Family Webicine

Part One

Everyone likes and deserves a vacation, but sometimes, the work required before the vacation and the work required after a vacation sort of negates the rest and relaxation aspect of getting away.

There are definitely more than a hundred places that I would like to see before I die. The idea of seeing the Pyramids, the Coliseum, the Great Wall in China, or the World’s Largest Ball of Twine in Darwin, Minnesota or Cawker City, Kansas (both claim to have it), is thrilling to me (well, not so much the twine). I have toured the Potato Museum in Blackfoot, Idaho and even met the mayor who was greeting people at the door. I have seen volcanoes erupt and glaciers calve, felt earthquakes in New Zealand, canoed down the Green River in the Canyonlands, walked along Hadrian’s wall, snorkeled at the Great Barrier reef, watched the Changing of the Guards at Buckingham Palace, seen geishas in Kyoto, Japan, petted whales, kissed the Blarney Stone, scoured the Smithsonian, swum with dolphins, and kayaked in four countries.  When you list just of few of those adventures, it sounds wonderful, but there are more places to go and more things to do. (more…)

Photo: © Getty Images

The neurological gag response (gagging reflex) is a protective measure to help prevent us from choking on food or objects attempting to go down our throats — such as those wooden tongue depressors used in medical offices, or dozens of unpleasant things that your dentist does while working on your teeth. When the back of the tongue, soft palate, pharynx (back of the throat), or even the tonsils are touched, a powerful gag response can occur.

In my primary care practice, the most common cause of a gag response is the dreaded tongue depressor. I once had a man who begged me not to use one. He said that he would surely vomit if I did. When he said those frightening words, I had already lifted a tongue depressor out of the jar and was holding it. Just seeing the tongue depressor caused him to vomit all over the floor. He had proven his point. (more…)

The United States government is behind it 100%. Insurance companies and accrediting agencies are giving monetary incentives for health organizations to convert to electronic medical records. No longer will medical care be hampered by illegible doctor scribbles or lost or misplaced charts. Lives will be saved. Money will be saved. Time will be saved. Electronic medical records are a win-win situation. Or, are they?

Our office converted lock, stock, and barrel into EMRs years ago; so long in fact, that I can’t remember not doing it. At first we were suspicious, having used the old paper charts religiously for decades. What was their underlying motivation to do this? It had to be money. (more…)

I tell my patients that pain is really in the mind of the beholder. Some people can naturally tolerate a huge amount of pain; others cannot tolerate the least amount of discomfort. You can ask any dentist about this. There are Bearers of Pain, and of course, The Screamers. Some people even feel pain just thinking something may hurt. A prime example of this would be injections.

In the gamut of painful medical acts, a shot is really not that painful, but you can’t convince some people who have preconceived ideas that this will be excruciating. I once held a sobbing, 280 pound high school football player in my arms, as my medical assistant gave him a meningitis vaccine. This is the same guy that would run for a touchdown on a broken leg. (more…)

I survived. The renal stone, a bit bigger than the urologist originally estimated, that was trapped and imbedded in my left ureter has now been pulverized by laser lithotripsy. It was another two to three hour ordeal (I slept through it) and very challenging for the urologist. We will both be glad not to see each other again for a while, but I do have to go back in a few days to have the stent removed — an office procedure that I will not explain, other than the fact that it involves a string that is currently taped to me, and a forceful yank.  I do not drink alcohol, but I am seriously considering some form of intoxication prior to this upcoming visit. (more…)

Actually, there was a creature stirring, and it was a mouse. I put one of those sticky mouse traps together and placed in our pantry, where a mouse has been helping him/herself to our dog food. The mouse eats the bottom of the bag, so it breaks when you pick it up. He has to go. I thought about putting the cats in there for the night, but cats don’t always eat the mice. They like to play with them, or torture them to death. I am not a big fan of killing things, but I do draw my line at vermin and chicken-eating coyotes. (more…)

Hope. How many times do we use this word on a daily basis? What is hope? We all hope for the best, but according to my best friend, Robert, hope is really just a delay in disappointment. When he told me that this morning, I had to really think about how much of our life is based on a series of successes, balanced with an equal amount of disappointments. When you have too many disappointments in life, you really do lose hope.

Maybe we lose hope when we set our expectations too high. I hope this new President does what he says he is going to do. I hope that your surgery goes well this time. I hope it doesn’t rain today and kill the rhubarb. I hope that the price of gasoline doesn’t hit $4.00. Oops, too late. I hope it doesn’t hit $5.00 a gallon. I hope I can afford to retire. The “Audacity of Hope.” (more…)

When I was a child in the late 1950’s, a medical office visit in our tiny Appalachian town was about three dollars; a house call was five dollars. Of course, gasoline was under 30 cents a gallon, too. As far as I know, no one in my family had health insurance. They simply paid the three bucks when we were ill. Since medications were simple and inexpensive, prescriptions were usually included in the price. I can remember only three or four medical visits in my entire childhood. Even adjusting for inflation, these visits were dirt cheap. I see some children in my practice that have three or four visits every month. They have insurance.  Do people utilize medical offices more when they have insurance? You bet. (more…)

I had surgery yesterday for the kidney stone that was painfully lodged in my ureter — the tube from my kidney to my bladder. Due to some unexpected and serious ureter swelling and the size of the stone, the surgeon was not able to get it out. She wasn’t even able to get the scope past the obstruction. She did insert a series of stents — devices to widen the narrowed area — so hopefully, she can get it out next time. Next time! It isn’t over for me by a long shot. (more…)

Photo: Jupiterimages
/ © Getty Images

I was hoping — really hoping — that my lodged ureter stone (the tiny tube from the kidney to the bladder), would miraculously free itself and I would be able to avoid surgery. No such luck.  According to my x-ray this morning, the stone is still sitting there like some type of calciferous sniper. My surgery is still scheduled and I am still pissing and moaning (pun intended) about it. It is time to cast that stone.

What does a kidney stone feel like? Okay…imagine someone threw a spear and it stuck in your side. Now, get a two-year old to stand on the spear and jump up and down. This would as close as I could explain it. The pain is humbling, all-consuming, and relentless. If I knew any state secrets, I would have willing spilled the beans for some relief. (more…)