Main Street Doctor- Diary

My patients provide me with a variety of interesting persons, medical diseases and experiences. There is always something noteworthy to tell if I pause long enough at the end of a busy day to write it down. This diary is a means of sharing stories and not diagnosing and treating certain diseases. The names of my patients have been changed to protect their confidentiality.

Why am I still living?

This is a question I am frequently asked by older persons at the end of their lives. It is usually a legitimate question. I often answer that we like having them around, and that God is not done using them on this earth. I feel that older persons offer a lot of wisdom and love if we take the time for them. It's also not why are we still here on earth, but how are we going to live out the rest of our lives.
The Apostle Paul also speaks more eloquently than I can, when he writes from jail in
Philippians 1:20-26.

I eagerly expect and hope that I will in no way be ashamed,
but will have sufficient courage so that now as always
Christ will be exalted in my body, whether by life or by death.
For to me, to live in Christ and to die is gain. If I am to go on
living in the body, this will mean fruitful labor for me. Yet
what shall I choose? I do not know! I am torn between the two:
I desire to depart and be with Christ, which is better by far;
but it is more necessary for you that I remain in the body.
Convinced of this, I know that I will remain, and I will continue
with all of you for your progress and joy in the faith, so that
through my being with you again your joy in Christ Jesus
will overflow on account of me.

Sciatica

Jim Cardinal* was better today when I saw him in follow up for his left leg
pain and numbness. He elected to treat his sciatica just as I would have
elected the same conservative treatment for myself If I had his problem ( and
I did at one time and so I can empathize). Three weeks ago this 40 year old
typesetter for a local newspaper presented with left buttock pain radiating to
the left leg which was quite severe and which had not responded to symptomatic
measures at home over the previous 4-5 days. In addition to the sciatica type
pain, he was also having muscle spasm in the lower back. My presumption at
that time was that he had a bulging intervertebral disc pinching the sciatic
nerve. The muscle spasm was caused by the lower back muscle reaction to the
inflammation, swelling and pain. He received the normal therapeutic
ultrasound and electrical stimulation treatment in the office which relieved
some of the spasm. He also received anti-inflammatory medication and
stretching exercises. He understood that the various options for treatment of
this problem all resulted in the same outcome in the long term and so he
elected to treat his sciatica problem conservatively. When I talked to him by
phone a few days later he was still having a great amount of pain despite pain
medication and so I ordered physical therapy. He had 3 or 4 sessions of
physical therapy with the local physical therapist and so between that and the
medication and time he was much better today when I saw him. On examination he
still had a slight loss of ankle jerk reflex consistent with sciatic nerve
irritation. I again gave him options for further studies and neurosurgical
consultation but since he was feeling a lot better and able to work he
declined further studies, consultation or therapy. He promised to continue
regular exercises, back stretching and in general staying in shape with
walking. He also wants to lose weight which I definitely concur with. I think
in the long run if he stays in shape and continues to keep his weight down he
should do fine. He may have an occasional flare up of the sciatica but so
might he with any other more aggressive treatment.

Tongue-tied

Jared* is a growing little boy whom I delivered 2 l/2 years ago. His mother
made the appointment today because of a rash which she wanted diagnosed. After
we took care of the simple problem of eczema and prescribed over the counter
cortisone cream, what the mother really wanted to know was why he was having
trouble with his speech. When I had taken care of him in the nursery after his
delivery I noticed that he was slightly tongue-tied. In retrospect I wish that
I would have clipped his frenulum then because today when I examined his
tongue it was tongue tied even more. This was making it difficult for him to
say many of his consonants properly. What can be quite a simple thing to do in
a newborn baby is quite difficult with a struggling strong 2 l/2 year old but
with the help of mother and two office nurses I was able to make this simple
cut of his frenulum membrane with a small scissors. With some practice he will
be able to talk just fine now.

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