Back to work!

Sam Time


Dear World,

Today I ate chocolate ice cream with Pop pop and went swimming in the pool.

*End of Sam Time*

Sam time is getting pretty original! Now we're getting a little more information then just going swimming, he's really keeping us on the edge of our seats! I've found that I keep getting more and more behind on my blogging. Like any habit I suppose, if you skip it one day it makes you more prone to skip it the next day but I'm trying to get better. To make up for lost time, I'm going to combine the last two days of work into one post.

I'm starting to really get used to seeing Suboxone or Subutex patients. I can almost completely recite the questionnaire that we have to ask each patient at our visits. I have mixed feelings about suboxone and I suppose it depends on the way that the patient handles the medicine. Some people feel that Suboxone is just substituting one drug for another, however I would beg to differ. When I first came to the clinic, I felt as though this were true but seeing how much the Suboxone patients improve their life because of it, it is almost impossible to say that it is substitution. Yes, you are taking a medication but it is so much different then being dependent on opiates. The goal of Suboxone is not to be on it for the rest of your life, but to make things a little bit easier while you are trying to get clean. Although this is the purpose, I feel as though some patients that we see have a skewed vision of what Suboxone is for. They become incredibly worried when Dr. Zook begins to taper down their dosage and immediately ask for "nerve pills". Of course Dr. Zook doesn't prescribe these because the last thing that a recovering addict needs is a medication from the benzodiazepine family.

Speaking of benzos, the practice here is getting a lot of people that want referrals to a new psychiatrist. On Monday, a Dr. Melbourne Williams (A psychiatrist) in Danville, KY had his medical license suspended. Officials are currently investigating allegations that more then 12 of his patients died of drug overdoses in the past year. The Board of Medical Licensure issued an emergency order of suspension that prohibits him from practicing any type of medicine. This is a huge deal. Typically, when a doctor is being investigated, they are on a probation period versus a full suspension. To put it bluntly, this guy is in the shitter. According to Kevin Johnson, the Clay County Sherif, Williams over prescribed Xanax and other prescriptions regardless of their diagnosis. The state medical board reported that Williams prescribed more then 1.3 million Xanax tablets on 12,622 separate prescriptions between April of 2011 and March of 2012. Some patients came to Danville from as far as Georgia just to get their "fix" from Williams. I have included the Hyperlink here if you would like to read more.

This whole situation is terrifying. It's a shame to think that a doctor would put money before the safety and care of his patients. If you get to that point, you pretty much become a respectable drug lord if there even is such a thing. Unfortunately enough, this happens more often then you would think. Things like this really irritate me. This just goes to show you that (unless you're an apparent drug addict or you really trust your doctor) you should always get a second opinion because you never know who is going to have another agenda.

Monday morning I was a little bit concerned when I came into the office. With our first couple patients, it was shaping up to be a day much like last thursday. I don't have a problem with patients and wanting to hear their concerns but sometimes, they just can be so whiney and you start to wonder whether they need a primary care physician or a psychologist. Sometimes I wonder whether or not some of Dr. Zook's patients think she's a counsellor. I can understand that because she's great to talk to but still, that isn't her job. To give you an example of this, there are two Suboxone patients that were dating. They had come in the previous week with the female patient's daughter who is 7. She had swallowed a penny. The male patient was our first of the day on Monday and looked clearly distressed. He told us his side of the story about how he and his girlfriend had broken up and she was no longer allowed to live in this house with his son. Because of his current stress, he stated that he wish he could use but luckily his urine screen (which every Suboxone patient must go through at every visit) was clean. Later that day, his girlfriend came in the office as well. Her side of the story was a bit more dramatic and put him in a much more negative light. She talked with us for a good forty-five minutes. This is not uncommon with her patients that are in relationships. One patient will come in and talk about the other and it is interesting to really get a good sense of their relationship just from talking to them. I think that almost all people should go see a psychologist or have someone that can be a sounding board. It is so important to get emotions off your chest rather then keeping them in because once they build up, you might explode.

I'm still finding that the patients that are the most interesting to me are the one's that have neurological symptoms. We had one particular patient, Patient 38, who came in with severe migraine accompanied by dizzy spells. She mentioned that changing positions particular triggers these episodes as well as any type of activity. She has high blood pressure which could be a potential cause of dizziness as well as excess of cerebrospinal fluid. She also had mentioned that she had been diagnosed previously with pseudotumor cerebri. Psuedotumor cerebri occurs when the pressure inside the skull (also known as intracranial pressure) increases for no obvious reason. Symptoms can mimic those of a brain tumor even when no tumor is present. It can occur in both children and adults but most common in obese women of childbearing age (this fits the description of the patient in question). If this patient had no underlying intracranial pressure (which she did due to the excess CSF) this can also be called idiopathic intracranial hypertension. This can cause swelling of the optic nerve and result in vision loss. Medications can often reduce the pressure but sometimes surgery is also necessary.

Over the last few days, I have also learned that I do not want to be a doctor that deals primarily with geriatric patients. A few are okay but we had one day this week when it seemed like we had one after another after another. It is almost like working with children again because they don't understand you and have trouble answering your questions or even paying attention. For example, Patient 41 is an older woman. She had an acid reflux problem and Dr. Zook asked her the question, "How often do you get your acid reflux per week?" As an answer to this question she continued to speak about how badly her reflux was bothering her. She then would go on to state that she had it all the time, but then say she didn't have it often, but then say she would have to take medication every night for it, but continue to say she only got it three or less times per week. About 30 minutes into the visit, Dr. Zook and I were both incredibly confused and didn't know which way was up. She also appeared (as most older patients do) to be quite the hypochondriac. She started mentioning how she had pain in her legs and her first reaction was to assume that she had fibromyalgia. Excuse me? Come again?

This is common in a lot of patients here in Kentucky. When they start experiencing something, they immediately jump to the worst case scenario. I suppose this could be to the large amount of "nerves" which is Kentuckian for anxiety or depression. I'm starting to wonder if this is a problem everywhere or just here. My guess would be that it is everywhere. It is almost like people want something to be wrong with them which I have a difficulty understanding.

Until Next Time,
~Wacko Jacko~