Thursday, December 22, 2016

Access issues

Many of us struggle with access issues.  I am getting burdensome inquiries frequently regarding whether a patient scheduled far in the future should be seen sooner.  Two such recent issues were resolved as below.

1)  Message to me:  7 year old patient has been referred for developmental delay, leg weakness and arm weakness.

Mom says he has always been at least a month behind in gaining skills.  Has difficulty riding a bike, going up stairs. Fatigues easily and legs hurt. Mom said his calves (bilateral) hurt, are always tense and are “huge,” beginning to walk on his toes, intermittently. When climbing stairs does not alternate feet and has to “pull” himself up using his arms and the railing. Trips and falls a lot. Has not seen any specialists previously.  He has been scheduled into your next available clinic on 2/6. Please advise whether this timing is appropriate.

Response:  Has this patient ever had a CK (creatine kinase, in the past often abbreviated CPK) checked?  If not, it is a simple blood study and could be very important.

Message to me:  No previous labs. I have a call in to the clinic to request the primary to have labs done. I’ll specifically request the creatine kinase, CPK, anything else you specifically would like requested?

Response:  No, just that one lab.

Two days later, message to me:  You recommend the patient have a CK lab done. The lab called with the abnormal CK value of 24,506.

He will see our neuromuscular specialist.

2)  Almost 12 year old being referred for possible seizures and dissociative disorder.   Staring off into space and does not respond, some tongue biting.     Mom would like to be called at work today.  Episodes  started over 1 year ago.  She had some major issues going on in her life so they thought it was due to that. Episodes are happening at school.  In the past she usually blamed her episodes on when she was in trouble.    Mom said episodes seem a little different now.   Pt. stares off into space, starting to chew on her tongue.  Lasts 20-30 seconds.  Not sure how often they are happening at school.  Most of the time she will come out of it when they call her name.  Happens 3x/week at home, snaps out of it when mom touches her shoulder.  Last week her eyes were twitching. Stops activity, stares off into space but resumes activity immediately after episode ends.

First available appt. with neuro NP is 3/29.

Paged Dr. Breningstall.

Per Dr. Breningstall, he would like pt. to have an EEG done initially.  Clinic appointment can be then be scheduled based on the results.

8 days later EEG done, demonstrating absence seizures.  Patient begun on ethosuximide.  Appointment pending.

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