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  • tugofwargame tugofwargame Jul 25, 2005 10:52 AM Flag


    "Hey doc, the patient's pulse has been a bit erractic lately. Do you think we should order up an EKG?"

    "Nah, not yet."

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    • ok doc! watch out for the sharks, have fun, and catch ya when you come back. have tons of fun.

    • your�re the greatest Tugo�i consider you my cyber epictetus once said �you can discover more about a person in an hour of play than in a years of conversation�...good luck!!

    • Tugo, you�re not only funny but extremely bright poster i have ever met in th cyber space and i wish to continue with our conversation but my vacation time is here and t am leaving tonight from a west coast of usa to see the great barrier reef in queensland, australia for period of four week�hope to continue our discussion when i come back�take care of all of the patients and mainly yourself....good luck!!!.....

    • Hey Doc, I just had a great idea for a new drug delivery system when I was talking on my Razr. MOT could partnership with a pharma co. They could develop a very thin drug delivery system, planted sub-q, that hooks up into the internet. We could then have it take readings send them to our office, have software installed in our office that monitors internal conditions, and adjust dosages automatically. We could also get it to set off audible alerts when other conditions arise so staff could monitor. I'm sure that patients would want to have their internal body functions monitored closely in order to extend life even longer.
      It shouldn't be too hard to make sure it's covered by Medicare. I mean, heck, the drug companies got them to cover prescriptions for Viagra for senior citizens. All we have to do is push this along under the same theme - quality of life.

    • Well they did come out with aerosol delivery systems. Personally, I think that's a joke as the pin-hole constantly clogs on patients causing unreliable dosages. Of course, Wall Street touted that big time...

      By the way, I took the liberty of contacting Dr. Small, the best urologist in the area for this procedure, to give him a heads up (pardon the pun) that there was some liklihood we'd be adding him to our widening circle of specialists. Dr. Small is familiar with all techniques and I've had the privilege of working with him in the past. (Privately I call him Dr. Big, which he always gets a kick out of.)

      I can assure you personally that length isn't an issue with this particular patient. On the contrary, I think we're going to have trouble catheterizing him properly.

      The wife would rather have the always ready capability and doesn't want to have to fool around with the scrotal pump-it-up variety. The patient doesn't really care, and is letting his wife choose the model. She seems pretty intent on maximizing the quality of their remaining time together so the solid insert will probably provide the quickest resolution and the most satisfaction under the circumstances. And of course, he seems pretty intent on going out with a bang. I think we can and should use this information from a psychological aspect to achieve some additional cooperation on the remaining tests, biopsies and operative procedures.

      I couldn't agree with you more about b/p problems within certain ethnic groups. The statistics on patients expiring pre-maturely surely are disappointing and are preventing further expansion of the medical community in some areas. Have you ever met Dr. Joyce from Walter Reed? He's been lobbying hard to get additional taxpayer funds to underwrite the medical care costs in the underprivileged nations. Of course he works closely with certain organizations that refer him patients, who are flown in from around the world.

      I did forget to mention that the liver is clear, so it's just the lung spots that are of additional concern at the moment.

      Whoopsie, I see the crash cart team running down the hall with the cart towards our patient's room, sounds like they are saying flat-lining. I'd better run down and help keep this one alive. Can't have him missing his chest ct tomorrow.

      Of course I will keep you updated.

    • i agree with you Tugo, the pharmaceutical industry needs to get on the ban wagon and come up with some new futuristic drug delivery system rather than relaying on the old outdated drug design technology developed 50 years ago�the b/p is a serious problem among african ,asian and muslim population an that could possibly compromise their future survival on this planet unless something is done..�i can�t imagine what it would be like to live in the world without their contribution�i am not a urologist but i understand that there are so many different options to take into consideration but we need to know more details on this issue�what would be of interest to the patient�s wife,,,,lengthening of the member where surgeons cut the suspensory ligament that attaches the penis to the pubic bone or thickening of the member which involves making a circumcision-like incision to open the shaft..we need to study each option very carefully and your input is vital in this matter�.yes, agree dr.driller may be currently negotiating a deal with the chinese government over the currency issues but i think it�s good idea to leave all the option open�.your patient will require lot of treatment please keep the new data coming�. si

    • I think what the drug companies need to do is invent a sub-q time release capsule (maybe with a way to have dosages adjusted electronically) that will dispense doses for 1-10 years at a time for stubborn or senile patients how refuse to acknolwedge that hi b/p is a problem.

      I privately discussed the possibility of a psych evaluation with his wife. She is fully convinced that all of his psychiatric symptoms will disappear upon completion of successful sex therapy instead. I informed her that we will have to get medical clearance from the entire team before proceding in that direction. She inquired about the possibility of prosthetic surgery as opposed to Viagra and I told her I'd seek your opinion on this.

      In the meantime, there were some small spots visible in the first few frames from the abdominal ct that picked up some suspiscious areas in the lower lung in additional to the abd. mass, so he's scheduled for a chest ct tomorrow. Depending on those results, you might be right about calling in Dr. Drillers, but I don't want to be too hasty about that.
      The abdominal mass has a blood supply, with some suspiscious looking nodes. We're looking at a radical, depending on getting clearance from others on the team.

      Obviously this one isn't getting discharged anytime soon.

    • Tugo you�re are doing incredible job in the management of the clinic�your strong personality and charismatic leadership is what it takes to be the best �just don�t give uip an inch�you have to be careful with the viagra sometimes and in certain cases the erection can last for hours�.the benicar is an excellent choice fo management in hypertension cases as long as liver and kidney endure and restriction of potassium intake is comply with�potassium in blood should never exceed 4.5-5 mmol/L during the period of extended therapy �as the patient gets physically better we may also need to consider psychiatric evaluation as well�what do you think? looking forward to the abdominal ct results�.take care!!

    • Patients aren't the only ones who have normal reactions. Somehow they seem to sense I have knowledge of specific areas of innervation.... well you get the drift. We were taught to use a quick sharp flick of finger; I've never resorted to that kind of cruelty tho.

      But, surely you jest with me this morning about latent gay fears. You know just as well as I do exactly how sensitive the prostate is to manual palpation. Maybe he wouldn't have gotten so shook up if we had sent in one of the female residents. But yes, you are right, this patient seems to be unable to deal with any kind of stress especially emotional.

      I've discussed some of the drug side effects with the patient and at the moment he insists he would rather have a prescription for Viagra.

      His wife showed me a bottle of Benicar that their primary prescribed as a temporary measure pending the cardio consult. She advised he took it for one day only and then quit. She also advised that this is typical for her husband, who refuses to follow thru on most medical care.

      Ah, here comes the abdominal CT results, looks like we're dealing with a large mass in the LLQ... I'll have to get back with you later.

    • good morning Tugo!!... it appears that your patient has a problem in dealing with any degree of mental or physical stress�first i thought that his arousal would have been caused by your own charismatic and warm female personality (which would be -by the way- a patient normal reaction) but now since you have mentioned that latent �gay fear aspect� i am not quite sure what the cause of his arousal may be �

      in any rate lowering of b/p shouldn�t be hard to manage with the abundance of so many chemical compounds available to choose from�you can start with mild diuretic like a diamox if that fails to produce desirable results administer broad spectrum beta-blocker like inderol (200 mg a day should deal with his homosexual fears) �for long term b/p management you can also try ace (angiotensin converting enzyme) inhibitors �these drugs are know to inhibit the formation of angiotensin which is not only to relax the arteries of the patient but also to lowers blood pressure which improves the pumping efficiency of a failing heart and improves cardiac output in patients with heart problems�diagnostic test of adrenal performance by simple blood test should also be conducted�that should do it out of the allopathic methodsp �please keep me posted�

      i was wondering what your thought would be like on consulting dr.driller_plano who is said to be well known neurologist currently residing on this board about your patient�i hear that he is well connected on wall street and does lot of charity work in south africa and north korea�what do you think?... just a thought for your consideration�

      good luck and have a great day!!!!

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