Enjoying a Saturday to myself. Anyone want to hang out?

Nothing that needs doing; no place to go. Just hangin'...

No Friday Night drinking thread tonight, my darlings.

I’m the pick-up-and-drop-off guy for Mrs. Aristus for her annual knitting convention.

Got to stay sober.

Buzzed or sober, however, I love you all…

This is my Valentine:

A little under the weather tonight. Sticking with a little medicinal brandy.

I don’t believe that ‘medicinal’ nonsense. Alcohol is alcohol. But I can pretend.

Happy Friday, my beloved Loungers.

I love you all…

Dateline Puyallup: Sounds like shots fired and police sirens.

Wonder if we have another mass shooting on our hands.

I had a patient yesterday who was misdiagnosed with 'migraine' headaches.

I'm sorry to see that one of my provider colleagues, a nurse practitioner, seems to have misdiagnosed a patient I visited with to review the result of a recent cranial MRI. (It could be that the diagnosis of migraine pre-dates her history with this patient. But somebody at least didn't do a little heavy lifting the first time this patient was evaluated for her recurrent headaches.)

For one thing, there seems to be this perception that the term 'migraine' is an indicator of severity; that if one has a headache, no matter what its cause, if it's severe enough, it is called a migraine. This is not the case, although my patient thought so.

One can have relatively mild migraine headaches, and also severe headaches that are not migraine headaches.

Migraines are caused by a number of factors, genetic, neurological, environmental, etc and some causes we don't fully understand. But there are many different kinds of headaches with different causes, and different presenting symptoms.

To give my colleague credit, the presentation seemed to spell migraine: right-sided pain located behind the right eye (retro-orbital). When I'm examining a patient complaining of headaches, I do a full ENT exam, plus a neurological evaluation. It's the ENT that my colleague seemed to have skipped.

The MRI result I reviewed before her clinic visit showed no intracranial abnormalities, only some mucosal thickening in the sinuses. So my first thought was "This isn't a migraine! It's a sinus headache!" I shared this information with her, and then did my examination. I was expecting painful right-sided swelling of the sinus, but I wasn't expecting a huge, swollen nasal polyp occluding the entire nasal passage. That, I'm guessing, is either the causative or a contributory factor.

I put her on a decongestant and a non-steroidal anti-inflammatory, and referred her to Ear, Nose, & Throat for excision of the polyp. If her headaches resolve, we'll know that was the cause. If not, well at least we ruled out the sinuses as a contributing factor.

A quick peek up in her nasal passages would have pointed my colleague to the right diagnosis. I'm not a medical genius by any stretch. But when all else fails, look at the patient.

Thank you for my Valentine Hearts!

I you back!...

"Hi. I'm here for a full head-to-toe annual physical exam and five other issues."

Whoa, whoa, whoa, whoa! Back up. Time out.

How long do you think a physical exam takes? We barely have time to do that. Your other issues are going to have to wait. And if they can't wait, we'll talk about them first, and postpone your exam until another time.

Seriously, dude; I want to help. But you're not the only patient on my schedule today.

Three providers at the mainstream clinic all resigned on the same day. More overwork is on the way.

I'm on call again next week after just two weeks off. My nominally not-for-profit health organization really needs to address the flaws in our system if they want to reduce turnover levels. But, based on prior experience, they'll just double-down on their work requirements, making every one's job more difficult.

Come what may, I'm not leaving my homeless patients. But our crosstown health care rival is planning a new clinic only five minutes from my house. It's not set to open for at least another year, but when it's up and running, I may serious consider resigning and going to work there.

Friday Night Vodka Buzz. Ask me anything.

Finally, a good day in clinic. Now it’s time to hit the weekend.