The Unconventional Doctor

Blog-block

2009-01-18T07:43:00.002-06:00

I just want to apologize to my faithful who like to read my blogs. I have been unashamedly uncreative for the past 5 or 6 weeks. I apologize. I just have not had it in me to invest the time and effort to find something creative to say about being a rural physician and a real human. I hope to return soon, as my children are often an awesome inspiration for me and I know that they have provided some opportunities, they are ones I'm just not sure of sharing yet.
Thank you for your patience and willingness to return to read my blogs.
If you want more regular updates, check out my wife's blog at www.theunconventionaldoctorswife.blogspot.com.
She keeps hers much more up to date than I.

Physician, Heal Thyself

2008-11-18T17:07:00.021-06:00

Okay,

So I will admit it.
I hate to.
I don't like to.
I mean, I have an INFANT!

I have 4 kids, some very onry.

But its true,

I AM GETTING OLDER!

Laugh Lines.

Knee Arthritis.
Had to give up jogging and start swimming.

I have to take cholesterol medicine because I like stuff like this.

So there's other medicines I have to take to keep myself working properly.

I decided to purchase some more palatable over-the-counter medicine the other day to assist my being honest with patients and not full of, well, you know.

So I made a fatal mistake.
Now I have made this mistake before and it has resulted in things like this:

Dessitin hair gel

Dessitin balloons

Dessitin cups washes (they get rashes too)

Left-over pankcake breakfast served over shag with juice

Pirate raids of leftover pancakes

Mouths stuffed with who knows what,

and mouths stuffed full of fully organic leaves.

One proud moment was my ice cream, found at 7 am in the hands of a little boy

They had decided to have homemade cookies-and-cream ice cream that morning,
dipping partially frozen cookie dough in the ice cream before munching away.

Spoons, of course, were included, I mean, that is what is proper

(we've taught them well - ALWAYS use utensils).

This one looked guilty, but had no explanation.

This one handled the interrogation well,
seeking comfort in his thumb,
and looking rather pitiful and ignoring the questions.

I must admit, he is a boy with my own heart's desire -
Ice cream in the morning,
candy and chocolate whenever it can be sneaked,
even large gulps of daddy's soda pop.

He definitely has this one right on.

Sitting on the pot and watching TV. He is a boy!

So this day the wonderful strawberry fiber tablet bottle was empty.
So my wife inquired how many the eldest son ate (Bub is his name).
4 to 8 was the deducted reply.
She inquired as to where the rest were.
The little guy (Bud) had some as well as evidenced by the pink drool stains on his shirt.
Some were found in the computer.
The rest, Bub informed us, were cooking in the microwave.

We don't know what the plan was for those, but they were ruined.

So the eldest had eaten a total of 12-20 grams of fiber in a 30 minute period.

The youngest (bud) had eaten 4 grams of fiber in a 30 minute period.

The end result was

having them drink lots of water

Lots of tootles

And I'll spare you the details of the rest of the story.

The moral of this story is...

Physician, protect your medicine.

Always have extra diapers on hand.

If you have kids, go with the powder fiber and keep it in the sugar jar.
Then you will have a psychological draw to taking it,
and your kids will have a psychological aversion to eating sugar.

Enjoy and laugh at the creativity of your kids,
lest you miss the joys of life.

24

2008-11-02T21:12:00.048-06:00

Nope, not the show. No Keifer Sutherland here. It's not my age. It's not how many pets I have. It may be how many Star Wars figures I have, or the average number of patients that I see in a day, but this blog is not about that. It is a time period that defines a day. I had a particularly great 24 hours that I thought I would share.

It started October 31 at 6 pm. The kids were all dressed up and ready to go. They seemed already juiced up on sugar, but it was the anticipation and the sugar rush would come later.

So we headed out, 7 walkers and one stroller, across brick streets and broken sidewalks. We saw all sorts on the way, from Spiderman to gouls, and fortunately all were friendly.

One place had my littlest a little bugged out, but he survived the attack of the big furry spider diddled on a string over the driveway by our interesting friend. I don't know if his reaction was due to the creepiness of the gentleman or if was due to some sour sweet-tarts he was eating. Either way, the look is worth a thousand words.

One friendly princess couldn't resist revealing her true colors as she lit her firestick to start casting spells on sugar-spunked kids. Maybe it was part of her character for halloween, or maybe it was part of her weight-loss plan. I don't know, I just found it funny. It's like smoking in your wedding dress - high class!

As the kids got tired, the complaints started coming.

My feet hurt!

My legs are tired!

I want to see mommy!

I want to go to my house!

I'm hungry! Can I have some candy?

We returned home, where the kids ate and I had the privilege of sitting on the porch handing out candy. One tricker-treater asked "can I trick or treat here for some water?" Yep, guess he was a'thursty. Some hispanic kids came dressed up as, well, kids. When asked what they were dressed up as, they could not get their stories straight, giving me answers of "homos" and "kids" and "mexicans." Really, very creative, and very lazy! At least put in some effort and don't conform to the preconceived notion that some have of some hispanic persons. One even tried to cope my hot dogs I had sitting there for dinner as their halloween treat! The kids came out and ran wild on the porch, giving out candy to tricker-treaters, even begging them to come up to our home. Do you think this one needs a little more social interaction?

The day ended with fast baths, cleaning up, and turning in as the morning would come quickly- at least for me!

Yep, 5:30 am, and that is not what time I arose. It was the time I was on the road for a very important day. You see, as an alumn of a local university whose football team has struggled intermittently over the past 10 years with a rival university within the state who has had success over the past 10 years, I have a duty and obligation to fully support my alumnus on this day.

The opportunity came via the graciousness of my wife (http://www.theunconventionaldoctorswife.com/) in the form of a birthday gift, called tickets. Yep, tickets back to my alma mater to enjoy the intrastate rivalry. What a glorious gift it was, as I love college f-ball and judgement had prevented me from purchasing season tickets this year. I was excited, elated, to experience this day.

I decided to take my pops with me, so I picked him up and we headed to my alma mater. The drive was filled with scenery, discussion of politics, diet Dr. Pepper, and, of course, McDonald's McGriddles.

On arrival, the tailgaters were out in full force. The university was glowing in the colors of oncoming fall. The tempurature was cool but warming up. The attitude was serene, and the anticipation was boiling, as my alma mater had struggled defensively as of late and their in-state rival made a run at a top 5 team the week before.

Before the game, my pops and I roamed the hill, enjoying the scenery and the pre-game excitement. He was not game-ready, however, so we supported the local bookstore sites by purchasing various assundries that would give us the appearance of true fans (can't tell who we were rooting for, can ya).

We entered the stadium and watched pre-game warm ups. We had awesome seats and were surrounded, amazingly, by other KU alumns who had entered into the medical field. A great day with wonderful weather, sightly scenery, comraderie company, and anxious anticipation. My team seemed ready and hyped to play their hardest.

My alma mater did not disappoint. They scored 31 unanswered points and all knew at the half that the game was over. My arms got tired from waving the wheat so much. An impaired rival fan who spilt pop down my back about 6 minutes into the game even gave up and went home to sleep off whatever had impaired her (don't worry, the pop did no harm and she offered to purchase me drinks at the snack bar and tried to give me her peanuts, but I deferred under the muse of being on a low salt diet - you don't take a rival's nuts)!

The half was filled with entertainment, hot dogs, pretzels, diet coke, and some shade. The second half was more of the same, a rout by the home team, my alma mater.

We knew who would win, and the unfortunate coach of the other team, failing where they had in previous years had success, could hear the hammering of the last nail in his coffin being driven as the second quarter came to an end. I think his job had even ended at the half and he had a new job during the second half, as evidenced by the pictures!

After the game, we enjoyed some bar-b-que - pulled pork has no better place than between the halves of a whole wheat bun. We then ended the day with a 4 hour drive with more great conversation with pops and beautiful scenery, rainbow included.

So those were a great 24 hours full of fun, laughs, smiles, sweets, good food, anticipation, excitement, connecting, beauty, and of course, a win. All I can say to my beautiful, wonderful wife is thank you, thank you, thank you for a wonderful 24!

Why?

2008-10-29T22:31:00.011-05:00

So, I have a few questions as to why people do things the way they do. See if you agree.

Why does the guy at Jiffy Lube stand outside when he's not busy and wave to me as I drive by at 8 AM as if he knows me? I mean really, its 33 degrees outside, snot is frozen on his mustache, and he thinks because he's standing out there waving to me I'll just "pop in" and get my oil changed, or maybe some 20 dollar wiper blades? Do they just put Jiffy Lube's in areas of low intelligence? Yep, as I passed by I thought, by golly, I think I need to have my oil changed, so I'll just pull in here and see friendly Hank and have him change the oil in my car while I enjoy some tea and crumpets and look at the latest edition of FHM (For Him Magazine). Really, why?

Why does our state mandate payment for neonatal screening tests for 29 conditions that have an incidence of less than 1 in 25,000 to less than 1 in 100,000? I mean really, would not the money be better spent on things that are more common, like preventing asthma and allergies from second-hand smoke exposure. There's probably enough money spent on these screening tests that eventually would be identified you could pay every new parent smoker to quit. Really, why?

I've had a few patients die recently and have attended their funerals. It is very interesting that a eulogy is given. You know, a eulogy is praise of a person. Would it not be better to praise them while they are alive? I mean, if the eulogy is about the person who died, what purpose does it serve to praise them when they can't hear you? Sure, it serves a purpose for those who are at the funeral, but they probably knew the person well enough that the praises being expoused were already known. It is, in essence, preaching to the choir. It's like going to the Sirloin Stockade, standing up in the resturaunt and announcing how succulent, tender, moist,and tasty the sliced roast beef is when everyone there has already tasted it. What I would propose are elegies (poems written about the dead), just because I like rhymes.

Need to grab a fast meal that looks after your abs? Heading for a "grilled" chicken sandwich? Well, guess what! Keep eating them and that 6 pack will become a 4 pack (or a 1 roll will become a 2 roll). I have patients that work at a certain fast food chain who tell me that sure, they're grilled, before they're frozen. But to thaw them and cook 'em up, they just throw them in the fryer, and whamo, after 90 seconds, they're done. So grilled chicken breast is what you call that? That's like taking a cholesterol lowering drug that acutally causes a heart attack, or ordering a diet pepsi and getting a regular pepsi. Or calling Britanny Spears a good role model (sure, she started out fine on Disney, but now? I guess with her you at least know what you're getting).

Our state has started puting government-funded TV ads on about getting out to vote and registering to vote. Really, you need to advertize to get voters? This is a good way to spend tax dollars? If you aren't educated enough to know to get out and register to vote and subsequently vote, I don't know if I want your vote counting in the election, because will it really be an informed choice your making, or will you always pick candidate C because that's what got you that passing D grade on your high-school geometry tests? Way to go state!

At the airport, do you really need a sign at the security check point that states "no guns." I think if you're dumb enough to go up there with a weapon, you deserve a good body cavity search. Maybe they'll find your brain up there before you're done and you head to the gates. That way maybe you won't board the wrong plane. See, it really is for your own good to not have that sign at the security check point!

Okay, so I could go on and on, but I have to wrap it up. Here are a few wasteful "really's" that are the result of the legal system.

McDonald's coffee cups warning that the coffee is hot and may cause burns.

Plastic bags with warnings to not put them over your head as they may cause suffocation.

Cigarette packages stating that their product may cause lung cancer and emphysema.

Gas station signs telling you to not smoke at the pump.

Hot tubs and swimming pools with a warning to not leave children unattended in them.

Beware of dog signs. Um, if it ain't your dog, don't mess with it.

Yard sale signs. Still can't get anyone to sell me their sod. What a farce.

Mattress tags. Um, took mine off and I've been on the run from the law ever since.

Menu warnings that eating raw or undercooked meat can lead to salmonella inection. Really?

Boxes of drinking glasses and dishes bought at stores that state on them "fragile: handle with care."

Budweiser Ad's that end with "Drink Responsibly."

Raw meat packaging that states: "Wash hands after handling."

Paint cans: "Do not inhale."

Herbicides: "Do not ingest."

Snow Ski resorts: "Not responsible for lost items."

If you're unfortunate enough to have suffered from the negative outcomes of not adhering to the above common sensicals, I encourage you to go to an airport security area packing heat. They'll help you become educated and you'll quickly learn the value of employing common sense.

Hey Batter Batter

2008-10-21T23:26:00.004-05:00

So I just returned from a medical education trip at Las Vegas about obstetrical ultrasound in high risk OB patients. This is an area of interest for me since I do OB and do OB sonograms. I wanted to write a little blog about my educational experience and its application. I have to say that I walked away from the experience a little bothered. You see, this conference was taught by big-wig ivory tower doctors that do a lot of research from Denver, UCLA, Columbia (New York), and even Italy. The main theme of the whole 3 days was that we can diagnose things earlier and earlier with ultrasound so that termination of pregnancy can be offered by 22 weeks if there is something wrong with the baby. This theme just floored me! I can't believe that as medical costs rise and outpace spending in other areas, and as people's health insurance costs continue to rise, our educators were preaching to do more testing earlier to diagnose abnormalities earlier, mostly in the name of information for the mother so they could decide what to do with their pregnancy. The majority of these tests they are now recommending are primarily for the detection of Down's syndrome and congenital heart defects. Why diagnose these conditions earlier? Well, it does lead to being prepared at delivery with the appropriate staff and care, but why does it matter to diagnose it at 10-14 weeks versus 18-22 weeks when it can usually be diagnosed with other tests that are much less expensive? It is to allow a parent a choice to terminate the pregnancy if something is wrong. My friends, I have major ethical issues with this point as a doctor. As a family doc, I take care of lots of people with mental and physical disabilities, including people with Down's syndrome and congenital heart defects which have been repaired. Many of these patients are wonderful people who contribute more to society than fully functioning "well" people. For example, I have some patients with Down's syndrome who are now in their 6th decade of life, are rarely sick, are always happy, have utilized little health care resources, and have held various jobs for over 30 years. I also have patients who are in their 50's and have a diagnosis of fibromyalgia, have not worked in 15 years, who live off of our tax dollars in the form of social security/disability, who utilize more and more health care dollars, and have completely functional limbs and mind that allows them to go bowling, cook, clean, take week long vacations to the beach, but they just can't work. The point I am trying to make is that just because a fetus has a genetic problem doesn't mean that that "person" does not have a huge potential. Potential cannot be measured by any standard medical test that I know of. To base a decision regarding the life of a baby on whether or not that baby has a problem (genetic or not) is a fallacy. Don't get me wrong. The genetic testing is accurate, but the largest part of the equation is missing, and that blank cannot be filled in until potential has been given its proper environment and circumstance to reveal itself, at which time the point of termination is moot. If you did genetic testing on every person, you would undoubtedly find genetic flaws in every person's DNA (why do you think we get old and die?). It does not mean, however, that that flaw has any significant consequence. Perhaps those individual flaws are what makes us unique as individuals. Thus, genetic flaws do not always result in negative results, and when they do have known negative results, the degree to which they are negative depends in a large part on the environment in which they are expressed. I thus believe that in this case, more knowledge is not necessarily better. Knowledge does not always lead us to correct decisions. That requires wisdom, which requires knowledge yet is separate from it. My point is, my friends, that knowledge does not always help provide the correct answer. It is sad when in medicine we try to get more answers through more knowledge but it ultimately only leads to more questions.
My friends, medicine will never be able to provide you with 100% of the answers. We are not God. We can't explain everything, nor can we predict everything. There are no guarantees in this life in regards to health, and that includes pregnancy. There are risks, and a responsible person, which I believe is a requirement to be a parent, should recognize those risks as a possible reality when they decide to pro-create. Life is full of curve balls; you can't stop the pitch from coming and you can't leave the game. All that is left for you is to do your best with what you have.
So what did I learn from this conference?
1. Ivory, though white, is not completely pure (referring to the ivory towers of medical education, of course).
2. Knowledge does not always facilitate wisdom, but rather can hinder it.
3. There is a huge monkey on the back of choice and action, and its name is responsibilty.
4. In the words of Forrest Gump, "Life is like a box of chocolates, you never know what you're gonna get."
I look forward to your comments and opinions.

I'm sorry but I need that pen back

2008-10-07T22:11:00.006-05:00

To all patients of the medical system (in other words, everyone),

I wanted to write you this letter of apology for my lack of not continuing to put your interests first and foremost in my day. I, along with the majority of my colleagues, are sorry that we have been so engaged in the day to day care of caring for the sick, dying, distressed and helping escort newlings into the world and elderlings into their new world that we have let the system of health care get out of control. The purpose of this letter is not to provide excuses, but to help you understand where we have failed you.

I am sorry that your coughing child who cannot keep down liquids because they are gagging on their mucus and that are fussy all day because they are up all night coughing can no longer get cough medicine. See, the FDA says they don't help, and because some parents were irresponsible in giving the medicine to their children and didn't follow the bottle's directions and their kids ended up overdosing on the medicine, they blamed the FDA for allowing these medicines to be marketed to children. The FDA reviewed the studies and said that since they don't decrease the DURATION of cough, they aren't useful. So now your insurance company won't pay for prescription cough medicine for your little cougher. I'm sorry we didn't go to fight for you with the FDA to show them that studies show it decreases the AMOUNT of coughing and night-time awakenings. I'm sorry that your insurance company is glad to not cover a medicine so it can make more profit off your insurance premiums. I'm sorry that the FDA is just worried about getting sued because <0.000008642358% of kids had problems with the medicine. I'm sorry that the paperwork I spend 15 minutes filling out explaining why it was medically necessary for your child to have the medicine was determined by them to still not be medically necessary. So as my solution, to show them that it is medically necessary, I recommend that the next time your child has a severe cough and snotty nose, and they can't sleep, eat, or drink well, that you take them to the homes of the FDA officials or the CEO's of your insurance company and leave them overnight. Then, I bet, you shall have your cough medicine for your child.

I'm sorry that we have not been able to provide the medical services that we decide are needed. I called your insurance company and talked with a nurse, who told me that the test was not medically necessary. I guess I should have been a nurse so I could make the decisions needed for your health care. I'm sorry that the medical review director of the insurance company left the office at 3 pm that day so I couldn't talk to them and tell them it was medically necessary for the tests I wanted to do to get done right away. I'm sorry that you ended up in the ER at 2 am with a ruptured appendix. I'm sorry you stayed in the hospital an extra week because your appendix ruptured and you are still off work. I'm sorry your insurance company only wants to pay for 3 days of hospitalization when you were still throwing up, not eating, and requiring IV pain medication on that day. I'm sorry they wouldn't cover your medication I sent you home on.

I am sorry that your formulary with your drug company is restricted and we have to use generics. See, I demand the best for the health of my patients, and when the concentration of a drug in a generic form can vary by 20%, I believe in some cases this makes a huge difference in the outcome of your health and you need brand name medication. I write your insurance company, but they deny the reasoning, as I guess they have more knowledge of your health and the health care decisions we make together. So I'm sorry that we put you on a generic medication and it doesn't work as we had hoped, or that you had an expected side effect. I'm sorry that for those three to six months your insurance company made more money from your insurance premium by not having to pay for a medicine that we decided was right for you.

I am sorry your insurance ran out and your cash cost for medical care is exorbident. See, we have no bargaining power with large insurance companies. I can't know what another practice down the street gets for a standard office visit, because it is illegal. Because of that, the insurance company can come in a give me a low-ball contract offer of payment based on a percentage of what I charge. I can accept the low-ball offer and jack up my charge so I can actually pay my medical school loans, or I can tell them it is too low and they will go down the street to the next doctor and sell your care to them for 1/2 a percent less. I just can't take that chance, since some income is better than none. Thus, I have to increase my charges so the insurance companies will pay me a decent amount for my time, training, education, and expenses. Well, just because you pay cash doesn't mean I can give you a discount. Because I accept medicare, I have to treat all patients equally, no matter who the payor (or lack of payor) is. Thus, I can't charge cash paying patients less or else I am committing a federal crime of fraud and can go to federal prison and lose my medical license. So I am sorry our office charge is so steep for a 7 minute office visit to tell you that you have a urinary tract infection and give you a script for a med to get you better.

I am sorry I don't have samples of medicine for you to try. See, the pharmaceutical industry is cutting back in order to preserve profits because the cost of new drug development is rising and they have investors to keep happy. For me to get you samples, I have to sit in front of a computer and watch a 15 minute presentation about the drug in order to order a 30 day supply of the sample you need. I just don't have the time to do this for 3 hours a day and still see patients, deliver babies, go to the hospital for emergencies, be on call, assist in surgeries, and still eat and see my kids.

I am sorry, but I can't let you keep that pen. See, the government for some reason thinks that because a pharmaceutical company gives me a pen that I will prescribe their medicine more often. So now they have created a regulation that we can no longer receive pens, notepads, or anything with their name or the product's name on the item. So I cannot relenquish my pen to you, for I need it to take notes and write prescriptions and instructions for you - it is the second most important instrument a physician uses. Every pen now affects my bottom line, what I can take home, and with declining reimbursements from the insurance companies (we don't want to loose you to the practice down the street, so we accept a reduction in percentage of pay nearly annually even though the cost of providing care goes up), every pen and piece of paper counts. Now I will admit that some big fancy institutions did studies in university medical centers (not doctors offices) which showed that when doctors received pens and menial gifts from pharmaceutical companies, they tended to prescribe their products more often. I can tell you that I would not risk compromising your care and a possible lawsuit because of a pen or a hot pack with a drug's name on it. Could it be that while they received that pen or menial gift they were talking to the representative about the product, learning more about it, and thus became more comfortable with the product and thus were more willing to prescribe it? Could it be that a person with 11 years of post-high school training through some of the toughest curriculum and training of any profession would actually make such a logical decision? Did they study this as the possible reason for increased prescribing practices when gifts are received? Nope. They just assumed because it influenced us that it must be the object itself that was the influencer, not the information that came with it. So sorry kids, I need my pen back, and please no coloring on my notepads. And I'm sorry that even though pharmaceutical companies aren't providing as many samples and we can't let you have those pens they give us that your drug costs are not going down. You see, they have investors to make happy and super bowl ads and magazine ads to produce. Welcome to being a financer of commercial advertising!

I am sorry that I won't prescribe medications (especially antibiotics) over the phone. You see, if I do that and you have a serious reaction to the medicine or you receive the wrong treatment because we did not diagnose the condition wrong, then I am liable, can be sued, and can lose my medical license and way of livelihood. Secondly, I would not want you to get misdiagnosed and end up in the hospital with something worse going on, which is not good for you, your family, or health care costs. Third, we have an issue in this country called bacterial resistance, and if we keep prescribing antibiotics for illnesses that do not require antibiotics, eventually none of the antibiotics will work, and you will be much worse off 6 feet under than enduring a few colds through your lifetime. Fourth, I do not have psychic abilities to tell what is going on with your body over the phone or through an email. Also, I could spend all day on the phone trying to help people and I would not earn one dime because your insurance company does not pay for phone consultation time. I have to meet a bottom line, and that line requires you to come in to be seen. I respect your time and understand you may have to miss work, but in all honesty it is in your and my best interest to do so. Thanks for understanding.

To my medicare patients, I am sorry that I can't spend more than 15 minutes of time with you. I'm sorry I ask you to come back to cover items 4-10 on your list of problems. You see, medicare doesn't care how much time I spend with you, they pay me close to a flat rate per visit. If I spend too much time with one patient, I don't see enough patients in a day to pay my nurses, my front office staff, the people that help fill out and fax forms for your walker, your non-approved medication, and your handicap placard, let alone my medical school loan for that month. I know your time is important. I respect that. I know it is hard to come to the office. I know gas is expensive. But I can't bargain with medicare for better pay. They haven't increased our pay for years. That's up to Congress, and Congress doesn't negotiate, nor do they care primarily about you - they care about the bottom line and the budget and getting re-elected. We don't get a cost of living increase, but we do get more paperwork and denials for payment. I don't want to loose you as a patient because I enjoy our visits and helping you, but I have to make ends meet. Thanks for understanding.

To the veterans who come to see me, I apologize for letting the government neglect your care through the VA system. I apologize for it taking so long to get the tests you need and the specialist care you need. I apologize you are seen as a number in the system. I apologize that you have a difficult time understanding some of the foreign medical graduates that work in the VA system to get in the door of working in the United States. I am sorry that you don't have the best medical care in the area available to you through the VA system.

I am sorry that our patient-physician relationship is no longer confidential. I am sorry that what we decide is best for you in the exam room is deemed to not be so by so many other entities. I am sorry that I have allowed insurance companies, pharmacies, pharmacy benefit managers, pharmaceutical companies, medical supply companies, the government, the DEA, and the FDA (I apologize if I missed anyone who deserves credit) interfere with your health care. I am sorry that medicine is no longer becoming your choice, but is being mandated to you. I am sorry that I have let socialism force its way into a capitalistic system. I can do no more nor yell any louder. I cannot strike for you, because that wouldn't be fair to you. I cannot go to Capitol Hill to fight for you, because I can't afford to and I need to stay here and care for you. Legislators will not listen to the minority. They may, however, listen to the majority. So I encourage you to speak up! Don't let the government or any other entity regulate and dictate to you and I what is in your best interest in regards to your health! Regulation is not freedom. We have a check and balance system for doctors- its called lawsuits. They don't need to watchdog us. We are the ones who care about you and your family. Our main motivation for going into medicine was to make a difference and to help people live long, happy and healthy lives. Do they go to the same restaurants we go to? Do their kids play ball together? To they have to answer to your family if you have a major problem? So speak up and keep the government out of our relationship and healthcare (would you trust Ted Kennedy to give you medical advice? Well, he wants to via a government-run healthcare system)! If you want a good look at government-run health care, talk to a veteran who goes to the VA. They can tell you what a debachle it is and how hard it is to get the care they need.
So to my patients, I apologize. I do promise, however, to do my best to continue to provide the care you need so that you can live a long, healthy life no matter who or what interferes in my ability to do so.
With all sincerity, anger, bitterness, resignation, indignance, and sorrow.

Doctor versus Daddy

2008-10-06T23:17:00.005-05:00

So this past week my wife needed a break from the children and I took a day to be a dad. Now, the majority of my day is spent with patients, and afterward I had quite a bit of time to think about my day and compare it to my usual day. What I found was that there are some ironies and contradictions that are amusing, insightful, and incredulous. I hope you enjoy these series of realizations from my time of reflection.

My kids require my input for their health and safety.

My patients request my input for their health and safety.

My kids love McDonalds.

My patients, apparently, love McDonald's food (see previous blog).

My kids require verbal discipline for their normal development as people.

My patients require verbal discipline for their normal development as people.

I will pay if I don't give my kids advice and direction.

My patients pay me for my advice and direction.

My kids listen to my advice and take it to heart.

Many of my patients rarely listen to my advice and take it to heart.

I can spank my kids to get their attention and make my point.

My patients can fire me for making my point.

If my kids don't like what I have to say, tough. They still have to live with me.

If my patients don't like what I have to say, tough. They can fire me.

My kids love and accept me no matter what I do or don't do for them.

My patients accept me based on what I do for them.

My kids don't freely discuss bathroom business.

My patients readily and frequently discuss bathroom business.

My kids see another doctor.

I wish some patients would see another doctor.

My kids know which chair in the house is mine.

My patients in the office don't know which chair in the room is mine.

My office at home is a mess.

My office at work is a mess.

My kids smile when they see me and greet me with a hug.

My patients are apathetic when they see me and greet me with a list.

My kids go outside and get exercise when advised.

My patients don't go get exercise when advised.

My kids wash their hands before leaving the bathroom.

My patients, well...sometimes its a flush with an immediate door opening.

My kids don't text people and talk on the phone while I'm talking to them.

My patients do text and talk on the phone while I'm with them.

My nanny at home is my wife.

My nanny at work is my nurse.

I eat chocolate at home for comfort when my kids don't pilfer it.

I eat chocolate at work for comfort and readily pilfer it.

I am appropriately responsible for my kids behavior and actions.

I am inappropriately held responsible for my patients behaviors and actions.

Okay, so maybe this sounds a little synical. I do have to admit that spending the day as the primary care provider for my kids was very rewarding because I could see the payoff for the investment of time, which is not always true at the office. Medicine has become extremely frustrating, as I will detail in a future blog. I however, have a desire and drive to continue in the quest to help people, and a great appreciation for what my wife does day in and day out. I could not do it and understand why a sigh of relief occasionally occurs when I walk in the door in the evening. She is a great woman, a better person than I, who is making a true difference in this world by raising our children correctly while I struggle to do the same with adults at the office.

Unconventional Day for a Doctor

2008-09-20T22:36:00.013-05:00

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.

Babies over a burger

2008-09-16T21:33:00.031-05:00

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.

From water to wind

2008-09-14T00:06:00.003-05:00

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.

Poohpouri post

2008-09-10T22:12:00.006-05:00

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.

Unconventional?

2008-09-03T22:43:00.008-05:00

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?

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.

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.

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.

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.

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.

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?

2008-09-03T21:39:00.007-05:00

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.theunconventi onaldoctorswife.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.