March - April 2013 - Hillsborough County Medical Association

Editor’s Page (continued)
ter). No wonder the “cost of medicine” is going through
the roof.
I don’t know about you clinicians out there, but being
rather blunt…I’m getting tired of severely overweight,
ok, fat patients, who refuse to do anything
for themselves to lose weight, especially the diabetics,
patients with metabolic syndrome, or those with high
lipid levels and elevated blood pressure. I don’t know
how a patient who weighs over 300 pounds cannot lose
weight with a reasonable diet. I’ve heard them all, numerous
times…“I only eat one meal,” “I watch what I
eat,” “I walk the dog every night,” “I joined the gym,”
and now my new favorite, “The air is very humid here.”
Yes it is, but I think that might only affect Sponge Bob
Square Pants.
I have a very nice female patient, 71 years old, who
weighs 268 pounds, with a BMI of 45. She has type 2
diabetes, hypertension, elevated lipids, hypothyroidism,
rheumatoid arthritis, knee pain secondary to osteoarthritis,
lower extremity edema, and, well, geez, that’s
enough, don’t you think She sees a rheumatologist and
between the two of us, we have her on maximum dosages
of meds. Her numbers are ok: lipids, A1C, blood
pressure, but she isn’t working on her weight, something
that would greatly help her. I don’t know what
else to do for her, but since I joined Weight Watchers
and YES, finally fulfilled my New Year’s resolution from
New Years past to lose 25 pounds, I can, having “talked
the talk and walked the walk,” encourage my patients to
join WW. The plan works, it’s simple, it’s not expensive,
and there are NO Weight Watchers foods that you have
to eat. There’s simply no reason not to join, but patients
want a quick fix or someone else to do it for them, and
not take the responsibility upon themselves. At our
Weight Watchers meetings, we say it’s “accountability”
that one must accept to be successful. If you don’t want
to be accountable to yourself, then there’s not much I
can do for you. I’m not your friend, I’m your doctor, and
I’m your medical messenger, not your miracle worker.
Accept that and don’t make excuses.
And lastly, I’m a bit perplexed by this one. I was asked
to evaluate an 80-year-old lady for eyelid surgery. She
was diabetic with an A1C over 8, but that really didn’t
concern me for the surgery. What did was a rather loud
bruit over one of her carotids. An ultrasound showed
between a 50-74% narrowing. I was concerned about
her undergoing any type of general anesthesia, so suggested
to the surgeon and patient that she see a vascular
surgeon for clearance. I received a report from a cardiologist,
whom the patient saw after her son made the
appointment, which included an echocardiogram and
exercise stress test. Both tests were essentially normal
for her age. I wanted someone to evaluate her carotids,
not her heart, and I was a bit confused. So I called
the cardiologist for an explanation. He told me that, in
his experience, blockage of a carotid, even in the 50-
74% range, was not a problem if the patient was asymptomatic.
I said, “Ok, that’s fine, but why did you do the
echo and stress test” He couldn’t really say, but he did
reiterate that the carotid blockage shouldn’t stop her
from having the eyelid surgery. I never did get an
explanation for why the tests were done. It still
doesn’t make any $en$e.
Photo Contest Answer…No One Guessed!
This was a tough one! After publishing the photo in THREE issues of The Bulletin, no one was able to come up with
the correct answer: The “Future Walk” sculpture at the HCC Ybor City Campus.
10 HCMA BULLETIN, Vol 58, No. 6 – March/April 2013