Re: Agent Orange Registery Exam

February 29, 2012

On Feb 29, 2012, at 8:22 PM, wrote: I'm reporting some of the more generic portions here while trying to not bore you with info that has nothing to do with most of your health. It started with a fasting blood test (which we reviewed and I will have the results online in a week). Then It was chest xray and supposidly seeing the doctor at 9am! I decided breakfast was in order so I was 10 minutes late! (No problem, Doc was 15 minutes late!) My DM doesn't like it when I skip breakfast! The doctor was very knowledgable, thorough and ready to answer any question I had and offer insight where I didn't know enough to ask! He knew what to look at and how to intrepret the tests for each "presumed condition" and reviewed them out loud while showing me what he was looking at on the computer. I asked him particularly about kidneys since a Neper tried to label me CKD Stage III! He opinioned the Neper "was crazy" and the kidneys were strong and "working overtime" clearing the excess issues caused by PA! I surmized it was NOT the first time he had heard about PA! In fact, he is the first doctor at the VA that I felt I was not able to provide a lot of info regarding PA! (I'm afraid he might have been awake the day they went over Conn's at Darmouth!) Dr. Grim, that raised a question for me. If we produce excess aldo and antagonize it down the line, where does it go? I'm assuming kidneys and liver are primarily responsible for that part of "waste mangement", is somebody assuming extra work when we treat w/meds instead of removing when appropriate?CEG: aldosterone in the blood is cleared 100% as it goes thru the liver. I digressed, sorry! We then moved on to BP and he thought it was "a little high". I told him it was currently because I was preparing for testing. He said it "always ran high" and turned the screen toward me so I could see the graph he was looking at. I responded that it was "bullshit" and reached into my folder for my graphs that I had updated the night before. He thought the trends looked similar and I told him to look closer at the numbers. He thought we were looking at to the same data until I explained his numbers were from clinical visits taken totally incorrectly so they were garbage! Mine were taken every morning in a controlled situation according to AHA and DoD/VA standards so I had an agreement w/Dr. Webster that we would only use mine to make life and death decisions! His response was something like, "Wow, I love it when a PTN cares enough to educate himself enough to help make healthcare decisions!" I wonder if his tech will have a new proceedure soon! Speaking of BP, did anyone else notice the article that Francis recently posted regarding doing testing in the VA system where the study group including Duke took them to task for their sloppy methods? They were very clear it was not unique to the VA system! (I'm starting another project where I will be using it so I will highlight it in another post in the next day or two.)I think I have mentioned before that after observing poor BP measurement in VA in MKE a number of years ago, I wanted to do a standardized knowledge assessment and then a training (if needed). The VA chief of Nursing refused stateing (to parphrase) his staff know how to take BP. We closed with his comment that Dr. Webster was doing an excellent job keeping track of me and and watching the right issues AND as an added bonus, "not bad to look at either"! He may have thought I was bullshitting when I responded "I hadn't noticed"!The "not bad to look at" is a sexist remark and should be reported. Nevertheless I think the Agent Orange PA issue should be explored. I have officially finished my VA locum at Minden VA thru a contractor. I am working on a note to the VA about their BP measurement and management standards and problems. CE Grim MD Summary: An hour+ well spent. I probably could have done as much damage if I had spent a week in Woodstock in 1968! (If you don't understand that you are too young or don't read foriegn news!) ;>) - 65 yo super ob., fastidious male - 12mm X 13mm rt. a.adnoma with previous rt. flank pain. Treating with DASH. Stats w/o meds = BP 175/90 HR 59 BS 125. D/C Spironolactone 12/20/2011 due to adverse SX. Other Issues/Opportunities: OSA w Bi-Pap settings 13/19, DM2, Gynecomastia, MDD and PTSD. Meds: Duloxetine hcl 80 MG, Metoprolol Tartrate 200 MG, AmlodipineBesylate 5mg, 81mg aspirin and Metformin 2000MG. Started washing Spironolactone 12/20/11 to prepare for AVS.

February 29, 2012

On Feb 29, 2012, at 8:22 PM, wrote: I'm reporting some of the more generic portions here while trying to not bore you with info that has nothing to do with most of your health. It started with a fasting blood test (which we reviewed and I will have the results online in a week). Then It was chest xray and supposidly seeing the doctor at 9am! I decided breakfast was in order so I was 10 minutes late! (No problem, Doc was 15 minutes late!) My DM doesn't like it when I skip breakfast! The doctor was very knowledgable, thorough and ready to answer any question I had and offer insight where I didn't know enough to ask! He knew what to look at and how to intrepret the tests for each "presumed condition" and reviewed them out loud while showing me what he was looking at on the computer. I asked him particularly about kidneys since a Neper tried to label me CKD Stage III! He opinioned the Neper "was crazy" and the kidneys were strong and "working overtime" clearing the excess issues caused by PA! I surmized it was NOT the first time he had heard about PA! In fact, he is the first doctor at the VA that I felt I was not able to provide a lot of info regarding PA! (I'm afraid he might have been awake the day they went over Conn's at Darmouth!) Dr. Grim, that raised a question for me. If we produce excess aldo and antagonize it down the line, where does it go? I'm assuming kidneys and liver are primarily responsible for that part of "waste mangement", is somebody assuming extra work when we treat w/meds instead of removing when appropriate?CEG: aldosterone in the blood is cleared 100% as it goes thru the liver. I digressed, sorry! We then moved on to BP and he thought it was "a little high". I told him it was currently because I was preparing for testing. He said it "always ran high" and turned the screen toward me so I could see the graph he was looking at. I responded that it was "bullshit" and reached into my folder for my graphs that I had updated the night before. He thought the trends looked similar and I told him to look closer at the numbers. He thought we were looking at to the same data until I explained his numbers were from clinical visits taken totally incorrectly so they were garbage! Mine were taken every morning in a controlled situation according to AHA and DoD/VA standards so I had an agreement w/Dr. Webster that we would only use mine to make life and death decisions! His response was something like, "Wow, I love it when a PTN cares enough to educate himself enough to help make healthcare decisions!" I wonder if his tech will have a new proceedure soon! Speaking of BP, did anyone else notice the article that Francis recently posted regarding doing testing in the VA system where the study group including Duke took them to task for their sloppy methods? They were very clear it was not unique to the VA system! (I'm starting another project where I will be using it so I will highlight it in another post in the next day or two.)I think I have mentioned before that after observing poor BP measurement in VA in MKE a number of years ago, I wanted to do a standardized knowledge assessment and then a training (if needed). The VA chief of Nursing refused stateing (to parphrase) his staff know how to take BP. We closed with his comment that Dr. Webster was doing an excellent job keeping track of me and and watching the right issues AND as an added bonus, "not bad to look at either"! He may have thought I was bullshitting when I responded "I hadn't noticed"!The "not bad to look at" is a sexist remark and should be reported. Nevertheless I think the Agent Orange PA issue should be explored. I have officially finished my VA locum at Minden VA thru a contractor. I am working on a note to the VA about their BP measurement and management standards and problems. CE Grim MD Summary: An hour+ well spent. I probably could have done as much damage if I had spent a week in Woodstock in 1968! (If you don't understand that you are too young or don't read foriegn news!) ;>) - 65 yo super ob., fastidious male - 12mm X 13mm rt. a.adnoma with previous rt. flank pain. Treating with DASH. Stats w/o meds = BP 175/90 HR 59 BS 125. D/C Spironolactone 12/20/2011 due to adverse SX. Other Issues/Opportunities: OSA w Bi-Pap settings 13/19, DM2, Gynecomastia, MDD and PTSD. Meds: Duloxetine hcl 80 MG, Metoprolol Tartrate 200 MG, AmlodipineBesylate 5mg, 81mg aspirin and Metformin 2000MG. Started washing Spironolactone 12/20/11 to prepare for AVS.

March 1, 2012

Is the Dr that did the exam a PCP or does he only do AO exams?

>

> I'm reporting some of the more generic portions here while trying to not bore

you with info that has nothing to do with most of your health.

>

> It started with a fasting blood test (which we reviewed and I will have the

results online in a week). Then It was chest xray and supposidly seeing the

doctor at 9am! I decided breakfast was in order so I was 10 minutes late! (No

problem, Doc was 15 minutes late!) My DM doesn't like it when I skip breakfast!

>

> The doctor was very knowledgable, thorough and ready to answer any question I

had and offer insight where I didn't know enough to ask! He knew what to look

at and how to intrepret the tests for each " presumed condition " and reviewed

them out loud while showing me what he was looking at on the computer.

>

> I asked him particularly about kidneys since a Neper tried to label me CKD

Stage III! He opinioned the Neper " was crazy " and the kidneys were strong and

" working overtime " clearing the excess issues caused by PA! I surmized it was

NOT the first time he had heard about PA! In fact, he is the first doctor at

the VA that I felt I was not able to provide a lot of info regarding PA! (I'm

afraid he might have been awake the day they went over Conn's at Darmouth!) Dr.

Grim, that raised a question for me. If we produce excess aldo and antagonize

it down the line, where does it go? I'm assuming kidneys and liver are

primarily responsible for that part of " waste mangement " , is somebody assuming

extra work when we treat w/meds instead of removing when appropriate?

>

> I digressed, sorry! We then moved on to BP and he thought it was " a little

high " . I told him it was currently because I was preparing for testing. He

said it " always ran high " and turned the screen toward me so I could see the

graph he was looking at. I responded that it was " bullshit " and reached into my

folder for my graphs that I had updated the night before. He thought the trends

looked similar and I told him to look closer at the numbers. He thought we were

looking at to the same data until I explained his numbers were from clinical

visits taken totally incorrectly so they were garbage! Mine were taken every

morning in a controlled situation according to AHA and DoD/VA standards so I had

an agreement w/Dr. Webster that we would only use mine to make life and death

decisions! His response was something like, " Wow, I love it when a PTN cares

enough to educate himself enough to help make healthcare decisions! " I wonder

if his tech will have a new proceedure soon!

>

> Speaking of BP, did anyone else notice the article that Francis recently

posted regarding doing testing in the VA system where the study group including

Duke took them to task for their sloppy methods? They were very clear it was

not unique to the VA system! (I'm starting another project where I will be

using it so I will highlight it in another post in the next day or two.)

>

> We closed with his comment that Dr. Webster was doing an excellent job keeping

track of me and and watching the right issues AND as an added bonus, " not bad to

look at either " ! He may have thought I was bullshitting when I responded " I

hadn't noticed " !

>

> Summary: An hour+ well spent. I probably could have done as much damage if I

had spent a week in Woodstock in 1968! (If you don't understand that you are

too young or don't read foriegn news!) ;>)

>

> - 65 yo super ob., fastidious male - 12mm X 13mm rt. a.adnoma with

previous rt. flank pain. Treating with DASH. Stats w/o meds = BP 175/90 HR 59

BS 125. D/C Spironolactone 12/20/2011 due to adverse SX.

> Other Issues/Opportunities: OSA w Bi-Pap settings 13/19, DM2, Gynecomastia,

MDD and PTSD.

> Meds: Duloxetine hcl 80 MG, Metoprolol Tartrate 200 MG, AmlodipineBesylate

5mg, 81mg aspirin and Metformin 2000MG. Started washing Spironolactone 12/20/11

to prepare for AVS.

>

March 1, 2012

He is listed as Internal Medicine, Geriatric Medicine (Internal Medicine). He

was doing another A-O exam and then headed to the Bratt. CBOC to fill in because

their doctor was out for the day. Don't know what his " normal " position is but

since it took me over a year to get my registery exam I will be recommending it

becomes his f/t position if it isn't already!

> >

> > I'm reporting some of the more generic portions here while trying to not

bore you with info that has nothing to do with most of your health.

> >

> > It started with a fasting blood test (which we reviewed and I will have the

results online in a week). Then It was chest xray and supposidly seeing the

doctor at 9am! I decided breakfast was in order so I was 10 minutes late! (No

problem, Doc was 15 minutes late!) My DM doesn't like it when I skip breakfast!

> >

> > The doctor was very knowledgable, thorough and ready to answer any question

I had and offer insight where I didn't know enough to ask! He knew what to look

at and how to intrepret the tests for each " presumed condition " and reviewed

them out loud while showing me what he was looking at on the computer.

> >

> > I asked him particularly about kidneys since a Neper tried to label me CKD