Last Week



Doc's Progress Notes

Week of February 26, 2001

Last Updated: 3/4/2001 at 8:28 PM PST

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Monday February 26, 2001

I'm back from three very intense days. I was busy the past three days, two nights of which I was on call. I got lots of phone calls both nights, mostly from parents of children with either upper respiratory stuff or diarrhea and vomiting. Rotavirus, which causes vomiting and diarrhea, is epidemic here at the present time so we are seeing a lot of children who are either on the edge of dehydration or clinically dehydrated. Some of these children need admitting to the hospital and others do not. Some of this triage can be done on the telephone, some cannot. The trick then was telling which child needed to be seen in the emergency department and which could wait and be evaluated the following day in the office. We managed to give IV's to a couple of children in the office and save them from having to be admitted.

All these children with upper respiratory illnesses and/or diarrhea made for a busy clinic schedule both days. I did end up admitting two people from the clinic, both of whom were adults.

Today was supposed to be a day off but most of it was spent at the hospital. I had to be there to sign out the patients I admitted last night to the inpatient physician this morning so I saw the three patients of mine who I had in after the weekend and then planned to go home. One of the patients chose to have chest pain, however, and I had to stay and take care of her along with one of our cardiologists. She had been admitted with a rapid heart rate which caused her to almost faint but had not had any chest pain all weekend until this morning. She will now need to be transferred to Portland for cardiac catheterization to find out where her blockage is. She had had two previous blockages opened with stents last June. It is unusual for her to have more problems this early after that type of treatment but this was an unusual weekend.

Speaking of unusual, I hope some of you watched my Arkansas Razorbacks defeat the ranked Kentucky Wildcats Sunday. I did not get to watch much of it but I was very pleased with the final score. I don't know which Arkansas team will show up at the SEC tournament and NCAA tournament, if they make the NCAA tournament, but if the one on Sunday shows up they could surprise a few teams who are ranked higher than them. I don't think most coaches would want to play them with only a day or two to prepare for their scramble defense.

Tomorrow is back to my usual office schedule. I don't think I have any meetings scheduled for tomorrow which will be a real rarity. I will make up for that on Wednesday which is supposed to be my day off but which will, as usual, be packed with things to do which I cannot get accomplished on office days. Before I go, surely there is someone out there who would like to buy a very nice BMW. Check it out here.

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Tuesday February 27, 2001

Very intense day in the office today. I was triple booked for a time this morning but managed to get through in time to be able to grab some lunch at a continuing medical education presentation on esophagitis and reflux disease. No, the lunch did not give me heartburn and the presentation was good. More and more the message is that acid reflux disease is chronic and cannot be cured by eight weeks of therapy, no matter what the therapy is or how powerful it is. It used to be thought that eight weeks was enough treatment for this condition and people were well after that time. No more; now it is recognized as a chronic condition so treatment needs to be chronic despite what some insurance companies would like to think.

This afternoon was a little less hectic but still my normally busy pace. We did have extra staff working today as another module in our electronic medical record software "went live" today. Of course, my medical assistant and I had been using this module for some time before today so it was old hat to us. There were no major problems voiced by the support staff that I am aware of. I just found myself with two people putting patients in rooms for me. I was talking to one of our medical assistants and she was saying how much she enjoyed using the software package now after having been one of the loudest about how she would never be able to learn it. She is transferring to another clinic next week which has not gone live yet and she doesn't want to think about not using this software in her daily work. Since that clinic has computers now which are networked I explained to her that she could use the software there since the software is "turned on" by her ID number not by computer. In other words, since she has been able to use it in our clinic that means her ID number is authorized to use it, the only reason the members of the other clinic can't use it yet is because their ID numbers have not been authorized to log onto the system yet. So she will sneak around and use it like my medical assistant and I have been doing for some time.

Tomorrow is my regular day off and once again I have an early morning meeting. This is my biweekly meeting but this time I will do it by teleconferencing rather than having to drive down to Vancouver, WA. That means I don't have to leave before 6 in the morning, I can wait and leave about 45 minutes later and still make it to the telephone at the office in time. After that, I need to make some nursing home rounds then have a team meeting at 12:30. I have nothing schedule for tomorrow afternoon but I am sure something will come up. I would like to get out and run in the sunshine tomorrow afternoon and should be able to find the time to do that. More tomorrow......

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Wednesday February 28, 2001

The earth moved and moved and moved and kept moving today. Of course, the big news in the Northwest today is the earthquake. For those who haven't heard, a 6.8 earthquake rattled all of us here today. Its epicenter was near Olympia which is about 75 miles north of here. It did much more damage in the Puget Sound area and very little if any here, at least that I've heard about up to this point. It did major damage but not catastrophic damage because it was 30 miles deep in the earth's crust. Still, it served to remind everyone here that this is a very active seismic area.

I was making nursing home rounds when the quake hit. I was actually sitting down writing on a chart when it began to move and I noticed the building moving also. I realized that it was an earthquake right away since I grew up in northeastern Arkansas near the New Madrid fault so I have been through a lot of earthquakes but few this strong. The staff at the nursing home were scared and unsure what to do but it did not seen to bother most of the residents any. The movement in this quake seemed to be more waves than what I had experienced before. It also seemed to last longer. There was no damage in the nursing home, just some pictures hanging on the walls were crooked afterward and the light fixtures were swinging during the quake. Everyone in the buildings around us ran out into the street to see what was happening and to check on their building from the outside. We stayed inside and just made sure everything was OK in the nursing home. The story at the hospital was the same, no problems just some scared people.

I spoke to Delanae right after the quake stopped. This was the first earthquake she had experienced and it frightened her. She was at home with the dogs who did not seem to sense it or be frightened about it. I understand that dogs in the Seattle area did sense it a few seconds before it hit there and were frightened. The Seattle area was much closer to the epicenter so their shock wave was greater and they had much more damage there and injuries. The Portland area felt the shock also and now, almost eight hours later their television stations are still doing "breaking news" coverage of the earthquake. How many times can you show the same fallen bricks and interview the same people about what they experienced during the quake?

That was pretty much the excitement for the day. My medical advisory committee meeting went fine this morning. I was certainly less inclined to participate in the discussion since I was listening on a speaker phone than I would have been if I was at the meeting in person. The next meeting, in two weeks, I will attend in person.

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Thursday March 1, 2001

Another Thursday is almost over. As I've said before on these pages, Thursday is my busiest day of the week in the office. Today was no exception. The stack of messages on my desk did not seem to shrink at all today no matter how many I did between patients that I saw. A couple of administrators came by to see how I was managing the stacks and then fled in horror when they saw them. One of them is supposed to be helping us find ways to be more efficient with our time. I invited her to take a few charts and work on them for me, she declined. Actually, my medical assistant and I did finish up on time tonight. That time was a little later than my goal has been but not as late as I have had to stay on other Thursdays.

Tomorrow will again start early. I have a breakfast continuing medical education meeting at 7 then I am supposed to do chart review at 8, then start in the office at 8:30. Some time tomorrow morning I need to make time to see two patients in the hospital, preferably before I start in the office at 8:30. I could be at the hospital at 6:30, see the two patients, then go to my breakfast meeting but that means I would not be able to drop Stephen off a school for his early class which begins about 6:45. I will probably end up going in earlier and he will probably miss that weightlifting class tomorrow. We'll see.

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Friday March 2, 2001

I am glad the week is finally over. I have mentally tired after having worked last weekend on call and having missed a lot of sleep for the last 10 days. I really hated to get up this morning although I knew I needed to get up a little early to get to the hospital in time to see my two patients before the breakfast meeting. I made it with a little time to spare. The breakfast meeting was a presentation on domestic violence which was given by an attorney from Austin, Texas who works in the prosecutor's office there. She directs their domestic violence program and is a speaker around the country on that subject. She was a welfare mother who was abused by her ex-husband and managed to get through college as a single mother and then go to Harvard Law School. Her main point was that we need to be asking about domestic abuse at every patient visit, not waiting for the patient to tell us or for us to pick up clues from the physical exam. I started to do that today, it is difficult at first but got easier as the day went by. The patients seemed to not mind especially when I explained why.

The rest of my day was normally busy. Well, maybe a little busier than some Fridays since I did not get finished until almost an hour later than normal. By the time I got home, Delanae had already gone to Portland to a business exposition at one of the malls, Stacey had gone to a friend's house for the night, and Stephen was wanting to leave to go to a local coffee shop that has live music on Friday nights. That left me at home by myself so I hopped on the NordicTrak and did my workout. Now I am writing this and reading other Daynoters' sites. Tomorrow night is the spring concert for the youth orchestra Stacey is in and she has to be at a final rehearsal at 11 AM. Before that, my plans are to catch up on some sleep. For now, I want to go read some before calling it a night.

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Saturday March 3, 2001

Today was a day to catch up on some rest. We slept in this morning then I got a nap this afternoon. I needed to recharge my batteries and am doing that this weekend. Delanae is keeping busy answering e-mails about her Creative Memories items she is auctioning off on Ebay. She has over one hundred items and says that is only about 10-20% of the items she will have to sell to get rid of them all. If you are interested in Creative Memories items keep an eye out on Ebay for her items.

Stacey's youth symphony concert was tonight. It was excellent. There were three different groups that performed. Stacey is in the beginning group and the audience can see the progress that is made by the kids as they work up to the advanced group. Their selections are much more difficult and are being played by junior high and high school kids. Their conductors do an excellent job with the youth groups.

Speaking of music, I am trying to get back to playing my bass again. It has been sitting unplayed for a while but I miss playing it. I ran into the worship leader from the church we used to go to while driving into the parking lot at the school to pick up Stacey from rehearsal earlier today. He and I talked about getting back together with another friend and play some more like we used to. It would be something that would take some time again but it is something that I really enjoy doing. Hopefully, we can work something out on a fairly regular basis.

Now, it is off to bed time for me. I am getting up early tomorrow morning to go to both worship services so I can learn the soundboard at the church better. It is time for me to start running it with the other sound techs on a schedule. That way one person would not have to worry about missing a Sunday once in awhile. Have a great day tomorrow!

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Sunday March 4, 2001

I need to bite the bullet and set up a home network so we can share an internet connection. By connecting two computers to the Internet through Earthlink using one account we are violating the terms of our agreement so we will be charged an additional usage fee of $1.00 an hour for every hour two lines are connected using our one account. I know this because we got an e-mail from them today informing us of this. I understand their reasons for charging this and it is only going to accelerate me doing what I should have already done. Delanae's computer already has a NIC in it so I would just need two more and some Cat 5 cable. I can use Windows 98's ICS software for this and Delanae and I could then share printers. Eventually, when cable modem service is available where we live then I would get a router with a cable modem in it for us to use. The reason to get two NIC's is so I could include the kids' computer in the network for the internet connection sharing. So, I have my next computer upgrade project set.

You may ask why I mentioned cable modem but not DSL. Unless I am very wrong about this, we have so much noise on our telephone lines that DSL would not give us much more improvement in connection speed than what we have now. Actually that is an exaggeration, it would not give us connection speed approaching what it is capable of. We would have to replace every bit of telephone wire in this house to eliminate the noise, as I understand it. The noise is so bad that the maximum connection speed I am able to get with a 56K modem is 28.8bps. That is why I am talking about getting a cable modem rather than DSL.

Tomorrow will start with an early meeting again. We have our biweekly Leadership Council meeting at 7 AM tomorrow morning. When we got back from church tonight there was a message on the answering machine asking if I could see hospital patients for my partners tomorrow, the answer is no, unless I can wait and see them at noon. It will fall back to the inpatient physician to see them if I cannot. Before I forget, I will also be on call tomorrow night so no update is likely here until Tuesday night.

One item that I forgot to mention yesterday is an update on my Pocket PC, the Compaq iPaq. PC Connection called Friday and left a message on the answering machine asking me to call them. I returned the call Saturday and their customer service person told me that the iPaq I had ordered was no longer available and that they would upgrade me to the new model from Compaq if I still wanted to order it. I told them I did and asked when I could expect it. She told me that she really had no idea as they had not been told by Compaq when they could expect shipment of the iPaq's. She did assure me that my position in the top thirty on the waiting list would not change. It seems like the 64MB version of the iPaq will be available before I get mine.

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