Doc's Progress Notes
Week of December 18, 2000
Last Updated: 12/24/2000 at 10:57 PM PST
Where did the last three days go? I realized late, late last night that I had not posted since Friday. Let me recreate those days and explain what happened.
Saturday, Stephen and I went to the Seahawks-Raiders game as I had mentioned we would be doing on Friday. We drove to a restaurant on the water, ate brunch, then were taken to the game on a boat. It would have been a great way to go to the game and was, other than the rain and wind. The wind was blowing up to 30-40mph and it rained the entire time. We stayed inside the boat, actually a ship used to take people on dinner cruises, the entire way there and back to stay out of the elements as much as possible. Our seats were in the second deck, under the "roof" and in the middle of the Raiders section. This was fine with Stephen as he is a big Raiders fan. I was really surprised that there were people there, in Seattle, dressed like they do at the Oakland Coliseum. I had seen pictures of the people on TV but never expected to see them in person, especially in Seattle.
Anyway, it rained and the wind blew for the entire game. We got wet and cold despite all the gear we had on because there was no way to stay completely out of the rain even though we were under the "roof". The wind kept blowing the rain in on us and it swirled the entire game. We stuck it out to the end, however, and witnessed a very entertaining game which Seattle won in the last minute with the benefit of a very questionable call. Seattle should not have been that close as Oakland dominated them for three quarters. They hung in there and never gave up. There were some very disappointed Raiders fans after the game. On our trip back to the car we warmed up by the heater in the ship.
Rather than fight the traffic on the Interstate right after the game, Stephen and I went with some friends to a restaurant near the University of Washington. It was called Romio's and had very good food. It had been recommended to us by another place as having the second best pizza in the area. I had a calzone with garlic, artichoke hearts, spinach, and pesto and Stephen had his usual pepperoni pizza. We had good conversation and excellent food, then drove home well stuffed. Delanae and Stacey had gone to Portland while we were in Seattle and were not home when we got back so we watched Mission Impossible II on DVD.
Yesterday, after church, it was time to go and get Delanae's really big present. We got her a Compaq Presario with an AMD Athlon 900mHz processor, 128 MB RAM, 20Gb hard drive, CD-RW drive, DVD-ROM drive, and WebCam to go with her new printer. She is very pleased as now she has a very powerful machine to do her graphics work with. It makes my P-200 with 64MB RAM look very puny. I got to spend all afternoon and evening setting up her new computer and installing her software on it. My plans were to migrate her data from her now old computer to the new computer on Zip disks. Those plans were thwarted, however, when Windows Me on her new system would not recognize the Zip drive. I went to the Iomega website and found that I would have to download an entirely new driver for Windows Me but, unfortunately, the page to download the driver was offline all evening. She still has data waiting to load onto the new computer and will have until I can download the new driver and software for the Zip drive. Obviously, I should have had the new driver ready before I got the new system but I had forgotten that it would have Windows Me and not Windows 98 on it. I did not finish trying all this until almost midnight last night so nothing was posted here last night, either.
Today, at the office, was fairly typical for the week before Christmas. Fairly slow in the morning then very busy in the afternoon. It is almost like people are waiting to see if they can make it without coming to the doctor, then midway through the day they see how close it is to Christmas and want to come in and get "fixed" before Christmas. I did have a good orthopedic story today, I had diagnosed a stress fracture in a patient's foot a little over a month ago after no one else could find it. She was back today, after being in a cast for 6 weeks, and was having no pain. Her x-ray shows the fracture is healing nicely so she no longer has to wear the cast. It will be a better Christmas for her, provided that she remembers to not do too much walking on it too soon.
I currently have one patient in the hospital. She is an elderly lady who lives in an assisted living home and was admitted over the weekend dehydrated after three days not taking liquids or food. She is getting better with some IV fluids but will need to be in most of the week to get her electrolyte in her blood back to normal. We have to slowly correct the abnormalities to prevent her brain from swelling and her lungs filling with fluid from too rapid correction of her fluid imbalance. She may have had a urinary tract infection start all this.
Tomorrow, as well as most days this week, I have an early morning meeting. This one will be to discuss how our group will interface with the company that is managing the Medicaid contract in our area. It is a new company formed by some physicians in the Vancouver, WA area and this is their first contract in our area. We don't know them and they don't know us yet. We need to get together to discuss what will be different and see if we can't streamline getting our patients the care they need. Tomorrow morning's meeting will likely lead to other meetings with them throughout the first few months of the new year. I so look forward to more meetings!
As meetings go this morning's was rather informative. I learned some things and took away some questions which I tried to get answered today but was unsuccessful in doing that. We have gotten several advisories about what diagnostic tests require preauthorization by the company administering the Medicaid contract locally beginning January 1 so I tried to call the medical director today to clear the conflicting advisories up. I left a message but have not received a call back yet. This from the man who told me face to face last week that he would be easy to contact at any time. I have been very frustrated all day with this as we need an answer immediately so we can start preparing our physicians for the changes they will need to make as of Jan 1. Tomorrow, on my day off, I get to try and track him down again.
My patient with dehydration continues to improve or at least her numbers do. She is not speaking and has some left facial weakness which probably means she suffered a stroke sometime before she was brought to the hospital. That may be why she stopped eating and drinking rather than because she had the infection. She is now eating and drinking better and should be able to return to her assisted living home within the next 48 hours.
I had to confront three patients about their narcotic pain medication use today. One tested positive for metamphetamine in her urine which meant she had violated her contract with me not to use any drugs other than the ones prescribed for her by me or another designated physician. She will get no more narcotic pain medication from me or any other member of my group. I referred her to a local drug treatment center for long overdue treatment.
Another patient was found to be visiting two other physicians and receiving prescriptions for narcotic pain medications from them as well. This voids his contract with me and means he will no longer receive those medications from me or any member of my group also. The third patient told me that she had left her pills in her suitcase in Florida when she flew back here unexpectedly and forgot her suitcase. I will refill her medication early this once but the next time she says she lost her medication for any reason I will refuse to prescribe it again. There is simply no way I can check out all these lost my medication stories so I tell patients up front that if you lose your medication more than once then no more medication. This is a standard rule in all the formal pain management programs around the country.
Delanae is in the midst of copying her data from one computer to another. I downloaded the new software for the Zip drive from Iomega last night and installed it tonight. Now the Zip drive works with Windows Me on the new computer so we can finish transferring the data soon. I received a package today from PC Connection which turned out to contain the serial synch cradle and AC charger for my Compaq iPaq which has not yet shipped. For a few minutes I thought the iPaq was here and I could start using it tomorrow but I will have to wait longer for it. When I ordered it I had expected it would take at least a month before I would get it as they are still backordered. Compaq said they would be able to fill all the orders in December but we will see when I actually get mine.
Before I close tonight let me say congratulations to Dan on his good news today.
Short update today which is usual for Wednesdays. I sent my lady with dehydration and a recent stroke to a nursing home today, actually to the best nursing home in town and probably in Washington based on their recent survey by the state health department. The surveyors could not find one problem there which is unheard of for a nursing home. I now have the majority of my nursing home patients there and the administrator keeps referring more to me. Anyway, the nursing home stay for this lady should be short, just long enough to recover her ability to be independent with her normal everyday activities.
I also made nursing home rounds today after discharging my patient from the hospital. There were no problems with the patients I saw today, at least none which had not already been handled earlier in the week.
This afternoon I tried to finish my Christmas shopping. I say tried because I think I am done but will be certain only after a couple of days during which I do not remember someone I forgot. I still need to wrap a couple of presents before our office party tomorrow night and put some cards on a couple of presents under the tree. Tomorrow night I will find out who my secret Santa is from the office and the person I am secret Santa for will get a big surprise in their box. It is my office mate and partner who is 70 and will be receiving a Christmas tie and Christmas boxers. I can't wait to see everyone's face there when he opens it. Come back tomorrow night and I will try and describe the scene.
Everyone enjoyed the boxers tonight. The recipient did not promise to wear them tomorrow but did promise to wear the tie that was also in the box. He had not guessed who his secret Santa was.
Today was very busy. I sent a patient to the nursing home for one of my partners today and that process took an hour. He has multiple medical problems and I had to find out what medications he needed continued and at what dose. Also, I had to arrange for when he needed followup lab and other tests. The other hospital patient I saw this morning had had a simple heart attack and was doing very well. She should be home in time for Christmas.
During and after office hours I diagnosed two new diabetics which took multiple phone calls to arrange the first step in their treatment and education about their disease. I should say that the education comes first, then the treatment. One had ignored his symptoms for several months, the other had only had symptoms for a couple of weeks. Hopefully, both can be controlled mainly by diet and exercise.
The rest of the patients today either had chronic pain or had upper respiratory infections and were afraid they would not be well by Christmas. Most of these were viral in origin and that was not much I could do other than tell them they probably would be OK for Christmas. I did arrange to do some bloodwork on a patient who I had been trying to get back in for two years to check his thyroid function. I think he is hypothyroid and two years ago was borderline. I had wanted him to recheck his blood tests in three months but he did not come back until today which was two years from the time I had wanted him to come back. He tells me that he is tired and gained several pounds during this time. I tell him those are the exact symptoms for hypothyroidism which I felt he probably had back in 1998 but he would not give me the chance to confirm it and treat him. Now, he and his wife say he is ready to address the problem but not until afterward he goes to the Fiesta Bowl to watch Oregon State, his alma mater, play. Pardon my cynicism but I will believe it when I see him back in the office.
Now we can get on with Christmas. I have four days off which means I can relax and catch up on some much needed rest and maybe have some time to do some serious computer work. I have been very spoiled by Delanae's new computer and need to get this one faster. That means reinstalling Windows 98 which is suffering from "Windows Rot" as well as files put on it by Stephen. I will be stripping it down, hopefully over this holiday weekend.
I am currently running back and forth upstairs to install parts of Norton Systemworks 2001 on Delanae's computer. I am installing Norton Antivirus and the optimization tools from Norton Utilities but not the entire suite. According to Dave Farquhar this is the best overall utilities suite but only use the components he recommends and configure them the way he recommends in his book for optimum efficiency.
The office today was very uneven. We were busy off and on but had several no-shows which is typical for the days just before a major holiday like Christmas. I saw no one today who was really sick which is a departure from other days just before Christmas in the past. Actually, the really sick ones usually come in on Christmas Eve and you are left wondering what to do with them short of admitting them to the hospital. Invariably, they refuse hospitalization, then end up coming back to the Emergency Department that night or Christmas Day itself.
One insurance story from today then I will quit so I can continue installing Norton Utilities upstairs. This story will, of course, show how an insurance company or companies can be be the Grinch for Christmas. It seems that I was scheduled to see a four year old today for a physical before he has dental surgery next week under general anesthesia. This is probably to fill cavities or pull teeth or something like that and he will be unable to hold still for local anesthesia. He doesn't show up so we call to find out why he did not. The father tells us that the insurance company calls today to tell them they have decided not to cover general anesthesia for this little boy, their reviewers have determined that the dental work does not need general anesthesia. The family has another insurance policy so they call that insurance company that says if the primary insurance won't pay then they won't either. Now, different arrangements will have to be made for this dental work at the last minute. I don't think the dentist is going to want to try and sedate the child in his office so he can do the work. At least the insurance company did not call the day before the procedure which was scheduled to be done on the 27th.
Delanae has made a Christmas card and has it up on her site here. Please visit there if you are interested in viewing it and accept it as our Christmas greeting to all of you for this holiday season.
Today is a very lazy day around here. No one, other than me, wants to get up before noon. Delanae says she is trying to catch up on her sleep and when she sets her mind to it she can really sleep. Stacey and Stephen are just like her as far as sleeping goes. Me, on the other hand, can't stay in bed longer than about nine hours at a stretch. Consequently, I am up and writing this now in the early afternoon rather than tonight. I have already run today and caught up on some newspaper reading which does not take long with our hometown newspaper. Later we have to go run a few errands and finish the grocery shopping for Christmas, I did some of it last night before picking Stephen up.
Today, hopefully, I can get started on straightening up my office and computer and finish that up over the next three days. Also, I need to move Delanae's old computer downstairs and set it up for the kids to use. They are asking where the games are that used to be on it. I don't know since I did not install them, there must be a CD around here that Delanae brought home and installed the games from. I will look for it as we straighten things up.
Now the whole family is up and stirring so I must go and work on some other things for awhile. Have a good day wherever you are and if you are traveling be careful.
Hope all of you men have your shopping done by now! If not, then you are probably out of luck unless there is a store near you that is open all night. Or, perhaps Santa will take pity on you and drop something off on his way over. Since it is after midnight in some places already he is out there dropping off presents now.
Speaking of presents, Stephen and Stacey opened one present apiece tonight. We open the majority on Christmas Day but they always get to open one on Christmas Eve. As fate would have it, each of the ones they opened will need to be exchanged on Tuesday as they were not exactly what they wanted. We adults have not asked to open any and will wait until tomorrow morning.
Currently, I am setting up Delanae's old computer for the kids. I am in the midst of doing a clean install of Windows 95 on it then I will install the Windows 98SE upgrade over that so I can use the USB port on it for the Intel Microscope for Stacey. She doesn't know I am doing this at the present so that will be part of her surprise. We have had to keep her upstairs tonight so she wouldn't stumble in on what I am doing. Installing Win95 the Dave Farquhar way is certainly faster than the original way. Thanks again for writing the book, Dave.
Before I close, I want to wish everyone a happy, safe Christmas tomorrow! I hope that everyone will remember the reason we celebrate this holiday. God bless you all!
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