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Emergiblog Gets Scoped

lost voiceI hope you can read the print on this.

It’s a hoot!

Apparently, the Vacuum Tympan cures the most “desperate causes” of hoarseness and sore throat, massages vocal cords and gives immediate flexibility (to what?). Oh, and after it brings relief, “a permanent cure soon follows”.

Maybe it sucks out the phlegm. (Ewww…just writing that made me gag.)

It sort of looks like the old incentive spirometers we’d use for post-op patients.

Or maybe it’s a type of  nebulizer.

Frankly, it looks like a bong.

********************

I’m at that age where certain tests involving scopes and colons are recommended, so I did my duty as the good custodian of my health and scheduled the pre-test appointment.

(Don’t worry, this will not be a case of “TMI”.)

I’m sitting there with the GI doc going over my health history, when he notices I’m on Protonix. Based on this fact (and the fact that my upper abdomen is sore on palpation – well, duh, you’re pushing on it!) he says “Well, you are going to be out anyway, I might as well take a look down there, too!”.

Say what? I’m here for a tube up one end and you want to put a tube down the other end, too?

I swear to (insert-your-own-deity-here), my first thought was “dude, you’re just trying to add a procedure to crank up the income.”

I’m not proud that was my first thought, but I’m being honest here. “Sure!” he said. It might be a structural problem, we can make sure you don’t have Barrett’s Esophagus (note to self: look that up) and basically just know what we are dealing with.

Well, okay. But I don’t have indigestion/heartburn when I’m on Protonix; I’m rather asymtomatic, actually.

“What kind of anesthesia would you prefer? We can use Versed/Fentanyl or if you want, we can use proprofol.

Propofol? Dude, you can stick a tube anywhere you want.  Go for it!

*****

Easiest thing I’ve ever done. I have no idea why I waited so long. When I fell asleep Shania Twain was feeling like a woman and when I woke up, the Eagles were takin’ it easy and I wondered when the hell they were going to start!

I was done.

The procedure went well, the biopsies were taken (routine) and I would get my results by mail within two weeks.

*****

My colon rocks. No problems except divertiulosis and I can live without nuts and seeds.

It was the endoscopy that I almost refused that showed the problem.

The biopsies showed acid-induced esophageal and gastric inflammation.

What??? How??? I thought the Protonix was taking care of that!

*****

And then came the “treatment” boxes checked off.

“Keep taking your medicine for the next three months, then stop.”

Okay…if I have this inflammation now, why would I stop the medication? Won’t it get worse if I do?

“Please avoid Aspirin, Naprosyn, and Motrin. Tylenol is okay.”

Aw man, Motrin is my best friend, my right hand! It’s gotten me through many a rough shift; 12 hours in the ER can make you ache. Tylenol isn’t worth the powder it is printed on.

I took a swig of my Diet Pepsi.

“Avoid fatty foods…”

Okay, doing that already with ol’ Richard Simmons’ plan.

“…chocolate, peppermint, spearmint and smoking”

Bah – I don’t smoke and I can live without chocolate and who wants spearmint anyway?

Took another swig of Diet Pepsi.

“…alcohol…”

No biggie, I only have two Bud Lights a month, during Nascar races, and that’s only to support Kasey Kahne’s sponsor (and I know you all just doubled that to four per month…).

“Avoid caffeinated beverages…”

Uh oh.

Took a tiny swig of Diet Pepsi.

“Decaffeinated coffee…”

That…means…ohh nooooo…

*****

Oh HELL no.

I will NOT give up Starbucks.

Damn it!

I don’t smoke, I barely drink, I don’t do drugs, my diet has more fiber that corrugated cardboard, I’ve lost close to 30 pounds and I’m working on the other 25.

My only “vice” is a total addiction to Starbucks and the goal of someday mainlining Diet Pepsi.

It will be a cold day in hell before I give those up.

*****

I’m giving them up.

I know the effects of chronic esophageal and gastric inflammation can lead to bigger problems.

And in the scheme of things, given the impact a diagnosis can make on a life, this borders on laughable.

But we all talk about how the patient has to take responsibility for their health. I could keep on downing Starbucks twice a day and Diet Pepsi in my sleep and then whine because my Protonix isn’t working.

Or I can make the changes suggested and see if they will make a difference.

But how ironic that the main problem was found in a test I didn’t even know I needed; and how scary that I was essentially asymptomatic, but the inflammation was still there!

Kudos to the doc for being interested enough to find out why I had needed to be on Protonix to begin with.

I shudder to think what things would have looked like had I been on no medication.

*****

Who knows?

Maybe I can go off Protonix if these changes work.

And I can still go to Starbucks, only my new drink will be a Grande Skinny Vanilla Steamed Milk.

With a little cinammon on top.

Hey, a girl’s gotta have something to look forward to…

*This blog post was originally published at Emergiblog*

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Latest Cartoon

Richmond, VA – In an effort to simplify inpatient medical billing, one area hospitalist group has determined that “altered mental status” (ICD-9 780.97) is the most efficient code for use in any patient work up.

“When you enter a hospital, you’re bound to have some kind of mental status change,” said Dr. Fishbinder, co-partner of Area Hospitalists, PLLC. “Whether it’s confusion about where your room is located in relationship to the visitor’s parking structure, frustration with being woken up every hour or two to check your vital signs, or just plain old fatigue from being sick, you are not thinking as clearly as before you were admitted. And that’s all the justification we need to order anything from drug and toxin screens, to blood cultures, brain MRIs, tagged red blood cell nuclear scans, or cardiac Holter monitoring. There really is no limit to what we can pursue with our tests.”

Common causes of mental status changes in the elderly include medicine-induced cognitive side effects, disorientation due to disruption in daily routines, age-related memory impairment, and urinary tract infections.

“The urinalysis is not a very exciting medical test,” stated Dr. Fishbinder. “It doesn’t matter that it’s cheap, fast, and most likely to provide an explanation for strange behavior in hospitalized patients. It’s really not as elegant as the testing involved in a chronic anemia or metabolic encephalopathy work up. I keep it in my back pocket in case all other tests are negative, including brain MRIs and PET scans.”

Nursing staff at Richmond Medical Hospital report that efforts to inform hospitalists about foul smelling urine have generally fallen on deaf ears. “I have tried to tell the hospitalists about cloudy or bloody urine that I see in patients who are undergoing extensive work ups for mental status changes,” reports nurse Sandy Anderson. “But they insist that ‘all urine smells bad’ and it’s really more of a red herring.”

Another nurse reports that delay in diagnosing urinary tract infections (while patients are scheduled for brain MRIs, nuclear scans, and biopsies) can lead to worsening symptoms which accelerate and expand testing. “Some of my patients are transferred to the ICU during the altered mental status work up,” states nurse Anita Misra. “The doctors seem to be very excited about the additional technology available to them in the intensive care setting. Between the central line placement, arterial blood gasses, and vast array of IV fluid and medication options, urosepsis is really an excellent entré into a whole new level of care.”

“As far as medicine-induced mental status changes are concerned,” added Dr. Fishbinder, “We’ve never seen a single case in the past 10 years. Today’s patients are incredibly resilient and can tolerate mixes of opioids, anti-depressants, anti-histamines, and benzodiazepines without any difficulty. We know this because most patients have been prescribed these cocktails and have been taking them for years.”

Patient family members have expressed gratitude for Dr. Fishbinder’s diagnostic process, and report that they are very pleased that he is doing everything in his power to “get to the bottom” of why their loved one isn’t as sharp as they used to be.

“I thought my mom was acting strange ever since she started taking stronger pain medicine for her arthritis,” says Nelly Hurtong, the daughter of one of Dr. Fishbinder’s inpatients. “But now I see that there are deeper reasons for her ‘altered mental status’ thanks to the brain MRI that showed some mild generalized atrophy.”

Hospital administrators praise Dr. Fishbinder as one of their top physicians. “He will do whatever it takes to figure out the true cause of patients’ cognitive impairments.” Says CEO, Daniel Griffiths. “And not only is that good medicine, it is great for our Press Ganey scores and our bottom line.”

As for the nursing staff, Griffiths offered a less glowing review. “It’s unfortunate that our nurses seem preoccupied with urine testing and medication reconciliation. I think it might be time for us to mandate further training to help them appreciate more of the medical nuances inherent in quality patient care.”

Dr. Fishbinder is in the process of creating a half-day seminar on ‘altered mental status in the inpatient setting,’ offering CME credits to physicians who enroll. Richmond Medical Hospital intends to sponsor Dr. Fishbinder’s course, and franchise it to other hospitals in the state, and ultimately nationally.

***

Click here for a musical take on over-testing.

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