Maternalistic Seminars, PBL, POD, and CHI

Today was another long and busy day, but it was a pretty good one. We had two seminars on maternal physiology this morning. One was about fertilization and conception, and the other was on pregnancy. The reading load was ridiculous like it has been this entire block. But since I gave up doing all of the reading a couple of weeks ago, I don't feel particularly stressed about it. The irony is that I am doing better than usual on my homework assignments. Go figure. Oh, and I learned a really cool new word: primigravida. It means a woman who is pregnant with her first child.

We had some good discussion today in PBL about the social implications of our patient's disease. Personally, I think the way the case ended was good. So far, pretty much all of our PBL cases have had happy endings. But the second years have told me that some of the cases next year won't.

I really liked today's POD speaker. She is an obesity psychologist. Basically, her job is to counsel patients who are coming to CCF for bariatric surgery. All of these patients have to attend a few hours of group therapy before having the surery. Of course there are a lot of psychological issues with having a major surgery like a gastric bypass. It turns out that maintaining the weight loss over the long term is not very easy. There are several reasons for this, some of which are physical (ex. the stomach pouch expands) and some of which are psychological. One fairly obvious thing I had never thought of before she mentioned it is that initially, patients have a lot of psychological reinforcement to lose the weight. The pounds comes flying off fast at first, people are telling them left and right how great they look, etc. But after a while, their weight loss slows down, they still aren't at the "ideal" body weight they would like to achieve, and the compliments dry up. Then it becomes easy for some of those pounds to creep back on.

I was scheduled to work at CHI today, and I was hoping to postpone and come next week instead because I have so much work to do. But they were short-handed, so I went for a couple of hours. I was doing the cholesterol testing again. One of the patients is a regular who has metabolic syndrome. The cholesterol test measures glucose levels as well as cholesterol, and both of them were sky high for this patient. That shouldn't be happening if the person is taking their medications correctly, so of course I started asking him about that. Many of our CHI patients have compliance issues and trouble getting their meds since they don't have insurance or visit a physician regularly. But the most frustrating thing in this patient's case is that financial issues are not the problem--the patient has insurance and can obtain meds, but he just doesn't take any of his conditions seriously. We measured his blood pressure too, and of course it was also high. I started asking him what he had eaten today, and he tells me that someone gave him cookies, but he only ate six of them. Only ate six of them! No wonder his sugar was so high.

So how do you deal with a patient like this who can comply, but won't? Fortunately or unfortunately, hypertension, diabetes, and hyperlipidemia are all painless diseases in the early stages. By the time symptoms start showing up, now you're looking at some major medical problems like heart disease, kidney disease, etc. I was discussing this with one of my classmates, and we thought it might be effective to show the patients pictures of people with foot ulcers, amputations, and other complications of diabetes. The best picture I found was of a diabetic man's necrotic testicles. If THAT doesn't grab a man's attention, nothing will.