Therapeutics Review Optimising treatment of type 2 diabetes with metformin There is good evidence that tight glycaemic control significantly improves outcomes in patients with type 2 diabetes. All practice nurses will be looking to achieve the new General Medical Services contract (GMS2) targets for HbA reduction in diabetes (see box). Practices will be developing prescribing strat
Family case studyA lay person's view of today's medical profession Jan 10, 2002 This is a totally unprofessional paper. I did no current research. I am relying on my memories of research that I have done periodically, memories of what others have told me and memories of my own personal experiences. I'm just going to tell you "what it looks like to me." Neither dates, names nor medical terminology will be accurate. I have a lousy memory for those things and the theme of this paper does not rely on hard facts - only feelings and impressions. I have too much to say and too little time to say it to spend time looking for exact terminology and citing references. I am going to explain how and why I have lost respect for, and faith in the medical profession. I will probably die of whatever fatal illness I might acquire before allowing "them" to get hold of me. This will be a more or less chronological account of my experiences with the medical profession during my 51 years of life. First, at 14 months old, I had polio. Now, I don't remember anything about that except vague feelings of wanting to lie down on the cool linoleum floor and visions of running up and down a staircase in my Granny's house. I have been told by my mother and sister that it was several weeks after the onset of my illness that it was finally correctly diagnosed. I've also heard that my prognosis was not particularly good - I might never walk. Well, I got over it and have been walking ever since. The staircase in my memory was recommended as a form of rehab. I have been relatively healthy for most of my life since then except for a few injuries and typical illnesses, and one or maybe two atypical illnesses. I was a good student and excelled in math and sciences in high school and intended to become a veterinarian. But like most young girls of my generation, I got married instead. My first husband smoked and I started smoking at that time, not because I wanted to, but because I smoked a few to pester him into quitting and was immediately addicted. At the age of 21, I had a son. I got a divorce when he was 14 months old and never looked back. I moved back to Texas, got a job and worked for 17 years at an electronics company until they shut down. During those years I went on birth control pills, had a few typical illnesses that required treatment - colds, flu, sinus infections. I rode and trained horses in my spare time, dabbled in the social drug and drinking thing with co-workers, married a raging alcoholic, divorced him after nine months of my own sobriety, had my tubes tied and went off the birth control pills. I never had regular checkups, just went to the doctor when I was sick, or needed to refill the birth control. One time I went in with a painful wrist and forearm that just occurred out of the blue. This was before carpal-tunnel became the disease of the year. The doctor told me that I had a tendon inflammation - "sort of like a cold in your wrist". I took some aspirin and it went away after a few days. Later, I had "tennis elbow" from playing too much racquetball all at once - more aspirin, a little time, all better. Another time, I had a sinus headache that persisted for 3 weeks - my first encounter with a "specialist" (other than ob/gyn). The ear nose and throat specialist informed me that yes, I do seem to have an infection in my sinuses, but my headache was probably due to tension. He prescribed antibiotics - 10 days worth, and a muscle relaxant - endless refills. I took the antibiotics, my headache was gone by about day 4. Day 12, when the antibiotics were all gone the headache returned. I called the specialist, he asked if I needed more muscle relaxants, I said no, I need another round of antibiotics, I never took muscle relaxants in the first place, because they made me goofy. Against his better judgement he refilled the antibiotics, I took another 10 days worth, my sinuses cleared up, my headache was long gone and I eventually threw the muscle relaxants away. I also began to suspect that doctors weren't always right, like most people, but some of them think they are. Then there was the mater of the tubal ligation (sp). I was in my mid thirties, had no intention of having more children and was suspicious that the birth control pills might be causing me some problems. The Gynecologist tried to talk me out of it because of my age and reminded me that it is not reversible. I persisted that I did not want more children and he sent me to a surgeon who would do the procedure. He explained the procedure. Since I was too stupid to ask, he did not mention any long-term side effects. I found out about them when my next menstrual cycle brought on cramps and flooding worse than childbirth. I had never had sever cramps before - didn't even realize they could be that bad. When I went back to the gynecologist with this complaint he said - and this is a quote - I remember it vividly: "If you didn't want to have cramps, you shouldn't have had your tubes tied." He prescribed 500mg naproxin sodium - take 2 at the onset of menstrual cycle and one every 4 hours as needed thereafter. I took at least 1500 mg of Anaprox every month for the next 10 or so years. It worked, but nobody ever mentioned what it might do to my stomach. I knew that I could not function without it, so it really didn't mater. What did mater was that the doctor who tried to talk me out of the tubal with the "it’s not reversible" approach never once said, "If you do this, you will have severe cramps during each menstrual cycle and will have to take a strong anti-inflammatory just to function until you reach menopause." This seems to be pretty common knowledge among gynecologists, but the women whom I've talked to who have the exact same problem have never put the two together until I mention it. No doctor had ever told one of them that there was a relationship between the surgery and the cramps. What's that all about? When my son was 14 years old he was diagnosed with ulcers. Rare in one so young, but not unheard of. Over the years he has been treated with the typical antacids, diet control, etc. Relief has always been temporary. About 10 years ago, I read about the discovery that ulcers are actually caused by a bacterium and could be cured with specific antibiotic treatment. The next time I talked to my son, I told him about this and suggested he look into it. The next time he had a flare up, he was treated the same way he always had been. I ask if he mentioned the antibiotics and he said he had. I was under the impression that he had been treated properly that time. Months later when I was talking to him he mentioned having stomach problems again. I asked about the antibiotics and he said he never got them. Of course he is grown and managing his own life so I don't have much say so in his health care anymore. Just last year - 10 years after to discovery of the true cause of ulcers - he was finally tested for the bacteria and treated with the antibiotics. It took a particularly serious bought and about three different referrals to finally get the proper treatment. The first doctor he saw, (a PPO assignee) did not even look at his previous records and refused to believe that he had ulcers. Chris said when he told him he had had ulcers since he was 14 the doctor just said that 14 year olds don't get ulcers. Another unsettling experience occurred when I took a friend of mine to the emergency room with something in her eye. She was in severe pain. I had already examined her eye and saw what looked like a splinter of wood or straw stuck in the white part of her eye above the iris. The ER doctor examined her eye and found some traces of mascara in the lower lid. He washed it out, put in some eye drops and sent her home. I tried to get him to look again, so I could show him what I had seen, but he wouldn't. (All women who wear mascara know that a little of it getting in the eye is common and not usually a problem.) She had to suffer through the night and go to her own doctor the next day. When I lost my job of 17 years and went to college at age 40, I developed a feeling of my heart skipping a beat every once in a while. I was taking physiology at the time, so I knew what it was, but was concerned that it was getting worse - about every nine beats when I counted. I went for an EKG. The doctor that did the test, pulled off the sheet, showed it to me, and said "see, regular as a clock." I had to point out the premature beat to him along with the printed warning at the bottom of the sheet. He looked a little closer and told me that every one does that sometimes - nothing to worry about - but he'd redo the EKG. When it showed up again, I told him that I had counted them at every nine or ten beats with a stethoscope, and that seemed a little out of the normal range. He blamed it on caffeine, nicotine and stress. The most stress came from knowing that I had to read the EKG for him. What if there had been something there outside the realm of my limited knowledge? Maybe there was, I haven't had another EKG until recently, but I'll get to that later. My degree was Animal science - pre-vet option, so I learned a lot about physiology, microbiology, nutrition, etc. I also learned that the students who get into medical or vet school are not necessarily the smartest ones, just the ones that know how to test well. It's an art. Has a lot more to do with the ability to memorize than deductive reasoning. Just because you can memorize all the names, etc. for long enough to ace a test doesn't mean that you can put that knowledge together and use it to make decisions. Professional schools always include a course in ethics. They should also include courses in deductive reasoning. The scientific method is pretty useless without it. It may be that all truths can be calculated with a mathematical formula, but, unfortunately, we don't have all the formulas yet. As I get older, I have more opportunities to deal with the medical profession. A few years ago I developed severe lower back pain. Now I spend a large portion of my time on the back of a horse, so it is not remarkable that I first noticed this pain while I was riding - at least not to me. It started as a twinge that seemed to originate in my right sacroiliac joint. That was the beginning of 3 months of misery. This first twinge was accompanied by spotting. I was menopausal and had not had a menstrual cycle in 4 or 5 months, so I suspected a relationship and set up an appointment with an OB/GYN. A trip to a clinic with unbearable pain before the OB appointment produced some X-rays that showed nothing remarkable, and a call by the DO that treated me to the OB/GYN to try and move up the appointment. The OB/GYN started me on hormone replacement and referred me to a neurologist. The neurologist decided that I did not have nerve problems therefore it must be arthritis of the sacroiliac and prescribed massive doses of ibuprofen. This had little effect except for eventual stomach problems. After a couple of months the pain began to subside and I almost got back to normal for about a week. Then, on a Friday it resumed. I made an appointment with another doctor for the following Monday, but woke up Saturday morning unable to get out of bed. I called the OD that had seen me once at the walk in clinic. I mentioned to him that I had had a minor rash across my stomach one day during the week that I was better and a light bulb went off over his head and he said "maybe you have shingles." I scoffed and said it wasn't that kind of rash and the pain was in my back. He explain about the nerve pain of shingles even when there was no rash and ask if I had ever had chickenpox, which of course, I had. He called in a prescription for one of the antiviral drugs and I called a friend to pick it up for me since my husband was on the road (he's a truck driver). I had crawled from the bedroom to the couch and phone and certainly couldn't drive. My friend brought the drugs, I started taking them and by my appointment on Monday, I was down to a relatively minor pain. The doctor that I saw said that I did not have shingles and sent me to a chiropractor. I had never tried that, so I went. The pain expanded to the left side after that although it was still bearable. I called the DO back and asked if it would hurt to take the antiviral even if I didn't have shingles, since they seemed to help and nothing else did. (Besides, I had already paid $75 for 4 days worth.) He said it couldn't hurt. By the 4th day I was totally pain free. On the 6th day it came back. I called and got the antiviral refilled took it for four more days. The pain was gone - absolutely. Just like it had never been there. I did a lot of Internet research on shingles and found very few references to "Zoster sans herpes" (shingles without a rash) There were numerous references to "post herpetic pain", supposedly due to nerve damage after the virus was gone. It was treated with pain management rather than the antiviral. I let it go, forgot about it and got on with my life. It recurred in about 6 months. I wasted no time with neurologists, orthopedist, or bone crackers. I called my doctor and begged him for a script for an antiviral. He finally gave in and called it in. I took it and in 4 days all was well again. I did some more research, this time on back pain in general. I found that "non-specific lower back pain" like mine was quite common. I also learned that most cases will recover in about 3 months with or without treatment. Interestingly, that is about the length of time it takes for an untreated case of shingles to clear up. I also learned that the X-ray anomaly known as bulging disc or slipped disc that is often sited as the cause of this pain occurs in a large percentage of people who have no back pain. Surgeries to correct the problem are minimally successful in alleviating the pain, they just make the X-ray look better. I have concluded that a large percentage of these cases may actually be Zoster sans herpes. I went on a campaign to get someone it the medical field to test this theory. It would take a simple double blind study of patients with non-specific back pain - some getting anti-virals others a placebo to prove or disprove my theory. Wouldn't it be great if you could spend $150 on a bottle of pills and be pain free in four days instead of spending 3 months of misery and thousands of dollars to get minimal results? Well, it would be great for the patients, but not so good for the back specialists who were getting the thousands, huh? No much incentive there to get the medical profession interested in such a study. I got either totally ignored or pooh-poohed. I was almost convinced that they were right. My recoveries had just been coincidental. Then it happened a third time. I got the drug. I took it. No pain in 4 days. The fourth time - this time was different. I was doing some serious lifting work - laying patio stones. I got in a hurry due to an impending storm, grabbed a stone off the pile and pulled and felt something snap in my back. Same kind of pain, but this time I knew there was a cause. This time I went to a chiropractor. I never held much faith in them before, but my faith in traditional medicine has become so shaken, that I figured it couldn't hurt. I got better. I wasn't cured in 4 days, but had just a little soreness after a couple of weeks. Might have healed in that length of time if I had done nothing. I don't know. I do know that if I had gone to a traditional doctor, I would have spent thousands on tests and treatment - possibly surgery if they found something that looked like it might be fun to cut on, and would not have healed any faster. Might have been laid up for 6 months if they opted for surgery. Might have died from the anesthesia, or infection by resistant bacteria. Do I sound a little cynical? Well, I haven't gotten to the part that caused me to write this essay (or whatever it is) yet. Before I get to the current problems, I need to mention my sister. She is nine years older than I am, so she reached some of the same conclusions about nine years ago. She found a lump in her breast. She had a mammography then a needle biopsy. Next to come was a lumpectomy. She said no. She was told that it wouldn't go away. Something would have to be done. She just refused. It went away. About five weeks ago, she developed a headache. It persisted for 2 weeks when she finally went to the doctor. Sixteen hundred dollars worth of tests later she had a clean bill of health from the hospital, a smaller bank account and, of course, the same headache. She had gone through a round of antibiotics for a sinus infection that they later decided she didn't have, and numerous pain pills that had little affect on the headache but kept her pretty doped up. She made an appointment with an acupuncturist in desperation. Two days later, the headache was gone. Her husband laughed at her for drinking the Chinese herbs the acupuncturist gave her and she told him she would rub them on her big toe if told to, since now she didn't have a headache and three weeks of traditional medicine had done nothing but lighten her pocketbook. Now I am pretty much one who scoffs at the various alternative medicines, especially the recent nutriceutical fad based more on hearsay than scientific studies. But, I can see how it would be much easier to believe in something that seems to work (even if it’s just a matter of time healing all) than in traditional medicine that often does more harm than good. Next is my husband. He has never been the picture of health. Smokes, is overweight, doesn't get enough exercise (he is a truck driver) and eats too much of all the wrong things. Year before last, he began having a "cramp" in his right calf anytime he walked farther than once around the truck. I convinced him to go to the doctor, finally. Sent for a Doppler (I thought that was weather radar) - poor circulation- minimal digital pulse in the right foot. Diagnosis - lower leg ischemia. He was told he might loose his right leg if something wasn't done. More circulation studies reveal complete blockage of the right femoral artery in the pelvis and partial blockage in both lower femoral arteries. Referred to a cardiac surgeon who wants to do a "fem-fem" first. Simple surgery - bypass around the blockage. Right! We now know that a "fem-fem" involves an incision from just below the sternum all the way to the pubic bone. In order to get to the offending artery where the "simple" surgery is performed, the doctor must literally lay the intestines out of the way, then put them back. That much shock to the intestinal tract shuts it down so that the patient must have a stomach tube for 4 to 6 days. In their infinite wisdom, the insurance company only approves a 3-day hospital stay for this operation. (After all, it's a simple surgery!) The doctor is obviously pleased with the results. His little "doppler" indicates a good pulse in the right foot. Four weeks of rehab - walk until it hurts then walk some more. Oh yeah, you've got to quit smoking or it won't work. From my husband’s standpoint the leg hurts just as bad as it ever did. Back to the doctor. Well now we are going to have to do a "fem-pop" Much less invasive than the "fem-fem". We just go in and graft the popliteal (sp?) vein into the femoral artery in the leg. Right! Seven or nine incisions in a dashed line from the groin to the ankle. Oh, did we mention that since your circulation is so poor, these may not heal very well and will be prone to infection? He was released to go back to work with two of these incisions oozing pus. The one nearest the groin actually swelled up the size of a baseball and burst after he went back to work. And as for the quitting smoking - well, you know how that goes. We both tried. Neither of us actually made it past the first month. I didn't have the heart to tell him that I did a little Internet research on these procedures and found that the real success rate was minimal. Most patients wind up losing a limb after a couple of years. Oh yeah, remember he went to the doctor because his right leg hurt when he walks around the truck? Well, it still does. Its not one bit better than before he went through all this agony. And guess what. Now his left leg hurts too. He is coming home next week, probably for good. He can't operate the clutch anymore. I made him an appointment - with an acupuncturist! I don't really have much faith that there will be a miracle cure, but it couldn't be any less effective or more painful than what was already done. What I believe might have been effective (hind sight is 20/20) would have been to send him to a health spa, changed his eating habits, exercise, stop smoking, etc. Of course the insurance would not have paid for that. Without a doctor's report, his disability would not have paid either. For the same money spent and time off work, he could probably be well on the road to good health by now. Of course any success would have depended upon him. And now for the finale'. My mother is 78. Until about 5 months ago, she lived alone, and managed her on affairs in reasonably good health. She called one day last summer and said she had a knot come up on her neck. Thought it might be a spider bite. It didn't go away so she went to the doctor. He did a needle biopsy and drained a considerable amount of whitish fluid out of it. Said he'd never seen anything quite like it according to Mama. Sent it off to a lab for testing. Came back negative for cancer. It refilled with fluid and she went back. Drained again, still unknown. Her GP referred her to an ear nose and throat specialist. (The same one that treated my headache/sinus infection years ago) He was going on vacation and would be gone for 2 weeks, but he drained fluid and sent it off to a lab for testing. An MRI was ordered sometime during this period. Mama called almost in tears and said he thought it was cancer, but wouldn't know until the biopsy came back. The MRI apparently showed the tumor to be deep in the neck, underneath the blood vessels running to the brain. This biopsy came back positive for squamous cell carcinoma - a metasticization, primary unknown. He scheduled her for surgery. I went and took her to the hospital for the surgery. I conferred with the doctor who said that once he got it out, the frozen section should tell him more about where it came from. After surgery he came and told me that it was a "big old cancer" but still did not have any idea where the primary was. It could have already been taken care of by the body and might not exist any more. Radiation treatment was arranged. I went to take her to the first treatment (actually just the marking) she was still very weak and sore from the surgery. She complained that they "nearly killed her" doing the treatment. Apparently, they tied her arms down, pulling her still very sore shoulder. I was assured that the early treatments would not make her sick. She would get weak towards the end of the treatments. They would arrange for transportation to the treatment center. (I live in a different town, 60 miles away) After the surgery, her mind never seemed to recover. You could not depend on what she said. She was somewhat confused and her memory was even less accurate than it had been before. I called her most every day to see how it was going. After the second or third treatment she said she was too sick to go. I got a call from the transportation people. They said she would refuse to go, then tell the treatment center that they didn’t come to pick her up. She called on a Saturday morning and said she had fallen during the night and was afraid to get out of bed again. I went down and found her on the bed, totally out of it. She had some pills and suppositories that the Doctor at the cancer center had given her for nausea. It was Compazine. I looked it up on the internet. Side effects were memory loss, confusion, and catatonia. She was in no condition to be living alone. I called her sister and told her the situation. I had to go back home. Her sister took her to her GP and he did a urine test and determined she had a bladder infection. Compazine causes bladder restriction, so would aggravate the problem. He prescribed an antibiotic, which looked very much like the Compazine pills. Mama called again, afraid to stay there by herself. I went and picked her up and brought her home with me. She got a little clearer in her head after I made sure she was taking the right pills for a couple of days. I took her to a doctor's appointment with the surgeon and told him about the Compazine. He agreed that it should not have been given to her living alone. I also found that she had a bottle of Darvocet that he had prescribed and wondered how much of that she had been taking. I was ready to stop the radiation treatments but he insisted she needed them and that they shouldn't be making her that sick. Maybe it was the urinary infection. This went on until she finally had to be hospitalized. She had lost 30 pounds and was not eating at all. In the hospital, they did an MRI and found no signs of cancer, but scaring in the lungs from the radiation and the urinary infection was still there. She was very dehydrated. After a couple of days of IV fluids she started eating a little and seemed to be improving. It was agreed to move her to a rehab hospital. In the meantime, they started radiation treatments again. After two treatments, she was worse than before. At the Rehab hospital, she seemed to be almost catatonic. I found out they were giving her another drug for nausea that "made her a little drowsy". She had quit eating altogether and was being kept too dopey to care. My sister met with her doctor and called me to say she thought he was a kook and seemed to think we should just let her die. He didn't want to give her intravenous nutrition because he felt it was against her wishes to be kept alive artificially. When asked why she was going down so fast, he said it was "the malignancy" When we pointed out that the MRI showed no malignancy anywhere, he didn't have an answer. We made it clear that she was to have IV food, no more radiation and no more mind altering drugs of any kind. She improved pretty quickly and I got her released and brought her home with me the next Tuesday, November 20. I got some home health care and PT set up for here and made an appointment with a local GP for November 28 to take over her case and receive her records. He did not examine her, just had us sign the records releases and made an appointment for January 8. I suggested to the home health nurses that she should have a urine culture, since I wasn't sure if the infection was cleared up. It came back positive and the Dr. prescribed two antibiotics. Up until that time she had been eating some and seemed to be getting stronger with the PT. Her mental state, however, varied between wanting to go home - she could take care of herself, and not being able to get out of bed. She was often confused and sometimes seemed to be in a dreamlike thought pattern. She quit eating altogether, wouldn't take the pills unless forced and began getting progressively weaker. We took her to the hospital emergency room on December 21st after she got down and couldn't get up the night before. She has been in the hospital for 8 days now and has gotten progressively worse. She was found to have a heart arrhythmia and put on digitalis. She is still not eating. She has seen several specialists and a parade of on-call doctors, as the doctor that I had hoped would take over her case and actively seek to find the problem has been gone. A swallowing study showed some problems but not sufficient to explain her not eating at all. The endoscopic exam of her nasal passages found nothing remarkable except for possible reflux. Chest X-rays show considerable scaring in the upper lobes of both lungs from the radiation treatments. (The ER doctor thought she had had tuberculosis.) The CAT scan shows the lung scaring, small vessel disease in the brain (probably consistent with her age?), some gall stones (should this be treated?), diverticulosis (old news), but nothing sufficiently remarkable to suggest her current condition as far as I can tell from what the doctors tell me. Having had my first personal experience with reflux disease just this week, I suspect that this is a large part of her eating problem. Although it was noted 2 days ago, nobody has seen fit to treat it. I have watched her eat and see her attempting to swallow and exhibiting a behavior very similar to mine when I get a "burb" reaction each time I swallow. She doesn't complain of pain on swallowing, but says it "hangs in her throat", or "tries to come back up." She also complains about her tongue burning, suggesting that acid is coming all the way into her mouth. As far as I can tell, everything that is wrong with my mother today is the result of treatment (or maltreatment.) When all she had was the cancer, (assuming it was cancer - I'm not totally convinced that it was), at least she was able to sit up and take nourishment. Right now, she is well on her way towards starvation, and if she gets past that, her mental capacity is sufficiently debilitating to insure that she will never live independently again. I'm wondering what happened to the concept of "first, do no harm." I think it has changed to: "first perform every procedure, test, and treatment that Medicare or insurance will pay for, then let the family deal with what ever is left." I hope I'm wrong, but I think that if radiation produced the scars in my mother's lungs that would lead a doctor to think she has had TB, then it has probably produced enough damage in her brain to assure that she will never be mentally competent again. She was never really given a chance to make an informed decision about her treatment. She was told, "You have cancer and if we don't treat it, it will kill you." Nobody said, "If we do treat it, it'll make you wish you were dead." When all of this started my sister and I were the only family members that had any doubts about the course of treatment. Her sisters, her friends, and most of her peers were encouraging her to go through with it. They saw it as the only option. When this started, our mother was perfectly capable of making her own decisions, so it really didn't matter what we thought. I have mentioned my recent experience with reflux and would like to add this latest chapter in the destruction of my trust in modern medicine. On Christmas day, my sister, my husband and I made a stop by the hospital to see Mama, then headed to Wichita Falls to have Christmas dinner with my Nephew's family. During that morning, I began experiencing a gnawing in my stomach and a tightness in my chest and throat. It progressed to a pain in my esophagus followed by a reflux contraction upwards each time I swallowed. I was able to eat Christmas dinner, but it was not enjoyable. That night it worsened until I started vomiting (sort of) each time I swallowed. We only had three Tums in the house and I ate them. The next morning, my husband had to leave in his truck and I attempted to call my doctor for an appointment. I got a recording saying call the ER and ask for the doctor on call. I did and was prescribed a "Protonix". I picked this up on my way to see Mama at the hospital. I read the warnings one of which was do not take this if you are having swallowing difficulties. Hmm, that's exactly what I was having. I took one and went on to visit Mama, then meandered over to the ER to see if I could get a little check up. They were very busy. I sat there for over an hour, then told them I was going back to see my mother in room 101. They said they'd call if it lightened up. I came back in about 30 minutes, sat there another hour, then got up and asked if they realized I'd been here for over 2 hours now. A doctor said he was just coming to see me. I told him what was going on. I told him it felt like something was stuck in my esophagus. He mentioned a possible Barium swallow to see what was there. He left and returned with an EKG machine and started sticking electrodes on. This didn't surprise me. I knew they would have to rule out a cardiac problem first. He ran the test, printed it, tore it off and wadded it up, then came and adjusted the electrode on my right leg and ran it again. This time he came and started to remove the electrodes, but then decided to just remove the leads and leave the stickers. That worried me a little. Another doctor came in and said something about admitting me. I looked astonished and he asked "Can you swallow at all?" I told him I could, that it just hurt. He said "Just a minute" and left. Then a girl came in with a wheel chair to take me to X-ray. When she started doing a full chest and abdomen X-ray series, I ask if she was sure she had the right patient - I was supposed to get a Barium swallow. She looked at my arm band and told me they had changed the order. She wheeled me back to the exam room where another nurse came in and drew blood. After a while the doctor came back and began explaining that the EKG showed some "changes" and he had to wait for the blood test. I asked if I could go back to my mother's room while we waited. He said ok, but don’t leave. When the blood test finally came back, I was given the usual papers to sign and instructions to see a Dr. Bhargava at 8:30 AM for an EGD (endoscope) I was given the address of his office and told to not eat, drink or smoke any thing after midnight. He would meet me there. I followed the instructions and arrived in his parking lot at about 8:35 after passing it twice. No one was there and the door was locked. I waited another 10 minutes then went to the ER and explained what had happened. The girl paged the doctor, then told me that I was supposed to go to outpatient admitting. He would do the test here. I took a number and waited 30 minutes only to be told I was not scheduled. I explained the situation and was told that I should go up to "short stay" and they would work me in. By now its after 10 AM, I was sans nicotine and caffeine and patience. I had left horses locked in the barn anticipating being back home by now. I told them if I didn't get better and didn't die, I would have it rescheduled and left. I've been around long enough to know what it means to "work me in" - another 3 or 4 hours. When I got home and made a pot of coffee, I called and made the next available appointment with my doctor, and asked them to see if they could get the emergency room records and find out what all that was about. The receptionist set the appointment for January 28th, and promised to request the records. It’s currently December 29, so I may not make it. Jan 9, 2007 I made it to that appointment and later to a very expensive cardiac stress test at SW Medical Center. Apparently I was fine, because I never did get any kind of report from the Dr or the Hospital about the results. Nor did I get any warning that this test would cost around $6000, $2000 or which my insurance wouldn’t cover. Of course, I did get a bill from the hospital. I asked for an itemized bill when I saw the bottom line. Basically, by the time I had the test, I was completely recovered from whatever had been ailing me and I passed with flying colors. The techs monitoring my workout on the treadmill ask if I was a runner. My mother came back home with me for a while and I finally gave in and put her in a nursing home. She passed away March 5, 2003 without ever fully recovering from the dementia that started during her radiation treatment.
Greenhouse TPM/IPM Weekly Report University of Maryland Cooperative Extension Central Maryland Research and Education Center From: Stanton Gill and Ethel Dutky, University of Maryland Cooperative Extension Ginny Rosenkranz, Extension Educator, Chuck Schuster, Extension Educator, Suzanne Klick and Shannon Wadkins, Technicians, University of Maryland Cooperative Extension Amanda L