September 25, 2024 by drkottaway

Weighing in

No nightmares about clinic since the one I wrote about two days ago. I do feel like a bit of a dinosaur in clinic, though. Most of my older patients seem to really be fond of dinosaurs.

I’ve heard from other docs that they don’t have time to talk to each other in clinic either. Patient time but primary care we read all the notes from everyone: specialists, PT, OT, xrays, CT, MRI, ultrasound, lab, lab, lab, lab, prescription refills, phone calls. I read that people are trying to insert Artificial Intelligence into this. I am fine with a computer learning to read mammograms, but condensing information from notes? The AIs currently can “hallucinate”, and make things up. Is that worrisome or am I being silly? Notes are often wrong ANYHOW, way more than I would like. I saw a patient yesterday who has a neurological disorder. The hospital discharge note lists the wrong one! The patient caught the error, I didn’t. I am very glad he corrected me, but the hospital note is still sitting there wrong. Having been labeled with wrong diagnoses myself, I think it is a big deal. In order to fix it, he would have to fill out a form and the form would go to the physician, who is supposed to respond and add an addendum to the note. How often do you think THAT happens?

The discharging physician suggests he see a specialist for testing. I call that specialist and they agree with me: that testing is not indicated, it won’t make one bit of difference in his treatment. The discharging physician also suggests lung testing. I don’t think it works or is useful with a serious neurological disorder that affects muscles! Think, people.

My patient is grumpy and asks how we know the medicine is working. I reply, “You’re not dead.” Which is true. Undiplomatic, but he does not mind, because he is already saying, “What is the point of this?” To explain more about the medicine working, I ask, “Is your breathing better than when you went to the emergency room?”

“Yes,” he says.

“That is because the medicine is working.” I explain how it works and what happens if he stops it.

Sometimes it makes me feel heavy, heavy, like a dinosaur.

But I think I will try discussing my clinic day with my cat. I think she might enjoy it and I can clear the grumps out. And it’s not a hipaa violation! She doesn’t like other cats and won’t tell them anything.

For the Ragtag Daily Prompt: dinosaur.

This is new to me:

I’ve never seen these cartoons. The animation is, well, not the best. The guitar work is fun though!

September 24, 2024 by drkottaway

Bolster meaning

It did not even occur to me that yesterday’s dream could be taken as complaints about patients! That was not my meaning!

I wrote the dream out because I wanted to know what it was trying to tell me. And I look at it from the perspective of all the people in the dream being aspects of myself.

So who is the whiny guy (me) who won’t cooperate with authority (me) and who wants attention and is difficult? That’s not a very nice aspect of myself!

First of all, he reminds me of my father. My father really did not like authority and did not like most men. When I was quite small, I announced that he would have to die first, because he couldn’t live without my mother, but she could live without him. I was wrong as well as being an awkward child. My father’s dislike of authority interfered with his employment and he was mostly underemployed. He finished a Master’s in Mathematics, but never wrote the thesis for his PhD. I asked him why once and he said, “I was bored.” I don’t know how much alcohol interfered with his working.

I am not brilliant with authority either, though I am trying. I notice systems and often annoy authority by asking why something is run a certain (foolish and unproductive) way. I used to study whatever system I was in and then say, “Here, I’ve thought up a solution for this problem.” Then I would get in trouble for suggesting that there was a problem and I would be the problem. I learned to go to authority first and ask, “So is this (huge problem) a problem? I find it difficult. What is your advice?” Priming the pump, so to speak.

As a temp, the authority problem is weirder. I am an outsider, short term, no one really has to be nice to me. That fast trip home and back made me realize that I am lonelier in a group clinic than I was in a solo clinic. In my solo clinic there was me, my receptionist and the patients. In this group clinic I have less people to talk to and it is lonely. My problem, not theirs. They are about to move me to another clinic and I will see what approach I can take to this. The system might have a Balint Group or I may be able to start one.

What about the frozen looking spouse? Ha, I think that’s the part of me that is trying to keep my mouth shut with authority. The kids? Some days I want to pull the system apart and fix it, but I am not in authority to do that here. The grumpy nurse? I am running behind and I can’t fix everyone. Some people don’t want to be fixed, including me.

I could go home and try another place. However, I think that the cracks in the US medical system are in the whole system. As a country, we built this. I hope that I see single payer healthcare in my lifetime, but I may not. And Martha is right too: I thought that this place was doing better handling a chronic illness than where I worked in 2021, but they aren’t, really. They apply a formula, but the patients don’t get much out of it. They just get shuffled in once every three months. I did upset that apple cart by spending more time with those people and talking to them, but I do not know what the next physician will do. Sigh. The patients are already my patients and are saying goodbye.

For the Ragtag Daily Prompt: meaning.

February 18, 2024 by drkottaway

Tile like

This would be amazing tile if it were tile. But it’s not. It is rock.

It is orbicular granite from Finland, gorgeous. I took the photographs in a Danish Museum in Copenhagen in March 2022.

Nature just blows me away, all the time.

And the long necked shadow? Oh, yes, that’s a fossil dinosaur skeleton.

For the Ragtag Daily Prompt: tile.

https://www.museumofevolution.com/the-permian-period

February 13, 2022 by drkottaway

Dinosaur dreams

Dinosaur Dreams

The problem
With Intelligent Design
Is those old bones
Those dinosaurs

Also that of 10,000 dreams of creation
One would be right
And the followers of all the others
Consigned to hell
If so, I go gladly, clutching
Dinosaur bones to my chest
And will enjoy the diversity
Not the narrow heaven with a narrow
Small-minded deity

But is evolution right?

Well, I think it’s on the right track

But wholly done and all correct?

After all, think how often
Medicine has been wrong
Think of tobacco and vioxx
Think of Galen, over 2000 years ago
Thinking that evil humors built up in the uterus
Causing hysteria
External pelvic massage was the cure
For over 2000 years
For old maids, widows and nuns
Who had no male to cleave unto
Massage was a treatment into the early 1900s
And now we wonder about prozac too

Evolution is an evolving science

I think of when my son was four
And he watched “Jurassic Park”
Against my wishes
Because I thought it was too violent
He studied it carefully many times

One day he asked me, anxiously,
“Mom, is DNA real?”
To check that it wasn’t another of those Santa stories
I was able to reassure him
Yes, I think DNA is real
He was pleased

A few days later he announced
That when he grows up
He wants to be a plant and animal scientist
Extract DNA from amber
And grow those dinosaurs

A laudable ambition
For any four year old

If God left the dinosaur bones
Around to fool us
And they never lived
She has a nasty sense of humor
And my son and I will not forgive

I believe in evolution
And dream of dinosaurs

written in 2009

February 13, 2022 by drkottaway

Dinosaurs got colds too

https://www.abc.net.au/news/science/2022-02-11/dolly-diplodocid-dinosaur-pneumonia-disease-respiratory-illness/100817258

Dolly the Dinosaur shows evidence of a respiratory infection: aka a “cold”. And a chronic cold. She died at age 15, about half way through her lifespan. I suspect a little guesswork there. Do old dinosaurs turn grey?

There are dinosaur bone changes in Dolly from chronic infection. The scientist posted photographs on the internet and other bone experts said, that is infection. That is evidence of respiratory infection. “A lot of the times when any disease or trauma is found in a dinosaur skeleton, it’s often in limb bones where you expect it to happen,” Dr Poropat said. “Seeing it where the air sacs penetrate the vertebrae in a sauropod is quite unusual.” Also, she didn’t die of volcanic ash: “Inhalation of volcanic ash can cause a disease similar to mesothelioma.” Who knew? I haven’t kept up on my dinosaur medicine. The pattern of lesions also didn’t fit with lung cancer. Instead, Dr Woodruff and his colleagues think bacterial or fungal infections such as chlamydiosis and aspergillosis are prime suspects. These respiratory infections are common in birds today. “We don’t know for sure if the infection was bad enough to ultimately do Dolly in.”

Dolly, with her long neck, had neck arthritis from a chronic cold. She thought it was allergies.

Coronoviruses are colds. We are have a pandemic of a really really nasty killer cold and a cold that is doing long term damage in way too many people. That seems hugely ironic to me. I thought it would be influenza. After flu nearly killed me in 2003 I read about it and have enormous respect for it. And influenza is endemic and is always circling the world, in the colder regions.

My ideas about allergies and asthma are changing. We define asthma by whether people respond to albuterol. I do not respond to albuterol so I do not have asthma. However, I respond to other adrenaline like molecules: coffee caffeine and terbutaline. So do I have an asthma like illness? My allergy testing in 2014 was resoundingly negative. I tested for celiac in 2020, because I just did not feel well. Negative. I have not retested yet, but even if that antibody testing is negative, it was gluten that flared up diverticulitis in me. The thing is, there could be other antibodies. Loads of them. We all make different ones.

I am thinking about tubulin. Tubulin powers our muscles and cilia and flagella. It is mitochondrial. We inherit mitochondria from the mother only: it is in the egg but not the sperm. Mitochondria is matrolineal. My son and daughter both have my mitochondria. I have a photograph of my maternal grandmother’s mother. Her expression is amazingly like my daughter’s expression when she is thinking. My daughter has my poor spelling skills, my attitude towards work, and her father’s muscular endurance. During college, her father’s goal was five sports a day. In high school my daughter said that she “just didn’t feel good” when the pool was closed. She was used to swimming 3-5 miles a day and lifting weights. Her father can get on a bicycle and ride at the speed of talking all day. He also has pioneered “jog golfing” in his area. When the golf course is empty in the winter, he plays golf and jogs from one hole to the next with his bag. Yes, he is nuts, I agree. I am jealous of that endurance.

The inheritance of antibodies would be from both parents, because they are made by the white blood cells. Do parents and children make the same antibodies or are they entirely different? I do not know that. I took an immunology course when I worked at NIH in the 1980s. I also had some immunology in medical school, but not nearly to the level that I am interested in now. I think I am hunting for a really good immunology course. And maybe more information about dinosaur medicine.

RDP-SUNDAY-THREAD

For the Ragtag Daily Prompt: thread. This post follows the thread of my thoughts this morning

February 9, 2022 by drkottaway

Where am I?

Do the ghosts wander the museum at night, wondering?

For the Ragtag Daily Prompt: perplexed.

January 21, 2022 by drkottaway

Skookum Smithsonian

I forget how BIG the Washington, DC Mall is. On my last day visiting out east over the winter holidays, my friend B and I went to the Mall. Above is the Smithsonian National Museum of Natural History (DINOSAURS!), then the National Gallery of Art and then the Capitol Building. We went to the National Gallery first because they opened late at 11 am, while the Smithsonian was opening some buildings at 1 pm.

Looking the other way, the Washington Monument, the National Museum of African American History and Culture, and the National Museum of American History.

The museum buildings are each two city blocks long and a city block wide. They are enormous. We only went through part of the National Gallery and then ducked in to Natural History. There are now 23 buildings, including the National Zoo, in the Smithsonian. It is amazing and wonderful. And there are other museums as well, including the National Gallery of Art.

The Smithsonian: https://www.si.edu/museums.

The National Gallery of Art: https://www.nga.gov/.

They are SKOOKUM museums.

November 22, 2021 by drkottaway

The Introverted Thinker in New York

The Introverted Thinker is eight. Her mother takes her out of school for a week to go to New York City.

They leave her sister and her father behind.

Her mother complains about the school paperwork. “Never let school get in the way of your children’s education,” she says. “That’s what my father says.”

The IT is not sure what all this means. But she is excited.

They go on an airplane. She gets to sit by the window. She can see the ground and it is squares like a quilt with hills. It is so beautiful! She is amazed, magic!

In New York City they go to the house of an old friend of her mother’s. The old friend is old and wears dresses to the ground and a lot of jewelry. The house is dark and there are many things in it. The IT is told that the things are antiques and she must not touch anything. She walks around carefully in the dark places, looking at all of the strange things while her mother talks to the old friend. They talk about the past and people that she does not know.

Her mother takes her to museums on some days. Some are art museums. The IT is already used to art museums because her mother is an artist. The museum is like an art gallery only much bigger and the ceilings are very high. A lot of the art is very big too.

One museum is different. Natural History, says her mother. There are dinosaur bones. The IT can’t touch them either but they are wonderful. Huge animals from the past that are not here any more! She loves it.

They fly home. First she has to thank the old friend with the house like a museum, only darker. Then they go to the plane. This time there are some clouds so the IT can’t see as much, but she still gets to see the quilt of the land.

She decides that she likes museums and she likes natural history. Especially dinosaurs.

July 4, 2021 by drkottaway

Forth

Happy Incendiary Device that Is Not Blowing People Up Day.

Happy Forth of July.

Happy Indigenous People Day.

But earlier in time: Happy Extinct Dinosaur Day.

Remember the Dinosaurs.

The book appeared in my Little Free Library Box. I read about pine siskins today. Mine have left or migrated or something. I miss them, particularly Brave, who would let me stroke him or her.

I am inveigling travel plans, to see an older friend with cancer, this month.

Love to all and be careful with any explosive devices.

________________________________________

For the Ragtag Daily Prompt: inveigle.

April 5, 2015 by drkottaway

Daughters and dinosaurs

D for daughter and dinosaur. Here is a poem I wrote quite a while ago, though it is about my son rather than my daughter.