Visiting the Doctor - Part 4

With each visit to the doctor, I continue to be intrigued. This last visit (or, as is usually the case, series of visits) was no exception.

I am an office worker. I have pale white skin. This is something I have gotten used to. In fact, I think I have been pale all my life, with the exception of the year that I was 13 and worked on the Grounds crew and developed a most amazing farmer's tan. But being pale doesn't bother me, particularly as I have no desire to either just hang out in the sun for the purpose of being fried or the skin cancer that likely comes with such fried skin.

Since I am pale, I know that I will quickly fry, so I am of the habit of using the strongest sun protection available, usually SPF 50. So while in Spain on vacation, I slathered this stuff on. I even re-applied. And did a post-sun treatment with some aloe vera stuff afterwards to take the heat out, cool, etc. And while I may have forgotten the tops of my ears the first day of golf, everything else was fine.

Until Friday night. Suddenly, the skin on my arms and legs that had been exposed to the skin (and thank goodness not my face) started, well, going rogue. I won't describe this in detail for the faint of heart, but think bad, itchy eczema that was hot to the touch with swelling that had my knuckles looking like little dimples. Hmmm.... It got worse and worse with my skin just pulling tight and the heat radiating through me. So, nutshell, not such good times. So I knew that on Monday morning I had to go to the doctor's office.

There are, as I may have mentioned before, kind of open office hours each day so you can just show up without an appointment and they slot you in when they can. I was there bright and early at 8:00 AM. Turns out the open season doesn't start until 8:30. Fine. I had some books on my iPhone to read. Around 8:40, I was up. I went into the doctor's office and presented an arm.

Doctor: What's that?

SIP (to herself): Isn't that what you're supposed to tell me?

SIP (out loud): My skin is apparently have a negative reaction to something. This is the case only in areas touched by the sun, but note that the none of the affected skin is actually burned. And this is despite the application of SPF50 sun cream.

He was clearly confused on what to do. So he called in another doctor who also said, "What's that?" Hmmm. Two for two.... Not so good.

There was some fast and furious German back and forth between them during which they apparently agreed that they should give me a combination of some drugs, some cream (and at the highest level, which appeared to freak them out, but which I was thinking was probably something you could buy over-the-counter in the US) and an injection to immediately halt the inflammation. Fine. So the doctor wrote a prescription for all of this -- and some vitamins. He keeps trying to prescribe vitamins for me and I keep throwing out those prescriptions as I have my own US multivitamin stash (you can't buy a multivitamin over the counter here, which I think is nuts). I have to wonder if he's getting a kickback of some kind for this, but I digress.

So I went back out into the waiting area to wait for my name to be called again for my injection. About 40 minutes later I heard it, but it wasn't for the injection. Nope. It was for a THIRD doctor to look at my arms. I now officially felt like a circus freak. Which is saying a lot, because as Preuscher, one grows up feeling "special and unique" (aka strange). And then I was sent back to the waiting area for more good times waiting for my name to be called.

It wasn't until nearly 12:00 that my name was called. I was getting a bit peeved, because during all this time I could've gone to the Apotheke that was around the corner (or every corner, if you're in Frankfurt) and already had some drugs streaming through my blood. Anyway, it was my time. And I should've anticipated this by now, but I am a creature of habit - they first took blood and then gave me not an injection but an intravenous drip. Grrrr.....! Of course their plans only become clear after I have already been separated from both my BlackBerry and my iPhone, so I was alone with my thoughts, the IV and concerns that there was going to be an air bubbled in the IV when it was done and I was going to die. But, clearly, I survived.

I didn't see any different on Tuesday in any way. I was not pleased.

I saw a difference on Wednesday morning, though. I had, overnight, swollen to the point that my face was nearing Campbell Soup kid roundness and I nearly had cankles. I was not pleased. So I went back to the doctor's office. More waiting. When the doctor saw me, he asked what had happened. Um, again, I'm thinking this should be his call.... I indicated I suspected it might be because of whatever combination of drugs and "injections" he had given me. Hmmm.... "I didn't anticipate this. Okay, we'll give you another injection....."

Geez. But these were actual injections. Plural. Two of 'em. And I was told to just sit still and not move. Okay..... And then I was released. By which time, either through having been moving or whatever was injected, I looked a bit more presentable, but now felt like a truck had run over me. Nice....

Things were actually a bit better on Thursday. The swelling was going down and my hands now looked like they were a nicely cured leather rather than something from a horror movie. And then, of course, I was supposed to go in for a check-up on Friday where he pronounced me on the mend. I said that was all well and good, but what in the world had happened on Wednesday and how was I supposed to prevent this from happening again? Uhhh.... Wednesday wasn't anticipated and, um, going forward, you should stay out of the sun and not use the same sun cream. Would that be the same sun cream that was fine for 5 days and protected me from being burned? Grrrr..... So it remains a mystery. But this was the least satisfying of my visits to the doctor here so far. I miss my Chicago doc terribly. Though there's something to be said about the drama of temporarily being a circus attraction!

21 February 2011 - Visiting the Doctor, Part 3

So with the last posting getting us up-to-speed on my history with the German medical establishment, allow me to continue to more recent events.

About a week ago, I woke up in the middle of the night with a hacking cough. Couldn't get back to sleep. Couldn't stop coughing. Not good. So even I know that this might mean a visit to the doctor was in order. The doctor basically has open office hours in the mornings, so you can just show up without an appointment, which is kind of a crazy idea to me. But that's what I did in this particular instance.

I wasn't quite as surprised this time when, in his office after I had explained my situation, the doctor asked me to pull up my shirt. He listened to my breathing in various spots (which deep breathing caused me to break out into an extemporaneous coughing fit) and then said he didn't want to give me antibiotics at this point. Instead, he gave me a prescription (I use the term loosely - not a controlled substance here in the way we might think in the US) for a "natural" remedy but also ordered some blood to be taken for testing and recommended an "injection" of vitamin C. Now I don't know about you, but the idea of a literal shot in the arm of vitamin C was a new thing and somewhat fascinating. Um, it's not when it amounts to an actual IV (yes, as in intravenous) that makes a hyperactive person like me try to be still for 30+ minutes as stuff is shooting into me and, of course, while I am still coughing like I am sure there is a lung ready to be forcibly ejected.

As the day wore on, I thought I was feeling better and proceeded with a trip to Switzerland later in the day. By that evening, I was quickly loosing energy and the ability to breathe, the latter of which is particularly troubling. I got very little sleep that night between long bouts of unabated coughing. Made it to my client meetings the next day, but that night was even worse. When I returned to Frankfurt the following morning, I went straight to the doctor as things clearly were getting worse, not better.

He told me at this point that it was a good thing they did that bloodwork as it seems I had a "lung infection." Now, if you're like me, hearing that term made me wonder whether gangrene was taking over my lung tissue or something. No, not so much. I guess it equates to "bronchitis" but the term "lung infection" still troubled me. He gave me a prescription for antibiotics, ordered (versus requesting, which clearly had had no impact earlier in the week) me to stay at home not only the rest of that day but also the following day. Grrrr.....

He also told me to go in the following day (Friday) for another (this would be my third) vitamin C IV. I was going to skip, but since I was not allowed to go to work, I figured I might as well go. Um, yeah, after the IV I was preparing to go back home, but the nurse said that I should return to the waiting room. Okay.... When they came back to get me, they said that I was to have an EKG. Ummm.... Seriously? Which they did right there. More of the "take off all your clothes from the waist up" that a year ago might have alarmed me, but which I was getting used to by this time. After that, I was told to come back the next week for a follow-up.

This is when I finally kinda figured out what was going on. While I had forgotten that my heart had an asymptomatic long QT syndrome that could be exacerbated/made symptomatic by antibiotics, he had not. Hence his trying a bunch of natural remedies first. And when it became clear I needed antibiotics, he did an EKG after the antibiotics had been in my system 24 hours and then again after the treatment was over to determine whether the antibiotics were having any adverse impact on my heart. All good. Just might've been nice for him to say this a bit earlier on when all I wanted him to do was give me the German version of NyQuil so I could just sleep through the night. But in the end, I lived to fight another day, so all is good. And he gave me a whole bunch of reports on the bloodwork and EKGs for my own use (and to scan and send to my awesome doc in the US).

15 February 2011 - Visiting the doctor, Part 2

(Perhaps the theme music for E.R., House or even Trapper John, MD)

This is a far overdue posting, which is finally only making it because I want to add part 3 to the saga, which happened today. But much happened in between my trip to the doctor today and the one from the posting of May 2010. So some backfilling is in order....

Last summer, I seemed to be having a consistently high (for me) heart rate. I suspect it was primarily related to stress, but I finally decided to visit the doctor. Given that nothing ever came out of the failed attempt in May, I decided to look for a new doctor. The firm has an arrangement with International SOS which, in addition to being able to find medical care for me when I am in the middle of nowhere and may need to be airlifted out, also can find local healthcare professionals in other countries. So I called them up and asked for a local doctor who was bilingual and whose staff members were bilingual as well. And they delivered.

The new doctor's practice had a nice website that boasted of its "Integrated City Practice" approach, having a cardiologist on-site as well as internists and an accupuncturist, with other specialists within walking distance. The building is an old pre-war house (think brownstone) on Schweizer Straße about 100 meters from the river. You walk in through a big wooden door and follow some signs to the practice on the second floor.

Now, I thought perhaps there would be a sort of modern rehab inside the building, it being a medical practice and all. Not so much. The high ceilings with detailed wood crownwork are still visible with some fascinating lighting fixtures. The windows in the waiting room were tall French doors. Hardwood parquet floors throughout in beautiful patterns. I was taking all of this in, when I was called into the doctor's office. And I do mean the doctor's office. It was a big room with a large desk and two chairs in front of it, and a large couch/seating area in the other half. He invited me to take one of the seats in front of the desk, where I had a nice view of the courtyard out behind through the open windows sans window treatments. So with this in mind, you can imagine how I thought it a bit odd when he unceremoniously asked me to pull up my shirt. Uhhh.... But he was just going to listen to my lungs, my heart and then take my blood pressure. This was when I began to realize how prudish we may have become in the US.

His initial comments were that the heartrate/blood pressure readings I had brought with me were not particularly high, he thought it might make sense to do a few tests just to be sure. First step was to outfit me with a low-tech version of what the May doctor tried - 24-blood pressure monitoring. The lower tech version was a device the size of about two walkie talkies worn in a bag slung across me and with a rubber hose snaking down my sleeve to an arm cuff. Ever 20 minutes, the machine would power up and take my blood pressure. Including during sleep. Not so much fun. It was particularly awkward when I attended a dinner event and during the speech by a banker I started to "buzz" with the blood pressure taking event. Awkward.....

Step two was a full battery of tests, all performed at their office. The procedure rooms, if you will, are really just separate compartments created out of somewhat temporary partitions and some curtains. Not exactly noiseproof, but I guess if the doctor gives you the news that you are dying or have some awful disease while you are in his huge office, perhaps whatever goes on in the procedures room is not a big deal?

The tests were performed one at a time. You waited until you were called, went in for one of the tests, then were returned to the waiting room until your name was called again. The tests, though, were all performed by different people, so this perhaps made more sense. The tests included a breathing test, bloodwork, ultrasound of major organs and a separate ultrasound of the heart. All were directly connected to computers to capture and display the results. And what was perhaps most surprising is that the ultrasounds were performed by my primary care physician and the cardiologist themselves, whereas I would have expected some kind of technician to do those in the US. The prudish American in me was awakened many times, such as when, after he had performed the ultrasound of major organs, my doctor said I could get dressed. Apparently while he was still in the room. No big deal. But honestly, once I got used to it, it is so much smarter than dealing with the paper gowns that we have in the US that are more awkward than helpful most of the time.

The third step was a review of the results. Nutshell, I have a great heart that is responding well to stress. But the doctor's guidance was that I just needed to have less stress in my life and I should at a minimum take a three week vacation. At which point I literally laughed out loud. Which was followed by him making a remark about workaholic Americans.... He then noted that as someone trained in western medicine, he is trained to look for symptoms and causes, but not whole life health so he suggested I consider accupunture to reduce my stress levels and improve my overall health in a systemic manner. Uhh...? More reminders that I wasn't in the US anymore as you know that wouldn't be covered by most health insurance plans. All in all, though, a satisfactory experience. Anyone want to guess what all of these tests cost?

22 May 2010 - Visiting the Doctor

One of the things that I have successfully avoided in my time here so far was being sick enough to actually have to find a doctor here. As discussed in the posting on the pharmacy, the idea of trying to explain symptoms is not exactly something that is covered in a basic German language course. So I continue to seek online counsel from my doc in the US.



But about six weeks ago, I was feeling really dizzy for a couple of days, one day it was bad enough and getting worse that I left work while it still seemed safe to drive. The next morning was bad, but I figured I must have some kind of inner ear issue and should get in to see a doctor. I recalled that my assistant had found a walk-in clinic for a Polish colleague, so I figured wherever that was must speak English. Alas, she could not recall where she had sent him, but she did note that it was Friday and the doctor came to our office a few hours that day.



Now, if you're like me, you did a double-take at that. A doctor? In OUR offices? Recall that I work for a professional services firm, not someplace with dangerous machinery (though sometimes our paper jam prone copier becomes a danger when I want to kick it), so the idea of a doctor around is, well, odd. But then I realize I am in Germany and somethings things are a bit different here. So she got an appointment and I went down to see him. Nutshell, no inner ear issue, but I had high blood pressure at the time, which was news to me. He asked if I had experienced much stress lately. Ha!! Anyway, he suggested that I go to his regular office the following Monday morning. At that time, they would outfit me with a blood pressure monitor that I would wear for 24 hours, it would record my information and they could then download that at their office and determine if there was a persistent issue or if they had just caught me at a particularly stressful time that Friday. And his office was conveniently located in Sachsenhausen, my neighborhood. Perfect!



So Monday morning came and I set Hudson's GPS to the task of finding the office. As I approached it, I was a bit confused, because it looked like an apartment building. Yep, pretty much. But there was a listing for him and another doctor, so up the stairs I walked, passing apartments listing the family names of the occupants. Not exactly what I am used to.



When I arrived at the right floor, the door to the office was slightly ajar. Okay.... I walked in and found a guy sitting at a desk wearing a sweater, not exactly what I expected of a receptionist or nurse or whatever. But he showed me to the waiting room, which, this being an apartment and all, had a balcony outside of a sliding glass door. I have not encountered that in a doctor's office before. All of the magazines were in neat little matchings covers. Interesting.



The doctor finally came out himself and took me to an office. He was wearing a blood-red cashmere v-neck sweater and some corduroy pants. No lab coat. No stethoscope. No trappings of doctor power. Interesting. He took me to what seemed like a regular office and we sat across the desk from each other and he asked if I was ready for the blood work. Um, blood work? I thought perhaps something had been lost in our conversation the previous Friday and reminded him that I thought I was just there to get the blood pressure monitor. Oh, ja, ja!



So he took me to a different room that also featured a desk and seem more like an exam room, except not really. The other sweater-wearing guy came in and tried to outfit me with the device. Couldn't get it to work. It's like a really ugly black sportswatch and it has to be calibrated twice in order for it to work. For whatever reason, it refused. We tried various combinations and permutations. We tried the other arm. The doctor attempted to assist. 90 minutes later still no deal. I swear, all jokes about accountants and lawyers being heartless aside, I DO have a pulse! But as I was watching all of this and having my wrists yanked this way and that, I continued to examine the examining room. What strikes me the most is that the entire office is carpeted. I don't think I have ever been in a carpeted exam room for, I assume, the obvious risk that some messy things can happen in exam rooms that might be difficult to clean up on carpet.



They never did get the blood pressure monitor to work. I ended up buying an automated blood pressure cuff and took some hourly readings for a few days. Not surprisingly, I experience pre-hypertensive readings primarily when I am in the office, particularly when I am talking about budgeting and capital expenditures. Go figure. I keep the cuff in my office and every once in a while take my blood pressure just to see where I am. I do, of course, track all of this on an Excel spreadsheet and have made some graphs that I find both fascinating and horrifying. But it has become something of a joke, now. When my guys see I am getting worked up about something, they ask if I'd like to take some time out to check my blood pressure. All in good fun, of course. Makes me laugh. Which I suppose probably brings my blood pressure down. Love my peeps!