Sad Alzheimers

The patient: an 80something year old male. He's had alzheimers for awhile, but his daughter and son in law brought him in urgently because he had an aggressive incident the evening before. During the visit, it was easy to see how confused he was. He would start a statement and not be able to finish it because he couldn't remember what he was saying. Dr. B was assessing how oriented he was. After asking the patient what state we were in, he couldn't answer. So Dr b gave him some choices. He correctly picked Colorado. Then Dr. B pointed to his son in law and asked who that was. He just looked at him blankly. After we asked several more times, he responds with "Well, that's a Colorado possum." We all busted out laughing. Definitely not what we were expecting. It was really really sad though. My grandpa had alzheimers and it was so sad talking to him. I don't hope this disease on anyone.

Oh and an interesting tidbit about the alzheimers medications. If you take a patient who has been on an alzheimers med, and discontinue the medication, the patient will rapidly progress to the point where they would have been without meds the entire time in a matter of months. So even though some of the side effects are vicious, many people will continue on them because of the ramifications of coming off.

My Amazing Patient and Pot

I saw a patient this week who is a spitfire. He's 80 and still works full time being in charge of around 400 people. And here's my favorite part: he does between 200-300 push-ups per day! *Jaw drop. Yeah, I was shocked. He was also a motormouth. I could barely get a word in, and his adorable wife just sat in the corner smirking. The whole thing was quite comical. I was kind of hoping he would get down and show me. LOL.

Being in Colorado, medical marijuana is legal. Dr. B has about 6 patients in his practice who he has on it. I think the whole thing is rather strange. I saw a 93 year old man this last week who has severe spinal stenosis. At his previous appt they had decided to give pot a try. His daughter came in to follow up with Dr. B. Well, they decided not to pursue using it because they don't think it really worked. The daughter says "We have had to change the music we listen to." LOL, I just had to hide a smile.

The Craziest Sinus Infection Ever

The patient- a 60 something year old male who for the past 4 years has had a watery right eye. He has seen ENT, eye doctors, etc. The eye doctor put in a stent to help the lacrimal gland tear correctly. Well, 3 weeks ago, the patient had a sudden onset of a horrible horrible headache over his right eye. He basically had it for 2 weeks, when all of a sudden a huge amount of puss came out his eye. The puss pushed out the stent. At the same time, a black jagged rock like thing fell into his mouth from the back of his throat. And then his headache stopped. Disgusting huh? He hasn't had a watery eye since that day. So basically this rock like thing was in his sinuses and pushing on his tear duct. Blech.

Internal Medicine Day 1

I started my internal medicine outpatient rotation today. I struggled to set this one up since my facilitators said I could do it out in Colorado. Everything I was planning on kept falling through. So finally, I went to the AOA's website, found Dr. B and called his office. He went to Kirksville, which is affiliated with my school. He said yes, thankfully. Anyways, I totally admire him. He has a private practice: just him and two medical assistants. He likes to take his time with his patients, so he spends 20-40 minutes with each patient. While I've done this with other doctors and hated it, Dr, B realizes that he can't do this and see a gagillion patients a day. His absolute max is around 20, typically more like 17. He says that he has done the 30-40 patients a day and was miserable. He makes less money now, but he's happy. We work 8:30-5 three days a week and 8:30-12 the two other days.

I try really hard to be fun and sweet to the patients. The medical assistant always asks the patients if they're ok with a student. Well one guy said no problem as long as he wasn't getting a prostate check. Well, I walked in the room and said "I hear you want a prostate exam today." He and his wife almost fell over laughing. I like making patients laugh. It lightens the mood.

Bestest Husband Ever

I am currently on spring break...my last one ever. It's kind of strange, but I'm enjoying it. And to make it even better, I'm spending it in Colorado with Jake. Oh yeah, and I'll be here for 5 weeks. I'm ecstatic. So I'm planning on spending my week reading, cooking, watching tv, and making a residency spreadsheet. Tonight's dinner is meatloaf muffins, mashed potatoes (real ones since the Kitchenaid is along) and a yummy salad. Jake is loving my spring break too because it means he has a stay at home wife.

Alright, so back to my title. On Thursday when Jake flew in, we drove back to my place and actually we fell asleep on the couch. When I woke up, he says to me "I know something you don't know." Ok, well I'm like a 4 year old and continued to press him until he finally sighed and got up. When he came back by me, his hand was clenched and he put a ring in my hand. He got me an emerald cut sapphire ring, exactly what I've been wanting for over a year. After bouncing up and down and shrieking like a 4 year old, I asked him for what reason he was giving this to me. His reply "Just because." Oh yeah, he's the best guy ever. 

So Inappropriate

Do you ever have a moment when people tell you a story and you're only thought is "wow that's so inappropriate?" Well, today I had one of those moments. We admitted a patient from the ER yesterday. He has pancreatitis. Yesterday, he was swearing up a storm and I kind of thought it was funny. Today, he was obviously feeling much better. He asked if I wanted to hear some stories and he looped in some kind of hook because I thought, sure why the hell not. First he tells me about how he had an Indian doctor and he asked her if she ever scalped white people. She kicked him out of her practice. Then he tells me about one time a girl was taking his blood, and when she bent over her boob went into his hand. What did he do? He grabbed it! He tells me "She wasn't even wearing a bra." I then proceeded to tell him that story time was over. When I told my attending all this he was not amused. And he apologized for making me go in there. The patient didn't harass me so I don't really care. I will know tomorrow though, that I will definitely not let him start telling me any stories.

What inappropriate stories have you heard lately?

My Final Week

I know it's been awhile. First, let me freak out for a second. Match day is less than a year away. Holy shit....how am I nearing the end of my 3rd year?
  Alright some updates: the patient who was hallucinating, the next day when I went to see him, he was lining up all the cords on his body and said "Now if I can just get these lined up, I'll get the clock to work." A couple days later, I saw him again and he told me that he was building a modular home in the room but he and Obama had gotten into a fight the night before about the house. Obama was taking the house away but making him pay $700,000; he was kind though and was letting him do a payment plan. Wow. So the diagnosis: pancreatic cancer. Bummer.....one of the worst cancers out there. I imagine he won't be with us too much longer.
   A 30 something female works out extensively on weekends. She did so a week ago. Monday, she woke up sore. Tuesday, she was feeling pretty weak. Wednesday, she couldn't move the lower half of her body. So she came to the ER. Her potassium was 1.6. That is the lowest value I've ever seen. It's supposed to be between 3.5-5. The next day that I saw her her K+ had increased to 2.2. I said something about it out loud in the dictation room and one of the other doctors was like "2.2 is not high." I was like "Well it was 1.6 yesterday so I'm pretty happy with the 2.2.  By the second day, she was able to walk again. It was one of the coolest cases ever. Not the normal heart attack, congestive heart failure, pneumonia, UTI patient. We had to consult heme/onc, rheumatology, and nephrology. She was gone today when I got there, so I was slightly disappointed but her K+ was up into the 3s.
   Last week, I had a new admit from the ER. He was an older gentleman who had a stroke. I had done his complete history and physical. He was sweet as pie. The next day I went to round on him, and he chewed me a new asshole. He was starving and was NPO because he was having a stress test. I walked in the room and quickly knew something was wrong since he started yelling the second I came in. I asked if he had his stress test yet and he yells back "You're giving me a stress test right now!" Okkkkkkkk. He kept saying he was going to refuse the tests and wither away and die. Drama queen much? And this man was not lacking for some body weight. He probably could have gone a lot longer and not withered away. Anyways, his daughter works at the hospital and she came and found me today to apologize for his behavior. Apparently the nurses called her after he yelled at me. LOL.