Tag Archives: Cancer

Family Med

Today I did my first punch biopsy which was surprisingly simple. If you’ve ever made Christmas cookies, you can do one of these. I thought I saw a Kaposi’s Sarcoma which is basically a skin cancer that’s really only seen in AIDS patients. I’ve only ever seen the like in pictures, but man it looked exactly like that. We won’t know the results for a while but I’ll keep you posted. There’s always a fun patient and today was no different. We had a middle aged white guy who was taking Percocet, Soma, AND Methadone! Those are three highly abused drugs, and Soma, a muscle relaxant, doesn’t really help anything according to most doctors I’ve spoken with. They say it’s just a worthless drug fraught with abuse. Whoever prescribed all of these meds to this guy (it was a pain management doctor who I won’t name) should lose their license in both Dr. Leonidas’ and my opinion. He described a terrible shooting arm pain with movement that went, I’m not making this up, straight across from the medial to lateral mid humerus… He was totally jacked (and was trying to convince me to give him extra testosterone despite elevated testosterone labs), had no pain on palpation, no decreased grip strength, no decreased range of motion, and not even a flinch when in “8/10 pain” (even with just a few days of posts I hope you can see my appreciation for the pain scale). He had to wear a neck brace at night and a back brace throughout the day which I highly suspect came off immediately upon leaving the office. What’s amazing about him is that he actually expected us to give him more meds and was angry when we wouldn’t. Clearly he had no problems (other than abusing multiple drugs), was on much much stronger meds than I would ever have prescribed in the first place, and was lying through his teeth to get more. It’s just sad to see someone who has nothing wrong taking up the time slot in the day for someone that legitimately needs help.

Advertisements

Family Med Rotation

Cancer, cancer, cancer. That was the name of the game today. Two probable prostate cancers (one of which had a PSA of 287!!! Normal is less than 4.0), hepatocellular carcinoma where the patient decided not to show for his appointment with the oncologist following a biopsy, and a prolactinoma (typically benign, hormone producing tumor in the sella turcica). One of the men with prostate cancer just stopped seeing his oncologist years ago when he didn’t like chemo and is now showing up to us because he isn’t doing well… Who would’ve thought? It’s tough to see that this guy isn’t likely to make it just because he wouldn’t go through with treatments when it could actually be treated. We had a few train wrecks to start the morning but then this 47 year old black male came in for a diabetes follow up. He had gained a considerable amount of weight and his HbA1c had spiked. I figured this would be the typical interaction we have with a DM (diabetes mellitus) patient where we just beg them to exercise, diet a little, and do the things that everyone knows to do. But this man shocked me by saying, “Look doc, I’ve been really struggling with my weight. I know what I’m supposed to do, and I’ve done it before. Is there any way I can come in and see you once a month just so I can have some more accountability?” I just sat there stunned; this is exactly the type of patient that people go into primary care to see. Of course I get irritated with patients when I see them eating and lounging themselves to death, but when someone is really willing to try, I’m going to do everything I possibly can and then some to help them.