Monday, July 11, 2016
Dog Days Of Summer
We've reached that time of summer when baseball's all-star game is being played. The all-star break is an absolute black hole in the sports landscape, where the only major league playing takes a break. We're somewhat lucky this year as the olympic trials have been going on, however. I still enjoy the olympics, not so much for the major sports, but for the more fringe sports that I don't typically pay attention to, such as track & field and women's gymnastics. Additionally, the weather has turned uncomfortably hot and my grass is now partially brown. Hence, the two month writer's block. I've either been too busy to write, or not busy enough to have anything to write about. I'm going to try to get back on the wagon. Cheers!
Tuesday, May 17, 2016
Babysitting Adults
Seeing as how there is a massive prescription narcotics abuse problem in this country, in late 2013 the state of Indiana released guidelines for prescribing chronic narcotics. Basically, anyone taking a certain amount of narcotic for greater than 3 months qualified for chronic pain management appointments. These appointments included extra paperwork to determine levels of anxiety and depression, abuse potential, doctor shopping habits, and urine drug screens. For various reasons I have been lax with these rules, until now.
By an overwhelming amount, the urine drug screen is by far the most interesting part of this process. The paperwork is mostly a waste of time as people lie about their abuse potential and it's mostly busywork. The urine drug screen is where the action is located. The majority, I would estimate 80%, of the urine drug screens I perform have discrepancies. Some people are taking others pain medicines. Some aren't taking the medicines they're prescribed. Others are taking street drugs, by far the most popular is marijuana. I'm convinced half the population is smoking pot. I'm to the point now where I expect people's drug screens to have inconsistencies. And when they do, I stop prescribing them narcotics. I absolutely should've been doing this from the beginning.
And yet I hate this aspect of my job. I don't think I've ever been loose with prescribing these medicines. But when people had pain complaints, and a reasonable response to the medicines, I would prescribe them. This process has opened my eyes so much have essentially done an about face. I've basically reached the point where I don't want to prescribe narcotics for any indication, especially as a primary care doctor. This is because (A) I have long term follow-up with these people and can't get them off the medicines (until they fail their drug screen) and (B) I don't want to spend my whole day doing these lengthy, cumbersome appointments for pain. I get asked several times per week to prescribe these medicines, usually for some benign condition or pain syndrome with an unknown diagnosis, and I just shake my head and politely offer them an anti-inflammatory. They typically then ride off into the sunset, never to be heard from again.
By an overwhelming amount, the urine drug screen is by far the most interesting part of this process. The paperwork is mostly a waste of time as people lie about their abuse potential and it's mostly busywork. The urine drug screen is where the action is located. The majority, I would estimate 80%, of the urine drug screens I perform have discrepancies. Some people are taking others pain medicines. Some aren't taking the medicines they're prescribed. Others are taking street drugs, by far the most popular is marijuana. I'm convinced half the population is smoking pot. I'm to the point now where I expect people's drug screens to have inconsistencies. And when they do, I stop prescribing them narcotics. I absolutely should've been doing this from the beginning.
And yet I hate this aspect of my job. I don't think I've ever been loose with prescribing these medicines. But when people had pain complaints, and a reasonable response to the medicines, I would prescribe them. This process has opened my eyes so much have essentially done an about face. I've basically reached the point where I don't want to prescribe narcotics for any indication, especially as a primary care doctor. This is because (A) I have long term follow-up with these people and can't get them off the medicines (until they fail their drug screen) and (B) I don't want to spend my whole day doing these lengthy, cumbersome appointments for pain. I get asked several times per week to prescribe these medicines, usually for some benign condition or pain syndrome with an unknown diagnosis, and I just shake my head and politely offer them an anti-inflammatory. They typically then ride off into the sunset, never to be heard from again.
Thursday, May 12, 2016
Oh It's On, Part II
Something strange is going on. Shortly after encountering the mouse invasion (which I think has been taken care of), we started noticing ants in our house. First a few per day, then a few every time we went into the kitchen, then 5-10 every time we went to the kitchen. They were always congregated around the kitchen sink. We never saw them anywhere else.
To some extent, having ants is worse than mice. We had the small, black type, which blended in with our countertops and were somewhat difficult to spot. Because of this, every time I picked up anything from the counter, especially if I was planning on eating it, I felt compelled to inspect it. It's the kind of feeling I'd expect to have if I were living in filth.
I've never had an ant problem inside the house before, so once again I was new to eliminating this type of pest. After consulting the internet (What would a home owner do without the internet, by the way?) and a couple of my friends, I decided to get ant baits instead of killers. When I bought them I had no idea how they worked (turns out it's a bit morbid, but really an ingenious way to get the job done). A few days after setting the traps, we noticed a marked increase in the number of ants we were seeing. I was becoming a bit nervous to be honest. But a few days later the number decreased and at this point we basically aren't seeing any ants. Hopefully this is the last pest we have to deal with for awhile.
To some extent, having ants is worse than mice. We had the small, black type, which blended in with our countertops and were somewhat difficult to spot. Because of this, every time I picked up anything from the counter, especially if I was planning on eating it, I felt compelled to inspect it. It's the kind of feeling I'd expect to have if I were living in filth.
I've never had an ant problem inside the house before, so once again I was new to eliminating this type of pest. After consulting the internet (What would a home owner do without the internet, by the way?) and a couple of my friends, I decided to get ant baits instead of killers. When I bought them I had no idea how they worked (turns out it's a bit morbid, but really an ingenious way to get the job done). A few days after setting the traps, we noticed a marked increase in the number of ants we were seeing. I was becoming a bit nervous to be honest. But a few days later the number decreased and at this point we basically aren't seeing any ants. Hopefully this is the last pest we have to deal with for awhile.
Saturday, May 7, 2016
My Fitbit Measures My Inactivity
This year our company changed their health insurance policies. No longer is the biometric screening process required. Instead, they are incorporating other measures of health, such as activity level. Generally speaking, I think this is a great idea. I don't want to go on too big of a tangent here, but screening the masses for high cholesterol doesn't benefit anyone. In order to track our activity levels, the company gave us all Fitbits for free. I picked up mine and have been wearing it (minus the weekend where I lost it) for the past few weeks. I knew I had low activity levels, but my results have been a bit alarming.
Apparently the national average is somewhere around 4,000 steps per day and the American Heart Association recommends at least 10,000 steps per day. According to my Fitbit, I average right around 4,000 steps per day. Thus far my high has been 8,600, so I haven't reached the recommended step count one time in two weeks. The majority of my steps come while I'm at work, which isn't many. Obviously to increase my count anywhere near the recommended 10,000 mark, I'm going to have to work on it outside of work. To be honest, I don't see that happening routinely. Maybe on the weekends, but not during the work week. Thus far my Fitbit has only confirmed what I already knew - that I live a sedentary lifestyle. Looks like I'll be getting that biometric screen anyway.
Apparently the national average is somewhere around 4,000 steps per day and the American Heart Association recommends at least 10,000 steps per day. According to my Fitbit, I average right around 4,000 steps per day. Thus far my high has been 8,600, so I haven't reached the recommended step count one time in two weeks. The majority of my steps come while I'm at work, which isn't many. Obviously to increase my count anywhere near the recommended 10,000 mark, I'm going to have to work on it outside of work. To be honest, I don't see that happening routinely. Maybe on the weekends, but not during the work week. Thus far my Fitbit has only confirmed what I already knew - that I live a sedentary lifestyle. Looks like I'll be getting that biometric screen anyway.
Wednesday, May 4, 2016
Burn The Witch
News came out earlier this week that Radiohead "disappeared from the internet", leading to speculation that they would be releasing a new album soon. They did release a song on YouTube the next day, and I like it a lot. I'm not saying that just because I'm a huge Radiohead fan. In fact, I typically have to listen to their new songs several times before I appreciate them. I think I listened to King of Limbs around 10 times before I liked it. But I liked this song from the beginning. Can't wait for them to release more music from the album.
Wednesday, April 27, 2016
Oh It's On
We knew we had a mouse problem. We had some food on the floor of the pantry that had been broken into and we saw droppings. We had a similar situation about a year ago, and simply setting a trap out seemed to take care of the situation, even though the trap never caught the mouse. So I sat the same trap this time expecting the same result. Except this time something else happened.
We were coming in from the sun room when Sarah saw a brown mouse running across the living room floor. We were able to trap it in a corner and escort it out the front door with a broom. Later that evening I was sitting at my desk where I have a trash can underneath. I heard what sounded like something moving in the trash can. I turned on the flash light on my phone and didn't see anything. The sound quieted but 15 minutes later I heard the sound again. I turned on my light and this time I saw a small white mouse sitting on top of the trash. It again ran to the living room where we were able to trap it in a corner and escort it out with a broom.
At this point I was pissed. I decided the newer, fancy traps weren't cutting it and decided to pick up the more traditional traps at the store after work the next day. Imagine my annoyance when Sarah texted and said she saw another mouse. What is going on? It's like we're being taken over by rodents.
I stopped by the Home Depot (after stopping at Target) and was reminded how awful traditional retail continues to be. I picked up a batch of traditional mouse traps. In all of the prior residencies I've lived, including growing up, I have never had to set a mouse trap and thus had no experience doing so. The directions provided sucked, and I was half scared because I didn't want to catch my finger in the damn thing, so I ended up watching a YouTube video to show me how to do it. Let me tell you, those things are medieval wicked. It actually has a part titled the "kill hammer."
Classic mouse traps are finicky as shit. I actually made one go off just transporting it from the counter to the floor (luckily without my finger in the way). So I was surprised, not shocked, when the next morning we checked the trap and the cheese was gone but there was no mouse. I was more annoyed than anything. Still no mouse! But we haven't seen any mice since the first night. I have since decided to load the trap with peanut butter. But thus far I feel a bit defeated. I can imagine the mouse sitting some where, nibbling on cheese and mocking me.
We were coming in from the sun room when Sarah saw a brown mouse running across the living room floor. We were able to trap it in a corner and escort it out the front door with a broom. Later that evening I was sitting at my desk where I have a trash can underneath. I heard what sounded like something moving in the trash can. I turned on the flash light on my phone and didn't see anything. The sound quieted but 15 minutes later I heard the sound again. I turned on my light and this time I saw a small white mouse sitting on top of the trash. It again ran to the living room where we were able to trap it in a corner and escort it out with a broom.
At this point I was pissed. I decided the newer, fancy traps weren't cutting it and decided to pick up the more traditional traps at the store after work the next day. Imagine my annoyance when Sarah texted and said she saw another mouse. What is going on? It's like we're being taken over by rodents.
I stopped by the Home Depot (after stopping at Target) and was reminded how awful traditional retail continues to be. I picked up a batch of traditional mouse traps. In all of the prior residencies I've lived, including growing up, I have never had to set a mouse trap and thus had no experience doing so. The directions provided sucked, and I was half scared because I didn't want to catch my finger in the damn thing, so I ended up watching a YouTube video to show me how to do it. Let me tell you, those things are medieval wicked. It actually has a part titled the "kill hammer."
Classic mouse traps are finicky as shit. I actually made one go off just transporting it from the counter to the floor (luckily without my finger in the way). So I was surprised, not shocked, when the next morning we checked the trap and the cheese was gone but there was no mouse. I was more annoyed than anything. Still no mouse! But we haven't seen any mice since the first night. I have since decided to load the trap with peanut butter. But thus far I feel a bit defeated. I can imagine the mouse sitting some where, nibbling on cheese and mocking me.
Monday, April 11, 2016
Coming Back To Reality Is Always The Hardest Part
While the warming temperatures of spring are always welcome, spring is not my favorite season. That distinction would go to fall for me. Since becoming a home owner, spring is littered with numerous house projects that need to be done year after year. This year is no different, with a laundry list of landscaping and mulching and various other outdoor projects that need to be done. Throw a full time job(s) and two young kids into the mix, along with weather that frequently doesn't agree with your plans, and spring time becomes a bit stressful for me. I think this in addition to the fact that work has been a bit stressful lately led to me not even thinking about our trip to Puerto Rico much until we landed in San Juan.
Puerto Rico is beautiful, a tropical island in the middle of the ocean that averages 80 degrees year long and has 340 days of sunshine per year. It's a US territory, meaning you don't need a passport, and yet has its own distinct culture and values. I'd recommend visiting at some point.
When we landed back in Indy, we were greeted with gray skies and nearly freezing temperatures. We made it home, and I was happy to see our kids for sure as it had been nearly a week. They acted a bit indifferent. Within a a few hours they both had dirty diapers and were fighting back and forth. Welcome back to reality. Paradise can't last forever - I don't have the cash.
Puerto Rico is beautiful, a tropical island in the middle of the ocean that averages 80 degrees year long and has 340 days of sunshine per year. It's a US territory, meaning you don't need a passport, and yet has its own distinct culture and values. I'd recommend visiting at some point.
When we landed back in Indy, we were greeted with gray skies and nearly freezing temperatures. We made it home, and I was happy to see our kids for sure as it had been nearly a week. They acted a bit indifferent. Within a a few hours they both had dirty diapers and were fighting back and forth. Welcome back to reality. Paradise can't last forever - I don't have the cash.
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