I don't know when this will get posted as I am having trouble connecting through my ISP. This has been happening at night the last three nights. The modems will get connected then the connection will be dropped. It does not happen early in the morning so I don't think there is anything wrong with my computer or modem, just the modems at the ISP. I really am writing this Tuesday night no matter when it gets posted.

Today was busy as usual. Not busy in the number of patients seen but busy with all the paperwork generated when two or three clinicians are gone for a week. I also have now three patients in the hospital who I need to see tomorrow even though it is my day off officially. I also need to make nursing home rounds and have a meeting at noon tomorrow. Sounds like a pretty full morning to me and I have a couple of errands to run tomorrow afternoon. It should still be hot tomorrow so I will get up and run in the morning. Probably no time for biking tomorrow.

The kids have been calling every night. They must be getting bored at their grandparents now. They went to visit my mother today and enjoyed themselves. She is coming out here to visit us in late September. It will be her first visit here in a year. We are looking forward to it.

Connectivity is back so I will end this post now. See you tomorrow.

I ended up spending most of the day either at the hospital or making nursing home rounds. Tomorrow looks very busy again with five patients to see in the hospital before my office hours begin. Friday I am inpatient physician again and that will run through Sunday. I will be on call Saturday night so I will end up covering the hospital for 36 hours in a row. That is like being a resident again. I only have to do it about once every three months or so due to the size of our group. Luckily, the Fourth of July falls on Tuesday this year and I am not on call so Delanae and I can go to the big fireworks show in Vancouver, Washington. Hopefully, it will be warm but not too hot during the day and not too cool at night. Last year was our first time to go and we really enjoyed it. More details as the day gets closer.

I only saw four patients in the hospital this morning, rather than five as expected. One had already gone home yesterday afternoon without me knowing about it. I sent one patient to a nursing home today which takes a lot of time as they have to have pages of orders filled out plus a discharge summary dictated right then. I did manage to get to the office on time and started the day off with a work-in patient with shoulder pain which she was afraid was coming from her heart. It was not, it was shoulder pain due to some inflammation of her rotator cuff probably from doing work with her left arm that she was not accustomed to doing. Pain due to inflammation of the rotator cuff is a very common presenting shoulder problem, one that many patients think is bursitis. It is not, technically it would be a tendonitis I suppose but is treated identically to a bursitis. The difference? A bursa is a fluid filled sac over a bony prominence to prevent that prominence from rubbing on the soft tissue structures that cross it. When it gets inflammed, it begins to hurt and can swell. In the shoulder, that will cause pain to palpation directly over the outside of the shoulder or upper arm. Rotator cuff tendonitis, on the other hand, does not cause pain to palpation there but rather pain when one tries to lift their arm overhead or reach behind themselves to, for instance, fasten their bra or scratch their back.

Tomorrow I go back to being the inpatient physician again. Tonight, the inpatient list does not look too long but that could change tomorrow. It should not with this weekend being a holiday weekend but you never know. The hospital is taking advantage of the smaller inpatient census at the present time to close a floor and replace the carpet. They plan to do this one floor at a time. Eventually, the plans are to remodel each patient floor but that may take a couple of years.

Tomorrow night Delanae and I are going to a concert featuring all Eric Clapton songs. The group playing is made up of several individuals from the community and is very good. I heard a little of their program two or three months ago when they performed at one of the high schools here. The program is the result of one boy's idea for a senior project to benefit the children's hospital in Portland. He recruited the band members and they gave a benefit concert for that hospital and raised several thousand dollars. Now they are doing it again for a local charity. We are looking forward to going and hearing the entire program. Because of that, tomorrow's post may be very short or nonexistent. See you later.