Moving on. I'll just be using this blog to itemize my own thoughts. I am committed to attending medical school but the grind that I am going to go through will be difficult.
I have just finished my Sociology and Psychology requirements(have one more online course that I will take over the fall.)
I'll take 9 credits of GMU BCPM(Biology, Chemistry, Physics, and Mathematics courses) each in the Fall and Spring to boost my GPA.
I am beginning to volunteer at Jill's house and at ACHN free clinic in chantilly(though I still need to hear back from them--the free clinic that is.)
On top of this, I'll still be working at my mom's office.
And I'll be retaking the MCAT. But I know I can do it.
Monday, June 27, 2016
Thursday, April 7, 2016
Nine Lives
Patient, F, Mid 50s, Asian.
This was a previous patient with ventricular shunt, with h/o saggital vein thrombosis and aneurysm rupture as indicated in previous cases.
Patient develops acute severe onset of headache, fever, and neck pain.
She goes to the ER.
ER believes she has like cold symptoms.(It is unfortunate that the ER needs to see patients too quickly that sometimes things are missed.) Thus, they beleived her temperature was not high enough to be considered serious. Er sends patient home. Patient becomes more ill. Good son takes mother back to ER as her condition worsens.
ER conducts a CSF(cerebral spinal fluid analysis or Spinal Tap-side note great movie.) Doctors note that her symptoms are highly suggestive of acute meningitis. Meningism lining of the cover of the brain became irritated.
Patient is put on immediate IV and two ABs to cover gram positive and negative bacterial infections. My mother stated you cannot take a chance with a suspicion of meningitis. The fatality rates can reach upwards of 50%.
Wonderfully, patient recovered fully and fever broke within a few days. CSF never grew culture. Which is odd(basically it is to confirm the bacterial infection, but patient still survived.)
If you read through my cases, this is the same patient who has survived three times through
1) aneurysm rupture
2) Saggital vein thrombosis
3) bacterial meningitis.
You could say given these ridiculous chances, she might have six more lives like a cat.
This was a previous patient with ventricular shunt, with h/o saggital vein thrombosis and aneurysm rupture as indicated in previous cases.
Patient develops acute severe onset of headache, fever, and neck pain.
She goes to the ER.
ER believes she has like cold symptoms.(It is unfortunate that the ER needs to see patients too quickly that sometimes things are missed.) Thus, they beleived her temperature was not high enough to be considered serious. Er sends patient home. Patient becomes more ill. Good son takes mother back to ER as her condition worsens.
ER conducts a CSF(cerebral spinal fluid analysis or Spinal Tap-side note great movie.) Doctors note that her symptoms are highly suggestive of acute meningitis. Meningism lining of the cover of the brain became irritated.
Patient is put on immediate IV and two ABs to cover gram positive and negative bacterial infections. My mother stated you cannot take a chance with a suspicion of meningitis. The fatality rates can reach upwards of 50%.
Wonderfully, patient recovered fully and fever broke within a few days. CSF never grew culture. Which is odd(basically it is to confirm the bacterial infection, but patient still survived.)
If you read through my cases, this is the same patient who has survived three times through
1) aneurysm rupture
2) Saggital vein thrombosis
3) bacterial meningitis.
You could say given these ridiculous chances, she might have six more lives like a cat.
Monday, March 28, 2016
Liver
In a physician's toolbox, blood tests are obviously one of their primary weapons.
In this particular patient, his or her stats were the following(please remember I always get permission from the patients.)
Patient believed he ate something bad. Patient presented acute onset of fatigue, nausea, but had no vomiting, diarrhea, abdominal pain, and fever. physical appearance was unremarkable except a look of acute fatigue. BT results showed:
bilirubin, total - 2.0
alkaline phosphatase, S(stands for serum) - 125
AST (SGOT) - 181
ALT (SGPT) - 197
Reference ranges as follows in the BT:
0.0-1.2
39-117
0-40
0-44
Now remember my mother has always emphasized the relative percentage from the baseline. Any person can see that this person's numbers are abnormal.
These blood test names correlate with liver function. These numbers indicate acute liver injury or parenchymal(meaning inside the tissue rather than an obstruction. Thus bilirubin and alkaline phosphatase numbers would be higher if there was an obstruction.) In the liver, these two items will be most likely elevated in the obstruction setting.
US(ultrasound) confirmed no obstruction. Remember, I said relative, 2.0 to 1.2 and 125 to 117 is not that high.
Doctor started patient on an antibiotic for presumed bacterial gastroenteritis. After 1 tablet, the patient significantly improved. He or she felt much better.
Conclusion? It could have been some acute food poisoning that affected his liver. The reason this is interesting is that most food poisonings do not affect the liver(particularly the liver enzymes.) Sometimes that is the problem with medicine, you might never know the problem but as long as the patient gets better, the end result is fine. Doctors need to be humble that they sometimes .cannot figure out everything - you just need to accept the result. Just be happy that the patient feels better.(It still bothers my mother as to what it was but she just golfs it off.)
Wednesday, February 24, 2016
Lucky Storm
Recently, the east coast had the storm of the century. By the way, if you ever live on a driveway, you should absolutely purchase a gas powered snow blower. It is one of the greatest inventions of all time and made my family's time in the snow a lot easier.
But one of my mother's patients had some complications during the storm.
Middle aged white male with a history of hypertension, hyper cholesterol, and was non compliant with medications. During the storm, the patient was shoveling the snow as most people were doing. After he had shoveled the snow, he experienced a sudden onset of severe upper back pain and had difficulty breathing.
He called 911 and they took him to the nearest ER. However, because of the storm the nearest ER was at capacity and they had to take him to the next nearest hospital. At the new hospital, the pt stated he was have severe back spasms but after examination, the doctors determined that he had an aortic aneuysm near the aortic arch and he needed to undergo urgent repair of his aorta. He underwent cardio thoracic surgery and his aorta was eventually repaired.
The luck came into the picture as if he had simply waited at the nearest ER, that facility was not equipped to handle a complicated procedure that the patient required. Thankfully, there were no complications and the patient fully recovered.
But one of my mother's patients had some complications during the storm.
Middle aged white male with a history of hypertension, hyper cholesterol, and was non compliant with medications. During the storm, the patient was shoveling the snow as most people were doing. After he had shoveled the snow, he experienced a sudden onset of severe upper back pain and had difficulty breathing.
He called 911 and they took him to the nearest ER. However, because of the storm the nearest ER was at capacity and they had to take him to the next nearest hospital. At the new hospital, the pt stated he was have severe back spasms but after examination, the doctors determined that he had an aortic aneuysm near the aortic arch and he needed to undergo urgent repair of his aorta. He underwent cardio thoracic surgery and his aorta was eventually repaired.
The luck came into the picture as if he had simply waited at the nearest ER, that facility was not equipped to handle a complicated procedure that the patient required. Thankfully, there were no complications and the patient fully recovered.
Tuesday, February 23, 2016
Missed time/hiatus
Been busy lately but I have many exciting cases that I will be posting. I also had to get some permission from a couple patient cases that I had forgotten but there are some really cool cases as well as some personal ones. Stay tuned!
Thursday, February 18, 2016
Father's Eyes
My father has been experiencing quite a complicated case.
He has had underlying issues of diabetes and hyperthyroidism. Both conditions were intermittently under control.
Subsequently about 6 months prior, patient's eyes started tearing especially in windy conditions and increasingly in colder weather. Patient was also experiencing double vision in the periphery. Looking down and looking side.
At evening, difficulty driving as a result of double vision.
Patient went to the first ophthalmologist. Pt stated it was a very short office visit(first time visit) and stated it was rushed and ended in 15 minutes. Patient was told it was simply blephariitis and docotr said to sue baby shampoo(so the eyes won't tear) and wipe.
Patient then went to a second ophthalmologist. This physician was concerned about the underlying conditions of diabetes and hyperthyroidism. This doctor checked his eye pressure and there was borderline glaucoma, This physician was also concerned of my father's outward appearance of bluging eyes which can be indicative of Grave's disease(see earlier posts).
However, the patient continued to doctor hop as he wasn't receiving any effective treatment options. Pt then went to see a series of specialists including some of the leading ophthalmologist at JHU. The third ophthalmologist was able to explain his double vision. He had an orbital ultrasound test done that showed that there was hypertrophy his inferior and medial rectus muscles (there are six muscles in the eye that help you move around.) The double vision was the result of his eyes being misaligned from hypertrophy from those particular surrounding eye muscles.
The ophthalmologist concludes that the eye tearing is most liekly from inflammation which was blocking the tear ducts.(we have tear ducts that allow some tears to drain so we don't look like we're crying all the time.)
The best way to treat inflammation is through oral steroids. However problem with steroids is that it increase sugar level(which is a complication from diabetes) which can contribute to the glaucoma.
The ophthalmologist together with the endocrinologist that it would be take methylprenisode 16 mg bid.
PT was on new methyl-steroid significantly reduced tearing and with new prescription with new prism eyeglasses, pt has adjusted vision while it is early to tell he seems to be doing much better.
He will be having followups with ophthalmologist and glaucoma specialist and endocrinologist.
He was very frustrated that he had to see so many doctors. Some in the beginning where he felt that the physicians didn't really care about him. And I saw that it is so critical to make sure that the patient knows that the doctor cares about your problems. Obviously he had a very unique case with complicated underlying issues. But the doctor needs to make sure that the patient feels cared for and isn't just one appointment in a day of thirty.
He has had underlying issues of diabetes and hyperthyroidism. Both conditions were intermittently under control.
Subsequently about 6 months prior, patient's eyes started tearing especially in windy conditions and increasingly in colder weather. Patient was also experiencing double vision in the periphery. Looking down and looking side.
At evening, difficulty driving as a result of double vision.
Patient went to the first ophthalmologist. Pt stated it was a very short office visit(first time visit) and stated it was rushed and ended in 15 minutes. Patient was told it was simply blephariitis and docotr said to sue baby shampoo(so the eyes won't tear) and wipe.
Patient then went to a second ophthalmologist. This physician was concerned about the underlying conditions of diabetes and hyperthyroidism. This doctor checked his eye pressure and there was borderline glaucoma, This physician was also concerned of my father's outward appearance of bluging eyes which can be indicative of Grave's disease(see earlier posts).
However, the patient continued to doctor hop as he wasn't receiving any effective treatment options. Pt then went to see a series of specialists including some of the leading ophthalmologist at JHU. The third ophthalmologist was able to explain his double vision. He had an orbital ultrasound test done that showed that there was hypertrophy his inferior and medial rectus muscles (there are six muscles in the eye that help you move around.) The double vision was the result of his eyes being misaligned from hypertrophy from those particular surrounding eye muscles.
The ophthalmologist concludes that the eye tearing is most liekly from inflammation which was blocking the tear ducts.(we have tear ducts that allow some tears to drain so we don't look like we're crying all the time.)
The best way to treat inflammation is through oral steroids. However problem with steroids is that it increase sugar level(which is a complication from diabetes) which can contribute to the glaucoma.
The ophthalmologist together with the endocrinologist that it would be take methylprenisode 16 mg bid.
PT was on new methyl-steroid significantly reduced tearing and with new prescription with new prism eyeglasses, pt has adjusted vision while it is early to tell he seems to be doing much better.
He will be having followups with ophthalmologist and glaucoma specialist and endocrinologist.
He was very frustrated that he had to see so many doctors. Some in the beginning where he felt that the physicians didn't really care about him. And I saw that it is so critical to make sure that the patient knows that the doctor cares about your problems. Obviously he had a very unique case with complicated underlying issues. But the doctor needs to make sure that the patient feels cared for and isn't just one appointment in a day of thirty.
Monday, February 1, 2016
Bad food
This case was a typical one but one that healthy middle aged woman.
After eating a hotdog and a pizza at a well known wholesale food court within one and a half hours, she developed severe abdominal cramps and profuse watery diarrhea. She also had nausea and vomiting for the rest of the day.
She was taken to the ER and was given a massive amount IV fluids and antiemetics(anti vomiting medication) and within two days she fully recovered.
What was the problem?
It was most likely staphylococcus aureus, which is an exotoxin related illness. Given that the patient's symptoms had a very acute onset within 3-6 hours after her meal and her very fast recovery.
Wednesday, January 13, 2016
Ramsay-Hunt Syndrome
Female middle aged woman with preceding flu like illness. She came in with acute onset of left ear pain. She developed some kind of tingling sensation on the right side of the face. She also complained of left ear tinnitus(ear ringing).
Upon examination, she had left ear drum vesicular rash with some surrounding redness.
The doctor narrowed it down to Ramsay-Hunt Syndrome caused by zoster virus. Patient was given short course of steroids and anti-viral medications and she completely recovered by follow up visit.
Even if you're relatively young, you can still get the zoster virus!
Monday, October 12, 2015
ICD 9 to ICD 10 Transition
So I missed a couple of posts from some time off so forgive me.
This past month was very busy.
At the beginning of this month, there was the much heralded transition from the ICD 9 to ICD 10.
I'll give a brief summary again here. The CPT codes are the procedure codes that the physician checks off as he sees you. Depending on the complexity and time of the case, the physician has varying degrees of office codes in addition to any treatment codes such as vaccines, blood tests, or other procedures like EKG, etc.
Each of these CPT codes needs a corresponding ICD codes. These codes can ensure that the insurance companies can verify that these CPT codes or procedures were necessary as well as just having a documented recording of what was done.
The number of ICD 9 codes were 14,315 codes. ICD 10 will be bringing that number to more than 69,000 distinct codes.
Now why would they do this? I can list several reasons.
1. Not specific enough.
Some of the codes get very very specific. Down to the exact location. In the old ICD 9 codes some of the pain in XYZ place codes were very generic.
2. Reducing redundancy.
For example, vaccines had a CPT code and a corresponding ICD 9 code. Now they just have one vaccine code along with those CPT codes removing those ICD 9 codes.
However, there have been some transition troubles. With our EHR some of the codes we cant find on the system and our medical management software has some of them or doesn't have some of the codes. Some of the lab companies have had problems as well. We have a phlebotomist that can't find some of the ICD 10 codes that correspond with the ICD 9 codes. However, these are transition issues that I believe will resolve themselves over time as people adjust.
This past month was very busy.
At the beginning of this month, there was the much heralded transition from the ICD 9 to ICD 10.
I'll give a brief summary again here. The CPT codes are the procedure codes that the physician checks off as he sees you. Depending on the complexity and time of the case, the physician has varying degrees of office codes in addition to any treatment codes such as vaccines, blood tests, or other procedures like EKG, etc.
Each of these CPT codes needs a corresponding ICD codes. These codes can ensure that the insurance companies can verify that these CPT codes or procedures were necessary as well as just having a documented recording of what was done.
The number of ICD 9 codes were 14,315 codes. ICD 10 will be bringing that number to more than 69,000 distinct codes.
Now why would they do this? I can list several reasons.
1. Not specific enough.
Some of the codes get very very specific. Down to the exact location. In the old ICD 9 codes some of the pain in XYZ place codes were very generic.
2. Reducing redundancy.
For example, vaccines had a CPT code and a corresponding ICD 9 code. Now they just have one vaccine code along with those CPT codes removing those ICD 9 codes.
However, there have been some transition troubles. With our EHR some of the codes we cant find on the system and our medical management software has some of them or doesn't have some of the codes. Some of the lab companies have had problems as well. We have a phlebotomist that can't find some of the ICD 10 codes that correspond with the ICD 9 codes. However, these are transition issues that I believe will resolve themselves over time as people adjust.
Monday, September 21, 2015
Rheumatology Shadowing
So this past week, I shadowed a great rheumatologist, Dr. Gradzka everyday.
Rheumatology is the study of of rehumatism(autoimmune diseases), arthritis, and other disorders of the joints, muscles, and ligaments.
It was really great to see other specialities of internal medicine. Especially with the advancement of biologics, the medicines available to treat some of the diseases has advanced. But for some of the patients there is frankly nothing that can be done except with the treatment of steroids. However, one has to be very careful of relying on steroids as they can have serious complications(see the Dr.Google case.)
It was funny, Dr. Gradzka mentioned that gold injections were once the go-to treatment. It goes to show how far medicine and treatments have advanced.
Rheumatology is the study of of rehumatism(autoimmune diseases), arthritis, and other disorders of the joints, muscles, and ligaments.
It was really great to see other specialities of internal medicine. Especially with the advancement of biologics, the medicines available to treat some of the diseases has advanced. But for some of the patients there is frankly nothing that can be done except with the treatment of steroids. However, one has to be very careful of relying on steroids as they can have serious complications(see the Dr.Google case.)
It was funny, Dr. Gradzka mentioned that gold injections were once the go-to treatment. It goes to show how far medicine and treatments have advanced.
Monday, August 24, 2015
A Doctor's Touch
A video that I saw a while ago after reading Verghase's book(An incredible read)
A simple concept but a powerful, touching one nonetheless.
A simple concept but a powerful, touching one nonetheless.
Thursday, August 20, 2015
New Saliva Test for Alzheimers
As testing becomes more and more sophisticated and easier (see Theranos for simpler blood tests), one wonders what role the analytical aspects of a doctor will play, if anything at all. With technology getting better and better and more widespead -- even sold by CVS for example), one wonders how doctor of the future must deal with such technologies.
I believe, however, that even with such tests, the training that doctors get and should continue to get should be an integral part of not only their training but also how they will practice medicine. Costs will be a consideration even if a test is good as well ease of use and false negatives that will give such tests credibility.
Occipital Stroke
Pt comes in complaining of vertigo and dizziness. The Pt had fallen because of the dizziness but he did not have any balance problems. He complained of low energy, very tense, and could not relax because of these symptoms. He had earlier stopped all of his medications because he believed that they were causing his his vertigo.
Upon examination, the Dr. confirmed the symptoms and checked that he had no vision problems, no vomiting, and no chills. Dr. conducted a neurology exam and it was non-specific. Doctor ordered an MRI. The results revealed that the pt had an occipital stroke.
Pt is retaking his medications under doctor's orders. He was subsequently admitted to the hospital for further evaluation and management.
Upon examination, the Dr. confirmed the symptoms and checked that he had no vision problems, no vomiting, and no chills. Dr. conducted a neurology exam and it was non-specific. Doctor ordered an MRI. The results revealed that the pt had an occipital stroke.
Pt is retaking his medications under doctor's orders. He was subsequently admitted to the hospital for further evaluation and management.
Wednesday, August 12, 2015
Close call
Pt called the office complaining of nose bleed and post nasal dripping.
Pt insisted that he did not have any other associated problems. Dr. advised him on the phone that he should go to the ER given that he underwent recent heart surgery and stress related issues.
Pt checked into ER for nose bleed and bloody sputum(a mixture of saliva and mucus coughed up from the respiratory tract.)
Chest x-ray in ER revealed some infiltration suggestive of pulmonary tuberculosis which was confirmed by sputum stain.
The ER had to immediately isolate the Pt. Pt is now taking multiple anti-tb medications under supervision. (They need to be supervised because if the pt misses a dose, it can be detrimental to cause multi-resistant TB.)
We still have to be vigilant of infectious diseases like TB.
It certainly was a close call as we could have also been infected.
Pt insisted that he did not have any other associated problems. Dr. advised him on the phone that he should go to the ER given that he underwent recent heart surgery and stress related issues.
Pt checked into ER for nose bleed and bloody sputum(a mixture of saliva and mucus coughed up from the respiratory tract.)
Chest x-ray in ER revealed some infiltration suggestive of pulmonary tuberculosis which was confirmed by sputum stain.
The ER had to immediately isolate the Pt. Pt is now taking multiple anti-tb medications under supervision. (They need to be supervised because if the pt misses a dose, it can be detrimental to cause multi-resistant TB.)
We still have to be vigilant of infectious diseases like TB.
It certainly was a close call as we could have also been infected.
Monday, July 20, 2015
Tech Docs...
So, even docs are not being lured by the tech siren calls....guess it's true that people went into medicine for money after all...
But young docs thinking about making millions in health tech may want to keep in mind that out of 19 named employees in the hot health startup, Rock Health, only one has an MD degree...not much of an opportunity for MDs there...
Although I can understand why the lure of tech for a group of highly educated people who are likely forced into mind-numbing routines might happen. I work in a doctors office as an office manager and I can truly say that if policy makers don't make it a priority to keep docs in the profession, they will soon find themselves on the operating table without anyone to attend to them.
But young docs thinking about making millions in health tech may want to keep in mind that out of 19 named employees in the hot health startup, Rock Health, only one has an MD degree...not much of an opportunity for MDs there...
Although I can understand why the lure of tech for a group of highly educated people who are likely forced into mind-numbing routines might happen. I work in a doctors office as an office manager and I can truly say that if policy makers don't make it a priority to keep docs in the profession, they will soon find themselves on the operating table without anyone to attend to them.
Tuesday, July 7, 2015
Dr. Google
Young white female presented with a history of chronic eczema or atopic dermatitis. She had this condition over several years all over her body. The chronic skin condition not only affected her physical wellbeing but negatively affected her mental wellbeing as it was very visible across her face and limbs. As a result, she had not maintained a full time job for two years.
She was using a topical steroid cream, cortisone for about one and a half years, as recommended by her doctor. After some time of steroid use, the patient was disappointed with the progress of the her skin condition, And in fact, when the patient googled the fact that steroid creams were actually bad for the skin, she was even more alarmed. So, the patient decided to suddenly stop using the cream without consulting Doc.
For the next two months, the patient had difficulties controlling her temperature when it was either cold or hot, persistent dizziness, nausea, loss of appetite, and her entire skin was swelling and oozing. She did not, however, visit the doctor because her parents told her that her reactions were the result of her own mental and psychological problems, not because of any other issues.
Finally, the patient decided to go see the doctor and explained everything, including how she found out that steroid creams were not good for her and why she stopped it suddenly and the additional conditions after she stopped using the steroid creams.
The doctor explained that when you administer exogenous (originating from outside the patient) corticosteroids, it disturbs the negative feedback loop. The body stops producing its own corticosteroids, because the it is constantly receiving it from outside sources. So, when the patient stopped using the steroids, it has severe adverse effects on the body and can push the body into an adrenal crisis. The Doctor mentioned that in some cases the death rates for adrenal crisis like the one that the patient suffered from by stopping the steroid cream is extremely high, as much as 50%.
She was using a topical steroid cream, cortisone for about one and a half years, as recommended by her doctor. After some time of steroid use, the patient was disappointed with the progress of the her skin condition, And in fact, when the patient googled the fact that steroid creams were actually bad for the skin, she was even more alarmed. So, the patient decided to suddenly stop using the cream without consulting Doc.
For the next two months, the patient had difficulties controlling her temperature when it was either cold or hot, persistent dizziness, nausea, loss of appetite, and her entire skin was swelling and oozing. She did not, however, visit the doctor because her parents told her that her reactions were the result of her own mental and psychological problems, not because of any other issues.
Finally, the patient decided to go see the doctor and explained everything, including how she found out that steroid creams were not good for her and why she stopped it suddenly and the additional conditions after she stopped using the steroid creams.
The doctor explained that when you administer exogenous (originating from outside the patient) corticosteroids, it disturbs the negative feedback loop. The body stops producing its own corticosteroids, because the it is constantly receiving it from outside sources. So, when the patient stopped using the steroids, it has severe adverse effects on the body and can push the body into an adrenal crisis. The Doctor mentioned that in some cases the death rates for adrenal crisis like the one that the patient suffered from by stopping the steroid cream is extremely high, as much as 50%.
Thursday, July 2, 2015
Why???????
An oncologist in Detroit was purposely misdiagnosing patients with multiple myeloma. Then gave chemotherapy treatments to over 500 people. In some cases, repeatedly giving them chemotherapy treatments until they were nearly dead.
Seriously, even if it was for the money just why?
Seriously, even if it was for the money just why?
Tuesday, June 30, 2015
The Price is Right!!
A 54 year old white male came in for a check up post motor vehicle accident (MVA) to claim for insurance or something. Anyway, Doctor asked when did the patient have his last regular check up. The patient apparently had never seen a doctor so he had a whole battery of blood tests and physical.
After his follow up, the blood tests showed some interesting results. His liver enzyme was a little elevated. His liver profile showed that he had hepatitis c. Upon a follow up appointment, the ultrasound showed that he had hepatoma and showed some significant symptoms of liver cancer(jaundice, yellow skin, etc.)
If it was back in 2000s, there would be limited treatment options, and for many a death sentence. However, starting this decade Gilead Sciences developed a drug called ledipasvir/sofosbuvir--its trade name being Harvoni. It's an absolutely revolutionary treatment and can successfully treat hepatitis c! Obviously, if you have a miracle drug that can essentially cure a life threatening disease, it will not come cheap. The total cost of a three month treatment(it is taken orally and the length of the treatment depends on the severity of the disease.) is $100,000. But if its worth your life, even at $100k, the price is right...
Sunday, June 28, 2015
Treat the Patient, Not the Disease
A teenager presented with years of bed wetting (enuresis) problems,
nearly every night. As a result, he was
socially isolated and had no experience of sleepovers, etc. because of his
condition.
He is a very athletic, active, and
academically strong teenager boy, an outstanding kid actually. Upon further
examination and questioning, it appeared the boy had anxiety issues because of
his mother. His mother would go to work every morning at 4 am. As a result, his
father took care of him during the day. The father was apparently very strict
with him. Mother would come back home
very late so as an only child he was mainly with the father and raised in a
very strict environment.
One obvious solution was imipramine which is the common treatment
for bedwetting as well as depression.
But the Doctor decided to forgo that usual treatment because she was concerned
about side-effects, and frankly, he was not depressed. Bed-wetting was a subconscious issue.
Instead, the Doctor asked that the patient write a monthly schedule of
when he wets or doesn't wet on that night. If he doesn't wet the night, Doctor told the mother to reward him at the end of each week. Within 6 months, the
patient did not have any more bed wetting problems and without the use of
drugs.
I thought about this and realized that the
patient had basically cured himself by visualizing on his chart his
progress. The things that caused his
issues, an absent mother, a strict father, could not be changed, but the
patient could be.
Too often in today’s medical environment,
few doctors would take the time to understand the patient, a more difficult and
more time consuming process than understanding the disease, especially since
drug companies make it easier for doctors to just medicate. But that method only
serves as a temporary solution not a permanent one. The Doctor went beyond that and
systematically solved what was affecting the patient, psychosomatically by
treating the patient rather than treating the disease.
Remember that Magic School Bus episode?
Back when I was a kid, I would watch a show called the Magic School Bus. It was about an eccentric school teacher named Ms. Frizzle who would lead her third grade class on this magical school bus that could take them anywhere.
Arnold turns orange in one episode and the whole class goes on an adventure trying to solve why he is orange. I actually had a similar case with the Doctor.
A middle aged man came in complaining of his skin tone. When I first saw him I thought that he was experiencing jaundice and other liver problems. It was that pronounced.
Of course, his skin tone was not as dramatically orange as Arnold was in the picture above. After a long diagnosis with the patient, he just simply ate and took a lot of other stuff that made him become orange. On a daily basis, he ate as much as two bags of carrots, drank at least a gallon of orange juice, and at least half a bag of clementine oranges. He had originally been scared that it might be a liver issue or even cancer, and this "orange" condition even affected him personally, including his relationships and his job.
The remedy was for him to just simply stop. In a few weeks, when he came back for a followup, he was fine. And his color returned to normal.
Arnold turns orange in one episode and the whole class goes on an adventure trying to solve why he is orange. I actually had a similar case with the Doctor.
A middle aged man came in complaining of his skin tone. When I first saw him I thought that he was experiencing jaundice and other liver problems. It was that pronounced.
Of course, his skin tone was not as dramatically orange as Arnold was in the picture above. After a long diagnosis with the patient, he just simply ate and took a lot of other stuff that made him become orange. On a daily basis, he ate as much as two bags of carrots, drank at least a gallon of orange juice, and at least half a bag of clementine oranges. He had originally been scared that it might be a liver issue or even cancer, and this "orange" condition even affected him personally, including his relationships and his job.
The remedy was for him to just simply stop. In a few weeks, when he came back for a followup, he was fine. And his color returned to normal.
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