Lab Results

Patient portals are great.  Lab drawn yesterday.  Results available to me today.  Not ideal numbers, if fact a gradual progression of a few things, enough to want me to act.  But nothing very dangerous.  I still think I am over medicated, as I never quite feel well, though rarely feel badly.  I can still donate platelets.  I can still modify my diet.  See what the doctor recommends when she calls, then set up appointment.

Addressing Problem Lab Work

 My serum took a down tick.  And the RBC from the purple top tube makes platelet donations uncertain.  For the first time my creatinine measures where I would notice it, not dangerously high but not where it had been.  Glucose borderline though not diabetic.  Traces of prior iron deficiency persist.  And lipid measurements not alarming but less well controlled on alternate day statin.

I don't feel as well, not explained by the lab.  But still, I need to change course.  Don't think I can do much with the renal function, other than not missing any antihypertensives.  To the extent that the CBC reflects this, my platelet donation days may be reaching an end, but too soon to tell.

I can restore the iron with a supplement.  No active bleeding on endoscopy, already on proton-pump inhibitor for Barrett's.  Just resume the multi-vitamin.  And the lipids were a lot better with daily rosuvastatin.  May just have to accept some minor achiness in return.

Discuss briefly with doctor soon.  Revise daily pill case now.

Updated Lab

Platelet donations have been on hold a while.  This has been among my most extended, gratifying contributions, interrupted when my desktop Hb fell below their threshold of 13.0 g/dl in a consistent enough way to have the lab confirm this.  At 12.2 g/dl on a random specimen, the desktop hemocytometer was apparently accurate.  Two months have elapsed.  I feel OK and it was time to have my periodic lab testing done anyway.  After NPO the Hb measured 12.9 g/dl.  While borderline, and done in a semi-dehydrated state which the Blood Bank does not allow its donors, it seems close enough to make another appointment to see if I can return to the donor corps.

Other lab testing did not seem worrisome at all.  Technically I classify as low grade CKD but the creatinine has not changed in a meaningful way.  My LDLC calculated, not really measured, to 83 mg/dl with full compliance with rosuvastatin, which I probably ought to suspend for a week to see if my achiness changes.  Do that next week.  Normal urine.

In effect, nothing worrisome or even in need of additional investigation, though it would be well to consider things that detract from how I feel that do not appear on screening lab testing.  My sleep has improved with minor intervention.  Achiness can be assessed with a selective drug holiday.  Sinuses have responded favorably to resumption of nasal steroid which I keep in my line of sight next to my laptop to assure two sprays early each morning.  Back on citalopram.  I've noticed that I'm less distracted and maybe have a longer fuse but not a great difference.  Maybe I'm not quite as sharp in some of the higher reasoning insights but discontinuing it right now does not seem the best choice.

Have to see if the doctor contacts me or trusts me to assess this on my own, though I have a Medicare Wellness Assessment not far off.

Reading Charts

Pet Peeve Time

My medical professors and senior residents trained me well.  I may not have liked it at the time, but they were insistent that I review old records when a patient was assigned to me.  Records were kept on paper with tabs for the various types of entries.  They would come up in a big basket, often with multiple volumes, and have the approximate appearance of a telephone directory from  a large city.  On the front of each admission would be a transcribed discharge summary which provided mostly useful information but occasionally became the source for propagated misinformation from one hospitalization to the next.  The specialists tended to go beyond discharge summaries,  needing to look at trends in lab data over time so I got very proficient at reviewing where the CBC's and creatinines had been the last few years.  Serial radiologic studies were more difficult to assess so a trip to the X-Ray File Room would be part of the chart review much of the time.

Computerization of records has made the review much easier.  Instead of having to go through each lab section of each admission, trends are now tabulated across admissions.  All the summaries are presented serially, all the X-Rays are presented in sequence, both images and reports.  This seems like a snap for those of us who once had to hunt for what we need but at least know what we need.  The amount of time spent doing these reviews probably has not changed much but the amount learned about the patient in that time has expanded enormously.  It helps, though, to know what you are looking for, a skill better developed by having to very selectively seeking out prior data from amid a multivolume record.

Many of my residents never acquired that skill.  They process through a new patient without ever looking at primary data from the past.  Summaries get propagated forward, misinformation with the correct diagnoses as a bundle.  But review of trends invariably comes from the consultants.  While this type of review is labor intensive, it is not that labor intensive.  And what might they be doing instead?  And why go through all the trouble of doing this if the patient will be handed off to somebody else in a day or two?  There is really no ownership of the patients, maybe not even stewardship.

So for now I have a useful but skill but one of diminishing interest.  I know how to use a stethoscope and slide rule too.