It's vacation now. We're in Orlando, with our six children. It's a vacation for the children, of course, not for the parents. Last year, in the summer, we were at Club Med -- another vacation for the children, not the parents. My beeper is off. I turned it off yesterday, for one week. The last time I turned it off, was at Club Med. Dr. A covers for me. He isn't a partner of mine. He's just another doctor in town who covers for me. I have a solo practice, so almost all of the time (except about one week per year or so) I carry a beeper. It's there so that my patients can reach me when they need me. Right now, they can't really get a hold of me. Dr. A can reach me, but he would never do that, nor would he really need to.
It's good to be there for people. It's a feeling that makes you think you're important. But you can't be there for people if you're not there. When I say "be there for you", I mean more than just being physically in the same location. I mean really present with your mind, listening, and willing to help (if you can). If you can't help someone, then just "being there" for them helps. That's because they're no longer alone. Being alone in the face of suffering can be overwhelming. So it's important that at least someone can be there. That's why beepers are important (so I can "be there") and that's why it's important that the beeper gets turned off.
When the beeper is turned off, that's when I'm not there for everyone. I'm there for me. I'm there for my family and me. That's all. So it's a respite. It's a time to take refuge. Responsibility is wonderful, but it also is difficult. It causes fatigue. I think it would be better for me to turn off the beeper even more than one week per year. That would create more rest. Rest is necessary for all of us. It allows us to be well cared for. Then we can "be there". But when we aren't taking good care of ourselves, we can't.
It's wonderful that I have a colleague who will help me with this. I have spent a few years without anyone to "cover me". Then, I couldn't turn off my beeper at all. So it was harder to do a good job of taking care of myself. Many of my colleagues are not happy. They aren't able to take good care of themselves. It's making it impossible for them to really be there for their patients. They are angry, frustrated, hurt, dishonored, rushing, and worrying. So when they go into the room with a patient, they just can't really be completely there. Their thoughts about other things get in the way, their schedule gets in their way, their fears and angers get in their way. Many of my patients complain to me about my colleagues. Unfortunately, I have almost no power to help with this. When I try to get my colleagues to take good care of themselves, they won't listen.
I have this problem with the caregivers of my patients. They don't ever turn off the beeper. They don't find a colleague like Dr. A to help them. They don't take good care of themselves. So they become tired: "burned out". I see them spending all of their time attending to very mundane tasks -- cleaning, cooking, changing sheets. But they don't have any time or energy to actually provide emotional support: to listen, to care, to share. I see this coming at least a year before the caregiver. I try to explain it, but I haven't been very successful. Some people feel that their responsibility precludes good self-care. But this is not correct.
When we try to do something, we are imperfect. So our best intentions may not be enough. We may try to do something wonderful, but we don't know that it will work. We try to take care of someone. But our care may not be exactly what they need. We think it's our responsibility to continue - no matter what. But it isn't. It's our responsibility to take good care of ourselves. Then, when we are well we can see more clearly what is most important. That is what helps us to combine our best intention with a practice that is effective in achieving our goal.
It's a very good idea to turn off the beeper.
Tuesday, July 24, 2007
Thursday, July 19, 2007
Walking is Nice
CP is getting now to where she just can't walk. She is 89 years old. Mostly she is in a wheelchair, but can get up and walk a little way (ten or fifteen feet) if someone is there to help her. She has been slowly getting worse over the years. She was diagnosed with neuropathy, before seeing me. I confirmed that diagnosis. It does caues trouble walking, and her examination is consistent with that. Recently, her walking got significantly worse. In just a couple of months she went from pretty good walking with a walker to mostly wheelchair. The type of neuropathy that she has isn't usually like that. She has a form of neuropathy that is very slowly progressive. When I first met her, I hadn't done a nerve study. I wish I had, because then I could repeat it now, and see if the Neuropathy has changed. I was trying to save doing too many tests and trying to decrease the cost of medical care. No good deed goes unpunished. I could do that test now, but it wouldn't help much, since I can't compare it to what it was before. But I thought that this might be more of a spinal cord problem. That's an odd thought, because the examination doesn't really support that. I've had some cases where patients clearly looked like they have neuropathy, but they have myelopathy (spinal cord injury) PLUS neuropathy. It's a terrible conundrum. You can't see the myelopathy because the signs are mostly covered up by the neuropathy, and it's very hard to know which problem is causing what. It's hard to justify surgery for the myelopathy since it likely won't help. So several times I've had patients with this and we've done the surgery for the spine. The rationale is this: It probably won't help. Surgery could make things even worse than they are now. However, the patient is currently getting worse. If we do nothing, then the future is continued worsening. So if the patient really wants to take the risk, then fixing the spine is the only possible option. It's a high risk, low yield option. But some people want that. This is something I've done less than ten times. It's helped on some of the occasions. And it hasn't on others. And it hasn't hurt any of them so far.
Anyway, for some reason I thought about that with CP. Mostly because of the nature of her rapid deterioration and also a little bit of clumsiness in the hands that I didn't think was exactly like the arthritis clumsiness that I'd expect or the neuropathy clumsiness I'd expect. She has some bladder issues, but that's a very vague thing that could indicate spinal cord issues, but almost always doesn't. She has pretty severe spinal cord compression with evidence of changes in the cord itself that indicate damage on her MRI. Since I got the MRI of the spine, I don't actually have to do the nerves again, so I got out of that mistake. Today I had to go in to tell her that she has this spinal cord problem. It's probably going to get worse, and there's probably nothing we can do to make her better. I wasn't looking forward to this.
You try putting on your somewhat happy face to go in and tell it how it is, in plain English and look into her eyes. It's the only way to go.
Well, she said that she pretty much knew this. She doesn't care about surgery, "I'm too old for that." And she said that she's happy to understand what's going on. "I'm lucky because I'm not blind. I can read. There are good people to help me get up and go to the bathroom. I have an electric scooter, so I get around pretty well. There's a man where I live who's blind. A lot of people are going blind at my age. And I can even hear OK." That's what she has to say about losing her spinal cord function.
I think walking is nice. I'm glad I can walk. I'm glad I'm not blind, too. But I sure am glad I can walk.
Anyway, for some reason I thought about that with CP. Mostly because of the nature of her rapid deterioration and also a little bit of clumsiness in the hands that I didn't think was exactly like the arthritis clumsiness that I'd expect or the neuropathy clumsiness I'd expect. She has some bladder issues, but that's a very vague thing that could indicate spinal cord issues, but almost always doesn't. She has pretty severe spinal cord compression with evidence of changes in the cord itself that indicate damage on her MRI. Since I got the MRI of the spine, I don't actually have to do the nerves again, so I got out of that mistake. Today I had to go in to tell her that she has this spinal cord problem. It's probably going to get worse, and there's probably nothing we can do to make her better. I wasn't looking forward to this.
You try putting on your somewhat happy face to go in and tell it how it is, in plain English and look into her eyes. It's the only way to go.
Well, she said that she pretty much knew this. She doesn't care about surgery, "I'm too old for that." And she said that she's happy to understand what's going on. "I'm lucky because I'm not blind. I can read. There are good people to help me get up and go to the bathroom. I have an electric scooter, so I get around pretty well. There's a man where I live who's blind. A lot of people are going blind at my age. And I can even hear OK." That's what she has to say about losing her spinal cord function.
I think walking is nice. I'm glad I can walk. I'm glad I'm not blind, too. But I sure am glad I can walk.
Wednesday, July 18, 2007
It's About Patients
Monday turned out to be a very great day. I felt very energized from work. It was as if I had made a contribution. I saw fifteen patients. This is a nice number. Some physicians can see sixty patients in one day. I don't think I could ever do that. Of the fifteen patients that I saw, not one was unpleasant, and almost all of them were wonderful or fantastic people. One of them is most certainly depressed, but she puts on an air. She pretends to be doing well. Some of the patients who believe that I've helped enormously were there. Some that I just like were there. There was a new patient who came in. She had been diagnosed with Parkinson's disease about eight years ago (in another state, luckily - by someone I don't know). Well, she certainly doesn't have Parkinson's disease. She has familial tremor. Her husband is very intelligent, but slightly humble. He respects authority greatly. That's why he hasn't questioned the diagnosis. But he's known that it's wrong. So when I said that I didn't think it was Parkinson's he felt very good. I changed her medications. She will do much better. It wasn't a difficult diagnosis, or a very difficult treatment issue. But it was a great deal of fun. It's great to be able to help someone with just a little effort. Three patients complained about how terribly (or terrible) it is to get old. We have some very serious issues in this country with aging. I have a lot to say about aging. Aging is very important. It's very wonderful. It's just that Americans hate it for no good reason. If you hate something, then you will see all its faults, but none of its benefits. With that sort of thinking, it isn't really possible to see clearly. One patient came in who was working with a colleague of mine, but she was fired. Only she didn't tell me, she told the staff, who told me. She was embarrassed. I have one patient who has had horrible headaches all of her life, and I've done well with her. She got non-compliant and her headaches got very bad. They are completely disabling when they're bad: she just can't function at all. So she agreed to go back to my protocol, which includes Botox. She didn't want to do the Botox, due to the cost. But finally, her husband talked her into it (I think he couldn't take it anymore). And now she's better again. And yesterday I saw a headache patient who had moved to Utah. He was seen at the University of Utah headache clinic. They sent me a copy of their work up. They changed most of what I had done with him. He moved back here after being there only about six months. He said that I had done a better job with his headaches than they had done there. These things are very important. They are the things that we have to focus on. It's about the patients. It's about doing something that has value. If you can do something that is good -- anything that is good, then the "work" is good work. What is "good" should be something that helps people in some way. Even if it's manufacturing - making a good product that helps people is good. It gives the work a sense of purpose, and that gives the person a sense of purpose.
Monday, July 16, 2007
Monday: Trying to Doctor Again
Morning:
It's a hard Monday morning. I don't like to have hard Monday mornings. I know that many people don't want to return to work on Monday. But I'm not supposed to feel that way. I do believe that I have a great job. Perhaps it's one of the greatest jobs there are. These days, there is enormous dissatisfaction among physicians. It's unfortunate. This is coming from severe downward economic pressures combined with decreasing automatic respect for physicians. It affects me, like it does "everyone" else. Sometimes it affects me more, and sometimes less. Still, most of the time I want to be in love with my job. I want to be as excited about it as I was when I started - in Medical School, and the beginning of Internship (before the severe sleep deprivation kicks in and creates numbness). But I don't think the trouble in coming back and being a doctor this morning is from the "illness of medicine". It's more just the ordinary "Monday morning blues". It was just a great weekend. After great weekends, work can seem ordinary -- even this type of "work". It's wrong to see doctoring as "work". There's a "higher" way to see it. Still, in this culture, in this day, it's hard not to see it as work. You can't really go in to a patient's room and think you're going to work and be a great doctor. It doesn't really work quite right, because you're not completely there, "doctoring". You're there "working". Those aren't at all the same. So even though I'm "at work", I can't "work here". It isn't an easy thing to do. I can put on my white coat. That's easy to do. But there's also a "white brain" that you need to put on. It's just that there's no way to take out the regular, every day gray brain and put in the white brain the way that you put on the white coat and the stethescope. I wrote a prayer for before I walk into a patient's room one time. I used to say it before I walked into there for about six months or so, but then I stopped. I think it might have helped with this issue. I used to think that coffee helped with this, but it really doesn't. I need to develop better "white brain" insurance: a procedure that guarantees I can have that frame of mind whenever I see a patient. I think I get it right most of the time. I hope I do, anyway. No one really checks for that. Medicare has a plan to measure "quality of care". I wonder if they're going to measure "white brain".
It's a hard Monday morning. I don't like to have hard Monday mornings. I know that many people don't want to return to work on Monday. But I'm not supposed to feel that way. I do believe that I have a great job. Perhaps it's one of the greatest jobs there are. These days, there is enormous dissatisfaction among physicians. It's unfortunate. This is coming from severe downward economic pressures combined with decreasing automatic respect for physicians. It affects me, like it does "everyone" else. Sometimes it affects me more, and sometimes less. Still, most of the time I want to be in love with my job. I want to be as excited about it as I was when I started - in Medical School, and the beginning of Internship (before the severe sleep deprivation kicks in and creates numbness). But I don't think the trouble in coming back and being a doctor this morning is from the "illness of medicine". It's more just the ordinary "Monday morning blues". It was just a great weekend. After great weekends, work can seem ordinary -- even this type of "work". It's wrong to see doctoring as "work". There's a "higher" way to see it. Still, in this culture, in this day, it's hard not to see it as work. You can't really go in to a patient's room and think you're going to work and be a great doctor. It doesn't really work quite right, because you're not completely there, "doctoring". You're there "working". Those aren't at all the same. So even though I'm "at work", I can't "work here". It isn't an easy thing to do. I can put on my white coat. That's easy to do. But there's also a "white brain" that you need to put on. It's just that there's no way to take out the regular, every day gray brain and put in the white brain the way that you put on the white coat and the stethescope. I wrote a prayer for before I walk into a patient's room one time. I used to say it before I walked into there for about six months or so, but then I stopped. I think it might have helped with this issue. I used to think that coffee helped with this, but it really doesn't. I need to develop better "white brain" insurance: a procedure that guarantees I can have that frame of mind whenever I see a patient. I think I get it right most of the time. I hope I do, anyway. No one really checks for that. Medicare has a plan to measure "quality of care". I wonder if they're going to measure "white brain".
Thursday, July 12, 2007
What's Good About Alzheimer's
Today there were three patients with back pain, three patients with Alzheimer's, one patient with severe neuropathy and weakness and one patient with neuropathy and carpal tunnel syndrome (both have diabetes), two patients with stroke (but one of them is also getting Alzheimer's and has migraines as well), one patient with migraines (she is actually doing quite well, right now) and two new patients, which I'm actually not sure what either one has.
Mrs. S is in her mid-seventies, and she is English. She met me when she had her stroke, about four years ago. She had never seen a doctor, because she was "deathly afraid of them." I sent her to a very gentle primary care physician who I knew would be able to handle her. And she is doing very well. We had to treat her hypertension, her chronic anxiety, her high cholesterol, and her irregular heart beat. She takes her medications, and she is able to see physicians now. She has about a thirty point increase in blood pressure when she sees a doctor, but she doesn't go into a total panic. At one point, I told her I didn't think she needed me. I don't think she does. I called her primary care doctor, and I told her I'm not doing very much for her at this point, except giving her Paxil prescriptions. She was OK with me not continuing to follow her. But she made an appointment anyway in three months. She just likes to come in here. She always tells me that I've been a great help to her. I like her and her husband very much. Although she is very impressed with the help that she got from me, it wasn't anything very dramatic, from my point of view.
I had another three of the really great patients today. So there were four of them. That is always wonderful. I count how many "great" patients there were each day. Sometimes there isn't even one for the whole day. That's not a good day. Four is extraordinary.
There was a lot of Alzheimer's today. Alzheimer's used to depress me. Now it doesn't. I've come to accept its purpose and see its goodness. We are all so excited about intelligence. But it's actually just another attribute. The issue is whether you truly believe that all people are equal or not. Alzheimer's really pushes the envelope on that issue. Is a person who is smart better than a person who is dumb? If the answer is no, then when we lose intelligence, we don't lose any value. If we're not losing value, then what are we really losing? People with Alzheimer's are generally very nice and very happy. These are good qualities, which are often not present with high intelligence people. People like to think that they are better than the other people. They like to think that they're smarter than the others. When that's gone, from Alzheimer's, they accept just being people. Just being people is really good enough. It's actually very complicated, how Alzheimer's is good. We don't see very much of that, because in our culture we only focus on the bad part of it.
Mrs. S is in her mid-seventies, and she is English. She met me when she had her stroke, about four years ago. She had never seen a doctor, because she was "deathly afraid of them." I sent her to a very gentle primary care physician who I knew would be able to handle her. And she is doing very well. We had to treat her hypertension, her chronic anxiety, her high cholesterol, and her irregular heart beat. She takes her medications, and she is able to see physicians now. She has about a thirty point increase in blood pressure when she sees a doctor, but she doesn't go into a total panic. At one point, I told her I didn't think she needed me. I don't think she does. I called her primary care doctor, and I told her I'm not doing very much for her at this point, except giving her Paxil prescriptions. She was OK with me not continuing to follow her. But she made an appointment anyway in three months. She just likes to come in here. She always tells me that I've been a great help to her. I like her and her husband very much. Although she is very impressed with the help that she got from me, it wasn't anything very dramatic, from my point of view.
I had another three of the really great patients today. So there were four of them. That is always wonderful. I count how many "great" patients there were each day. Sometimes there isn't even one for the whole day. That's not a good day. Four is extraordinary.
There was a lot of Alzheimer's today. Alzheimer's used to depress me. Now it doesn't. I've come to accept its purpose and see its goodness. We are all so excited about intelligence. But it's actually just another attribute. The issue is whether you truly believe that all people are equal or not. Alzheimer's really pushes the envelope on that issue. Is a person who is smart better than a person who is dumb? If the answer is no, then when we lose intelligence, we don't lose any value. If we're not losing value, then what are we really losing? People with Alzheimer's are generally very nice and very happy. These are good qualities, which are often not present with high intelligence people. People like to think that they are better than the other people. They like to think that they're smarter than the others. When that's gone, from Alzheimer's, they accept just being people. Just being people is really good enough. It's actually very complicated, how Alzheimer's is good. We don't see very much of that, because in our culture we only focus on the bad part of it.
Tuesday, July 10, 2007
Getting Through the Workday
July 10, 2007
Yesterday was pretty good. I got through the Monday, which is typically the hardest. Especially after five days of no work. I haven't kept my angel in my pocket for a while, and yesterday and today I have. It's a small piece of metal, about the size of a quarter, with an angel stamped on it. It's silly, I suppose, but very helpful.
Today I took the bicycle to work. It's good for the environment and good for the body. It takes about 20 to 25 minutes, and that's a good time to think. In the car, for some reason, I seem to think less. I've made a very good pot of green tea with Jasmine flavor for today. The day has plenty of open spaces in it, since it's July. This July is slower than any I've ever had. It's bad for income, but good for rest and studying and developing new thoughts and new directions. So the plan will be to get through the day with a good attitude; to be happy and appreciate things. Appreciation and Thankfulness are the most important aspects of the battle against consumerism. Consumerism is the religion of the day, and it's not a good one. It creates suffering. It also creates obesity. The culture creates advertising and even more subtle and serious, it creates an entire way of thinking that is for the benefit of capitalism, which is essentially for the benefit of the large coorporations and ultra-wealthy. For the regular people, it is creating alienation, depression (anti-depressants are the number one prescribed class of drugs in America), and a sense of depersonalization. So I need to practice appreciation and thankfulness today. That's always hard when I see that the schedule isn't full: I worry that I won't have "enough" money.
The schedule looks like it's going to have some pretty good patients.
Yesterday was pretty good. I got through the Monday, which is typically the hardest. Especially after five days of no work. I haven't kept my angel in my pocket for a while, and yesterday and today I have. It's a small piece of metal, about the size of a quarter, with an angel stamped on it. It's silly, I suppose, but very helpful.
Today I took the bicycle to work. It's good for the environment and good for the body. It takes about 20 to 25 minutes, and that's a good time to think. In the car, for some reason, I seem to think less. I've made a very good pot of green tea with Jasmine flavor for today. The day has plenty of open spaces in it, since it's July. This July is slower than any I've ever had. It's bad for income, but good for rest and studying and developing new thoughts and new directions. So the plan will be to get through the day with a good attitude; to be happy and appreciate things. Appreciation and Thankfulness are the most important aspects of the battle against consumerism. Consumerism is the religion of the day, and it's not a good one. It creates suffering. It also creates obesity. The culture creates advertising and even more subtle and serious, it creates an entire way of thinking that is for the benefit of capitalism, which is essentially for the benefit of the large coorporations and ultra-wealthy. For the regular people, it is creating alienation, depression (anti-depressants are the number one prescribed class of drugs in America), and a sense of depersonalization. So I need to practice appreciation and thankfulness today. That's always hard when I see that the schedule isn't full: I worry that I won't have "enough" money.
The schedule looks like it's going to have some pretty good patients.
Monday, July 9, 2007
A Day at Work
7/9/07:
Today I started with Mr.S. He had a stroke about 4 years ago, and has a totally occluded right internal carotid artery. I have him on Coumadin, blood pressure medicine, and cholesterol medicine. We've managed to decrease his smoking from 3 packs per day to five cigarettes per day, which I can live with. He's a cantekerous person who has a very dry sense of humor. He is very stable, and I see him rarely (every 6 months). I enjoy his visits. He is a "success" to me. There isn't the great glory from some of the patients, but we're preventing him from another stroke; at least we have for the last four years. I told him, "You're doing great!" He said, "Sure, until I drop dead tomorrow."
I saw Ms. S. She is only about 19. She was in a car accident about one year ago, and injured her spinal cord - just a little. It causes her to be in a moderate amount of constant pain and she suffers from extreme sensitivity to heat. That's hard, since she works at McDonald's. I don't want her to work there, because I think that's contributing to her fairly severe obesity. That, in turn, is contributing to her chronic back pain. In about twenty years from now, it will also contribute to her stroke, high blood pressure, and diabetes. I hate McDonald's. I think they (and their kind) are causing more harm than the tobacco companies.
Mrs. B: She comes in for an every day headache. She is 71 years old. Her 95 year old demented mother is in a nursing home; She visits her mother every other day, but it's unpleasant. She (her mother) has a lot of delusions, which are difficult to deal with. Also, she doesn't remember that "B" was there just a day ago. Her husband had a stroke 7 years ago, and is very depressed. He wants her to wait on him hand and foot. She hates that. She says she's very lonely and unhappy and stressed. She's been with her husband since she was 16 years old, but he's changed. She doesn't feel that she can motivate him to even try anymore -- he's "given up." I told her that I think her headaches are due to stress: "tension headaches". Her psychiatrist already has her on Zoloft - a pretty high dose of it. I suggested they both go to counseling together. I suggested that she takes some time off, for herself, to relax. I don't think she was completely happy. She wanted something a little more magical to cure her. This doesn't really count as much of a success.
Mrs. M: She is very overweight, and has pretty bad diabetes, and has a lot of diabetic neuropathy problems. She is very frustrated that her pain won't just go away. We are sending her to be evaluated for a research trial. It is hopeless to try to get her to lose weight. Most of the medicines we've tried with her don't help very much.
Mrs. K: New patient, who is extremely weak -- she can't go up stairs at all. She is very overweight and diabetic. She has high cholesterol and is on cholesterol medicine. I'm not exactly sure at this point why she's so weak. She needs some tests done. There is a chance for making her stronger.
Today there weren't too many great success patients.
Sometimes I feel like I'm battling the culture, not the diseases. So much of what I see is our environment: the over-eating and the under-exercising. There is too much TV and not enough walking on the beach. There is too much stress and not enough sleep. Sometimes I feel like I'm battling the insurance companies and medicare. It's not good when I'm in a battle. Today, I wasn't. I was aware of how much of my practice is dealing with the "American Way" and its ultimate poisoning of my patients. Usually that will make me feel like it's a war (a losing war). It's a war against the TV, the advertisements, the big business food, the grocery stores, the restaurants, and even the zoning laws that make everyone drive everywhere. It's not good for me to be at war. So I have to notice that there are poisons in the environment that are out of my control. That's how it is. I just need to try to help my patients with what I can help with. It's important not to lose sight of that; not to get lost in the frustrations.
Today I started with Mr.S. He had a stroke about 4 years ago, and has a totally occluded right internal carotid artery. I have him on Coumadin, blood pressure medicine, and cholesterol medicine. We've managed to decrease his smoking from 3 packs per day to five cigarettes per day, which I can live with. He's a cantekerous person who has a very dry sense of humor. He is very stable, and I see him rarely (every 6 months). I enjoy his visits. He is a "success" to me. There isn't the great glory from some of the patients, but we're preventing him from another stroke; at least we have for the last four years. I told him, "You're doing great!" He said, "Sure, until I drop dead tomorrow."
I saw Ms. S. She is only about 19. She was in a car accident about one year ago, and injured her spinal cord - just a little. It causes her to be in a moderate amount of constant pain and she suffers from extreme sensitivity to heat. That's hard, since she works at McDonald's. I don't want her to work there, because I think that's contributing to her fairly severe obesity. That, in turn, is contributing to her chronic back pain. In about twenty years from now, it will also contribute to her stroke, high blood pressure, and diabetes. I hate McDonald's. I think they (and their kind) are causing more harm than the tobacco companies.
Mrs. B: She comes in for an every day headache. She is 71 years old. Her 95 year old demented mother is in a nursing home; She visits her mother every other day, but it's unpleasant. She (her mother) has a lot of delusions, which are difficult to deal with. Also, she doesn't remember that "B" was there just a day ago. Her husband had a stroke 7 years ago, and is very depressed. He wants her to wait on him hand and foot. She hates that. She says she's very lonely and unhappy and stressed. She's been with her husband since she was 16 years old, but he's changed. She doesn't feel that she can motivate him to even try anymore -- he's "given up." I told her that I think her headaches are due to stress: "tension headaches". Her psychiatrist already has her on Zoloft - a pretty high dose of it. I suggested they both go to counseling together. I suggested that she takes some time off, for herself, to relax. I don't think she was completely happy. She wanted something a little more magical to cure her. This doesn't really count as much of a success.
Mrs. M: She is very overweight, and has pretty bad diabetes, and has a lot of diabetic neuropathy problems. She is very frustrated that her pain won't just go away. We are sending her to be evaluated for a research trial. It is hopeless to try to get her to lose weight. Most of the medicines we've tried with her don't help very much.
Mrs. K: New patient, who is extremely weak -- she can't go up stairs at all. She is very overweight and diabetic. She has high cholesterol and is on cholesterol medicine. I'm not exactly sure at this point why she's so weak. She needs some tests done. There is a chance for making her stronger.
Today there weren't too many great success patients.
Sometimes I feel like I'm battling the culture, not the diseases. So much of what I see is our environment: the over-eating and the under-exercising. There is too much TV and not enough walking on the beach. There is too much stress and not enough sleep. Sometimes I feel like I'm battling the insurance companies and medicare. It's not good when I'm in a battle. Today, I wasn't. I was aware of how much of my practice is dealing with the "American Way" and its ultimate poisoning of my patients. Usually that will make me feel like it's a war (a losing war). It's a war against the TV, the advertisements, the big business food, the grocery stores, the restaurants, and even the zoning laws that make everyone drive everywhere. It's not good for me to be at war. So I have to notice that there are poisons in the environment that are out of my control. That's how it is. I just need to try to help my patients with what I can help with. It's important not to lose sight of that; not to get lost in the frustrations.
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