Last Week



Doc's Progress Notes

Week of March 5, 2001

Last Updated: 3/11/2001 at 9:01 PM PST

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Monday March 5, 2001

No update.

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Tuesday March 6, 2001

Another call night down and many, many more to go. Actually, last night after about 10 PM wasn't too bad. I did not have to go back to the hospital to admit anyone but I did have phone calls off and on all night. That means my sleep was very intermittent and I was very tired this morning. Some caffeine in the form of Diet Pepsi got me going however after I got to the hospital. No meetings for a change this morning so I was able to make my hospital rounds early.

I have two patients in the hospital right now, both smokers and both in with lung problems. One has to go on and off a ventilator and has a tracheostomy tube in place now. She was getting changed to one that would allow her to talk some today. She will have to keep the tracheostomy tube in place permanently, without it she simply stops breathing due to a combination of her emphysema and sleep apnea. With it she can be on a ventilator at night while sleeping so she does not stop breathing. She is looking at having to go to a special hospital in the Seattle area to be trained how to manage the tracheostomy tube and ventilator for use at home. Included in that training will be how to suction her bronchial system out through the tube without going too deep and causing her heart rate to slow and her blood pressure to fall low enough that she passes out (and may not wake up again).

The other patient is in her late 40's and was admitted with a pneumonia and a new lung cancer. She came in because of the lung infection and the cancer is a new diagnosis. Of course she had no symptoms directly attributable to the cancer, the diagnosis was made because of the chest x-ray for suspected pneumonia. This is the way most lung cancer is diagnosed, by chest x-ray looking for an infection or a reason for a cough. Since almost 100% of lung cancers are in smokers they are the population who need chest x-rays the most. But, does routine chest x-ray monitoring in smokers lead to improved survival from lung cancer? It seems intuitive that it should but the studies done up to this point to answer that question do not show an improved survival percentage for the group of smokers who got the chest x-rays (or, for that matter, those who had yearly CT scans of their lungs). Therein lies the dilemma, how do we do a better job of curing lung cancer than we do now if we cannot reliably find it early enough to have better odds of curing it? Stay tuned and someday I can hopefully answer that question with some certainty.

The rest of my day was fairly routine. No big crises, some small ones and a puzzling patient or two. One I need to talk to one of our friendly hematologists about tomorrow. She has a puzzling anemia which I cannot find the cause for. She is not losing blood through her bowels, she is not eating well but her blood counts should not be dropping so quickly due to that. Time to call for help. Now, if you will excuse me, I am going to wrap this up, FTP it to the web site and then go to bed early tonight so I can catch up on some of the sleep I missed last night. Tomorrow promises to be sunny and unseasonably warm here so hopefully I can enjoy some of that nice weather on my day off.

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Wednesday March 7, 2001

My hospital census is growing, even on my day off. It is up to four now after being only one Monday. I went in to see my two patients whom I talked about yesterday and found out I had another one in with a bad urinary tract infection.

Then, later this afternoon I got a call from my partner on inpatient physician duty this week telling me that another of my patients had just been admitted with congestive heart failure. This man has a very weak heart from years of smoking and uncontrolled diabetes which have caused blockage in his coronary arteries leading to damage to the heart muscle itself. Now it is not always able to pump enough blood to the rest of the body which is defined as heart failure. In his case, it is congestive heart failure as he gets a buildup of fluid in the lungs and the lower legs. He then comes in very short of breath and needs to be placed at bedrest and his medications adjusted. Unfortunately, medication is not keeping him out of the hospital which means his heart function is worsening fairly rapidly. He may be young enough to consider a heart transplant but I do not know if they transplant hearts into diabetics.

So, tomorrow will be busy. I will have four patients to see in the hospital then a full schedule in the office. Tomorrow night Stacey is performing in a talent show at her school which I will probably be going straight to from the office. I will probably also have to get Delanae up early tomorrow so she can get her car wrapped starting at 8 AM. All in all, it will be a long day. Someone remarked after church tonight that I looked tired, I stopped and thought for a moment and realized that I had been on call Monday night which had begun my week with sleep deprivation and I have not recovered fully yet. Fifteen years ago it did not bother me as much as it does now. I just don't recover as quickly as I used to even though I keep myself in fairly good shape. I don't even want to think how I would feel if I did not exercise.

Am I passionate about exercise? You bet I am. I do it and I ask all my patients to, even those with chronic diseases that limit their exercise tolerance. Most of them can exercise a little and it will help them combat their disease and make them feel better. For those without a chronic disease, it can literally prevent diseases like high blood pressure, diabetes, obesity, and heart disease. But, since less than 40% of Americans exercise with any regularity, I will get to deal with these diseases for the rest of my career in medicine and I will continue to counsel patients to exercise.

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Thursday March 8, 2001

Short post tonight. Too many things to do tomorrow so must get up earlier than usual to start my day earlier than usual. I have three or four patients in the hospital that need to be seen before 8 AM. One of them needs to be discharged.

Stacey did very well in the talent show tonight. Her singing has improved so much from last year. She is growing up more and more each day. Before Delanae and I know it she will be sixteen and learning to drive just like her brother. See you tomorrow.

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Friday March 9, 2001

I was on the run all day today. It began at 6:30 this morning trying to see four patients before starting office hours at 8 rather than 8:30. During that time I sent one patient home, did an initial physical exam on a newborn, saw an eighty-one year old man with severe depression and malnutrition, and told my patient with lung cancer that it had already had spread to her brain making it incurable.

When I got to the office I found that I only had two patients scheduled between 8 and 9 rather than the four that were supposed to be. For some reason the schedulers had moved them to 10 AM which meant I had three patients scheduled at 10, two more at 10:15 and more at 10:30. To top it all off the meeting that was supposed to begin at 9 got cancelled at 8:45. That meant I had nobody to see for an hour then people backed up in the lobby at 10. At times, administrators, even if they used to be practicing physicians, forget that if changes are made at the last minute that affect practicing physicians then patient care can and often does suffer.

Later in the afternoon I had to go back into the hospital to send my patient with the lung cancer home as I had promised earlier. She is set up to begin radiation therapy to her brain Monday. Then it was back to the office, finish dictating, make a couple of phone calls, then rush to the restaurant where Delanae and I were meeting to be part of an interview dinner for a prospective new clinician in our OB-GYN clinic. It was a relaxing meal with good company and no pressure which allowed me to unwind from the day spent on the run.

Delanae is getting up early in the morning to go to Portland for a business meeting so we are going to bed early. I am tired anyway. Good night.

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Saturday March 10, 2001

Today I took Stacey to be judged at a school music festival. She performed one song on the violin for a judge who then critiqued her. Stacey doesn't particularly do well when she is being critiqued, she tends to withdraw and get very quiet. She looked like she was going to cry a couple of times. The judge was not being harsh, he was simply pointing out to her what she needed to improve on. She needs a private violin teacher if she wants to get a lot better but I am not sure she really wants to become that serious about the violin.

Delanae's trip to Portland was evidently a success. For details check out her page. She is busy packing up items to ship to successful bidders on those items on eBay. Earlier this evening we were able to take time to watch a movie for the first time in a couple of weeks. We chose Cider House Rules which we had not seen before. I found the movie to be interesting but it is not one I would rent again.

After church tomorrow I really need to start cleaning this office. I also need to finish up the tax information and get it sent to our accountant next week. Sounds like a busy day tomorrow between church services but I had a lazy day today so that's not so bad.

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Sunday March 11, 2001

Nothing medical today. I did not get my office cleaned up as I said last night I would. Somehow this turned into another lazy day. I did some reading, I did some running, and I played Frisbee with our dog Dexter between church services. After church I paid some bills and did this update as well as checking out a couple of websites.

Tomorrow I am heading out very early in the morning (6 AM) to PeaceHealth's corporate headquarters in Bellevue. That is just east of Seattle. There we are having a meeting of a corporate wide task force I am serving on. This task force is concerned with patient privacy and the security of personal medical records. Most meetings are by video conferencing but twice a year we have to meet face to face. This is my first face to face meeting with the other members who are from other regions that the company serves; Eugene, OR, Alaska, Florence, OR, Bellingham, WA, and our region. I do not look forward to either leg of the trip, in the morning it will be into the morning commute around Seattle which is horrible and the afternoon leg is likely also to be in the afternoon commuting traffic. If I sound frazzled tomorrow night you will know why. Have a great Monday everybody.

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