family practice issues and general life events

Archive for May, 2011

Lifestyle Changes

OK, OK, I know this topic has been covered about a million times, but I repeat it today because it is important.  Also because I am in the process of trying to lose my baby weight.  (we won’t discuss that my baby will be 6 in September, thus not making it a valid excuse anymore)  Diets may work in the short term, but they don’t in the long term, because usually they succeed by temporarily denying yourself a food that you love.  I joke with my patients that to lose weight their diet is simple.  “If it tastes good, spit it out.  It is probably not good for you.”  While that does work for a a lot of food, it is unrealistic and can lead to yo yo dieting, something unsuccessful in the long run.

 

Make small changes at first.  It is probably unrealistic to quit smoking and decide to lose 30 pounds at the same time.  The fact is most smokers seem to have in addition to a nicotine addiction, an oral fixation component, thus the weight gain many experience when they quit smoking.  (though some of the gain could result from the long term substitution of food with a cigarette.)

 

So make the change something manageable.  Maybe cut out the daily Coke, or increase the amount of times you exercise to three times a week.  Please choose an exercise you like.  Don’t say you are going to start running half marathons, when putting on running shoes give you hives.  It needs to be something you enjoy and you can stick with throughout your life to make it something you can call a lifestyle change

 

But don’t forget to let yourself indulge occasionally.  I tell that to my diabetics.  Let’s be honest it has to be something you can live with, and I for one don’t want to have a lifetime without chocolate.  And sometimes denying yourself of indulges will set you up for defeat since it often leads to bingeing, and self loathing.  And having to begin again.

 

So this week, try to make a small life style change for healthy living, and if your successful, maybe add another one next week.

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What were we thinking?

About a month ago now, a fellow doctor approached us about being the guardian of her records because she was leaving town, and needed someone willing to do that.  It didn’t seem too big of a deal at the time, so we agreed.  We figured that we would probably captured some of her patients in the deal for mere convenience of them not having to have their records moved.  10 days after she closed her office, I now feel an exhaustion, that I have not felt since I was getting up in the middle of the night to feed my youngest.

I feel bad for most of her patients, I really do.  They are caught up in a limbo, where they cannot go forward or backward, but at the same time we are currently averaging 10 new patients a day through our doors, and these are not simple cough and cold healthy patients either.  These are people with real medical problems taking a huge amount of medication, and most have been really nice and considerate.  However, the whole putting in new patient information and learning about their particular disease processes has been exhausting, and we are not expecting to let up for about a month.

Don’t get me wrong it is a good problem to have, I am not complaining.  Well maybe I am, but it is more due to exhaustion than patient load.  30 patients a day, with one or two new ones, no problem.  22 patients with 6 or 7 new ones, exhausting.  Add to that, the patient records did not arrive to  my office until Monday, it is a migraine waiting to happen.  Which it did- Tuesday, followed by stress headache Wednesday.  Currently sitting in a chair, keeping an ear out for my boys, and feeling like some one hit me between the shoulder blades with a baseball.

This is not a bad problem, it is now time to find a balance.  To do what is best for the patient, and help smooth out the rough waters.  The other thing to remember is that while we cannot please everyone, we can provide the best care to each individual at least as they attempt to find their new provider.

The dreaded list

While all magazine articles recommend you write a list to bring into your doctor’s appointment with you, I can tell you as a physician, there are few things that cause panic in the doctor’s mind than the patient pulling out a list.  While most will admit that it is a useful memory tool, and probably preferable to the patient saying “I was going to ask about something, but don’t remember what it was.”  And then continue to try to remember.  It is a dreaded obstacle to trying to keep somewhat close to the schedule.
It is never a good sign when the nurse says, “She’s got a list.”  That means that means they are so concerned that they will forget something on that list that they want the nurse to tell you about their list.
The worst list I ever got from a patient was two pages single spaced.  Let’s be honest, there is no way I will ever get through that list in a 15 minute visit, much less 3 months worth of 15 minute visits.  At some point you have to say, “Let’s pick the three most important issues that you want addressed today, and then work on the rest of the list as we can.”  While this may seem cruel to the average individual, it helps to insure that the items can be managed effectively.   Sometimes addressing the most important items will help to take care of the rest of the issues that you have.
Lists are even worse on sick visits.  You know the visits for a sore throat or cough, and suddenly you want to address your erectile dysfunction, your ingrown toenail and the colonoscopy that you had at the specialist.  Sick visits are usually scheduled shorter periods of time, because they are specifically designed for your one chief complaint.  While sometimes it might be appropriate and even ok to take care of both issues at the same visit many times it is not.  And if you want to make sure that you don’t get worked in again, lie to the front and tell them you are running a 104 fever only to get to the back and say, “I need a refill on my pain medicine.”
The list can be useful as a memory tool, but it often causes panic through your doctor.  And it is not that they don’t want to help you, but sometimes less is more.  A list that is a couple items long is no problem, 2 pages front and back is ridiculous.

Table underwater

Apparently the wind from the storm that came through yesterday was significant, because while I was watching Pirates of the Caribbean at the movie theater, mother nature was throwing my deck furniture into the pool.

When we arrived home last night it was dusk and coming in the front we noticed significant number of limbs in the front yard, but didn’t even bother to look out back.  This was discovered this morning.  I thought that I would enjoy the sunrise, while drinking a cup of coffee on the deck.  Instead upon walking out my back door I discovered and entirely different scene than I remember from yesterday afternoon.

While fairly certain that a tornado did not come through, the winds were significant.

We were debating yesterday what to do this afternoon, go through a state park, but I think I now know.  Get the table out of the swimming pool!  I am thinking about asking my husband when he wakes up if we should change out the tiles on the outside table and see what he thinks.  OR if he has decided on what we should do this afternoon, because I may have an idea.  All in all, I am laughing, because while there is quite the mess to clean up, it could have been worse.  Though I do wish that it had taken the shingles off of the roof, so that I could convince the insurance adjuster that there was greater damage from the wind than my deductible, so they will pay for the badly needed roof, but that is not the case.

So if you need me this afternoon, I will be in the pool, getting out my table

Boats

I am absolutely in love with the idea of boat ownership.  The thought of owning something that I could just take out on the water and leave all of my worries behind on the shore just fascinates me to no end.  I fully love the idea.  Our vacations tend to be somewhere that is near water, and possibly a beach.  Every year, we take a trip to St Johns which requires a boat trip from ST Thomas to St John.  Any way I love the water.

I say that I am in love with the idea of boat ownership.  Not so sure that I would be truly in love with boat ownership, I should probably just stick with the paddle boat that my husband gave me for my birthday.  Owning a boat is hard work.  Sure we all dream of owning a yacht with a crew, but the reality is that is quite a bit of of my price range.

I was out at the lake today, and was watching a boat owner take care of their boat.  The maintenance, cleaning it and working considerably harder than I would like for something that is supposed to be a leisure activity.  In fact, I don’t know that I have the time to maintain a decent size boat.  IT is quite the investment.  And investment is not even the correct word.  Boats don’t tend to keep their value, they are a lot like cars, or maybe children.  They are something you must love and have a passion for.  And you must have the time to take care of them.

Not to mention the expense, you either have to rent a dock or boat house or already have some place to keep them already- which requires space.  The romantic notion of boat ownership I have in my head include cruising along in lakes, or sailing in the oceans.  I don’t want it altered by the reality of maintenance.  So maybe it is best that I kept to my paddle boat, and not commit the folly of truly owning a boat.  But a girl can dream, can’t she.

Eating out

Had an interesting experience tonight.  We were at a restaurant because the day was long and neither I nor my husband felt like eating, and did not want fast food.  So when my youngest said he didn’t want Olive Garden, but Red Lobster, to Red Lobster we went.

Our server was definitely better than the average server we had lately.  She kept our drinks filled, bread basket filled, made an attempt to call both children by name, which they loved.  So when it came time to pay the bill and a tip, I rounded it up to the nearest $10 and calculated 20% based on that value.  (mostly because tips based on $10 denomination is much easier the other numbers)

This is not an attempt to say how generous I am, but to make a comment as to the Server’s behavior.  She made a special effort to come back and thank us for the tip, which in our case may be slightly more than standard, but it was not extravagant.  It also made me even more fully aware of how the current economy has made it almost the norm to stiff the waitress.  I have previously read articles to that effect, but had not realized how common it had become until the waitress came back to thank us for the tip.  I don’t know the solution for them.  I know that the economy have caused many to cut back on eating out, and while I do not fault them for that, I do find fault for those that eat out, but neglect to reward their servers, especially those that do a good job.  Because let’s be honest they are performing a service that you don’t want to do, and in many cases are making less than minimum wage.

Fifths disease

Today I am going to discuss a viral rash that many have never heard of, but most of us have had it.  Why?  Because I think my son might currently have it, and I may have to keep him out of school for a couple of days because of it.  Currently there appears to be a slight epidemic going through north Texas and southeastern Oklahoma of Fifths disease or Parvo virus.  The name fifths disease comes from when they were naming the viruses that cause rashes; such as measles, rubella, roseala, this was the fifth one they came to, and thus named it fifth.  Weird and uninteresting story, but true

Fifths disease is frustrating for doctors, and not because with the exception of pregnant women, that it causes any long term problems.  It is frustrating because when you see a case initially, rarely do you realize that it is Fifths disease.  Instead you know they kid has a virus, but for those parents who insist on knowing what every bacteria and virus their child has ever had, you cannot tell them what.  A week later, when they are no longer running a fever, the parents return with the child with a bright red rash on their face.  Now you can tell them why they were sick a week ago, but now you have to explain to the schools, that they are no longer contagious since they have the rash.  Schools seem to believe that all rashes are contagious, and must therefore send all children with rashes home, no matter how many notes you write to the contrary.

Anyway back to me, today I received a call from the school that my youngest had a fever.  And both children came home with notes about Fifths disease, which I have also been seeing in my office.  The fever today, makes me think that in 7 to 10 days, he will have a nice rash on his face, but what will I do with him in the meantime.

I am not worried about my oldest.  He had it while I was still in residency, and I missed it is him, too.  Didn’t know why he had a fever, and then a week later he had the characteristic rash.  It is like he read the textbook and knew exactly what symptoms to have.  My only problem was that I was pregnant with his brother at  the time, and called my OB crying because of the problems it could cause my unborn child.  (Sometimes knowledge is a bad thing)  However, they had already checked to make sure that I had already had the disease, so I could be relieved and go on about my way.  Anyway long story, not so long, I am currently hoping that my youngest does not run a fever tomorrow, so I don’t have to keep him at my office, so that he might be able to catch any other number of viruses.

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