I’m Back Again, with My Personal Blueprint for Health!

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claudia-mdHi there. It’s Dr. Louella… Yes! I’m still alive!!! It’s been over a year since I’ve posted. I’ve been through many transitions since then. For example, I now see ‘dead people.’ I do medico-legal duty which involves pronouncing people dead from homicides and accidental deaths and referring bodies for autopsy if needed. I am not a CSI (crime scene investigator) but I work with them.

On the lighter side, I have been trying to practice what I preach, a healthy lifestyle. Over my 20 something years in medicine, I’ve heard all kinds of formulas. But for my life, I just want to keep it SIMPLE. My formula for health is to lead a balanced life.

I now emphasize the basics as a lifelong approach to health. It contains nothing new, but as a natural mathematician, I need my own formula. The first four are for your physical health. The last 2 are for your emotional well being. Do not underestimate the power of either. We need them both:health-living.jpg

1.  EAT….we agree it must be done to live.

Eat regularly. Starvation is wrong for many reasons.

But eat small portions (this is key).

Eat balanced: your fruits/veggies, starches/fibre, beans/meat.

Eat a variety of foods. Who cares about ‘superfoods’? Each fruit and vegetable has different benefits which man has not yet discovered. Why go off on the latest trend? Eat them all.

Reduce sugar. Reduce fats.

Use specific vitamin/mineral supplements we are still likely to be lacking.

2.   DRINK WATER…. water is in a class by itself. Most people don’t drink enough. Drink it and drink it often. It actually is needed more than food.

3.   SLEEP….. many of us do not understand the importance of sleep. When we sleep insufficiently our brains do not function at their maximum, leaving us with slower thought processes and fatigue. Find out how much sleep you need at nights, according to what makes you function best, and schedule it!

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4.   EXERCISE….. you may or may not lose weight but exercise has a dozen other benefits. You will also live longer with less pain in later life. Exercise (power-walk, run, skip, cycle, dance, swim, kick box, weight train, do aerobics, karate, etc.) for about half hour a day, plus other routine physical activity (house chores, regular walking, gardening). If you lie around all day and then do half hour exercise, it will benefit you little.

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5.  GIVE LOVE AND RECEIVE LOVE…. to your creator, co-workers, friends, family, significant other, pets. Both giving and receiving love release the feel-good hormone, oxytocin, and improves your well being and functioning.

6.  RELAX/DO WHAT YOU ENJOY…. obviously this would make for a healthier you. Life for most of us on planet earth is stressful. When we are stressed our blood pressure and sugar can rise. Relaxation/de-stressing/fun are aspects of the human nature we cannot properly live without. Schedule breaks. Do something different. Switch your mind off work. Do something you really enjoy. This will give your body and mind time to better assimilate the work you have done and prepare you for what lies ahead. Recreate to re-create your being.

Now that there is MY blue print for me to live healthy. I haven’t got it mastered as yet. For example, I started having more fast food as I was ‘transitioning’. Now I have to practice good old home cooking to get what I need. And I am starting back to exercise…again!!!

This is Dr. Louella, over and out! From the beautiful isle of Trinidad.

Talking To The Trini Patient; The Language Barrier

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Hi there! This is Dr. Louella. I’m literally stealing time here (hope I don’t get caught). But I was just thinking how I am not sure I can be a doctor anywhere in the world besides Trinidad because of the language. Yes! The language.

Of course, we speak English here, as a first (and practically only) language, although Spanish is our second. But these patients!!! It’s pure ‘Tringlish’ (Trinidadian English; ok fine, that isn’t a word; pure ‘creole’ then).

That was the strangest part of newly becoming a doctor, for me… the communication barrier! These people used different terms and different sentence construction from me.

I was raised in central Trinidad but honestly, my family didn’t mix much.  My mum sent me to a private primary school, then I passed for a convent for my secondary education, then off to university. So I was not well exposed.

I’m frequently asked by patients, “You’re not from here?” I still want to knock  someone’s head off every time I hear that. I bet them that I am more from here than they are, because I work three minutes from where I grew up.

Some say it’s because I have some sort of an accent. What accent??? I’ve never lived anywhere else!!! One or two have tried to explain it’s just that I speak well. Ok, I can accept that.

But it’s been sixteen years and by now I can understand the patients. I also ensure that they understand me.

I understand when a granny has ‘junjuni’ (parasthesiae; i.e. pins and needles) and when her head ‘hutting’ her (i.e. is hurting her). Maybe she has an ‘inside fever’ (is feeling feverish) or perhaps the poor old dear was ‘waking’ all night (probably went to a ‘prayers’ or wake or something and got to bed fairly late.

I can even interpret when an old man says he is ‘whizzing,’ ‘Ah only whizzing doctor!’ because the elderly gentleman is wheezing constantly. I start calling it ‘whizzing’ too so he’ll have no confusion.

A real classic in Trinidad is ‘gas,’ a nuisance that reaches up as far as the shoulders and head in some patients. I explain to some that ‘gas’ resides in the stomach and intestine only, but not to everyone, because they would not believe me if I tried.

One thing that still gets me is the ‘bad feeling’. When a patient is getting a ‘bad feeling’ I don’t know if they mean nausea,  dizziness or some other symptom, so I enquire.

I sometimes come across the unpleasant cases where they are differences in terminology, such as a grandmother being distressed that her  grandson was ‘interfering’ with her little granddaughter’s ‘bajina’ (i.e vagina, i.e. a case of incest).

When you ask a Trini patient how long he or she has had an ailment, say a pain, the answer is usually, ‘A while now,’ or better yet, ‘A long while now.’ They then need to be  asked for clarification because their ‘while’ and your ‘while’ may be very different (like weeks and years!)

When someone says their ‘stomach’ is hurting I insist they point to the area. In Trinidad the stomach seems  to be anywhere from the neck to the pelvis and I don’t pretend like I know where they mean.

Recently a clerk was laughing at a patient who was saying ‘CDAT’ for ‘CDAP’ (Chronic Disease Assistance Programme, where our patients get free medicines). I couldn’t join her because that was old news for me. As far as I see, more than half of them call it CDAT and I am cool with that.

What about the (mis)-pronunciation of drugs?  Does not bother me. Sometimes I correct them but if they are elderly, I am just glad they were able to come up with something identifiable.

So! The one who has changed in all this is me. I’m quite used to their language so there is usually a smooth flow of  Trini talk between the patient and me, except when they want to know if, ‘I’m not from here!!!’

Dr. Louella, over and out. Enjoy the season y’alls!!!!

 

 

Doctor, Does This Drug Have Any Side Effects?

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Hello again. It’s Dr. Louella, just winding up my weekend here. I’m a bit tired but still very much excited that I got some time to do this post.

You see, yesterday I was musing on a young patient I had seen earlier this week. He had asked me one of the most frequent questions I get from patients.

But let me give you the context of this case first. It was another busy chronic disease clinic. The ‘patient care attendant’ told me about a walk-in patient to be seen who had chest pain.

I asked for his age. He was 22 years old. Cool. I ordered an ECG ( EKG, electrocardiograph; or ‘heart tracing’) and said that I would see him later.

A few patients later they brought a perfect ECG for me in ‘normal sinus rhythm’ with no abnormalities. Good. No serious heart problem. I saw him a few patients after that.

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He was a healthy looking young male. It was easy to make the diagnosis. He told me he had central chest pain. I asked him why (because most of the times patient already know the cause). He confessed to having lifted some heavy boxes of meat the day before.

I did a brief examination of the heart, lungs and chest wall. He had a muscular strain. Case closed.

But not quite. When I attempted to prescribe an analgaesic (pain killer) for him I was confronted with the oh too familiar question…

“Does this drug have any side effects, doc?”

I think this is where public education should step in because I am asked this question repeatedly nowadays. People need to understand these simple concepts so they can make informed choices.

I start by replying, ‘Of course. All tablets have side effects.  If you look in my book right here (the British National Formulary on my desk), each drug has a long list of side effects.

And there is no way for anyone to remember all of them. That’s why I walk with my book. Doctors usually know the most common and/or most serious effects.

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I like to refer to them as potential or possible side effects because it does not mean that you are going to get them.

Research is done so they know how many people suffer with each side effect of a drug and it is usually a very small number, like 5% or 0.5%. If many people are affected they wouldn’t allow the drug to be sold.

Now for the most, you may get one side effect of a drug. Or if you are really ‘bad lucky’ (Trinidadian for ‘unfortunate’) you may get two.

No one can predict whether you will get a side effect. It is only if  you use the drug you will know the effect. If something happens we  will deal with it. But we would not want to lose the benefit of this drug for no reason.’

Now there are some conditions where I can tell patients that using a medication is optional, such as for pain, itch or stomach discomfort but for diseases such as diabetes and hypertension which can ravage their lives, I urge them to take their pills everyday.

Many of our patients have heard from friends and family that these medication damage their kidneys and liver. They often do not take them as a result, or take them intermittently to mitigate these supposed effects.

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I stress to them that chronic diseases (especially diabetes and hypertension)  are the ones that have been proven to damage their organs. The pills are given to them to protect them.

Yes, sometimes the pills themselves can damage organs but this is rare compared to diabetes and hypertension which ALWAYS impair kidneys, whether to a minor or great extent.

People get complications and die of chronic diseases all the time. I don’t really hear of people dying from their medication. But I know it probably happens.

Our patients are also exposed to television advertisements where side effects of drugs are rattled off. But without the explanation I gave above we can see this turning people further away from conventional medicine if they believe that all these negative effects would happen to them.

The young man I saw that day accepted my prescription in the end. He understood that the likelihood of him getting a side effect of the drug was slim and we would deal with that if and when it occurs.

I also explained to him that although he was young and fit there was no reason to strain his body beyond its capacity as he had done recently because he would suffer for it. Damaged muscles often take several months to heal.

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Unlike the young man, some patients turn to alternative medicines. They are free to do so but I let them know my position on it.

I let them know that the medicines we use originally came from plants but they have been purified and from them synthetic ones were made.

All our drugs are extensively researched and the effects documented. Yet allopathic medicine is still far from perfect.

Many herbal products are not purified and contain several chemical compounds with varying effects. There is very little in the way of formal study of these chemicals.

Claims are based on anecdotal accounts (of people’s personal experiences) rather than on large controlled studies. Anyone can sell anything and claim anything about them because there is no regulation of these products. But not everything ‘natural’ is safe.

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But the thing is, it’s not that herbal products don’t have side effects. It’s just that the people distributing them don’t know, so everyone pretends like they don’t. And when people experience them, does anyone sue the herbalist? No! But sue your doctor, because he is rich!

Never mind that, if you see Dr. Louella dying, bring me the tablet, bring me the ‘erb, the weed, bring anything!!!

But while I’m living and can make a rationale choice, bring me the evidence to support your medicine!

Dr. Louella saying, do enjoy your day! Laugh! Sing! Dance! … I do!!!

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But No One Told me I am Diabetic, Doc!

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Hi. It’s Dr. Louella in a sombre mood today. I keep thinking about this patient I had today in chronic disease clinic; a young guy in his thirties.

No drama here. I started off with my usual verification of what the patient suffers with. I’ve been doing that a while now, since discovering that patients attend our clinics for years with only a vague idea of what they’re being treated for.

I don’t know if it’s a Trinidadian thing with the responses I receive but I’ve asked this question so many times that I’m no longer surprised…

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‘What are you suffering with sir/madame?’

Some patients get offended. They start to stammer that I am the doctor and therefore I should know. So I let them know it’s a big file (we use handwritten patient notes) and we would move a lot faster if they tell me rather than me having to go through all these notes.

Furthermore I remind them that they are the patient. It is their health and their responsibility to know what they are afflicted with.

‘So, would you like to tell me, sir/madame, what are you suffering with?’

There are other patients who begin everything with ‘they say’. For example that, ‘They say I have diabetes’. When I try to confirm that they mean that they have been diagnosed with diabetes, they respond consistently, ‘So they say’. So in my estimation, they are in huge denial!

Sometimes I would make a check in the notes only to find that they have had this said to them for five years or more. I let them know that ‘they’ say it only because it is true and it’s very important they learn to accept it and deal with it.

Then there are those patients who try to respond correctly but leave out diagnoses. When I check the notes there may be an additional diagnosis such as ischaemic heart disease or chronic kidney disease that they are clueless about and which they sometimes deny vehemently.

So then I need to backtrack to find out where that came from, if they were diagnosed at hospital or presumed to have the disorder or what. I need to know if a diagnosis is true or not to convey this to the patient sitting in front of me.

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Finally there are patients who give additional diagnoses to what are documented. Something may have happened since the last visit or more likely they had been suffering with some disorder and didn’t think it necessary to inform us.

Our patients attend several different doctors, clinics and institutions simultaneously. Very little official information is shared between these groups.

It is often up to the patient to let us know what is going on. To some of them it is a secret. Others forget or don’t think it relevant. Me, I grab up this stuff, because I want to know everything.

I use the diagnosis as a starting point to inform and educate the patient. It’s not that you maybe sometimes could probably have hypertension. You HAVE it and you need to deal with it. It’s not about a bunch of numbers but really debilitating complications that you could get but we are trying to prevent.

Getting back to the case at hand… When I had my usual discussion with this young man about his diagnoses today, I was a bit thrown. He knew he was overweight and had elevated cholesterol but knew nothing about having had diabetes.

But it was staring at me in his notes! He was newly diagnosed as a diabetic on the previous visit. Apparently he had not been told. Oops! That was a problem. And he seemed intelligent enough that he would have remembered.

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I proceeded to take the time to double check his blood investigations. Those results pointed to pre-diabetes, which as I explained to him, was in between ‘normal’ and ‘diabetic’. He was becoming diabetic. Steps had to be taken to try to prevent, or at least delay, full blown diabetes.

(The term ‘Impaired Glucose Tolerance’ is an older term that was and is still used for this condition. I much prefer the simpler ‘pre-diabetes’ when dealing with patients as ‘pre-‘ indicates ‘before’.)

While advising the patient about his condition, I needed to reassure him as well. He had been started on the appropriate medication (metformin). I actually increased his meds for now because his glucose level was high.

I advised him strongly about weight loss, that that in itself may reverse his condition and referred him to the dietitian (they make our life so much easier).

I spoke a lot about exercise because I know that if you’re not into it, it could take you a while to get started. I wanted to get him thinking that this thing was doable.

I threw out different ideas of different types of exercise he could attempt and explained how the day-to-day routine he described was physical activity but not intense enough to be classed as exercise. And he had the size to show for it.

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In the end he was really grateful for the information. But of course, other patients were waiting.

I really feel passionate about helping younger patients prevent and manage chronic diseases. That’s why I spend extra time with them.

It is often more difficult for them to come to terms with their illnesses than older adults. They want to enjoy their youth and do not want to be saddled with strict diets and medication.

I let them see that I take their health seriously and they should too. But I also try to inspire hope within them because without it they wouldn’t even try.

I will continue to ask patients the question ‘What are you suffering with’ or seek verification from the patient as to his/her diagnoses because it is important. It is only when people properly understand what is going on with them can they make informed decisions and live healthier lives.

I feel better now that I’ve shared that. I’d like to think I am making a difference in this world, one dot at a time. Dr. Louella is out!!!

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Once I Had a Naked Patient

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Hi. It’s Dr. Louella on a Saturday afternoon. I just remembered this doctor-patient story. It is a classic and I love to tell it.

I was at work in a rural health centre in deep south Trinidad. I had only worked in the community about two years then.

I was attending to patients, when the nurse called me, for some emergency I presumed. I started to grab my stethoscope. She said I wouldn’t be needing that but refused to say what the problem was.

Of course, I became suspicious, but not for long. As soon as I stepped out my door and unto the corridor I saw a naked female  in the waiting area.

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I looked again. Yes! There was a young woman in her forties of African descent butt naked, as they say, standing among the seated patients in the health centre!

So naturally I was shocked and disturbed and thinking, oh my God, what am I supposed to do? The doctor is always in charge, right?

The history was that of a mentally in female walking in off the streets without any clothes. The only real experience I had had with psychiatric patients was in medical school. Mentally ill patients were seen in a separate clinic at another centre.

Ok, so we had to do something. All the other patients were staring and it was causing quite a commotion.

All the clothes we had were on our back but nurse got a yellow surgical gown. It was a task to convince the patient to put it on but eventually she complied. What a relief! Remember, everyone was watching and listening and commenting.

We decided that she needed to be taken to hospital. We would call the ambulance but she had to be sedated first. Another task!

We got her to go with us into the treatment room. I had researched how much CPZ (chlorpromazine) to give. We used 100 mg and thankfully she fell off to sleep.

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She reached her destination but unfortunately it was said that she jumped out the ambulance and ran off into the town as soon as she did. I didn’t give enough CPZ! Hopefully she kept the gown on.

All that drama took a while but of course I had to resume seeing patients. I will never forget one of them, this elderly gentleman, smiling from ear to ear saying that he enjoyed the show. Dirty old man!

One has such amazing experiences as a doctor! Trouble is you are usually the one expected to fix the situation. I do it. With all the terror inside, I still do it.

Enjoy the rest of the day folks. This has been Dr. Louella down memory lane and back. Laterrrr!

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Ew! Sometimes It’s Yucky Being a Doctor!!!

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IMG-20140910-WA014Hi! It’s Dr Louella again on a cool Thursday evening (at least with the a/c on) here in our beautiful island of Trinidad. I want to recount this story from work because it definitely impacted me. It entailed basic medicine, yet it was quite unique and reminded of how unglamorous a doctor’s job often is.

This was about a week ago, in a clinic dedicated to children at the health centre. My morning had been busy, because there was an asthmatic emergency, along with routine cases and those without appointments.

The asthmatic was not settling down and needed transferral to the emergency centre. Securing an ambulance is not easy nowadays and we were relieved to get one and send her off.

There was a lull as clinic was almost over. I thought I’d grab a quick lunch in the kitchen.

Some nurse or other had tried to tell me about an adult patient they wanted seen, an amputee. Honestly, I did not pay much attention at the time because I was tired. But as I picked up my lunch bag I knew I would have to assess the situation before settling down so I went in search of the patient.

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She was easy to find. The female patient was seated on a wheelchair just outside the screening room. She was in fact a double amputee and had only two stumps without knees. She was flapping here arms up and down. One female relative beside her was panicking.

I identified myself and tried to bring some order to the situation. I enquired as to why they had brought her. There was a bit of rambling but from what I could decipher the elderly wheelchair-bound patient was well the day before but started shaking violently today.

Then I heard the word ‘fever.’ I was very glad that I did. I asked the nurse to include a temperature with the screening and explained to the relative that if she indeed had a fever then this would most likely be chills she was having.

Of course, she wanted to know why she would have a fever. I explained that a simple viral illness (or ‘the virus’ as we say it in Trinidad) could be the cause but when I attend to her I would be looking for a source of infection to make sure that is not the cause.

Whilst having lunch they gave me her temperature as 39 degrees Celsius. That was pretty high so she did have a fever. I ordered two Paracetamol (acetaminophen) for her and said I would see her shortly. I could not order a cold shower.

fever-thermometer-11947388While still eating I found out that this patient’s relatives had been trying to accost the ambulance attendants for our asthmatic patient to take their mother down to the emergency facility even before she had been seen by a doctor.

It seemed quite strange to me that they would behave so desperately. I was glad I had taken a little time to explain to them that it was most likely something minor.

I didn’t spend any extra time in the lunch room that day. But now I wish I had. I went to the office, called the patient and they wheeled her into my office.

The door was still open as they were positioning her wheelchair when she lurched forward in what I thought was a sneeze. Then I felt wet stuff on both my forearms. I flew out of my seat and sprinted to the wash basin about 5 feet away.

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I could not help it. I got into protect-me mode. I continued scrubbing my forearms intently until I felt clean again. I did not pay any attention to the patient and the relatives at this point. I had heard them mentioning something about vomit.

When I returned to my seat there it was. The old lady had vomited all over her clothes, the wheelchair handle, the wheel and the floor. They had a vomit bag for her. They had gotten it from the nurses when I was busy cleaning myself.

I quickly realized that I could not continue this consultation with things in this state. The wheelchair was rolling in vomit. I excused myself to find one of the cleaners.

Well I found them, but both cleaners were having their lunch in the kitchen. One asked me to relocate because they would not be coming right away. I had no choice. I could not talk to these people while staring at and smelling vomit.

(It is only when everything was over and I was recounting the events to some nurses later that they pointed out to me a few spots of vomitus on my pants. Of course I was disgusted and did a make-shift cleaning. I couldn’t wait to fling those filthy trousers to be washed.)

At the time I felt all clean, though. But I had to ask someone to leave a room for me to use it. A clerk was using one of the doctors’ offices as we are short of doctors this month so I borrowed that room and the relatives wheeled the patient over.

I understood from one daughter that it was whilst the patient was being bathed that morning that she began complaining of feeling cold and started to shake. The shaking grew worse as the day progressed. With the vomiting she was now convinced that it could be “the virus”.

The patient had had one leg amputated earlier this year and one three years prior. They were all properly healed and there were no signs of infection on the stumps. She was diabetic of course.

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Examination was otherwise normal, including the chest. I confirmed my presumptive diagnosis of a viral illness and gave her medication for vomiting (“Gravol” – dimenhydrinate), rehydration salts (Gesol) and more Paracetamol. I advised on increased fluid intake.

I was pleased with my management of the patient but I still felt a little shaken. It reminded me of other exposures I have had from one of the fattest needles ever going straight through my finger; to a needle stick injury with a confirmed HIV infected needle and my developing a fungal rash on the forehead from being kicked by a baby’s booty.

But what can I say? Every day is not the same. This one could not have been prevented but we take precautions whenever we can. Importantly, I was able to bring some assurance to this family.

I will bring you more interesting cases as I explain the some of the medicine behind it as well as the social aspects.

Life is still more than good. It is great and terrific and we must ever have gratitude that we live! Catch you later… Dr. Louella!!!

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Doctor advise us! This man’s blood pressure is very low!!!

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Hi. It’s Dr Louella. I had an awesome time dancing in church today. I promised to tell you about a sweet elderly gentleman in “Caring for others more than they care for themselves part II.” Well this is it, but with a different title.

The new title reflects how they bombarded me that day, as soon as I dropped my bags in my office. When I walked into the screening room last Wednesday, I was accosted by nurses.

They were sorry to disturb me so early but they wanted advice on an elderly man with a very low pressure. Now we hardly ever get patients with low blood pressure as a problem; unless they are in heart failure or it is from blood or fluid loss or a severe allergy.

This old timer was a regular, they said. He had been seen for low blood pressure before and had already been  referred to hospital. I looked at the BP. It was for real, 59/35. That’s quite low. I looked at the man. He looked terrible, really sunken in temples and cheeks. He looked like a homeless person.

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He was not out cold so he could speak. He complained of dizziness and some weakness. Said he was 72 years old. First thing that came to mind is if he had had breakfast. Yes he did, was the reply, after I had identified myself. He had had a coconut water. (Ok, so now I knew he did not have breakfast).The nurses had started giving him water to drink. I said, “Let’s get this man something to eat”. All we had were his crackers and my slice of chocolate cake (my lovely cake that I had baked from scratch and brought to have as a snack).

We moved him to the treatment room and gave him these things to eat. I proceeded to find out what his normal diet was like. Turns out he was married, his wife died and he lived with three subsequent women after that, all of whom had died. He has eleven children, who visit him from time to time but he lives alone. He drives his own vehicle.

He often neglected his meals now that there was no one to care for him and did not go through the trouble of preparing anything. He drank about quarter of a 1.5 litre water bottle a day. He sometimes felt weak when going to his garden.

So I was wrong about one thing. Here was no homeless person but a gentleman with the means to take care of himself but not the will to do so. I stressed the importance of regular meals and lots of water and asked if he wouldn’t mind a visit with our dietitian to advise him on meal planning.

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Water is needed for blood. It makes up about 50% of it. When we are dehydrated the blood volume decreases and there is less blood for the heart to pump so blood pressure drops. Eating helps the water to remain in the circulation by providing salt.

I explained that he found difficulty going to the garden because his muscles were weakened by old age and without eating and drinking he would feel much weaker. He was interested in avoiding that.

As soon as he had eaten the snacks he wanted to leave. I had to say “Slow down pappy. That food is not digested so it cannot benefit you as yet”. He himself admitted to still feeling somewhat ill.

I realised that with all this talk I did not do a physical exam on this man. When I did, I found him to have a bradycardia, an unusually slow heart rate. His was 48 while the normal heart beats between 60 and 100 beats per min.

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Here was another cause of a low blood pressure. I ordered an electrocardiogram (ECG or EKG), or heart tracing. It was normal except for a heart rate of 54. He was not on any medication.

I was now able to explain to him that his slow heart rate was most likely responsible for his low blood pressure. But this becomes exacerbated when he is dehydrated. Also when he does not eat, there is less salt to keep liquid in the circulation.

I explained that if his heart rate decreased further to the point where he could not support a decent blood pressure he would need a pacemaker inserted in his heart. He reacted strongly to that because in no way did he wish to go to hospital.

After a couple hours I felt pleased to see our elderly gentleman walking out of the centre, looking and feeling much improved, and with a blood pressure of 105/65. I’m sure that he would now be more empowered to manage such episodes. I’m also sure we’ll be seeing him again, if even for an update.

My next case will be what the doctor does when threatened by someone else’s body fluids. Does she save herself or play the brave doctor? My next post will tell. Bye for now! Dr Louella.

 

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Caring for Others More Than They Care for Themselves Part 1

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Hi folks. Dr Louella is back after a long break!!! I was busy getting married and settling into this new phase of my life (at this age).

I’ve always been looking for a new approach to this blog and I finally hit upon it. I plan to use my numerous unique patient experiences to teach about medicine, and by extension, life.

I have two interesting, touching cases to bring to you to demonstrate the title of this post and the medicine that goes along with it. The second case will be in the following post.

Now the part of medicine that I really enjoy is relating with the patients. I am different in this regard from many doctors I know. I take the time to find out about my patients and work with their situation. That’s one of the reasons why I am such a good family doctor.

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Just yesterday (Oct 6, 2015) we had a chronic disease clinic on work. Clinic was practically over when a nurse came to ask me to re-write an insulin prescription for a diabetic patient. She was an amputee. He husband had broken her insulin vial. He had also put her out of the house and she was staying with a cousin.

I was about to re-write it when she also revealed that the patient had missed her appointment and had come to get a new one. She was in the car.

Well, I thought that the only humane thing to me was for me to attend to her one time. But it was not that easy because this patient believed herself to be inappropriately dressed and refused to get out of the car.

To speed things up I said I would go outside and have a look at what she was wearing. I thought it was fine, a dress with a tube top, and reassured her.

Continue reading

My Name is ANXIETY!!!

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Hi, Dr. Louella again. I want to chat with you about anxiety today. This comes off our talk on insomnia, where I realized that anxiety was the cause of my recent bout of insomnia.

Now, this is not a treatise on anxiety. It is just want to make you more aware of it and how to deal with it. I am in the advantageous position of both having studied and treated people with anxiety disorders and having suffered anxiety myself. Advantageous? Yes, I know both ends of the stick and it is a good feeling when what you’ve been through can benefit someone else.

Now, I’m not going to pretend that I am cured of anxiety because it is usually not that easy. But I am managing it so that it does not interfere with my life. That’s the key, how functional you are. And I do function!

Well, what is anxiety to begin with? The very essence of it is fear. It may be disguised as concern or worry. It is a negative respond to stress. We allow ourselves to ruminate or obsess over a situation because we are afraid of something going wrong in the future or are unable to let go of the hurts of the past.

Anxiety is basically a human emotion which we all feel. It can be useful in small doses. Say you are crossing a road. Next thing you see a truck come speeding out of nowhere. The anxiety you feel can catapult you to the other side of the road. That’s our “fight or fight” response due to adrenaline (‘epinephrine’, to the Americans), and we surely need it.

But there are other times when that response is misplaced. Your daughter goes out with a friend, and as the night draws later you start to worry more and more about her safety in these times of high crime. You think you have a right to worry about her as a parent. But do you? Examine it with me for a while.

You will be evoking in your body a similar but milder ‘fight or flight’ response with your worry. Hormones are going to be released. Your heart beats faster, blood pressure will elevate, digestive system is suppressed, muscles tense up, but unlike in the previous example, there is no action. You can’t run across the road and save her! You can do nothing.

You get your body in this hyped up state and the excess fuel is not used for any physical activity. Normal bodily functions are suppressed when we are ‘stressed’, including the ability to fight off diseases. You are like this, yet you can do nothing to help your daughter. I let my patients know they’re not helping her, and they’re certainly not helping themselves with their worry.

So now, imagine if you do this repeatedly. Everyday there is something new to worry about: the state of the economy, the package delivered late, the traffic conditions, murder, the failed dinner, the sick child, the list is exhaustive. What happens in our minds? What happens to our bodies?

You may be surprised by what a negative response to stress does to our bodies. Remember, everyone is faced with stressful situations on a daily basis. But we don’t all respond the same. Something one person throws over the shoulder, another person laughs at and yet another rants and raves about. So, it is not the actual stressor but our response to it that affects our bodies.

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When we respond with frequent expressions of fear such as concern, worry, fretting and anxiety, it affects us physically. We are constantly putting our bodies on alert to act but never do. Chronic anxiety affects us through: dizziness, fast heartbeat, fatigue, headaches, inability to concentrate, irritability, nausea, rapid breathing, trembling, digestive disorders, memory loss and premature heart attack.

Look again at those symptoms. Don’t you get some of those from time to time? I have sooo many otherwise healthy patients who come in with the symptoms above. I automatically think ‘stress’ when I see a young woman with mild dizziness. More often than not, there is a huge stressor in her life that she is not coping well with.

And isn’t everyone ‘tired’ or has lack of energy these days? What about stomach problems and memory loss? Hey! I’m not saying we simply dismiss these symptoms as stress-related but it is important to be aware, especially in general practice, that you may not be able to find an actual physical cause of a problem. The possibility that there are psychological factors triggering symptoms is real.

But, being a doctor and knowing my body, if I ever feel dizziness I say to myself, “Girl, you are stressing over something. You didn’t realize, huh?” And when I am forgetting a whole lot, I know I need a rest. When my acid reflux resurfaces, I don’t take meds. I just make a note to myself that I’m stressed.

I must re-direct you to the symptoms one final time. Do you see why you need a good night’s sleep before exams? For memory and concentration. And how could a healthy corporate executive just keel over with a heart attack? Extreme stress. Ever notice you’re just sitting there but you’re breathing hard?

So the long and short of it is that anxiety and excessive stress are not good for our bodies, especially as cortisol suppresses our immune system making us more susceptible to diseases. When I’m stressing myself out a lot I think, “You’re killing yourself girl; shortening your life. Stop it!”

But really, I would like to take you more inside the mind of an anxious person (you may well find that mind is your own) because it’s no big taboo. All of us get anxious, some more so than others. I want to teach you to be able to recognize the state and be able to get out of it quickly.

Ok, so I gotta go now. Will chat more later in the week. I have got an hour and 30 min to get to church, and for me, that ain’t enough. I’m not like my sis who needs an hour. Ciao!!!

 

Insomnia!!!

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teddy-is-sleeping-vector-583552Hi, it’s Dr. Louella again. Would you imagine that after that talk about the basics of health I haven’t yet gotten enough sleep? While people looked forward to this, another long weekend in Trinidad, I didn’t. I knew that preparing for the Indian dance on Friday would take all day. Today I’m opening my office and then am part of a community-based clinic. I must attend a wake tonight then church tomorrow and event planning after. Breathe doc!

But there was a time, not so very long ago, that I wanted this very sleep but could not get it. I experienced insomnia for the first time in my life the end of 2013 into 2014. Now I know this is common among patients, but when you yourself suffer with something you sit up.

And my doc tried everything. He was a psychiatrist so I trusted his judgment and tried very much not to practice self-medicating. But I knew the medical options were limited.

First he thought the air-conditioning in my bedroom was too cold. If you research it you will see that environmental factors have a lot to do with sleep. You need a dark room. They advise you turn off your TV, computer, cell phone, anything with a lighted screen, about an hour before going to bed.

They repeatedly say the bed is only for sleep and sex. But we are all guilty of lazing around, reading, talking, using the computer, watching TV etc. on our beds.

Then what about the noise factor? Our bedrooms should be quiet except for some soothing or isochronic music (did not work for me though; isochronic tones got me tense).

Now these things never mattered to me before. I used my computer, watched TV and chat on my bed. Then next moment I was asleep. It is when you begin to have problems that you need to start examining your environment.

Is your partner’s snoring affecting you. Let him visit an ENT doctor or research solutions on the net. Maybe it’s frequent awakenings from a crying child. Can no one babysit for a couple of nights for you to get back your rhythm? At the other extreme we have the elderly who may need mild sedation at night to prevent them from disturbing the household.

I turned off my air condition and used the fan and still couldn’t sleep on my own. Then I admitted to my doctor my frequent trips to the bathroom. That obviously disturbed my sleep. He wanted me to do less water guzzling (or as they say abstain from fluids for an hour or two before bedtime). When I said it was small amounts of urine he said I needed to learn to hold it, to retrain my bladder.

Good advice. But it didn’t work. I still awoke frequently and couldn’t get back to sleep. This is when I started doing my own research as to what else was out there. I had been using melatonin, which is supposed to be a natural sleep aid, but it just wasn’t kicking in.

I focused on trying to get myself to relax prior to bed. Against my will I had a warm cup of milk, I did not exercise too close to bedtime, I tried mild meditation, and progressive relaxation. As I said, the isochronic tones were not for me but my radio chimed love music throughout the night.

I tried to have a routine time to go to bed and to wake up. I saw where it was said that you ought to limit daytime naps to 30 min and then not after 3 pm. Now, mind you, I have no qualms in telling this to my patients. Because that’s what ‘they say’. But to me it was a bunch of hogwash since I have been taking afternoon naps for years and sleeping perfectly.

In this present scenario, when I missed a nap I slept no better at night. At least if I could get an hour or two under my belt during the day I would feel better.

Of course I know someone who sleeps a lot during the day may having difficulty sleeping at night. I didn’t sleep all day. And the elderly with little physical activity or who sleep all day, may be also unable to sleep at night.

Another rule that I broke is where they say if you haven’t fallen asleep after half hour, get out the bed. Go do something. When you’re sleepy again come back. Sounds good. But when I’m battling with my bed to sleep I’m down for the long-haul. (Maybe that’s why I usually lost the battle).

I feel for my patients a lot more in this area of insomnia after having been through this myself. It was terrible!!! You “awake” on mornings totally unrested, eyes heavy and burning, head groggy. And of course you have to go to work that day.

I only got a good night’s rest when I used the benzodiazepines (e.g. Valium, Ativan) my doctor prescribed. He kept trying to reset my clock with them and started and stopped them. He was particularly concerned about not aggravating another condition I have, that is triggered by lack of sleep.

But we all know benzodiazepines are addictive. You simply cannot take them for long. By now I thought I had figured out what caused my insomnia…anxiety. I never realized anxiety could cause such horrible insomnia. I was getting insights for my patients all the time. But I couldn’t shake the anxiety.

I had always thought that patients often had trouble sleeping because of their thoughts at night. But I had no self-defeating thoughts at night (except “I can’t sleep; I’m gonna die”). I learnt that it was also the daytime thoughts, fears, worries, ruminations that play on our subconscious and prevent us from sleeping at night.

My doctor next prescribed antipsychotics. I went along with it because things were not improving. Within three days I had horrible side effects so I stopped. I realized I had reached the end of the line. This anxiety thing had to stop. I willed my mind to be calm and trust in the Lord I believe in.

In two days, I was sleeping naturally again. It had to happen. I came from a history of beautiful sleep and I was not now going to be condemned to a life of insomnia.

I’ve been sleeping well since, making it two and a half months. I’m still working on the anxiety and have insights to share on this.

I know that a lot, a lot of people have problems to sleep. Please try some of these methods I mentioned above, I can always clarify, and above all, be anxious for nothing (KJV).

Dr. Louella. Over and out!