Monday, July 30, 2012

So why would a gallon of milk a day be bad for you?

Posted by Tom Vassas at Monday, July 30, 2012

Well unbeknownst to me, the world seems to move faster than it does on rotation. It's been 5 weeks since my last post and it seemed so hard to just write a blurb about my ambulatory care rotation but that could not do it justice. So here's a little, brief, thesis paper on my time in ambulatory care:

I was at the UM Canton Clinic with Stu Rockafellow, which by fanciful coincedence was only a 5 minute drive from my house (like omg weird right?). We managed patients with both types of diabetes, hypertension, hyperlipidemia and the occiasional asthma patient. 9 times out of 10 it was DM II, and most of the patients were being followed up from a previous in clinic visist or phoned for a quick update. A lot of patients like the phone call to keep them accountable on they're lifestyle and adjust insulin. We would talk to about 4-8 patients on a half day (that's in clinic and phone) and about 14-20 patients on a full day.

The time there was amazing; my days mostly consisted of the night before looking at my patients on schedule for tomorrow and doing brief workups on them. I would look at their PMH and med list, and any other documents about their reasons for seeing us. I would also start filling out intervention checklists we were required to fill for ongoing research based on what we talked to patients about. The day of, I would go over with Dr. Rockafellow the patients and what I wanted to talk to them about. Most of the time it was talking about how lifestyle changes were going, what barriers they were running into, and if we could offer advice or adjust meds to help. New patients required a long med rec and history. Each patient in clinic, new or old, I would still take their BP (which really is fun after 100 or so). After patients I would finish the checklist and complete a care note and start on the next day.

The coolest parts were being able to see any progress with patients. It didn't happen often due to time, but the feeling you get when you talk to a patient, get them to commit to something, they achieve that and you both see the results in their A1c, is just phenomenal. Most patients were very typical, with needing some diet and exercise changes and maybe adding insulin or dosing. There were some shall we say....unique...patients.

The hardest patient was an older gent with cerebral palsy and a diet consisting of 2 gallons of chocolate milk a day. With 5 weeks of seeing him we got him to ride an indoor bike...There isn't much else to that just because he was very resistant to change and one of the many patients who were also depressed. On that note, depression is a truly hard thing to deal with in patients. Those who had it were not only the hardest to work with, but the ones I felt would benefit the most from seeing even tiny changes. Even though we are not counselors, some patients seem to feel much happier and relaxed to talk to us about medicine and health, compared to a nurse or physician.

Unfortunately, this was a rotation where you wish you had another 5 weeks to track the patients, because ambulatory care really is long-term care. Typically very little change can be seen with anyone (especially since an A1c is done q3mo!) and in the mean time it's the report and trust that can change the most.

So next is cardio and I can only hope I'll have enough time to write a few more, but til then I leave you with this:

Watermelon is really sugar water, a garbonzo bean is a chick pea, and just because a cherry is a low-sugar fruit does NOT mean eating 35 at once is ok.


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