Saturday, September 20, 2008

Unconventional Day for a Doctor

So I thought I would share my unconventional day with you, so I could confirm that I am an unconventional doctor.

Serenity Now!

The day today started with two children climbing into bed with my wife and I at 6:00 AM. I thought I would let my wife sleep in for a day, since she is up at 6 am every day with the kiddos. So in my morning fog, groggy, I brought the two bedbugs downstairs. Now I had a rough day the day before and made a special trip on my way home to pick up a treat for myself (I often console myself with sweets, believing I deserve it for a hard day's work, only to beat myself up about it the next day in the name of exercising more). I came home with chocolate, diet dr. pepper, and white chocolate macadamian nut cookies. Now, I would say that cookies are my second favorite food, right behind ice cream (I didn't get ice cream in the name of moderation. I can eat just 1 or 2 cookies and quit if I start feeling guilty, and if I don't I can eat more; with ice cream, there's no stopping me. It's all destined for digestion). So desiring some sweats this morn to awaken my senses, I start searching for my cookies. They aren't where I left them, so I inquire of my 4 yr old son if he knew their whereabouts. He proceeded to tell me that he had my cookies and he hid them, but he couldn't remember where. So we start looking. And we look. And we ask, "where are the cookies, Bub?" And we look some more. Now I'm getting frustrated, and I let loose on my son, "Bub, if you want some of daddy's cookies, ask first. If you eat some, put them back where you get them! All I wanted this morning was some cookies!" (Who is the 4 year old)? So I walk away in frustration, peeved at my 4 year old because he hid my cookies. I sulked for 30 minutes, spoke abruptly to my son when he asked for a snack, and instead had a piece of chocolate. Later in the day, my wife completed the story. The cookies weren't lost; they were on top of the fridge where she put them after she found him with them at 5 am, next to him while he played his Nintendo DS.

The moral of this story: Don't love cookies more than your kids!

The lesson learned: "For where your treasure is, there will be your heart be also" (Matt 6:21)

Lidded versus Unlidded

So the day continued with a haircut at the local barbershop. As I noticed my hair falling around me, there was something about it that shocked me. I blinked and studied it again, and realized that about 50% of it was grey! This at age 35! What a bummer! So as he finished trimming my hair, I thought I had better get it short so all that grey would not show as much (the paleness of scalp hides grey much better than a background of medium-brown hair). So I asked him to take a little more off until I was satisfied that I couldn't see any grey. Now my hair was ultra short, and paranoid about my balding spot appearing more bald, I promptly went out and put a hat on. I told my wife this story, and she told me that she'll love me even if I am grey, and even if I'm bald. Suffice it to say the hat is still on.
The moral of this story: Don't cut your hair, and otherwise wear a hat, even to bed.

The lesson learned: Count your blessings. It could always be worse.

Ulmus crassifolia

So I headed home and decided that today was the day to take down a tree that had been storm damaged. It needed to come down, but in all honesty it was a way for me to get some exercise, be outdoors, play with a chainsaw, and give me some time to think and re-prioritize. I set out cutting down limbs, cutting them up, and hauling the limbs to the limb dump. It took 8 trips to the limb dump, 2 episodes of repairing the chainsaw, one episode of getting the chainsaw caught and hanging in a limb for 20 minutes, multiple scratches, and only one limb-to-the-eye episode. As I neared the last hour the limb dump was open, I was fretting that i wasn't going to get all the limbs there in time, lamenting that I was doing this all alone. Just then, a gentleman pulled up in a pickup truck with chainsaws in back, inquiring if I was going to use the tree for firewood. We struck a deal, and he helped me finish up the job in time to get the limbs to the dump, relieving my worries. It is finally down!


The moral of this story: Don't plant trees, because the tree limb dump is open long enough.


The lesson learned: "And my God will meet all your needs according to his glorious riches in Christ Jesus. (Phil 4:19)


Hymenoptera

I cleaned up the yard and went to stack the wood in the wood rack. In the way was a plastic slide from a swingset, which I dragged out of the way and began stacking wood. Suddenly, a wasp presented itself in my face, and I began both my flight and fight response as I backed away, swatting at the wasp. Well, it stung me on the arm and flew away. I looked for the source of the wasp, looked over at the slide, and lo and behold, wasps were pouring out of 2 screw holes. I grabbed some wasp spray that was sitting nearby (lucky, huh) and took aim, killing a total of 12 wasps (I think I got two more with some Jose Canseco home run swings with be broom as well). So what did I do? I finished stacking my wood, hauled the slide over by the trash, cleaned up, and went in for a shower. Yep, it's true, I didn't go to the ER. Can you believe it? My arm became red and swollen and it was painful, but instead of pursuing the route of emergency care like some of my patients, I toughed it out. Used some ice. Found the benadryl in case I needed it. Ahh, independent thinking, lack of panic, and common sense. If only we were all born with it!


The moral of this story: Put on black clothes and giant fake wings each time you go outside so you'll intimidate wasps that are in the area.

The lesson learned: "So do not fear, for I am with you; do not be dismayed, for I am your God. I will strengthen you and help you; I will uphold you with my righteous right hand." (Isaiah 41:10)


So this was the day I had as an unconventional doctor. I was cranky with one of my children, obsessed about a food item, concerned about my personal appearance, exaggerated feelings of injustice and neglect, cut down a tree, and got stung by a wasp. Perhaps unconventional for a doctor, but not for a person.

The lesson finale of the day: The next time when you want ice cream, just get ice cream.
Photos by stinker over there to your right.

Tuesday, September 16, 2008

Babies over a burger

So as a rural physician, you practice medicine in all sorts of places. This is a prime example of "one of those days."

The Brownie

One day, I decided to meet my wife and kids for lunch at a local fast food resturaunt. There wasn't any lunch provided at the office that day due to impending medicare cuts. So I hop in my truck and drive over to meet them at the local noon hot spot, where 1000 calories costs the same as a movie rental. I sit down and enjoy my lunch in the peace of my kids smearing ketchup on their faces, running around the tables, fighting over toys, and generally raising a ruckus (ah, the peace of a quiet lunch after a busy morning). As I am there enjoying my 734th calorie, I notice a young couple sitting a few tables over who have requested my services in the office on multiple occasions. Okay, so they are patients of mine. As I am leaving with a 14 month old wiggling rendition of a hot dog with ketchup and mustard in my arms, trying to keep my clothes clean to go back to see patients, my patients speak up, hollering my name from across the eatery. As I recognize them, the proceed to tell me of her medical dilemma. She tells me that she thinks she is pregnant, as she hasn't had her period in a while, she's gaining weight (remember we're eating at a gain-fat-a-minute establishment), and she's been tired. As the eyes turn and the ghost of silence sweeps over the booths, I suggest that she make an appointment. I continue to move towards the door as she relates to me that all of her pregnancy tests have been negative, but that happened with her last pregnancy. I again suggest the obvious, that perhaps she should make an appointment to discuss this. Her husband proceeds to tell me that she must be pregnant, as he can feel the baby moving inside and she's eating 200 dollars worth of groceries a week. Suffice it to say, the conversation ended there with a smile, as I said, "Well, you had definitely better make an appointment!"

The Ice Cream


Oh my friend, tis not the end of the story. As we load all the children in mom's moose of a vehicle, I notice a distressed and distracted look on her face. I ask the perpetual question you should not ask when you are short on time and you can see in your mind the patients lining up to check in at the front desk, your rooms loaded with octogenarians with their lists of issues to discuss that day(dry skin, fatigue, constipation, poor sleep, fatigue, food intolerances, medications, the 4 dollar list at Wal-mart, and grandson Johnny's first deer photos), the desk full of phone message sticky notes, the overgrown grass that needs mowing that night if I get home in time since I'll be an hour behind: "Honey, what's bothering you." Lips start to quiver, frown begins to appear, eyes tear up. She requests to be polite and not tell me till later, but she knows I wouldn't be able to concentrate at work and with more prodding, she tells me - "I'm pregnant."


Now this after deciding to have no further younglings, taking all necessary precautions with medication and lack of exposure to swimmers. I hold her close in the parking lot, kids baking inside the car, hollering and fighting, people/patients/co-workers/mayor driving by to go through the drive thru (some wave), as she sobs and I tell her it will be okay. My thoughts of not getting the grass cut tonight are swept away with a fast-frame slide show of pregnant wife sick as a dog, chasing kids all over belly-first, enduring birth and telling me to shut up again, changing diapers, late nights rocking a screaming muffin ball, the mind-bending sleeplessness, how we will never have vacation alone again (who will watch 4 kids under 7 for 3 or more days?), never having a boat to go fishing, being outnumbered when teenagers, the whining, crying, pooping, diapers, bottles, college funds, cars, etc (now you see why my wife calls me a pessimist (truly I am a REALIST)). We hug a while, I wipe her tears, tell her again it will be okay, and we depart with a kiss and a few deep sighs. Ah, a nice, quiet, peaceful, relaxing, mind-restoring lunch.

The Whipped Cream and Cherry on Top

But, there is more!! The next day, one of my nurses informed me that I have a twin! A twin here in our small town of 14,000, and my parents still had not told me about him all these years? As I inquire about this twin, she relates to me that as she was driving through the drive thru of this establishment, she saw my twin hugging a good-looking blonde. The implication was obvious to me, the question asked indirectly - are you having an affair? I put 16 and 32 together (why 2 and 2, who made that up?) and clarify that no, that was not my twin, that was my wife and I, sharing a "moment" in the parking lot after a nice, peaceful, joyful, relaxing, calming lunch.

The Nuts


So the subsequent day my eating and conversation companions from the restaurant arrive in the office, to figure out this dilemma. I knew the history, the exam was unremarkable, so we proceed with the pee-in-a-cup test and use our super special urine pregnancy test that is the same as the over-the-counter EPT tests, just bought in bulk and kept in a box on a shelf for a year. Yep, negative. I return to the patient to ask some pointed questions. "Are you not on any birth control?" The answer was astounding, dumbfounding, awe-inspiring for our educational system, and humorous all at once: "Not since I had my tubes tied. I've been fixed." Oh, the pride just swelled up in me, what a wonderful job I have done educating my patients about pregnancy and pregnancy prevention, especially to those who already have children (yes, she has 2 rugrats). What a great historian I am, obtaining all the pertinent information before ordering tests. The visit ended by my answering 2 questions:
Patient: "So am I pregnant?"
Doctor: "No, your test was negative. You don't have to worry about getting pregnant after having your tubes tied. It's permanent and 99.98% effective at preventing pregnancy."
Patient's husband: "Then why is she gaining weight and what was that moving in her belly?"
Doctor: "Have you ever felt 1000 calories or more and 200 dollars of groceries a week travel through the bowels? Where do you think those calories go?"
The light came on, smiles all around, and a laugh. They haven't come in for a missed period since.

Ah, burgers over lunch with the family. What surprises it brings. We haven't had lunch there together on a work day since.

Sunday, September 14, 2008

From water to wind

So this week I have had the opportunity to help some families bring their little ones from out of the water (womb) into the wind. In my times of reflection on these times, I thought I would share some thoughts about the world of obstetrics.



Fetii (just kidding) are nortorious for being onry when the doctor is around. Labor and the course of delivery just seem to take longer when you are there than when you are not. I have learned this first hand after sitting with mothers as they are pushing for 1-2 hours, and somehow I end up having the task of counting the ten count for each push, over and over. (I think this task falls to me because the birth partner is so excited/distracted/grossed out that they can't focus to even count to ten. They also tend to get frustrated when the OB nurse tells them to slow their counting down, as if they are implying that they can't count to 10 correctly (by that time, most men feel like they can't do anything right). Suffice it to say, I can now count to 10 in 9 different languages, including 2 Peruvian Indian dialects (awesome - lets hit the mission field) and sign it with the best of them (you'd think I was deaf for all my life, and my fingers sign it with enthusiasm!)) I have counted to 10 so many times that if medicine doesn't work out, I could definitely find a job as the voice-in for the plethora of speechless boxing referees in the country. The lesson is, if you sit and wait on the baby, things will take longer (its true, a watched pot doesn't boil). If you don't, things go much shorter. So, this year I have decided to await being present and let others assume the counting responsibilities until I am needed. Well, this invariably leads to some babies being born or partially born without my presence. I have tried to make my presence known, but have been occassionally prevented from being present by lack of notification of an impending birth, by family members chit-chatting with me in the stairwell as I am running up the stairs to get to the delivery, by inadequate pain control (due to the nursing instruction of "push that pain away" that gets ingrained in their heads the prior 82 times they've pushed), by impatient babies, and by the "it's coming!" phenomenon. Thus is the nature of OB! Your doctor is dammed if they do, dammed if they don't - they can sit with each laboring patient until the baby is born, making you wonder if he or she is "enjoying their coffee break" while you've been waiting in an office exam room for 2 hours just to have a 6 minute visit, or they can attempt to be there at delivery when needed and risk missing the birth. The rule of OB is that nothing goes as planned! So, to have a baby, not only does mom have to be flexible, so does the doctor. So I say to moms, you have a choice. You can choose to have your doctor present for your pushing and not risk your doctor missing the delivery, thus officially making him or her a common-law partner, or you can have them rush in at the last minute, deliver the baby, and take care of the both of you, resulting in a shorter course of labor and pushing! Shorter labor or a new common-law partner - seems like the decision is easy to make (being married to a doctor is not all its cracked up to be - just ask my wife (I hope all my clothes are still in the closet when I get home and not in the yard)). So please don't scold me, growl at me, furrow your brow at me if I'm late to your delivery - I'm just trying to do you a favor, sister. You'll thank me later. Later.

Wednesday, September 10, 2008

Poohpouri post

Okay, well, it is time for my first medically related post. If you are grossed out, I apologize, but as stated in the title of my blog page, this is a site of medically-related musings and observations by a doctor. So here it goes.

What in the world is the public's fascination with bowel movements? I mean, I thought I would be spending my days helping people get healthier, not talking about their super-ability and/or inability of thier internal garbage disposal and sewer pipes to get rid of their space junk. You know, as a FP, #2 talk dominates probably more than any other problem on a regular (or irregular) basis, especially when you have a largely geriatric patient population. I thus wanted to share some insights, theories, and myths I have learned over the years.


Myth #1: Your pooh does not provide an indication of your overall health.

One of my patients, an elderly gentleman and prior cattle farmer, is somewhat obsessed with his excrement. On every visit, and at least every two weeks, he communicates with me in detail about his bowels. The details are so explicit that even I get a little nauseated and sickened and I try to move the conversation along to more pertinent details. Just to give you an idea, it takes him about 8 minutes to describe his garbage. Now yes, he does have medical conditions that affect his bowels on a daily basis, but he has been "going well" for years. Why does someone have such interest in their toilet orphan that they study it with such detail that it takes that long to describe it? I have a theory. As a cattleman, I believe that there is a long-held tradition and a secret book passed down from one cattleman to another that describes the characteristics of cow patties and how each individual characteristic of the patty correlates with the internal health of the cow (I believe, my friends, this is the true purpose and tradition of a well-known "cult" in the USA - the Masons). I have news for you friends. I do not believe this to be true of cattle, and even if it was, I don't think you can apply it to people, since we obviously don't have hooves or a tail. Your pooh has everything to do with what is going on outside your body, as it is essentially in a tube that runs through your body, not into it (if your pooh runs into your body, you really have a problem, and may truly be full of it). It does, however, tell you information about what you have eaten and how you digest what you've eaten, which if you don't remember that, then I think that is a more pressing problem to worry about and discuss with your doctor. Thus, it is a myth - your dookie says nothing about your internal health.

Myth #2: "When I eat, my food goes right through me."

Okay, what this complaint usually means is that when you eat certain foods, you have to go sit on the porcelain throne within a fixed amount of time. Some, however, believe that they eat and food traverses the 26 feet of bowel and makes its presence known for ejection within 10 minutes or so. This would equate to a rate of speed of 2.6 feet per minute through something with more twists and turns in it than Bill Clinton trying to define what "intercourse" really means. This speed is 1/2 the speed of the movement of the sloth, the slowest mammal on earth. In truth, what people actually experience is that the food actually causes the bowels to spasm and move your previous meals on down the shoot, causing the swoon for the bathroom. Don't believe me? Swallow gum or corn and then don't have either of those substances in your diet for a week. Keep an eye out for what you see and how quickly. If the thought of doing that is just too icky, swallow a coin, set a metal detector next to your commode, and when you go, turn it on and see how many days it is until it alarms. See, medicine doesn't always require expensive tests to figure out answers! My son can attest to this. His bowel transit time for a penny was about 70 hours. He's in training now, so we hope to cut his time by 35 hours or so he'll qualify for the 2016 olympics!!

Myth #3: "I don't know what it was like!!"

I hear this quote frequently from patients who come in complaining of bowel problems and in obtaining an accurate history, are asked to describe their doo-doo. Come on now, you can't tell me that you don't look at it, especially if you are a guy. Guys are extrodinarily proud of their accomplishments in the bathroom, as evidenced by their willingness to brag about it as teenagers, show it to their friends, leave it unflushed for others to admire in public restrooms, etc. Now I have never been in invited to the "inner circle", otherwise known as the women's restroom, when occupied, but if I were a fly on the wall, I would suspect women do the same thing, just in a more discrete manner. Want proof? Okay, well, I theorize that this is the reason women go to the restroom together at public places. I mean, do we really know why they go together? I think in women's code, that what it means to "freshen up." Proof number two is IBS. No, not the International Builders Show, not International Bible Society, not Internet Banking System, not Inflatable Boat, small. I'm talking Irritable Bowel Syndrome. This medical malady affects 25-55 million people in the US, and affects about 15-25% of women, twice as many as men. Now, to establish the diagnosis of IBS and exclude other diagnoses, a description of terd patterns and characteristics are required. The most common used scale to medically describe poo is the Bristol scale, which is detailed below.



Now if this medical condition affects more women than men, and requires the descriptive features as above to aid in that diagnosis, well, then, do I need any more proof? Don't tell us stories, we aren't stupid. Don't be ashamed, we are doctors. Don't feel guilty, it's not a sin. You can tell us you look at your pooh. I know some counselors to help you if you are in denial, and for those family members who plan an intervention for those in denial, check out "Frank's Doodie Denial Intervention Services" based out of Muskogee, OK (they throw in a free septic tank clean out!) and for a small fee we won't put your name in our book of "Poop Perousers and Excrement Experts: People who are Fecal Focussed."

So, that sums it up! This is a long blog, but I felt it was necessary. I don't have a fancy of kaka, nor do I enjoy talking about it, but as evidenced by my post, most Americans do (do)! It is an obsession. Why else would we have a scale to describe it, thousands of office visits a year to address it (resulting in lost productivity time in the bathroom, because I'm not following you in there), medicines to loosen it, soften it, firm it, slow it down, speed it up, make it bigger, make it smaller, help it make the turns easier and help it hurt less. In the words of Martin Luther King, Jr, "Our lives begin to end the day we become silent about things that matter." So if there is a problem, speak up! Stuck on the slow train? Speak up! Swelling like a toad with a 130 degree tempurature? Speak up! Hurting like a punch in the gut? Speak up! But I will tell you my friends, the solution is simple - just let it go, just let it go.

Wednesday, September 3, 2008

Unconventional?

Okay, so the next question to answer is what insight do I have that people would want to read about when there are tons of medical sites on the web? Well, I think it is because I am an unconventional doctor. I don't think I look at things the same way as others, and rarely do you get inside the brain of a physician who thinks of his profession as a job, not as a character trait. So what makes me unconventional?



  1. Personality type: I'm the type of doctor who sees every patient as another person or human, like a member of my own family (yes, some patients you don't like a lot, but the same is true in your family - Uncle Cletus the tow-truck driver who always wears overalls, smells like the local 7-11 outside trashcan, and always smacks you on the hind end and tries to pinch your chest every time you see him at the annual family reunion is a great example). Patients have great stories from their lives from which you can laugh and learn, and I hope to share some of those stories here.

  2. Practice style: Because I listen to my patients stories (ranging from about how much they like a certain type of oatmeal to stories of war from 50 years ago), I tend to move a little slower, listen a little longer, and spend more time with my patients. Thus, I have become somewhat of an inigma in the medical community. I am relatively young, yet have a fairly large geriatric practice, since I will sit and listen and they have no where else to go or no one else to talk to about their bowels or their fatigue (you wouldn't believe how common this topic of conversation comes up in a day. I don't understand how a conversation about bowel movements could take 15 minutes, but it commonly does, multiple times a day). Also, I'm a huge believer in preventive medicine and the fact that 80% of health comes from a healthy weight, adequate rest, diet, and exercise, not pills.

  3. Scope of practice: My practice in rural America is not limited to the office nor to certain ages. I help parents bring infants into this world, care for all ages, and provide comfort to those going to the grave. I practice in an office, a hospital, nursing homes and in people's private homes. My schedule is not limited by the clock or by distance from home. My patients can find me anywhere, and its not uncommon to give medical advice (including information on the best medicine for yeast infections) in the isles at the local grocery store or at lunch with my family at McDonald's.

  4. Personal preferences: I am not the typical doctor in style or dress, at home or in the office. At work, I typically wear pants and a shirt, no tie (they are notorious for carrying more bacteria than poo), no white coat (do you know what all those sleeves touch in a day?), no suit jacket. I don't drive a BMW or Lexus. Not a Cadillac. Nope, I drive a 11 year-old pickup truck, and I am hoping to possibly acquire a mini-truck to drive back and forth to work. At home and in the community, I can often be seen wearing a grubby t-shirt, shorts with holes in them, and a sweat-stained ball cap (they don't have a antiperspirant for your head - yet. Patent Pending). I am often confused for a young man who works for an auto shop or a lawn maintenance company due to my dirtiness from work at home, which in all honesty, is a disguise so I don't get stopped as often to be asked which laxative is the best for Johnny who hasn't poo'd in 6 days. I utilize the grease gun in my garage quite frequently, getting dirtied up just to go to the store.

  5. My free time: In my own time, I enjoy getting down and dirty (keep it clean, kids). I do work on my own home, from glazing windows to digging trenches for new electrical and sewer lines for my home. I love to work outdoors, and the destructiveness of weed-eating lets me take out my frustrations at something pretty benign. I am a masochist when it comes to exercise, always pushing the limits of my middle-aged body (yeah, I'll never have that six-pack back from age 16, I just don't want to admit it yet). Nintendo rocks, and my kids would tell you that I get a little greedy with their games.

  6. My wife: Finally, I would say I have an unconventional wife. She isn't your typical woman, as evidenced by her reflexive laugh that occurs when people are hurt or injured. She doesn't care what others think of her, she is solid in who she is as a person, she doesn't volunteer for groups and activities just to be seen and noticed. She's not afraid to go to the store in her grubbies and without make-up. She's willing to spank our kids in public if necessary. She's incredibly tough, yet sweet as chocolate. You can learn more about her at http://www.theunconventionaldoctorswife.blogspot.com/.

So I could go on about why I feel I'm an unconventional doctor, but the boredom had begun and it is time to bring it to an end. I will let you make your own judgement based on what you read. I hope you enjoy future posts that promise the lack of lamity found in this one. Adios.

What in the world?



So this was my first response when introduced to blogs. Sure, I had run across blogs on internet searches, but I ignored them as unreliable sources of information (do a search on any search engine for fibromyalgia and you will understand; I doubt Star, age 19, from Can Do, North Dakota, who works as a casino drink server on the local Native American reservation can augment my knowledge regarding the subject). I mean really, what use does a blog serve for a middle-aged physician in rural America with limited free time? It wasn't until my wife introduced me to some of her favorite blogs and subsequently started her own blog (http://www.theunconventionaldoctorswife.blogspot.com/) that I took interest. Thus, I decided to start this blog, not as a source of medical information per se, but rather as a source of communication, humor, insights, and thoughts for my friends and family. I thus hope this blog makes you ponder, laugh, smile, and even wonder "Is he alright? Does he need some counselling?" (don't worry, I'm already there - this is part of my quack's therapy requirements). Read on and enjoy.
Disclaimer: Due to the graphic nature of the medical profession, it is recommended that you not eat while or within 30 minutes of reading this blog or if you are squimish or in the first trimester of pregnancy, unless you are bulimic, which if you are, maybe some of these stories will help you achieve your end goal.
Disclaimer 2: Bulimia is not a medically recommended method of weight loss.