so life is easy, been studying for step, and doing lots of driving back and forth. my preceptor also runs a botox clinic in my university med center town, and boy does he get excited about some botox! personally, the only cosmetic procedure i think i would be interested in is the laser hair removal, but it is interesting to watch the botox being done. i think botox is ok when it's done to "slow down" aging just a bit...the person still looks like a NORMAL person that can show emotions, they just aren't as wrinkly. however, the people who flip out because their forehead can still move and it's "not supposed to"? wtf. it just weirds me out. he also does smartlipo and juvederm fillers, so i'm hoping to get to see some of that while i'm there.
so here's my take on the kind of patients that i've been seeing:
- problem lists consist of at least 95% of the following: diabetes, hypertension, GERD, hypothyroidism, CAD, PVD, atrial fib, COPD
- at least 1/2 are obese
- they all say "i hate taking medicines" and their medicine list is like freaking 30 pills long, and they want more
- if they smoke, they don't smoke "too much". i mean, i only smoke like 1/4 of my cigarette at a time! i don't even smoke a whole pack!
- everyone has sinusitis, so everyone gets antibiotics and flonase spray
- what kind of numbers are you getting with your blood pressure?
- what are your sugar numbers?
- are you still taking all your medicines?
- so are you checking your sugars at home? your last A1c was 8.7...
- i am doing a great job...i check it about once a week! but i can always tell when my sugar is too high or too low!
- how do you know when it's too low?
- i get shaky and feel like i'm going to faint!
- and when it's high?
- oh, i just know when it's high.
- what happens?
- i just get a feeling.
- what is that?
- you can't normally tell when your sugars are too high, that's why you need to check them everyday to make sure that your medicine is working.
- well, the nurses just checked it and it was 160! that's the lowest it's been!
- 160 is not good...it should be closer to 100.
- but 160 is the lowest it's been in a long time! i'm doing great, see?! i don't need no insulin!
- (smacks forehead).
or how about this:
- your blood pressure today is 160/100...are you taking all of your blood pressure medicines? (proceed to read off medicines.)
- i mean, i take them when i feel like it, but i didn't take them this morning, and oh, hey doc, my back hurts can i have some lortab?
oooh, what about this one?
- so i've been having these weird sensations in my arms and legs...it's not muscle tingling, it's sort of like a twitch but i've never seen them twitch. it's like a pull. yeah, a pull! but it twitches and it wakes me up from sleep and then i rub them and then it tingles...etc...etc...
- ummm...have you started exercising lately? any differences in sensation? you sure you've never seen twitching? changed your medicines lately? etc...etc...
- nothing's changed...no...it's got to be my heart! it has to be circulation, and then when i think really hard my heart is pounding and then i get shaky and then my head starts to hurt and then my neck has this bulge but it's been there forever and oh yeah i stopped my synthroid but that was back in 2009. could it be nerves? i think i have carpal tunnel and i've also been having diarrhea and i don't understand why dr. ___ took me off that medicine and changed it and i don't trust generics so don't give me one of those.
- ummm, why don't i get dr. ___ in here and see what we can do?
yeah, so i can't wait to just be a surgeon, or whatever i become...