DOCTORS ' LOUNGE
DOCTORS ' LOUNGE
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Many times over the past 35 years ,
I have wondered if , in fact , I am floating just over the exam table , dreamily searching imaginary library shelves . I check the patient sitting dutifully across , who is not looking at her phone , but is appearing to listen . Yet my words seem to have been snatched into the ether , never to penetrate her brain .
This feeling of talking across an invisible barrier happened most predictably with certain topics . Some of them may ring a bell with you .
A . LEG SWELLING
Fatter ankles and tiny bits of late afternoon puffiness do not immediately point to heart , lung or kidney failure . They generally announce only one ’ s truncal body mass , age , and prolonged standing / sitting . Yet to the patient , they are dire warnings of loss of shapeliness and youth . They stir uneasy memories of stout grandmothers whose legs got wrapped in heavy canvas stockings , who stumped into kitchens and had to rest between sentences . I can see patients remembering , alarm in their eyes .
Yet when I explain that “ everything rolls downhill ,” that “ venous valves can get saggy ,” that “ static muscles don ’ t pump water upwards as well as contracting ones ,” my words fall straight to the floor . I can see I have lost this battle , because the recommendations of “ all-day compression sleeves , plus intermittent brief elevation ,” are clearly Martian . They meet a wall of blank stares . That mental door will only open if the patient hears “ water pills .” Alas , only compression is on offer , so there ’ s a miasma of discontent wafting out the door .
24 LOUISVILLE MEDICINE
THE OUT OF BODY INTERNIST AUTHOR Mary Barry , MD
B . BLOOD SUGAR CHECKING
Because of the cost of the strips , I always favor only 90 min or so post-prandial blood sugar sticks for the non-insulin dependent diabetic person . I ’ d suggest checking every day after every breakfast for a week ( or two days , if you only ever ate one of two breakfasts ), then check after lunch for several weeks , and after supper for as long as it took to run out of new meal combinations . This plan involves minimal effort but can produce maximum data .
Wasting a strip on fasting sugars never appealed to me , but the patients seemed extremely intent - I believe because they got a lower number . Finding out “ If you eat this , then your blood sugar runs that ,” 90 minutes after their meals , was just not appealing . It brought accountability right into the room . It also contradicted what all the diabetes educators said . I could see my words levitating right down the hall . But some folks ( oh , how they make me smile ) had better ears than I knew , and two months later would appear with sheafs of blood sugars , all postprandial , all lots better than before .
The apple cider vinegar people invariably embraced this plan . Was this an index of hardheadedness , self-sufficiency or masochism ? I was never sure .
C . EXERCISE
Getting oneself to stand up and start walking , when every fiber screams “ Finish this chapter !” or “ The game is starting !” is one problem . The others are legion : is it safe ? Is it hot , cold , dark , humid , lonesome , rainy , buggy , icy , boring ? Got bad feet , bad shoes , bad knees , bad hips , bad back , bad attitude ? There are myriad ways to get moving , I begin , but stop to attend the litany of reasons why this one cannot . The patients suffer , having to make excuses , feeling worse and worse about themselves . So in my mind I design a workout room for their houses , my detached self stretched on the special cushy gym floor . Then I hire a nanny and a cook for them ,