St Croix River Road Ramblings

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Friday, January 30, 2015

A Two Year Lube, Fluid Check and Battery Exam

Spent Thursday at the clinic getting some tests. Hadn't been in for 2 years, and everything is wonderful except my weight, blood pressure, thyroid level, heart rhythm, 1/3 shrinkage in my back vertebra from osteoporosis, and a few dozen other minor things. 

The test results would bother me a lot more except I feel fine.  I wouldn't have gone in at all, except my ongoing prescriptions won't get refilled without a few status tests to see if I need more, less, or can idle along at the current levels.  Like my father, I go see a doctor when I don't feel fine and only after a few weeks of not feeling fine.  And right now I feel fine!

The doctor thought my feeling fine was likely early dementia, and if I started feeling better than fine, I should be tested.  

 My body is being donated to the Mayo medical school, so a couple of med students stopped over to check me out and left rubbing their hands with eager anticipation!  This gift of what is left of me meets my frugality principle:  I get someone to haul my body in the back of the pickup to the Mayo loading dock and dump it off and no other costs, and a year or so later a few ashes are returned to my family to be snuck in a relative's plot at Wolf Creek. 

Recycling me also appeals to my scientific bent.  If someone can learn about the effects of a life lived on a rich diet, low exercise, and intellectual challenge, then great.   If all that is learned is how to cut and paste in surgery, even that is fine.  Even better would be a few parts reused, although I hope to use up mine to the fullest extent before passing them on.    

After the exam and the edgeline BP, I promised to lose 25 lbs, exercise regularly, give up salt, and try to cut down on lying both ways.

I have a followup BP and weight check in a month to see if my promises are actually being followed.  I figure if I lose 5 lbs in a month and my my BP is 149/82 (rather than 150/83) I will be given an "atta boy" and left along for another 2 years!

I made a point of weighing in with my shoes on and my pockets full, so emptying them and removing my shoes should get me half way there!   
Often someone sits down at the Atrium piano and plays a song.  If only I had listened to my mother and continued my lessons, I too could sit down and impress the old sick folks sitting nearby.

Famous bronze statue of man passing a kidney stone and crying out "Why me, Lord?, Why me?"

Everything is stored on the computer!

The inside of a Family Medicine exam room -- for a Nurse Practitioner.  A place to hassle out of shape, overweight old people, while getting paid to do it.  The perfect job for a masochist!

The blinds are closed on the ground level room--the view is out to the north and second street.  

Everything about your health record is instantly available on the Mayo Clinic computer system.  The Clinic just signed onto a new project to replace the existing system with a system called "EPIC."  A huge job for the IT professionals (which I used to be at Mayo).  

A private booth so you can change into a flimsy gown with dignity and privacy before getting an exam that probes your inner-most cavities. 
Some of us look better clothed.  An old man taking a selfie. Does he look like his blood pressure and weight are above average?  Some of us are happy to be above average any way we can. 

Is the fuzziness is due to essential tremor, Parkinson's or neuropathy?    

And after the exam, I can look up everything in the online Mayo Patient application.  Here are some notes from Thursday's visit.  The PHQ is a depression test -- some questions to see if someone as old and decrepit as me is likely to off himself in the next few weeks or months, giving the clinic bad publicity.  The 0 on the test means zero thoughts of ending it all in the last week.  

IMPRESSION/REPORT/PLAN #1 RN blood Pressure check PATIENT EDUCATION Patient reports having had previous education on diet and diet which could lower his blood pressure. He laughingly states that he could be motivated to lose weight and watching his dietary intake if it meant not taking a medication, but is willing to if that is what Dr. A____  feels is necessary. 
He reports that with his Myasthenia Gravis Dr. A___ was worried, but now that he no longer has symptoms, he feels great. 
His PHQ-2 was 0 with no suicidal ideation. I will review with Dr. A___ and contact the patient with additional recommendations. He uses Mayo mail out pharmacy

IMPRESSION/REPORT/PLAN Dr. A___ has reviewed. Per Dr. A____ the patient was told "by new guidelines based on age, blood pressure less than or equal to 150/90 is acceptable, so he is right there. At this time she would recommend working on diet, exercise, and lifestyle changes to see if this number can decrease some, but he can hold off on medication initiation at this time. The patient states he is well aware of what needs to be done, it is just getting his head and body to go along with it that is the hard part. He plans to work on this. He will continue to monitor his blood pressure at home and notify Dr. A___'s office if blood pressures are going over 150/90

IMPRESSION/REPORT/PLAN  Per Dr. A___, labs test from 1-29-15 including TSH was elevated at 13 and TPO Ab was also elevated. Recommended to increase Synthroid from 75 mcg to 88 mcg (although with the elevation he may need 100 mcg) then recheck TSH in 8-12 weeks. Patient states he is taking Synthroid on an empty stomach at least one half hour prior to breakfast. BMD osteopenia, is stable and improved compared to last check. Recommended to continue Fosamax at this time for at least 5 years.

I had tests for ongoing thyroid autoimmune disease (my immune system has met the thyroid gland, decided it is an enemy and is creating antibodies to destroy it --TPO antibody test).  The treatment is to let the immune system wreak it's destruction and take synthetic thyroid medicine to compensate for the lack of thyroid output.   

I had tests for osteoporosis and have been taking a bone density medicine Fosamax, and that appears to be working and so I get to continue that.  I would very much appreciate increased bone density, although the opportunity rises rarely.  

As part of my winter overhaul, I am getting an eye exam to see if my cataracts have "ripened."   My vision is OK, although increasingly my world view is dimmed by floaters (air gaps in the vitreous humor).  I find these gaps in my humor distressing.  It appears that my large doses of prednisone in 2012-2013 for myasthenia gravis (still in remission) did do a little extra mucking about ( I think the medical term might be some other word) with my vision.  

Anyway, I feel fine, it is nice to have someone worrying about my health, and I suppose I will have to try to cut the BP as I have a followup check in a month to see if I am headed in the right direction.  

The goal of modern medicine is to keep one alive until all of his money and insurance are used up paying for the privilege.  I am trying hard not to abuse Medicare and my insurance by having a living will that says "if Mr. Hanson is unable to enter his password into his computer within 1 minute, you should pull every plug that connects him to life and Facebook and his blog."

Good health to you all.