Life is hard. Daily Obstacles.

Keep Pushing. Even if it feels impossible.

Grin and bear it. Force through.

Hard work. Practice. Must pursue.

Never give up. Keep fighting.

Believe in yourself. Blood spilling. End is frightening.

Body is broken. Stress holding.

Looking for answers. But bowels are slowing.

Always had grit. Perseverance.

Still failing. Blocked sigmoid. Inteference.

Stressed. Stop guessing. Not abstract.

Not cancer. Not death. Bowels will not relax. Need miralax.

Face sweating. Fists tight. Push hard. Success. Elation.

From demons to depression. Not those. Just constipation.

You finish. Release. Destroy the bowl.

Nothing could stop you. Won the war. Against your own butt hole.

Testing – Urine Drug Testing

Physicians often say the hardest thing about medical school was getting in.  I am not sure that I agree but the rest of the experiences do not happen if you do not get in.  How do you get into medical school?  A test score is the main answer.  We all had to take the MCAT.  I remember realizing that many of my friends had taken a full prep course for this test while I had been teaching myself from a work book to take a test that would decide whether or not my life’s dream would come true.  I cannot imagine where my life would be if had not done decent on that test. 

Medical school was all about tests.  We had different systems taught in modules ending with a test.  The first 2 years were more about passing tests than learning for me.  It was biochemistry and physiology and I was still trying to process how this information would help me take care of patients.  Third year of medical school things start to come together.  Each rotation was followed with a test but at least these tests were asking clinical information.  We have Step 1 and then Step 2 and Step 3 and then board certification.  The tests keep coming.

But one has finally been canceled.  The Step 2 Clinical Skills exam has been canceled.  This was the test that cost over 1000 dollars.  It was also only held in 4 cities at the time I was in medical school.  This test consisted of medical students interviewing standardized patients.  I think that this cancellation was a step in the right direction.  Medical schools have the patient interaction/experience added into their curriculums.  This test was a money grab for the boards.  The financial and mental stress that adding this test in was too much for medical students.  From the time it was started many knew this test was wasteful.  All we needed was a pandemic to end it.

It is a new year and we have been updating our controlled substance contracts in my office.  Which means I have been testing my patient’s urine.  This is a test that one cannot study for.  Most patients are taking medicine for the right reasons but the UDS does shed some light on the substance abuse issues that patients are not also forthcoming about.  In medical school there is a plan to focus on certain areas if a particular test is failed.  Tutoring and extra study time.  But what to do if a patient fails a urine drug test.

Do I cut the patient off immediately?  Do we taper down?  I many times have asked the patient if they had issues with substance abuse?  But often times patients do not want to admit.  There was a mistake.  My pills got flushed down the toilet, so I had to take something else.  I promise that I did not take that.  One even wanted to do a lie detector test.  I do not argue about the validity.  This is not meant to be punitive.  I am trying to find ways with these failed tests to see in which ways I can help this patient going forward.  But in a way without prescribing controlled medicines.

Tests are had.  Tests are stressful.  We need to find a way if someone does not do well on a test to help them perform better in the future.  I love seeing patients but still hate discussing their urine drug tests.  I am getting ready to take the Family Medicine Boards again.  At this point in my career I would do well in the Step 2 CS but I am glad it is gone.  Due to the opiate epidemic we need to work together to make sure that urine drug tests that are abnormal can lead to ways to help patients.  Everyone needs to find ways to use this to help improve patients lives.  We can figure this answer out together.  If you do not have the answer right now that is ok.  It is not a test.

The Doc Is In

What having the flu can teach us about nutrition. Everyone has gotten sick. Laying in bed with fevers, chills, and cough. We used to hope that we did not have the flu. Now we say I hope I have the flu and not Covid. Then we ask our loved ones to make us some chicken soup. As an overall theme Americans eat too much and way too many processed foods. Until we get sick. When you get the flu, your immune system goes on overdrive. Our body is working on controlling our temperature and fighting off a cough. At this time you may also have nausea, diarrhea, or headaches. 

All of these symptoms negatively affect appetite. We need to let our gastrointestinal tract rest so that more of our body’s energy can work on releasing cytokines and immune modulators to help us get better. Our bodies conserve energy in digestion by decreasing our appetites. Yet many of the foods/thoughts that we turn to while having the flu could actually help us overall with our daily nutrition. When one gets the flu we turn to chicken broth, we increase our fluids and oatmeal. Leafy green vegetables have likely immune-boosting benefits. 

As opposed to bacon and eggs, sick patients often will have a bowl of yogurt. You want to avoid fatty foods. It would be unlikely for you to get gout or have your gallstones flare while on the flu diet. Also, most people drink less alcohol when they have the flu. More water gets consumed and less vodka. Lots of people want to lose weight and eat healthier. So I am going to propose a new diet fad for the world. The Flu Diet. Yogurt or granola for breakfast. Lots of water and/or low sugar electrolyte drinks during the day. Lots of leafy green vegetables including broccoli or one of those kale smoothies that people are always trying to get me to drink. Low salt chicken soup for dinner. And definitely get your flu shot. But if you really want to lose weight consider eating like you have the flu.

The Doc is In

A virus has spread.

You start to cough. It’s too late.

Your grandma is gone.

Being a family physician we get to hear about the good things going on in patients lives but we also are there for the bad.  I have done my best to take care of patients yet no one lives forever.  On every patient note I write I try to include a little interesting tidbit about each patient.

Because patients die.  I am often involved with their health as it takes a down turn or am surprised and trying to find out what happened to their loved one. I have said the wrong things a few times and insightful things at other times. Here is my guide to talking to a grieving family member.

Ask questions.  How are you coping?  Is there anything you need?  For a husband and/or wife that lost their loved ones I ask how they met?  Where was their first date?  People realize their loved ones may have died but they do not want them to be forgotten. 

Remind them of a funny/interesting interaction you had with their family member.  Like I remember the time I gave your husband a cortisone shot in his knee so he could compete in his bowling tournament.  Or how excited someone’s recently deceased mother was when she went to her granddaughters wedding. 

Leave out the negatives.  This is not a time to remind a woman that her husband had cheated on her years back.  Or that his kidneys failed because he did not take his blood pressure medications.  There is no need to bring up the past at this time. 

Continue to ask about how they are doing.  It could be 6 months or 6 years but people grieve for different amounts of time.  Do not avoid the topic.  Widows want to talk about their husbands that have passed.  Unless they are there with their new boyfriends. 

Take notes on patients.  Learn about their lives.  Because no one will be here forever.  And everyone hopes to be remembered by someone.

The Doc Is In