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Dr. Chip
Dr. Chip, Doctor (MD)
Category: Health
Satisfied Customers: 30155
Experience:  Over 20 yrs of Family Practice
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My foot is puffy

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My foot is puffy
Just the one foot?
Customer: replied 3 years ago.
Yep. When i press on it it turns white and then takes many seconds to return to normal color
Just suddenly happened? No pain or itching? Does it make an indentation when you press with your thumb?
Customer: replied 3 years ago.
I kinda noticed it this am because my sandle felt tight across the top of my foot. And no it doesnt create an indent
Hard to say with just one foot. If it were more generalized it could be thyroid, fluid overload, low salt. I worry a little about a possible deep venous thrombosis in a leg vein with something like this so, old story--you need to have it looked at right away
Customer: replied 3 years ago.
Seriously? Im in Rochester. I dont even know where I would go to get examined.
Just telling you my thoughts since you brought it up.
Customer: replied 3 years ago.
Done with the scan for today
OK
Customer: replied 3 years ago.
Do you think itll be normal
You keep asking that--I think so but I can't be sure
Customer: replied 3 years ago.
I want someone to diagnose whats wrong with me.
They haven't finished yet so be patient
Customer: replied 3 years ago.
But if this is normalThen i wont have a diagnosisHow long does it take mag citrate to work
Mag citrate takes arou 12 hours to work
Customer: replied 3 years ago.
Yuk
Maybe less--depends
Customer: replied 3 years ago.
Im neevous for this scan tomorrow
You're nervous a lot--why so much with a simple scan?
Customer: replied 3 years ago.
Well first of all im not known for laying still for long periods of time. And secondly what if they find a tumor
What if's again--natural to have that worry but it won't be long now. And it's not fun to lie still like that but you can do it. By the way--you need to rate that last, very long page.
Customer: replied 3 years ago.
Im just scared
I know but really I don't think they'll find a tumor
Customer: replied 3 years ago.
I worry they wont have a diagnosis besides chronic abdominal pain and ulcer, nos
We're just going round and round with this--you have to wait until they finish their evaluation
Customer: replied 3 years ago.
I hate waiting
We all have to wait some time and this hits your control issue--a good example of how we don't have any control over certain things and a good opportunity to practice letting go
Customer: replied 3 years ago.
What if they dont give me a diagnosis
What if questions are also a control issue--it's a complete waste of energy in a case like this to ask what if
Customer: replied 3 years ago.
Just answer it
No because I don't know exactly how to answer it. I think it will involved not using PPI's and Zantac and maybe switching to something like Reglan but it just makes no sense to think that the MAYO won't give you a diagnosis--they will
Customer: replied 3 years ago.
Fine dont be frustrated with me
Not frustrated but let's just not do the what if thing.
Customer: replied 3 years ago.
Im sorry
That's OK--I just have to say that to a lot of people since it's such a natural thing for them to do
Customer: replied 3 years ago.
What questions should i ask the mayo dr tomorriw
I gave you that list already
Customer: replied 3 years ago.
Ill have to see if i can find it. I think im
Dehydrated
Not likely with a swollen foot
Customer: replied 3 years ago.
Im being serious here. My pee is super dark, my mouth tongue and lips feel dry
You'd know if you were dehydrated just by knowing if you've had enough fluids today.
Customer: replied 3 years ago.
Ive had like 16 oz of fluid. I know you are going to say its not an excuse but i dont feel well
Well, up to you about drinking any more fluids since it's just a commonsense way to keep from being dehydrated. Now, enough of this particular thread
Customer: replied 3 years ago.
Nite
Nite
Customer: replied 3 years ago.
My pain is unbearable
I can't do anything about that and you know it--it's really a waste of time for you to tell me that
Customer: replied 3 years ago.
Why are you being so mean lately? Im taking 10 grams of fiber daily. But i still only go every 3rd day or so. Why is that? Should i switch to miralax
Not mean at all--I just can't tell you anything except to get it checked out. I noticed you asked about it with another expert and he told you the same thing--ER. What do you expect us to say when you say you've got unbearable abdominal pain? You don't need the Miralax and again with what you eat I don't expect you do go every day even though they told you you should--and I'm not even sure why they said that.
Customer: replied 3 years ago.
I have beem eating about 1200 calories thank you very much
I wasn't saying you weren't doing well there--I don't make innuendos with comments. I just don't know why they want you to have a BM every day
Customer: replied 3 years ago.
I dont want to do this scan
Too bad. And by the way, if you could manage 1200 calories a day you can also up the fluids which will both keep you hydrated and maybe help with the BM's.
Customer: replied 3 years ago.
Wow you are so nice and caring. I havent really eaten in a day and a half. As i dont feel well
What do you want me to say when you whine about not doing the scan? I can't be there to hold your hand so saying something like that is just chatting. So why did you try to--I won't say lie here--be devious with me about the 1200 calories, implying that that's what you've had on a daily basis?
Customer: replied 3 years ago.
I have eaten 1200 calories except
The last couple
Days. I wast devious
So where are we going with this?
Customer: replied 3 years ago.
Idk but i will let you know how my appt goes. Im done with the scan
OK
Customer: replied 3 years ago.
Btw i wasnt being devious
It came off that what but whatever
Customer: replied 3 years ago.
I am really incredibly nervous
About what?
Customer: replied 3 years ago.
About the results
You'll just have to wait until they're available--you've been stewing about this for days
Customer: replied 3 years ago.
They said my dr will have the results when i see him today
Then just wait until then--not much longer
Customer: replied 3 years ago.
But you think itll be normal? Are you done thinkimg it crohns
No on the Crohn's as yet and how many times do I have to tell you I think it'll be normal?
Customer: replied 3 years ago.
Whys wont you stop thinking its crohns
Customer: replied 3 years ago.
Hes still not convinced i dont have a tumor He wants to do an upper EUS to check for tiny tumors
What all did he say?
Customer: replied 3 years ago.
That the scan was normal but since my gastrin was elavated he thinks i have a tiny tumor that the scan coulda missed.
Did you tell him about the bad pain and that you hadn't eaten in two days?
Customer: replied 3 years ago.
Yes and he said its from the ulcers. He gave me an rx for Amitrytaline and increased the ranitidine
OK. Did you happen to ask him what's next if he doesn't find a tumor?
Customer: replied 3 years ago.
He said repeat gastrin level in 8-12 weeks
Does he think the gastrin level being elevated is causing the problem?
Customer: replied 3 years ago.
Yes he does
OK. So I guess you're still worried?
Customer: replied 3 years ago.
Ya. He specifically said he thinks its a tumor
Did you ask what's done if it is?
Customer: replied 3 years ago.
No i dont want to know.
OK
Customer: replied 3 years ago.
They wanna do the EUS on friday
Sorry--had to opt out because I was blocked. So can you swing Friday?
Customer: replied 3 years ago.
Idk. My boss hasnt called me back yet.
Sorry--keep getting blocked
Customer: replied 3 years ago.
Do i need to open a new ?
No, I think we're OK for now but get back to me in about two hours
Customer: replied 3 years ago.
I am so fricken scared.
Customer: replied 3 years ago.
How do i stop being scared
Well it's scary but I wish you had friends to fall back on
Customer: replied 3 years ago.
Would you be scared
No--honestly I wouldn't be
Customer: replied 3 years ago.
Why?
Well, first let me ask--why exactly does it scare you?
Customer: replied 3 years ago.
Because i coukd have a tumor. I guess im afraid of the unknown
But why exactly, if you had a tumor, would that scare you?
Customer: replied 3 years ago.
I dont really know
Well, would it be the fear that you might die?
Customer: replied 3 years ago.
No i dont think i would die from it. It might be the fear if needing surgery to remove it
OK--the only reason I asked is so I could tell you that it wouldn't scare me because I don't fear death and certainly I wouldn't fear surgery
Customer: replied 3 years ago.
Could i die if i had a tumor?
Well, since you've had ct scans that were normal, if it were a gastrinoma and there were no metastases, that's about 98% curable with surgery alone
Customer: replied 3 years ago.
Would it be a simple surgery or complex
Depends on where it was
Customer: replied 3 years ago.
This is his dictation so far

Mrs. Miller comes for followup visit for evaluation of the results of the octreotide scan. The octreotide scan was negative. There were no signs of a tumor. This is consistent with the negative CT scan. These results were shared with the patient, and we had a discussion about neuroendocrine tumors and gastrinomas. Seems like her gastrinoma _______?_______ microscopically therefore we are trying to complete the assessment with an upper endoscopic ultrasound. Once this has been completed we will have further recommendations. In the meantime, the patient mentions that her pain is not well-controlled. Therefore, we recommend to try to fill in the prescription of the AcipHex as prescribed in prior appointment. We are going to decrease the ranitidine to 300 mg twice a day, continue the Compazine which has been working for nausea, and we are going to add amitriptyline 25 mg p.o. daily as a neuromodulator. We recommend that the patient continue on the MiraLAX and fiber for her constipation and use magnesium-based products as needed for epigastric pain.
Why the blank with the question mark there?
Customer: replied 3 years ago.
I. Dont think his transcriptionist knew what he said.
Well he basically is saying if it were a gastrinoma it would be nonmetastatic and like I said that would be 98% curable in patients.
Customer: replied 3 years ago.
Does it make it sound like he thinks there is one
I don't think he does but it would help greatly do know what was in that blank space
Customer: replied 3 years ago.
He told me he thinks i do
Well, if he did, why did you want me to try to read his mind when you already knew what was in his mind? Sometimes I just don't understand you
Customer: replied 3 years ago.
He told me they are going to look specifically at my pancreas and small bowel
OK that's where they commonly occur but where are we going with this?
Customer: replied 3 years ago.
Idk. Sorry. Nite
Nite
Customer: replied 3 years ago.
What if my boss doesnt let me have the day off?
Reschedule the test, of course--and it could be done by your GI
Customer: replied 3 years ago.
My gi doesnt do EUS
We're starting to chat again--you can eventually get the test one way or the other
Customer: replied 3 years ago.
Sorry.
That's OK--anything specific to talk about before we close this page?
Customer: replied 3 years ago.
Why do you think the mayo dr thinks there is a tumor
Simple--you've got an elevated gastrin level. Like I told you before, atrophic gastritis with an inability of the stomach to make acid can cause that, but since it doesn't seem that's what you've got, you have to consider a tumor and do everything to try to find one.
Customer: replied 3 years ago.
I was hoping when the scan was done he would drop the idea of a tumor
Well, with the scan there's more evidence you don't have one but he needs the EUS to make sure. The fact that the scan was negative is really very good news
Customer: replied 3 years ago.
I hate all of this
I know but you're almost finished with it. Anything else?
Customer: replied 3 years ago.
I guess not.
OK--page is long again so let's close and get back to me when you need to
Customer: replied 3 years ago.
My boss said shed rather i wait
So schedule it when you can--we need to close please.
Customer: replied 3 years ago.
Last thing my anxiety will kill me if i have to keep waiting for this test
No it won't kill you and hold onto the fact that I think the EUS is still going to show no tumor. And talk to your boss because it sounds like this is the last time you'll have to be off work for this.
Dr. Chip and 4 other Health Specialists are ready to help you
Customer: replied 3 years ago.
Getting scoped tomorriw
OK--let me know how it goes
Customer: replied 3 years ago.
Last time they had a hard time waking me up. They gave me 10 mg of versed. 100 mcg of fentanyl and 50 mg of benadryl. Do you think that was too much
Way too much Versed--1 or 2 mg at most and I'd drop the fentanyl to 50 mcgm