Doc's Progress Notes
Week of July 31, 2000
Last Updated: 8/6/2000 at 9:43 PM PDT
I played telephone tag today. That is a very frustrating game. Actually it was not really tag since no one was chasing me. I had called this morning to speak to a surgeon at Oregon Health Sciences University about a mutual patient. This patient has had a gastric(stomach) stapling operation in the past for extreme obesity. It has worked well until the past few months when she has developed vomiting with anything she tries to eat no matter how small the amount. This surgeon has seen her and is planning to do an operation to reverse the stapling but wanted some more information about the function of her stomach and esophagus first. He now has that information but it has taken more time than he meant for it to and now I am trying to get a date and time for her to come down to be admitted for the surgery. Anyway, I tried to reach him today to discuss this with him and he was in surgery when I first called him and took my number to call me back. He did not call all day and now I just got home from running and found out he had just tried to return my call at 8:30 PM tonight. That means I will have to try and find him again tomorrow which should be fun again.
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.
My patient from yesterday with the abdominal pain had his ultrasound this morning. He has a thickened gall bladder wall but no visible stones. A thickened wall means he has inflammation which is probably been going on for some time. He was to see a surgeon this afternoon who will advise that the gall bladder be taken out soon to relieve his discomfort. When the gall bladder is out stones may be found in it since there is so much inflammation present. Not all gall stones show up on ultrasound, especially very small ones.
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.
Yesterday's update was written last night, but I was unable to post it last night. I have finally been able to today. Last night we had to have a family meeting before I could post it. Stephen needed to be disciplined for failing to wear his bicycle helmet while riding his bicycle downtown yesterday. That was the topic of the meeting and appropriate punishment has been handed out.
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.
First, let me catch you up on the events of Wednesday night then I will explain about yesterday. We did go to the concert and the singers name is Chely Wright. She was good and everyone enjoyed the concert. We then wandered around the fairgrounds and looked at all the animals there and enjoyed ourselves. On the way home, we stopped and looked at a nice Ford Ranger 4x4 that we were seriously thinking about buying for Stephen and told him that. Then, about 3:30 Thursday morning, the telephone rings and it is a Longview Police officer asking if we had a son named Stephen. My answer was yes, and did we know that he was out of the house in a neighborhood just below where we lived. No, we did not know that but it seems that he sneaked out of the house and met some "friends" and they proceeded to create a disturbance there by consuming a little beer and smoking some pot. The police were called because of the noise they were making and found them in possession of alcohol. Since Stephen told them the truth when they asked him if he had been drinking they decided to release him to us without charges but if he is caught again he will face charges.
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.
Today is a day for catching up on missed sleep the last two nights. Delanae and I both slept in then she went off to scout out a huge garage sale and I have been working in the garden. I just tilled up the snow peas as they had stopped producing and were drying up. My tomato plants have green tomatoes on them which should now ripen fairly quickly. I have three different varieties of tomato plants so will have to see which variety ripens first. The garden looks pretty empty now with only tomatoes and corn and one row of beans left. Next year, I am seriously considering planting a lot more densely in a smaller space as that seems to work well around here and keeps the weeding to a minimum.
Tonight I am fixing dinner again. I will probably do barbecued chicken maybe with corn on the cob and the last of the snow peas I picked today. I must go run now before I fix dinner so probably nothing again until tomorrow.
First, let me say thanks to all you readers who wrote me about what we are experiencing with Stephen. The e-mails keep coming in and are very much appreciated. No matter how much you think you know beforehand, raising a teenager is a learning experience and all the advice is welcome. He is doing well at the present time but he basically has no privileges right now. Delanae is really spending a lot of time with him trying to re-establish some communication that has been lost.
She keeps getting replies from his teenage mailing list agreeing with what we are doing to modify his behavior. Even a couple of his acquaintances who we thought were "bad" kids have replied that they agree with what we are doing and have told us why they will not use drugs or drink alcohol. Now hopefully they also know that their e-mail is not completely private and other people are reading it. One girl had offered her body to Stephen and he had wisely declined; she wrote to apologize for doing that and explaining how wrong she realized it was and how happy she was that he had turned her down but had still remained her friend.
Today was a pretty lazy day. We went to a local park for a church picnic after worship this morning. It was a very good turn out and a very nice day with clear skies and the temperature in the low 80's with low humidity. One couple there had just arrived back here after spending a year in the Phillipines as missionaries. They were remarking on how nice the weather was and how they understood it had been a great summer here. In the Phillipines, they pray for weather like this. They have been having to wear sweatshirts at night though because they are not used to the cool nights yet.
Tomorrow looks very busy already. I have a Leadership Council meeting in the morning at 7 AM and have already heard that I have at least two patients to see in the hospital tomorrow for one of my associates. On top of that, I am on call tomorrow night so it looks like it will be a long day. There may be no post tomorrow, check back and see.
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