoperatively had had problems urinating leading to his being started on a medication to help his prostate relax and let urine pass easier (did I mention he is 76 years old?).
On exam, his bladder was almost up to his navel when it should not be felt above the pubic symphysis. Ultrasound confirmed a massively enlarged bladder that, amazingly, had not caused him much discomfort; probably it had been enlarging very slowly for a long time because he was unable to empty it completely due to an enlarged prostate gland. This urine backup had caused injury to his kidneys which hopefully is completely reversible with drainage of the urine. We inserted a tube into his bladder (a foley catheter) and drained over 2.5 liters of urine out. Try filling up a half gallon jug of milk and imagine that in your bladder. Tomorrow we will see how much better his kidney function is just by draining off all that urine. He has other problems too which we will address while he is in the hospital but he will probably end up having to have his prostate addressed surgically.
Delanae spent the day at home by herself today and did well. She is doing better each day but still is very sore. She is not supposed to be on her feet longer than five minutes at a time until after her appointment with the surgeon on Friday. Hopefully, I fixed enough spaghetti tonight for the kids to heat up tomorrow night for her so I can go to my usual Tuesday night meetings. If not, then I will just be late for one.
Sorry about the short post tonight. I have to get my lunch ready for tomorrow and get other things ready for tomorrow and get to bed at a decent hour tonight. Tomorrow I should find out if I have to be on call on July 4th this year since my name is one of four going into a hat to be drawn. The winner gets to be on call on that holiday. I am on call the weekend before so I don't think it is fair that I should even be in the drawing but some changes have to be made in the way call is done on the holidays before it is entirely fair. I have voiced my complaints, now we will see what transpires. More tomorrow...
No call on July Fourth! Yes, my name was not drawn from the figurative hat so Delanae and I are free to go to the fireworks show as we had planned. She should be well enough to go and enjoy herself. It is a big production in Vancouver, Washington at Fort Vancouver and is supposed to be the biggest fireworks show in the West. They have events all day and hopefully we can go this year and spend the day there among something like 50,000 people. The show itself is launched from barges on the Columbia River.
I have been asked for an update about my patient with the FULL bladder. He eventually emptied out almost five liters of urine yesterday from early in the afternoon to 7 AM today. His only complaint today is about the catheter or tube in his bladder to keep it emptying. He says it is irritating and would like it out. It does tend to irritate the bladder walls until the bladder adapts to it being there but if we removed it now he would just fill up again and not be able to empty the bladder. The bladder musculature has become very weak and it needs to contract back down which it will do if the bladder is kept empty with the catheter. The whole process will probably take a minimum of four weeks during which time he will need to keep the catheter in. Then, he will need some kind of procedure to open up the prostate so this doesn't happen again. His heart function is still not entirely known, the cardiologist is evaluating that right now. He will probably be able to go home by Thursday unless the cardiologist finds something critical that would necessitate him staying longer.
This morning, at the office, was slow but it really picked up this afternoon. Everyone needed extra time so I was late getting out again. It was 7 PM before I was finished with phone calls and dictation, then after 10 PM before I got home. I did make it back by the store to pick up the things I forgot last night, finally remembering to write down what we needed rather than depend on my memory which deserts me at the most inopportune times it seems. Tomorrow, I get to play chauffeur for Stephen's two appointments and Stacey's one appointment plus taking two bicycles in for checkups and going by Delanae's office to transfer her e-mail from there home and .... Let me write these things down so I don't forget what it was I am supposed to do.
That's all for tonight, folks, see you tomorrow.
Another day this week missed. Somehow, I could not find enough time on my day "off" yesterday to put up a post. I played taxi driver all day for the kids then after running, fixing dinner, and church followed by a long talk with Stephen it was too late to post. Where are those twenty six hour days when I need them?
Tonight, I am on call which means I got home a little after ten this evening after admitting three people to the hospital after I finished at the office. One of the ones I admitted I had just discharged this morning. It was the patient with the prostate blocking his bladder outlet. He thought he was independent enough this morning to go home with the help arranged. Well, the help never materialized so he is back until we can get him to a nursing home for a short period of time where he can regain more of his strength. One of the others is a lady with breast cancer that has spread throughout her body and was not getting enough pain relief on the medications she had at home. She is now in for IV pain medications to control the pain near the end of her life.
One other patient may be coming in later tonight. He was just discharged from Oregon Health Sciences University hospital in Portland earlier today but a visiting nurse called me tonight to say his wife can't handle all the things he needs done. I am not surprised, knowing her, but his physicians there didn't ask me or tell me he was being discharged today. He needs to go to a nursing home for awhile due to the amount of care he needs as he is recovering from extensive surgery on his tongue, throat, and neck. He wants to come back to our hospital although his surgery was done at the university hospital. He really should go back down there and then be transferred to a nursing home here next week. We will see what happens later tonight.
Enough posting for tonight. I still have a couple of e-mails to write and send then I will try and get some sleep between calls. Good night.
It's the end of the week and I'm not on call. That is something to celebrate. Last night was a long night and today turned out to be a long day also. Through the night I admitted four patients to the hospital, two of whom had taken overdoses of various drugs. They are stable now and are undergoing psychiatric evaluations. The cancer patient is much more comfortable now that she is getting enough pain medication. Now, the end of her life will be much more comfortable. The other patient I told you about decided he did not want to go to a nursing home yet so is still at home. His wife came in today to talk to me but she cannot stand the stress of trying to take care of him at home. It is more than she can handle, especially with no medical background. I asked her to talk him into being admitted to a nursing home early next week at least long enough for him to get back to the point where he can eat and not require tube feeding. I would be happy to admit him to a nursing home here in Longview so he can be much closer to his home.
Also today our medical director ran into me in the hall of the hospital and asked me to think about taking on some administrative duties for our group. I would trade some of my patient care time for the time spent doing administrative work and would be compensated for that time. He also wants me to chair one of our group's committees that deals with managed care issues. I have until June 15th to make a decision about this. I will probably do it but I want to be sure that I will not have to give up any more time away from my family. More about this as I learn more details.
This afternoon was a refreshing break for me. I did several minor surgical procedures which were very refreshing. When I was in medical school I had a real interest in surgery and after my junior year was asked to apply for a residency position in surgery there. I decided not to as I really wanted to be a family physician but I still enjoy surgery and the times I get to do minor surgical procedures in the office are very enjoyable. I used to assist in the operating room a lot when I first started in private practice but now don't have the time. I do miss it.
Tonight, Delanae and I watched "American Beauty". It is hard for me to believe that it won an Academy Award. I may be in the minority but I thought it was too dark and pessimistic as well as glorifying the drug scene. I won't let Stephen or Stacey watch it now. We have others for tomorrow night which I hope will be better. Delanae is recovering well and got her bandages off today and her sutures out tonight (I did it) but she is not up to being out much yet. Stephen is gone with a friend and his family to the Seattle area for the weekend so I will be entertaining the girls this weekend. Tomorrow, she and I will be playing catch (her request) and she will be learning how to mow the lawn. Have a great weekend.
Lazy day today. The lawn did not get mowed but Delanae and I did go down to the lake today and walked around a little. She is improving although she was sore afterward. I took a long nap this afternoon after watching Portland lose to the Lakers. Hopefully, Monday night's game will have a different outcome. Stacey and I did play catch on two different occasions today. She wants to throw around a baseball now for some reason. She is not interested in playing catch with a softball. We are going to have to get her a baseball glove now, she has been using mine and I have been catching the ball with my bare hands. So far she will not tell me what has gotten her so interested in baseball.
I got a notice from the Social Security Administration today, informing me that I had worked long enough now that I could start drawing benefits when I reached age 62 but could draw more if I waited until I was 70. I don't know whether to feel comforted or OLD. Never mind that 70 is 25 years away for me. Now Delanae has one more thing to tease me about regarding our age difference (10 years if you must know).
Tonight, we watched two movies, the latest James Bond movie "The World is Not Enough" and "Mumford". I really liked the latest BMW convertible in the James Bond movie which was good suspend reality fun. Mumford was an interesting morality play with a nice twist for an ending. It is not an action film but has some funny moments and was enjoyable for me.
Short post tonight since it is the weekend. After church tomorrow I need to weed the garden and get the lawn mowed so Stacey can help me and then Stephen after he gets back. I am sure both kids will look forward to this. Have a great day tomorrow.
I got a little more accomplished today. The front yard got mowed by me and the garden got weeded which is what really needed to be accomplished. Stacey was no help since she had a friend over. Stephen was gone so it was up to me. He will finish the mowing tomorrow after school as well as doing the trimming of the edges.
Mostly, it has been another lazy day. I got involved watching the Knicks-Heat game which turned out to be much better than I thought it was going to be. The outcome disappointed me as I am no Knicks fan but the Heat choked in the fourth quarter and deserved to lose if they can't play any better than that at home in the most important game in their franchise history.
I got a call from one of my associates earlier this evening informing me that I have three patients in the hospital now. That means tomorrow will be a very busy day beginning at 7 AM with a meeting, then I will have to round on at least two of them before office hours start and the other one I should be able to see at noon. Tomorrow night is worship team practice so I will probably not get home until some time after 9 PM. This practice will include Delanae though as she will go down and sit in a chair rather than stand up and sing as she usually does. Must go and get ready for tomorrow.
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