Week 3 Blog:

Day 11

The patient is a 53 year old transgender patient, male to female, who is in for follow up. She remains chronically depressed. She is morbidly obese and has been considering bariatric surgery. Her back pain limits her mobility and she has 2 + pitting edema (swelling that leaves an indentation when pressed) of both lower legs up to her knees. She is fortunately not in heart failure. The solution: another gentle nudge for patient to call the bariatric surgeons. If she could lose weight, it would help all of her multiple medical problems. No more water pills for her legs—they are not helping that much. Walk, walk ,walk and the fluid will mobilize.

Day 12

The patient is a 65 year old female in good health who has been having abdominal pain radiating into her back after eating for 3-4 weeks. She has not had nausea or vomiting but did note an increase in symptoms early this week after a burger and fries. Gallbladder disease would typically cause an exacerbation of symptoms after a fatty meal, but her pain is both sides of her mid-back and she denies excess belching. The solution: An ultrasound of the gallbladder definitely shows sludge, so even though the symptoms are not textbook, I think we have our answer. Patient was referred to the surgical group.

Day 13

A tough case. The patient is an 86 yr old female that I have known well for years with worsening dementia. Is widowed x 4 and living alone, which she hates. Has only her nephew, who is also her POA checking up on her via phone call daily and an actual visit one time /week. The patient had previously lost 30 pounds because she forgot to eat. Although she is not aware of forgetting to eat and says her apetite is great. She is missing her medications 3-4 days /week even though the POA sets them up in a planner and often calls and reminds her to take them. She does not appear to be a safety issue yet, but it won’t be long until she cannot be left alone. She is not bathing as frequently as is needed as is evidenced by the body odor that assaults my nose when she removes her coat. This is difficult to witness, because she was always ‘put-together’ well with a fancy hat on top. The Ensure/Boost, one can per day, approach is helping the weight this visit, so she is remembering to drink them. She is missing her memory meds and heart pills, so POA will have to arrange to pay someone to come by daily to administer her meds. This is great because then there are ‘eyes-on’ the patient every day. There are so many patients just like this one with cognitive impairment that would really benefit from a nursing facility or more in-home help, but the funds are just not there. We can only do so much.

Day 14

The patient is a 77 yr old who was having some shortness of breath. Work up subsequently showed a large mass on her kidney, lesions in her liver and a couple of spots on her chest. No definitive diagnosis has been made, because biopsy of two of the liver lesions was negative, but this bad boy sure looks like a renal cell carcinoma. Pt is aware of my concerns and will follow up with the urology folks. She most likely needs that kidney removed, but her renal function is not 100% because of years of high blood pressure and diabetes—both of which are controlled. Her spirits are good, and we are tackling this together!

Day 15

The patient is a 72 year old female with bad COPD. She is on chronic oxygen via nasal cannula and is here for a check up. Her breathing has been stable. She just recently retired and is regretting it. Misses her co-workers and having something concrete to do every day. We discussed antidepressant medications, but we both agree that she is going through an adjustment period, and things will get better. She is volunteering at the local hospital, and her and her husband are downsizing and moving into a 55 and over community. These things are helping to keep her busy. She also is disappointed with how little she can do physically because of her dyspnea with exertion (shortness of breath when she does physical things)The solution: listening to the patient and encouraging her to stay involved in things and trying to accept her limitations.