Tag Archives: help
I wrapped objects for a care package to mail to a family member today. The cats “helped”. They particularly enjoy the tissue paper. It crackles and you can pounce on it and hide under it and in it.
Avoid death by fentanyl
Some of the West Point Cadets overdosed on March 12, 2022 are still on ventilators. They took what they thought was cocaine. It was laced with fentanyl and they all nearly died.
Not only that, but two of the bystanders who did not use the drug, but did cardiopulmonary resuscitation, CPR, also succumbed. They stopped breathing because they got a heavy dose of fentanyl giving CPR.
Fentanyl is being laced into ANY illegal drug, and being 50 times stronger than morphine, it can kill you by making you stop breathing. Also, fake pills are made. Do not buy pills on the street. And I don’t care if it is your friend. Remember that when someone is really addicted, the addiction is running the show. They need the drug more than your friendship. People will lie, steal and sell drugs. Protect yourself:
Please read the website at
If you or a family member uses illegal drugs, please get naloxone to have at home. If the shot is given in time, very soon after the person stops breathing, it can save their life.
If you give someone a dose of naloxone CALL AN AMBULANCE. Because it is short acting and the opioid may take back over. The person may need to be on naloxone iv! You must get them to an emergency room as fast as possible.
Our local Health Department was giving out naloxone shot kits in the last few years for free. Our local police carry naloxone. If you are on prescription opioids, you should be offered a prescription for naloxone and your family should be instructed on how to use it.
And teach your children well. I interviewed my patients for years on the age they started smoking. Most of my patients started at age nine. One woman said age seven. We have to start talking to children about drugs and risk and not smoking anything by third grade. That is the horrific reality.
And Bless the punk band The Offspring for reaching out to opioid overuse people and saying, “Get help. You can do it. Please do not die.”
And they too are inimitable.
What I learned from my first doctor job
When I started my first job, I had a nurse and a receptionist within a bigger clinic, all primary care. Fresh out of residency. One month in I asked to meet with my nurse and the receptionist.
The receptionist brought the office manager. I was surprised, but ok.
I started the meeting. “I am having trouble keeping up with 18-20 patients with fat charts that I have never seen before, but I think I am getting a little better at it. What sort of complaints are you hearing and how can we make it smoother?”
The office manager and the receptionist exchanged a look. Then the office manager excused herself.
Weird, I thought.
The three of us talked about the patients and the flow and me trying to keep up. About one third were Spanish speaking only and I needed my nurse to translate. That tended to gum things up a bit, because she could not be rooming another patient or giving a child vaccinations.
I thanked them both and the meeting broke up.
Later I found that the office manager had been brought in because another doctor tended to manage by yelling and throwing things. And another doctor had tantrums. So the receptionist was afraid of me and had asked the office manager to stay. The moment they realized that it was collaborative and I was asking for feedback and help, the receptionist was fine without the office manager.
That was an interesting lesson on working with people. I had been very collaborative with the nurses and unit secretaries in residency. As a chief resident, I told my Family Practice residents to treat the nurses and unit secretaries and in fact everyone, like gold. “They know more than you do and if you take care of them, they will save your ass!” The unit secretaries would go out of their way to call me in residency. “Mr. Smith is not getting that ultrasound today.”
“Shit. Why not? What the hell?” I would go roaring off to radiology to see what the hold up was.
The unit secretaries did not help the arrogant residents who treated them like dirt.
I thought it takes a team. I can’t do my work without the nurse, the pharmacist, the unit secretary, the laundry, the cafeteria workers, the administration. It takes the whole team. I value all of them.
“If oxygen might help with chronic fatigue, as it has helped you,” a friend asks, “how do I get on oxygen?”
First of all, one of the things that is not clear, is what recovery looks like. I think I’ve had low grade chronic fatigue for the last 7 years compared to my “normal”. Now, will I get off oxygen? I don’t know. I am hoping for September but it may be that 7 years of low grade hypoxia means I have lung damage and no, I won’t get totally off oxygen.
They have apparently recently made the guidelines for oxygen more stringent. I sort of missed that update, even though I just recertified in Advanced Cardiac Life Support. You now have to have an oxygen saturation that goes to 87% or below. It used to be 88.
Now, you can test this at home with a pulse oximeter. In 2005 after the influenza, I held my saturations but my heart rate would go up to 135. Which means that I walked across the room very very slowly because a heart rate of 135 sustained does not feel good at all. Normal is 70-100 beats per minute. You can measure pulse with just a second hand, number of beats in a minute. For oxygen saturation, you need the pulse ox and it will measure both heart rate and oxygen saturation.
So: measure pulse and saturation at rest first. Write them down.
Then walk. I usually send patients up and down the hall three times then sit them down and watch the pulse ox. In some, the heart rate jumps up. If it’s over 100 and they are getting over pneumonia, I don’t want them back at work until it is staying under 100. Or if sitting they are at a pulse of 60 and then walking it’s 95, well, I think that person needs to convalesce for a while yet. They can test at home.
As the heart rate returns to the baseline, the oxygen level will often start to drop. Does it drop to 87? Describe the test to the doctor and make sure the respiratory technician does it that way and also they should do pulmonary function tests. Mine were not normal.
Now, what if the oxygen doesn’t drop to 87? We are not done yet. What does the person do for work or do they have a toddler? If they have a toddler do the same test carrying the toddler: they sit down, exhausted and grey and this time the oxygen level drops below 87. If they do not have a toddler, do the test with two bags of groceries. Or four bricks.
When I did the formal test, the respiratory therapist said, “Let’s have you put your things down so you don’t have to carry so much.”
“I’d rather not.” I said, “I want to be able to walk on the beach, so I need the two small oxygen tanks, my bird book, camera, binoculars and something to eat.”
“Oh, ok,” she said.
So I did the test with two full tanks of oxygen, small ones, and my bird book and etc. I dropped like a rock loaded. I think I would have dropped not loaded but perhaps not as definitively. Still hurts to carry anything, even one tank of oxygen.
We are making a mistake medically when we test people without having them carry the groceries, the toddler, the oxygen tank. My father’s concentrator is pre 2013. It weighs nearly 30 pounds. Now they make ones that weight 5 pounds. Huge massive difference.
Christmas for Children
For the Ragtag Daily Prompt: shop.
The main thing I am going to shop for today is a little tag that I got at my Sunrise Rotary yesterday. This is a gift request for a child, part of Christmas for Children, run by our local Kiwanis. Here: Port Townsend Kiwanis.
Applications for gifts for children are here: https://www.christmas4children.com/.
This year, Christmas for Children is not only handling Port Townsend requests, but Chimacum and Port Hadlock and Quilcene.
A friend just remarried and he says that they are comparing stuff. They have two of many many things! Kitchen items, house items. Maybe as a wedding gift we should all offer to go choose between two of the things and take one away to donate to someone in need! All those decisions!
At the fair!
I had fair duty yesterday at the Jefferson County Fair. Two hours in the Port Townsend Sunrise Rotary booth. We’re in the new Commercial Building. The day started out with a fabulous band parade. I got a few photographs, next post. The fair booth is to tell about our Sunrise Rotary and what we do in the community and the world! The list is the banner on the right, everything from picture dictionaries for every 3rd grader in the county, to exchange students learning about the world, to Polio Plus and Shelterbox and big and small projects in our county and other countries. Hooray for teamwork and for all the people who donate their time and energy and fellowship and money.
The booth is still up today. We are already selling tickets for our “Running of the Balls” fundraiser. We roll numbered golf balls down Monroe Street before the Rhody Parade and the winner and 2nd and 3rd get cash! $2000.00 to the winning golf ball!
If you buy five tickets for $20.00 at the fair, you go into a drawing to get 50 more numbered golf balls in the race. Stop by!
And for the golfers, we need more golf balls. We don’t have enough for next year. Some get away, darn it. Contact me or another Sunrise Rotarian to get rid of the old golf balls.
hipaa, health insurance, and health information
Blogging from A to Z, my theme is happy things. Letter H is for HIPAA and health insurance and health information.
H is for hipaa: the Health Information Portability and Accountability Act, from 1996. I’ve been thinking about HIPAA and I have a question: if the patient handouts are supposed to be written at the fifth grade reading level for patients, why doesn’t Congress have to write laws at the fifth grade reading level?
Ignorance of the law is no excuse, right? Everyone in the US is supposed to follow the laws. Have you read them? I am supposed to follow HIPAA, right? I am supposed to follow the Affordable Care Act, (also nicknamed ObamaCare). It is 3600 pages long. It is written by Congress and attorneys.
What about health insurance? Have you read your health insurance policy? It’s a contract. If multiple US citizens have difficulty reading, why isn’t health insurance written at a fifth grade level?
CMS too and triwest and medicaid. I do not have time as a physician to learn the language of their websites. I run my own small practice. It is infuriating to try to read, understand and follow medicare, medicaid and Veterans Choice rules and they change every year. We ask why health care costs so much, and then there are over 800 different insurance companies, each with multiple insurance plans, and more and more people are hired to try to navigate and understand the rules. It’s ridiculous. We need a single payer system so there is ONE set of rules. Everybody in, nobody out.
At the UW Telepain telemedicine, I said that I show chronic pain patients the link to the Washington State Law about opioids and pain medicine.
One of the faculty said, “Patients can’t understand that.”
I said, “Well, I’m supposed to follow that law and I am not an attorney. ”
My patients are all smart in something. Some of them can’t read well. I have had two recently that I recognized a reading issue in the clinic room when I gave them a survey tool to fill out. I promptly said, “Let’s do this together.” I read them the questions and the answers. They are not stupid, but I am not sure that their reading skills were up to the form.
I am not using the American Academy of Family Practice patient handouts much because I think they are too dumb. I use the Mayo Clinic much more. I direct patients to the CDC, to NIH, to the Mayo Clinic website. Sometimes my patients may not be able to read at that level, but I think everyone appreciates being treated with respect. I am also happy to go over and explain more about a topic. I also warn them that there are loads of crappy medical sites and pseudo scientific sites and misinformation on the internet. If they want to look something up, I want them on a decent site.
Now how are these happy things to think about? It makes me happy to question my own behavior and my own assumptions. It makes me wonder how our country can insist that medical information has to be at a fifth grade level but lets Congress write laws that I find nearly unreadable.
Now I am warning my patients that a federal law may go into effect in January 2019, about opioids, and that it will be different and override the state law. Change will keep coming.
The photograph is from the beach last night: brant. What would the flock think about our health insurance?
I took this yesterday, some of the 300 attendees for the 20th Annual Fundamentals of Addiction Medicine Conference.
Multidisciplinary, all trying to help.
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