Spent the day with the endocrinologist at the diabetes wellness center today. This is a pretty nice diabetes clinic that sees all sorts of patients with some sort of hormonal disorder. I probably learned more today than I have since I started this rotation because of all the discussions and applications of practice to a seriously diabetic prone population. In fact, there are families in the Choctaw nation in which every person in the family has type 2 diabetes.
Learned all about Cushing's Disease, Addison's Disease, goiter, and acromegaly today as well. Talked all about the different steroids and safe strategies to apply them to practice. As for patients, I met one man who is 25 years old and recently lost about 60lbs--> he dropped from 419lbs to about 360-something. I can only think of one larger person I have seen in my life and that was on my internal medicine rotation at Duke. That man weighed about 500lbs if not more. We pumped him with several grams of Vancomycin to reach steady state- it was unbelievable. Anyways, the 25 yo patient I saw today had full-blown type 1 DM and was on all sorts of medicines I don't expect to be on until I'm 65 or older such as a statin and ACE-Inhibitor.
Also saw a patient who has reasonably controlled thyroid disease. It has been uncontrolled in the past and she had several miscarriages due to the imbalance. She is on her sixth pregnancy and this will (hopefully) be her third child. My favorite patient of the day was a young grandmother who has a non-cancerous growth on her adrenal gland which is causing a serious potassium imbalance. She takes 50mg of spironolactone 2 times per day for it and her numbers are still running low- I believe 3.4 today. However, she tells us she takes that medicine as she remembers. She is also on telmisartan and takes her mother's lisinopril when her blood pressure is running high. These stories are waaaayyyyyyyyy too much...
Probably one of my more memorable moments of the day was talking to Dr. Robinson (the endocrinologist) about the food that is served in the cafeteria. It is free to students and therefore I do not shop to buy food here cause I'm doing my best to keep expenses down. The food here is LOADED with salt, fat, sugar, you name it. I try so hard not to have fried, rich food but the options are limited. The vegetables that are served are generally cooked so much that all the viable vitamins and enzymes are definitely non-absorbable or contributory to our diets.
SO the funny part was that I thought this food was unhealthy. Then I saw this sign with my buddy Tuan (pharmacy student from Drake Univ. in Des Moines, IA) while on the lunch line that read "Sorry for the inconvenience but our deep-fat fryer is out of commission. We apologize for this inconvenience." I started laughing out loud- literally. Why would a hospital/clinic funded by both the local government and federal government grants serve this type of food since they are paying for all of these peoples' health care?!?!?!?!?!?! It makes no fucking sense to me whatsoever. It's asking for more expenses in health bills despite how cheap that fare is to them. Well anyways, a new deep-fat fryer was installed today and it will be up and running tomorrow. It was the buzz of the place today. Unfucking believable!
To top it all off, I asked if they have ever attempted to rid the cafeteria of this shitty food and put something decent in there for all of these patients that have heart disease, hypertension, and diabetes. He said that they have tried it several times. Every time they have done it, citizens of the Choctaw nation call their local government trustees and complain in numbers. They claim that the FREE FOOD that they are being given at the hospital is awful and they want these other fried food items back. I mean COME ON: a government funded hospital is serving healthier food and people call to complain that they are dissatisfied. First off, this service does NOT need to be provided to these people, they should be grateful. Secondly, this is an indirect way of the folks who are securing the funds for this hospital to look out for the health of their Indian nation.
They went back to the unhealthy menu. The fryer will be in full operation tomorrow so i can't imagine how horrified I will be when I'm in the cafeteria tomorrow. I know there was a great deal of debate a few months ago regarding happy meal toys (therefore providing less incentive for kids to want fast food!) being banned in the city of San Francisco. People said we need to leave trust in the public to make their own decisions. I disagree to a large extent. People who are getting cheap, friend, unhealthy food are generally getting it because they are meals that they can afford. If we give a nudge in the right direction, our bills will go down- sensible? Have the citizens best interest in mind? YES. That is my rant for the day on the food. Bring on the deep fryer...and the Lipitor, Crestor, Lopid, Beta-Blockers, and Nitrates. And let's increase the costs of health care while we're at it ;)
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