On a darker note, people say we are heading towards another depression, and I don’t doubt it. So I asked myself the question: “Can we learn something from the past to help us with where we might be going?” Well of course the answer is YES! I wonder what some of my relatives did who actually lived through the Great Depression…
Showing posts with label Retroflexion Blog By Frederick Gandolfo MD. Show all posts
Showing posts with label Retroflexion Blog By Frederick Gandolfo MD. Show all posts
Saturday, May 27, 2023
article notes from retroflexion
Fast-forward to May 2020, and we are living in strange times indeed. Society has been “on pause” for the past 2 months due to the coronavirus pandemic. Family budgets are growing tight and it’s no longer a good idea to make frequent trips to the grocery store every time you need an ingredient. Many restaurants are closed, and most people are rediscovering home cooking by necessity. Like many people, I used to really enjoy cooking when I had the time to experiment and there was no real pressure. After all, it was just my wife and I: We were happy to eat whatever, whenever!
Wednesday, April 12, 2023
“When Can I Go Home?”
Most patients want to get out of the hospital as soon as possible. No one wants to sleep in a loud hospital room with constant interruptions for rounding, vital sign checks, blood work, etc. Hospitals are a place for people when they’re sick, and if you aren’t sick you shouldn’t be in a hospital.
I have noticed a funny thing…often the less ill a patient is, the less they ask about discharge, and the more sick a patient is, the more they focus on going home. A scenario that repeats itself day and day again is as follows (Warning: hyperbole ahead):
Me: “So Mr. Jones, I see here in your chart that you have a history of heart trouble, diabetes, and emphysema. What brought you in today?”
Mr. Jones: “Well I can’t breathe, and I’m passing black tarry stools, and my pacemaker fired three times today during dialysis, and I’m having severe belly pain. Did I mention I can’t breathe?”
Me: “Yes, I can see you’re got a lot going on. Tell me, when did you start having black tarry stools and severe abdominal pain?”
Mr. Jones: “Oh that started a few days ago. When can I go home?”
I guess there is a natural tendency to focus on the light at the end of the tunnel when you are really sick. Maybe fixating on the goal of discharge takes away some of the anxiety of the hospitalization. The thing is, I simply have no idea when a patient with multiple active problems will be able to go home.
No one can really tell when an individual patient will be able to safely leave the hospital after a major illness. I can tell you what the average length of stay is for a certain disease based on past experience, but this number often has little bearing on the individual patient. Everyone is different. The average time in the hospital for an isolated bleeding ulcer requiring blood transfusions and endoscopy may be 2-3 days, however if there are other problems that come up along the way the length of stay may be two weeks. Predicting how long someone has to stay is really just an educated guessing game.
Truth be told, I would rather someone who is sick ask me the impossible question of “when am I going home” than the opposite extreme…
Me: “OK Mrs. Smith, it looks like everything checks out: Your EKG, labs, cardiac enzymes, stress test, and chest X-ray are all normal. The mild vague pain that started two months ago and has since disappeared after antacids is probably just heartburn. I can have you follow up with me in the office next week for any further testing needed.”
Mrs. Smith: “Oh no, I’m not in any rush to leave until I have everything checked out! I want an endoscopy tomorrow. I’m overdue for my mammogram, and I think I just got a letter telling me to schedule my colonoscopy too. My knee has been bothering me for months…do you know any good orthopedists? My daughter is out of town and can’t pick me up from the hospital until at least next Thursday anyway…”
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Sunday, March 19, 2023
Saturday, March 18, 2023
growing mentally and emotionally?
Who makes sure that the kids are growing mentally and emotionally?
stay fit mentally and physically
trying to keep my promise to myself to stay fit mentally and physically as I age,
social media and reality
However, there is a big difference between what you see on social media and reality.
Frederick Gandolfo, MD
A Long Island native, Dr. Frederick Gandolfo graduated with a BS in biology from Fordham University in Bronx, NY. He attended SUNY Stony Brook School of Medicine. He completed internal medicine residency training at New York University. He continued at NYU for gastroenterology fellowship and was awarded fellow of the year. Dr. Gandolfo is board-certified in internal and gastroenterology.
After practicing in a large group for several years, Dr. Gandolfo decided to go solo in 2018 and started his own practice, Precision Digestive Care, located in Huntington, NY
Dr. Gandolfo lives in Long Island with his wife and two children. Most of his time outside of medicine revolves happily around doing dad stuff, but he is also an amateur photographer, fitness enthusiatic, frustrated writer, and empiricist at heart.
Lower gastrointestinal bleeding (LGIB)
Lower gastrointestinal bleeding (LGIB) refers to blood loss of recent onset originating from a site distal to the ligament of Treitz [1,2].
It is usually suspected when patients complain of
As a general rule of thumb, black tarry stool is usually caused by bleeding in the upper gastrointestinal tract (esophagus, stomach, duodenum) and red blood usually comes from the lower GI tract
GI bleeding Rainbow photo (click the link and check the color)
Black tarry : Common causes include bleeding ulcers in the stomach or duodenum.
Melenic stool is often described as glossy and sticky and has a characteristic horrible smell.
maroon stool, burgundy stool, and even mahogany stool. Dark red blood is most often a sign of colonic bleeding,
Bright red blood is usually indicative of an anorectal source of bleeding such as a hemorrhoid or anal fissure. (BRBPR=Bright red bleeding per rectum )
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