I both love and hate my phone.

I am so behind that yesterday catches up with tomorrow.

There is no such thing as too much sunscreen. Only not enough.

The Doc

Stubborn patients are slow to change their thinking. Yet quick to die. Not all are meant to live long lives.

The Doc

Residency was a difficult time for most young physicians.  But it was also a time that my family grew.  We got a dog named Murray.  He is a Shih Tzu that is 10 pounds with a Mo-Hawk.  He was named after a character from a television show on HBO called Flight of the Concords. 

In between long days of seeing patients Murray was always there to greet me at the door upon arrival home.  He never complained how much I worked and was always ready to cuddle.  We took long walks which were part of my attempt at preventing burnout. 

Since I have completed residency and I have now been an attending for over 12 years.  Murray has been here with me for many years.  I have learned about many medical conditions and illnesses.  Day after day treating humans does not always prepare one for the illnesses that may also happen to your animals.

Murray is 14 years old now.  His hearing and sight have diminished but the hardest part is seeing his spark dim.  He has been getting lost in our house.  He has forgotten how to get in and out of our home.  He does not even want to go for walks anymore.  I think he recognizes my smell and voice, but I am not sure.  He appears confused and I think he has dementia.

I have treated many patients with dementia but never an animal.  He did not get an MRI of his brain.  I did not do a Doggie Mini-Mental Status Exam.  He has not been prescribed Aricept or Namena.  But I know his memory is leaving his cute little body.  Just earlier today he got lost in the house he has lived for many years. 

Doggie Dementia is a real disease but it is actually called Canine Cognitive Disorder.  Canine Cognitive Disorder,  also know as Doggie Dementia presents with anxiety, failure to remember routines, decreased desire to play, confusion and dogs wandering aimlessly.  Murry has CCD.  Vets do tests to rule out other conditions and at times, actually do MRIs of dog’s brains. 

Some dogs are treated with Anipryl (generic selegiline) which in the human world we use to treat Parkinson’s.  But not for Murray.  I will carry him outside.  I will retrieve him from the corner and put him back in his bed if he gets lost.  I will continue to talk to him hoping that he recognizes my voice.  Murray is not the same dog that he was when he was a puppy, but he is still loved.  He may not have his memory, but he still has his Mo-Hawk. 

Not everyone has a favorite type of white blood cell, but I sure do.  Eosinophils have always been my favorite.  If I see them elevated on the differential, I am usually less worried than when there are other elevations in different types of white blood cells.  Neutrophils worry me about a significant infection and lymphocytes are even worse. 

Eosinophils help in many ways from trapping substances, killing cells, bactericidal activity and even anti-parasitic activity.  But usually, it just means that you are a highly allergic person.  Often these patients have 1 or all of the allergic triad.  The allergic triad consists of allergic rhinitis, asthma and atopic dermatitis.

I have had allergies for years and so I realize that my bone marrow is working hard right now making eosinophils.  Runny noses, sneezing, scratchy throat, itching eyes and post-nasal drip are all symptoms that may be coming from these eosinophils.  I cannot even spend time with someone that has cats due to my allergies.  They set my eosinophils on fire.  I once had to end a relationship with a girlfriend (that had a cat) over allergy issues. 

Asthma is a common respiratory condition that can be associated with eosinophils.  Asthma causes inflammation and bronchoconstriction in airways.  There are some new medicines that specifically treat allergic asthma.  These patients often have to get their IgE levels checked.  This is a way of checking your immunoglobulin levels associated with eosinophils.  Attacking the eosinophils has lead to big changes for some patients with asthma. 

Ivermectin has become an infamous medication over the past few months.  But it has been used in the past to treat certain parasites.  Both strongyloidiasis and river blindness are treated with ivermectin.  Why is this relevant?  Because parasites cause eosinophils to rise. 

But now we are seeing more eosinophilic esophagitis.  This is a condition that was first diagnosed in the 1980s.  This causes esophageal impaction, abdominal pain and even food refusal at times.  This has been diagnosed more and more over the past few years.  Patients with this condition often have food allergies that lead to this food impaction and gastrointestinal symptoms.  These classic symptoms along with more than 15 eosinophils per high power field is how the diagnosis is made. 

Now that I have thought about all the issues that are associated with eosinophils, I am going to rethink my favorite type of white blood cells.  Maybe it is time for me to move my love to monocytes.  But if not for eosinophils and the reaction I had to cats maybe I would not have met my wife.  Which lead to me having my children.  This is a thank you to my eosinophils.  If they were not as responsive in my life who knows where I would be in life.  Thank you Eosinophils. 

The Doc is In

I spend my days running from room to room seeing patients.  My weekends chasing my children.  While trying to sneak in time to exercise and improve my health.  And also time punishing my body with chips and occasional IPAs.

But you never see the change in your joints coming and then it is there.  I took a step.  Felt a shearing force in my knee.  I was not jumping or hurdling but something funny happened.  I continue my day and pretend that I am fine. 

Then the next day walking to a patient room I feel my knee give out.  Luckily my peripheral nerves, cerebellum and my vestibular center are still intact.  I do not fall.  Immediately I feel a click and realize that this joint is now swollen. Fluid pushing posteriorly.  There is no Baker’s cyst but I am sure that I have an effusion.

There is not pain but I realize that my knee has failed me.  I do not have my partner prescribe me Percocet.  I do not stop working.  I push through because that is what we are taught to do.  I ice my knee and use the occasional ibuprofen.  It is now 2 weeks later and I have still not had it examined.  I have been ignoring and hoping it will go away. 

I often am surprised when patients are not able to explain their pain.  I give them descriptive options if they cannot come up with a description on their own – sharp, achy, lancinating, burning, throbbing, crushing, gnawing, tingling, dull and more.  Yet I cannot even describe how my own knee feels.  It is not pain but discomfort.  Yet discomfort is a type of pain.  It feels tight.  I cannot feel tearing along my tibial plateau.  I cannot tell if it is patella vs medial. 

I worry that I have torn my meniscus.  I am a trained physician.  Yet all I can think about is how my body has failed me.  Will it heal on its own?  When do I get an MRI?  Will I ever play basketball again?  Should my weekend runs come to an end?  Was this an acute tear or degenerative?  Could I be that old that I have a degenerative meniscal tear?  I have started some PT and hope everyday that the effusion will have disappear.  But it has not. 

But if a patient came in with this complaint it would be a simple visit.  I could get a history, examine and create a plan in a few minutes.  I would ask the patient if they had any questions, while hoping the answer was no.  But I am the patient.  And it feels so different and yet it is not even a scary medical issue that I am dealing with.

If I feel this way, I cannot imagine how patients feel.  I realize I need patients to ask me more questions because they have them.  They have concerns and fears.  As do I.  Now that I have finished writing about my fears maybe it is time for me to see a doctor. 

The Doc Is In