My last patient today also required some phone work. He is having right upper abdominal pain which I think is due to an inflammed gallbladder due to stones. He needs an ultrasound which I felt could be done early tomorrow morning to confirm the diagnosis. At first the ultrasound department did not want to work him in early tomorrow morning but I told them it was either that or he will come to the Emergency Department tonight and they will get called back in to do it tonight. They relented and agreed to work him in early tomorrow morning. I know they work by appointments just like we do but they do stat ultrasounds from the Emergency Department all the time, they just don't want to believe me when I say it needs to be done NOW.

The rest of my day at the office went well. It was not to be after I got home, however. As at least some of you know, I have an Australian Shepherd named Dexter that was given to me for Christmas 1997 when he was about eight weeks of age. He soon moved cross-country with us in January 1998 and has been with us since. He is a very loving and gentle dog around us and has been through obedience training and been neutered as we decided not to breed him even though he is a pure bred and has papers.

His main flaw has been that he does not like small children and never has learned to tolerate them. Any child shorter than about four feet tall he instantly does not like and has tried to bite two or three in the past. Everyone else is fine but, for this reason, we have not been able to let him run loose even though there are not many houses in our neighborhood which is not inside the city limits. One of our closest neighbors has a small boy who Dexter has refused to believe belongs in his own yard. He has chased after him a couple of times in the past but we thought he had mellowed out as he has not bothered any of the other small children who live in the neighborhood, even one who lives across the street from us now. However, tonight Delanae had Dexter with her in the front yard while she was watering a flower bed and he took off down the street and into the yard with the small boy that he does not like. Delanae was able to call him back before he could do anything but it has become apparent to me and her that he is not going to learn that small children are to be left alone, especially when they are in their own yard. I know that this child has never done anything to Dexter as we have talked to his parents and they don't understand it either. It looks like we are going to be forced to find Dexter a new home where he can run and where there are no small children around. We cannot afford to spend the thousands it would require to landscape the yard enough to put up a fence and he is too big a dog to always have him on a cable and walk him on a leash all the time. We will start looking for him the perfect second home where we can be sure he will be happy. On that note, I think I will call it a night.

Things like this now affect me more. I saw a fourteen year old girl in the office today who wanted to be put on birth control pills for contraception and acne control. When I asked her how long she had been sexually active, she said since age thirteen which was in the summer after her seventh grade year. At one time I would have simply shrugged and said she was being smart to be asking for contraception, now I told her about the virtues of abstinence before marriage. It's amazing how one's opinion changes when you have a daughter near that age and know what God teaches us about premarital sex in the Bible. This girl plans to continue being sexually active and sees nothing wrong with it at her age. Her mother brought her in for the contraceptives and was aware that her daughter was not a virgin but I don't think she was aware of how sexually active her daughter is. Along with the discussion about abstinence was a discussion about sexually transmitted diseases.

Then, guess what our noontime conference was on; an update on genital herpes. That topic dovetailed well with what had happened in the morning. I did learn some new things about genital herpes including the high prevalence among people over 18. The surveillance numbers are that 25% of people over 18 are infected and 20% of people 12 and over. 80% of those people are asymptomatic but have the capacity to pass it onto someone who may very well be symptomatic then. While it is truly only a skin disease, except in newborns, it has the capacity to wreck relationships and lives. There is good suppressive medication now but nothing to prevent acquiring the virus(es).

My patient with the obstruction in her stomach due to a previous gastroplasty for treatment of obesity (see Monday), is going down to OHSU Thursday and will have her surgery scheduled at that time. The problem is whether or not her esophagus will be able to function properly to allow her to swallow normally. I did speak to her surgeon from OHSU today finally and that is his concern. He's afraid the operation will not be a success since her esophagus is not functioning properly at the present time. She will have a feeding tube after surgery for some length of time to see if her esophagus will resume functioning properly. I foresee a long road ahead for her.

Today has been a day to run errands. I took both kids with me today and they have helped. We met Delanae for lunch at the lake. Tonight we are going to a concert at the Cowlitz County Fair. You can tell I follow country music since I do not know who the artist is. Delanae and Stacey have told me but I do not remember. She has released a song called "Single White Female", I think.

My medical records are now all signed at the hospital and I have accomplished all I had planned to do today so I think I will go read some. Have a great rest of the day wherever you are.

Needless to say, I got no more sleep after that and Thursday was a long day. Since Stephen was under the influence of alcohol when we got him home Thursday morning, we saved the real discussion for Thursday night after I got home from the office. That discussion did not end until real late so I did not post anything yesterday. Stephen is now grounded for an indefinite time and will not be allowed to get a drivers license for an indefinite time and, of course, will not be getting the little pickup now. We have also taken away his telephone and internet privileges. Delanae wrote a letter to his e-mail list and ICQ list telling them what had happened and why they would not be able to correspond with him for some length of time. Amazingly, a couple of teenagers have replied saying they agree with what we have done in punishing him and believe it will make him a better person. Stephen thinks we are being too strict, that there are parents of his friends who are cooler and as long as their teenagers tell them what they are doing, they don't get punished like this. If this is true, it is no wonder we have problems with drug abuse and premarital sex among our teenagers; they get the message that it is "cool" and OK to flaunt laws and morals as long as their parents do not set limits on them. When we set limits and enforce them then we are really "uncool". Well, so be it!

Today began with an early meeting at 7 AM then the morning was rather slow. That was good since I was the only physician in the office today as the others were on vacation. I managed to be caught up on all the paperwork by noon but this afternoon got very busy. I got some interesting new patient this afternoon, one of them the chairman of the board for Dotster. I had no idea that this company was based here in Longview so he and I spent some time discussing it. He had just gotten back from traveling in Thailand, Cambodia, and Japan on business and was happy to be home to the Pacific Northwest.

I did not finish up until after 6:30 PM, then met my family to go to the rodeo at the Fair. That was the first rodeo I had been to for several years and was quite fun. They had the usual rodeo events like steer wrestling, bareback bronc riding, and bull riding but also had an animal trainer who had a trained buffalo. This buffalo was 23 years old and the trainer had had him since he was six months of age. This buffalo would let the trainer ride on his back and would lie down and place his head on the trainer's chest. Now, this buffalo weighed 1800 lbs so that head had to weigh quite a bit and to get his head on the trainer's chest the buffalo had to kneel over the trainer, then lie down. It took a lot of trust on the trainer's part to do this trick.

Afterward, we came home and stayed up past midnight talking to Stephen again. That is why this update is not being posted until Saturday.