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Wednesday, January 30, 2013

A Stressful Life

I’m running low on ondansetron, the best antinausea pill. Upset stomachs are the second most common ailment in a hotel doctor’s practice, and I’ve been seeing more than usual.

Unfortunately, I’m not low on many other supplies. I buy through an internet pharmaceutical company that charges a fat handling fee for orders under $150. Eight bottles of ondansetron, 240 pills, will cost $32. I could use more tongue depressors, but 500 at $6.50 is not much help. I dispense large quantities of lidocaine gargle for sore throats and cough medicine, and my bottle of 500 doxycycline antibiotic capsules is half empty; stocking up would help but medicines have expiration dates, so one must be careful.

Recently, after thirty years, my blood pressure cuff broke, but at some time in the past I’d bought a spare. Should I buy another? Will I be practicing when I’m 103?....

One of my boasts is that, unlike other hotel doctors, the fee I announce is the fee I collect. I don’t charge extra for anything. It turns out that pills and injectables for common ailments are so cheap that I struggle to assemble an order exceeding $150. Do I have your sympathy?

Saturday, January 26, 2013

Dealing With Buenos Aires

“Can you make a visit to Palo Alto?”

“That’s four hundred miles away!”

“How much would you charge?”

“I’m in Los Angeles. Do you understand?”

“Yes. How much would you charge?”

In fact, she didn’t understand. To save money, many travel insurers have closed their US offices, so this call originated from the patient’s home country. Inevitably, dispatchers in Buenos Aires don’t speak English as well as their former colleagues in Miami. I carefully explained that the distance made a visit impossible.

Unlike most European travel insurers who require clients to pay up front and submit a claim, South American insurers send a doctor. I’ve made over two thousand visits for them. They’re among my favorites because patients who don’t pay directly are less demanding. Also, the insurers send me to hotels that don’t call or, even better, to my competitor’s hotels. A downside is that, if I don’t listen carefully, they send me to the wrong address. In Spanish “v” and “b” have identical sounds; so do “y” and “l.” The letter “i” is pronounced “ee” in Spanish. 

Then there was the time an insurer called me at midnight.

“Can you make a visit to Culver City tomorrow morning?”

“Yes… But why did you call me so late?”

“Because it says on your profile that you are available 24 hours.”

Monday, January 21, 2013

Traffic

A guest at the Georgian felt stabbing pain in his back as he bent over. He could barely move.

Acute back pain usually doesn’t last long, so I assured him that he would be disabled for a day and then gradually improve. I admit I was not anxious to make this visit because it was 4 p.m. I would be driving to Santa Monica and back during the rush hour, a tedious experience. But he wanted a visit as soon as possible.

It was a tedious drive, not improved by the sight of immobile traffic on the opposite side of the freeway. The guest answered the door himself, always a good sign in someone with back pain. I examined him and handed over pain medication; it was an easy visit.

My hope that the freeway would speed up in time for my return was in vain, so I settled into the rear of a nearly motionless stream of cars. I was in no hurry; it was suppertime, but I wasn’t too hungry. After ten minutes, my phone rang. A guest at the Crowne Plaza in Beverly Hills asked for a doctor. His wife was vomiting.

I often delay visits a few hours, but people who are vomiting hate waiting. This would normally be a quick drive because the Crowne Plaza was only five miles away, and I was headed in that direction. But it was the rush hour. I left the freeway and crept for thirty minutes along Pico Boulevard to the hotel. The visit went well, and the drive home was tolerable.

Wednesday, January 16, 2013

Good News

A child at the Disneyland Hotel had a fever. Disneyland is forty miles away, but the call arrived as I finished breakfast on Sunday morning. Freeway traffic was light; a perfect time for a long drive.

It was nearly noon when I greeted the father and three other children. Being stuck in a hotel room with a sick child was not part of their plans, so all looked depressed. The child had a fever and cold symptoms but did not seem ill. I explained that children catch half a dozen viral infections every year; they last from a few days to a week or two; one can treat the symptoms, but there is no cure. Rest does not help.

“You mean we can go to Disneyland?” asked the father.

“Saying in bed doesn’t make it go away quicker.”

The family erupted in cheers and followed me out the door.   

Saturday, January 12, 2013

A Bonus

I was pleased at a request to see a patient at the Angeleno. The source was an international travel service, not the hotel, but the Angeleno hadn’t called in a year, so this gave me the opportunity to make a pitch at the front desk.

The patient was a Brazilian two-year old who may or may not have had ear pain. Infants love everyone, and older toddlers are often frightened into holding still, but from about one to three years, children who don’t like doctors are uncontrollable. Taking a temperature in the armpit required the parents to hold her down. I did not look forward to the ear exam.

There was a knock on the door, and an elderly gentleman entered. This was the child’s grandfather, I learned as we shook hands, and he was a pediatrician. Immediately I held out my otoscope which he accepted with thanks. Everyone piled on; she screamed and struggled. Afterward, he forced her mouth open to examine her throat. He spoke little English but made it clear that nothing abnormal had turned up. He delivered an elaborate explanation to the family in Portuguese. I handed over a bottle of Tylenol, and everyone was happy.

 

Tuesday, January 8, 2013

Why Do I Get So Many?....

Everyone believes he or she has a weak spot. “My kidneys are weak...” “I have a tendency to strep...” “My resistance is low...” In fact, most recurrent complaints are not your fault.

Colds (or other viral infections such as bronchitis, tonsillitis, flu) are contagious diseases. You catch them from another person. They are not caused by chilly weather, wetness, stress, poor nutrition, or a weak immune system.

Backaches happen because our skeleton is defective. Animals walked on four legs for hundreds of millions of years. Humans stood erect a few million years ago, too soon for evolution to correct matters, so back muscles are too weak for the extra work, and our spine is not built to carry so much weight.

Bladder infections plague young women. Many suspect something is wrong, but this is rarely the case. In young adults, these are caused by germs that normally live around the genitalia. Young men suffer much less often because having a penis gives germs much further to travel to reach the bladder. Men catch up after middle-age when their swelling prostate obstructs urine flow.       

Bruises.  Black-and-blue marks occur after an injury to the skin. Rarely, they are the sign of a bleeding disorder, but in young women bruises often appear for no reason at all.
 
Gas is part of life. Mostly, flatulence is a sign of good health. Humans digest protein and fat easily, so very little reaches the colon. Carbohydrates are another matter; a person who eats a great deal of grain, vegetables, and fruits delivers plenty of undigested carbohydrate to colonic bacteria that feed on it, producing gas.

Age spots become tiresome if you and your doctor don’t take them seriously. They begin on the face and scalp around age forty as small brown spots. A quick freeze with liquid nitrogen makes them vanish with no scarring. If ignored, they never go away. They enlarge; some become thick and wart-like; others appear. Eventually there are too many to treat.

Allergies tend to appear in childhood. Most reactions that adults call allergies are something else. If a medicine makes you ill, that’s probably what doctor’s call “drug intolerance,” not an allergy. This is not splitting hairs. A drug allergy can kill you; drug intolerance is merely annoying. Most stuffy noses are not allergies. Neither are most rashes or upset stomachs.

Thursday, January 3, 2013

A Light at the End of the Tunnel

I’ve been warning that this blog may vanish on January 15 when my E-mail provider, Physicians On-Line, goes out of business. Google could make it easy for bloggers to change their primary E-mail, but it turns out to be nearly impossible. However, Google does allow us to invite another person to join the blog and share all contributing and editing privileges.

So I sent an invitation to myself which I accepted. Google apparently has no objection to two Mike Oppenheim’s hosting a blog, identical in all areas except E-mail. I keep my fingers crossed that one will remain after the 15th.