Home Forums Discussions General Discussion Carl's Blog On His Recovery From His Car vs Bike Encounter

Hi everyone,

I cannot remember a time this board has been this slow.

I can think of three general possibilities. First, everything is going great, and there is no need to post because of the wonderfulness. Second, everyone is jumping ship and no one is still using Amazing Charts.

Third, and I suspect most accurately, life is just too busy.

About a year ago, during the initial lockdown, we were very very slow at this time. Things picked up over the summer, Covid really hit this area in early October, I was infected in mid-October and was sick for about a week, but overall a rather mild case. One of my medical assistance contracted Covid in December, she had a subsequent pneumonia, was not actually admitted but very close to, and missed about a month of work. Ironically, we both got Covid from our spouses, not from patients.

Then in January my PA got Covid, really uncertain where she got it, not obviously from a patient but not obviously from anyone else. She was sick for about a month, seemed to have pneumonia with dropping oxygen saturation but x-ray was normal.

Since then Covid has dropped off, patient volume has increased. But it seems like the intensity of each encounter has increased, people have been saving up a years worth of problems, they are older and sicker, and so forth.

I have been following the threads on alternative EMRs with interest. I am not ready to give up on Amazing Charts, but I wonder if the handwriting is on the wall.…

How has everyone else out there doing?

Thanks

Gene

We have been busier lately as kids go back to school and are getting sick again.

Also, no updates lately, so fewer problems (?)

Sad to see that AC seems to be neglected (nonexistent support) and kinda sounds like people are (understandably) moving away from AC.

I think we'll be staying with AC. I just got our state vaccine registry interface to work after purchasing it in July 2020 (!!). I don't want to go through that painful process again.

I may be in the minority now, but I still love AC, and since the cloud AC moved to citrix it has been much better, other than the occasional freeze which requires getting a hold of guardian support. Which 9/10 i can get hold of quickly although last time it took over an hour and i had to reschedule patients. But that is the only time I have had to do that. Plus even though Updox went up in cost, the texting and secure video chats have been a phenomenal addition to how i can now do things at the office, and now (although i have not tried it out yet) i can do up to three other people to do a group chat on the secure video chat. So this will work good for a patient in assisted living visit with family member outside area all to be part of the chat. So I hope AC and Updox stay solvent till I retire likely in the next 5-10 years. Transitioning to a 4 day work week to prepare my wife to get use to me being around more has been a very good thing too.

Hi Serene,

Sounds like things are going well for you guys. Hope that continues!



Hi Jimmie,

Good to hear from you! Sounds like things are going well for you right now as well.

I am not giving up on Amazing Charts, by any means. But I am very concerned about the future. I believe the release of version 11 is over a year late.

Have you been following some of the threads about other EMR is, especially Praxis? I have been around long enough to know that things that sound too good to be true usually are. However, anything that would reduce the burden of charting, either timewise or "difficulty of work" wise would be wonderful.

I am like you, I am thinking about 7 or 8 years, give or take, left to practice. I am 64 now, for some reason age 72 seems to be a good time to retire.

Gene

Gene,

I have been following the threads on other EMR's just in case if anything ever happens to AC I can at least have a game plan to transition to, hopefully will never have to. Been busy here too, but enjoying my Fridays "off" finding that I am often busier doing non office related work then, but able to remote in a few times on Fridays just to keep things running so technically still working just not face to face stuff.

The board has been slow, and that has been for a number of reasons. First, I haven't been posting as I have been very busy. Very busy. I don't know why it would be inherently busy for me other than the projects I have taken on or for anyone else.

Keep in mind the single greatest reason the board is slow. When the board was hurriedly put together, we got a lot of people to jump over. But, a lot of users didn't make it. Didn't find us.

There was a time when there were many more interesting topics relating to Amazing Charts: Workarounds. We have nothing to work around anymore as version 10 is boring. We used to spend hours arguing about P2P vs Server. That is just over.

Amazing Charts weighed in with good and bad and we responded. There are many reasons. I think a lot of us are on auto pilot. I really hope I don't end up getting to a point where in September I have to pay support. I hope to be long gone by then when I get my projects done.

Amazing Charts just hasn't tried to keep up with the competition or Windows updates. For me, it has become boring.

Bert -- everything is in slow motion. The latest insult is Covid -- which undoubtedly has sapped will and energy.
But so many things are wrong: Medicare can't decide what they are going to do about "payment reform" (MIPS/MACRA) so it isn't any wonder that AC can't decide how to finish V11.

Our local hospital uses a Cerner program which is just awful, and it doesn't matter what the doctors say -- it never gets any better.
Other hospitals in the area mostly use EPIC which I have never used, but I hear is mind numbing -- and the records we get from them are wretched.

Query Google for "top EHR" and everyone is at the top -- dozens of them. That seems unlikely, since according to Medscape, one of the main reasons for "physician burnout" is the EMR

My impression is that 10 years ago EMR was a rather innovative, cutting edge sort of business -- most doctors were invested in making it better. Now we see that it is just another corporate tool to keep us under the administrative thumb, and we have turned into sheep -- just keep your head down and eat the grass in front of you. We have seen that all the work we put into practice improvement is wasted energy.

Hi Gene,

Well, since you asked how everyone else is doing . . .

I'm done.

I'm told that an elderly driver turned left into me head-on on my daily bike ride on March 29th.

Luckily, I was smart enough years ago to arrange to have a brother-in-law who's an orthopedic surgeon.

So now I'm in storage at a skilled nursing facility for the next ten weeks with four non-weight-bearing limbs while I grow enough bone to bear weight and start real rehab.

Since my clients can't wait for months to get their computers fixed, I've called and told them to find someone else.

The only useful computer trick that I've learned so far is to get a compact keyboard with built-in touch-pad or roller-ball to put on my lap to type while peering up at the laptop screen that's on the hospital bed's table--the laptop's keyboard is far too high to use even if both arms work.

(Picking a surgeon for a brother-in-law is an advanced trick beyond the scope of this post.)

Cheers,

Carl Fogel

Hi Carl,

I suppose I could start off with I am very sorry to hear that. But, I am sure you have heard that a million times.

When I read it, I felt so bad for you. I hope that after rehab, you can once again enjoy life, even if not to the same that you used to.

By the way, is there no one who can take over your business until you are back up and running? Sandeep even who seems to be able to do anything and everything.

I know you have heard this as well, but if there is ANYTHING I can do, let me know either here or pm or email: badams AT riverviewpediatrics.org____removespam

Seriously, take it one day at a time and get back to work when you can even if three months or longer. I didn't know you did computers and were not a doctor on here. Or are you both? I apologize for not knowing. If you do networking, I will be your first new customer.

Carl, this is horrible news. It is amazing that can remain so upbeat! Your "patented" cheers, even after a post like that.
What Bert says is correct.. let us know here (or by PM) if you can think of anything we can do to ease your pain... other than narcotics.
Let's hope you are back on your feet... though it sounds like with a challenging road ahead... sooner than expected.

Carl,
I add my sentiment about how awful this is for you. I am grateful that you are alive, your brain is intact and you are able to communicate with us. You are a valuable member of our community, and have provided enormous help over the years, as well as amusement and good cheer. There is very little that any of us can do since it is mainly about time to heal. But, I add my willingness to help if you think of something that we can do for you. Hoping that the pain is not too bad, and that you will heal quickly.

Hi Bert,

Thanks for your kind offer, but my medical problems are covered, my business was something that I could have stopped, and things look reasonably optimistic.

Another trick is to have a friend who happens to be a CPA and can take care of the sales and income tax for you, plus another friend who arranges a lawyer whil you're in surgery.

Damn, but I'm lucky.

Cheers,

Carl Fogel

Hi Jon,

Thanks, but I'm very lucky and have a lot of friends and family taking care of everything from finding a surgeon to filing tax forms to suggesting Biotene for the horrible dry mouth that left me unable to whistle.

I've been off the opiates for a while--they tried a wide variety of such stuff, from dilaudid to fetanyl and even morphine, before settling on oxy. Mostly I look forward to the muscle relaxants, flexerill and gabo-pentin (at least that's what they sound like). They stop my legs from marching on their own and squirming.

Cheers,

Carl Fogel

Hi Donna,

Thanks for your kind thoughts--it's nice of you and Jon and Bert to offer to help.

But really your posts are enough--they give me something to do and take my mind off things.

Amusingly, the legs and arms take a back seat to my bowels--I thought that I'd be keeping a noble stiff upper lip about all the broken bones, but instead I moan and whine about intestinal matters.

Fortunately, much of that is behind me now, as they say, and I celebrated a reasonably normal day with three victory laps around the facility in wonderful weather in my snazzy electric wheelchair.

Cheers,

Carl Fogel

Well I am sure that dilaudid, fentanyl and morphine can play havoc on your belly. Remember, MiraLax is your friend.

Write when you want. It will take our minds off AC.

Hi Bert,

Yes, the Miralax comes with the Lovenox injection for blood clots--tastes about the same as water.

Despite all the stool softeners and good intentions, an impaction cunningly hid from the medical staff.

Apparently, enough straining can force some stuff to ooze around an impaction and fool everyone except the patient into thinking that there's no problem. The patient, of course, knows that no matter what has emerged, there's still a burning baseball stuck in the exit.

Eventually, enough complaining led to someone trying a suppository, which failed, and then an enema, which succeeded.

Then the whole damn thing jammed up again, but the medical staff was on to its tricks now and administered milk of magnesia, so the dam burst about an hour later.

If nothing else, these intestinal follies kept my mind off the orthopedic adventures.

Cheers,

Carl Fogel

Well, while on this subject. I have a couple of patients with severe constipation. One with short-segment Hirschsprungs's. They did this procedure where they run a tube, I think through or around the naval into the colon, and then water is poured directly into the colon. Worked great for one patient, not so much for the other.

This was after failing Linzess, etc. I now one thing probiotics and fiber doesn't seem to work.

Amusingly, the legs and arms take a back seat to my bowels--I thought that I'd be keeping a noble stiff upper lip about all the broken bones, but instead I moan and whine about intestinal matters.[/quote]


Well as a gastroenterologist I can say that at least you are gaining an appropriate sense of what is important!

Impactions are no fun. Your description is accurate... sometimes they paradoxically produce diarrhea. Happy to discuss the physiology with you, but I suspect your mind is on more practical issues. A word to the wise... stay on the "easy passage" side, whatever it takes. If someone warns about becoming "laxative dependent" then ignore them, at least for the foreseeable future.

I must say, Carl, that I admire your sense of humor about this whole “crappy” affair.

Thanks, Donna.

Sadly, I lost most of my good humor today while waiting for 55 minutes to be hoisted out of my wheelchair, which was bending my legs painfully, and back onto the wonderful air-mattress.

While waiting and staring at the ceiling with the wheelchair in full tip-back mode, I'd resolved to leave the desk where I was waiting and look for another nurse who might have helped.

As it turned out, I wouldn't have made it, since the damned muscle spasms went wild when I lowered the chair to a normal position, and they had to run the joystick for me to get me into my nearby room.

At that point, I decided that it was better to say nothing than to vent what was on my mind.

Unfortunately, my noble silence was rightly interpreted as angry sulking by the nurses.

Luckily, we're all pretty good at forgetting little things like this.

Cheers,

Carl Fogel

Hi Jon,

So far, I've hit a brick wall when asking for anything more than a cup of MiraLax and the tiny red cholase pill.

But I'll keep asking, since ten minutes of heroic straining seems like a bad idea.

Thanks for the encouragement.

Cheers,

Carl Fogel

Hi Carl,

So, every time I get constipated (not often), I think of you.

You never told us what happened to the older man who turned and hit you.

Have you read the non-fiction book by Stephen King. It is relatively short, but a great book on Write and the beginning of his journey. The last chapter, though, is the story of when he got hit by the van when he was taking a walk. He describes everything in detail including his frustration with the driver of the van.

I think it will even make your plight seem better. I can always get you a one on one interview with him given he lives 10 minutes away.

Finally, grab your chart and schedule a colonoscopy for two days from now. The end result is always take until clear. Usually with mine, it is about one small bottle mixed in 48 hours, 1/2 one day, then 1/2 the next. Take three to four squares of Ex-Lax. But, as they say, or as I say, if MiraLax isn't working, you aren't getting enough. It sounds like they are using a maintenance dose like what we use once we get a four-year-old cleaned out. 1/2 capful bid, titrate to effect.

Hell make it three days a way and take the MiraLax faithfully. As far as preps go, there are 50 different ones, by 50 different GI doctors. Hell, I would go with Jon's.

Hi Carl,

Keeping with all of the comments above, I was shocked and stunned to hear of your accident. It is a trite phrase, but heartfelt, our deepest, deepest sympathies to you, and wishes for a total and speedy recovery.

Your interest in, and comments on, this user forum have always been greatly appreciated. You truly seem to be genuinely good guy, interested in helping.

I agree that your attitude has been absolutely amazing. It will go far toward speeding up your recovery.

As you recover, I suspect you will go through phases, you are far too bright a guy to just sit around with nothing to occupy your mind. Perhaps, when you are ready, you can reestablish your business as an Amazing Charts consultant….

Seriously, wishing all the best!

Gene

Carl,
I am sorry to hear of the difficult day you had yesterday, and hope that today was better.

Unfortunately, there is no medical facility that I know of that is not understaffed. Patients suffer having to wait for too long for things at times. I used to always recommend that they have someone with them to serve as their advocate and helper, but, with COVID, that has not been possible.

Cheers to you

Hi Bert,

I knew that King was hit by a car and had terrible injuries, but never read the details.

I have no memory of the accident, but am told that the driver was over 80, stopped, was remorseful, and said it was his fault.

Oddly, I have no interest in him, no anger, no outrage. I'd like to claim a wonderful forgiving nature, but the fact is that he just doesn't show up on my radar--the first thing that I remember was wondering why I was in an ambulance. Since then, I've been busy with more important matters.

Speaking of which, my bowels are slowly resuming a more normal regimen, but I plan to ask about those Ex-Lax squares, which never occurred to me--thanks.

Cheers,

Carl Fogel

Hi Gene,

Thanks for your kind wishes.

Probably I'll retire, since my clients have been told that I'm not available for the foreseeable future and had to find someone else to remind them to try turning things off and on again.

Luckily, I'm very fortunate financially and could have retired years ago before going on MediCare in February. I kept doing it because it was fun to fix computer problems, but I often made or lost more in a day on the stock market than I made in a year of pointing out that things work better when plugged in and turned on.

It's more abrupt than I expected, but it beats being dead.

And I have another activity that will keep me busy as long as the keyboard works. I'm no Stephen King, despite the parallel that Bert drew, but I like to scribble.

Cheers,

Carl Fogel

Hi Donna,

I spent a few months in my mother's hospital room, so I appreciate what you say about having an advocate.

Luckily, I have a Harvard professor of orthopedic surgery on call as my brother-in-law, so I'm better off than just about anybody else.

As for the virus, I'm even luckier in that I can't pull the trick of naming someone as my end-of-life agent (I can't remember the correct phrase) so that they can get in the room past the virus restrictions. A friend arranged that for his mother recently and made things much easier for her through outright chicanery.

I'm banged up, but expecting to survive, so no end-of-life hornswoggling of the bureaucracy. Right now I'm just circling in a holding pattern before my triumphant discharge in what I now hope is 4-8 weeks. to real rehab on weight-bearing legs.

Time now to make sure that I have YouTube ready to play the favorite song of this night's nurse. I had no idea that Melanie sang "Brand New Roller Skates," so I was pleased when I found it and saw that she also did "Look What They've Done to My Song"--which was a fairly faithful translation from the French, unlike the Branigan "Gloria," which had no earthly resemblance to the Italian original.

Cheers,

Carl Fogel

Ohhh....you have to plug the computer in?

Also, don't make any rash decisions while you are in this condition. Get better, start slow. I could use someone to help me find outlets for my computer. But, seriously. And, I have been vaccinated and still wear a mask.

Hi Bert,

The secret is to plug the cord in at BOTH ends.



Cheers,

Carl Fogel

Hi Bert,

My rash decisions right now focus on why the leg staples haven't been removed after almost 4 weeks and what the plan is for removing the catheter--someone just yanked it out, saw that I couldn't pass urine, and shoved it back in for the 100 mile ambulance ride,

Cheers,

Carl Fogel

Carl,

It’s not funny, but I love your descriptions of the goings-on.

It’s very good to hear that this will not be a financial burden to you, and that you have excellent medical help in your corner.

Keep writing and we will keep sending good wishes for your recovery.

Hi Donna,

With my leg staples and stitches finally out and my bowels beginning to respect my wishes, I was hoisted into a skeletal gurney and rolled down to the shower room, where I fell in love with the world's biggest shower wand--hot water felt wonderful on my legs.

The bad news was that the certified nursing attendant looked at the soles of my feet in horror, grabbed a wet towel, and tried to scrub off a thriving case of athlete's foot, which I hadn't noticed because of long-standing neuropathy inherited from my father.

Probably the fungus was the result of a month of bare feet trapped in huge anti-heel sore plastic boots.

So now I wear the usual hospital socks with traction bars that won't be needed for another month or so, but which hold half a can of foot powder each and waft white dust when anyone touches them, much like the yellow clouds when you shake a pine tree branch in pollen season.

***

For anyone unlucky enough to spend time in a hospital bed, a laptop on top of the bedside table is a wretched thing unless you plug a separate keyboard into its usb port--then you can type comfortably even with one arm in a cast and the other with a broken collarbone while looking at the laptop's screen almost a foot above your fingers.

Cheers,

Carl Fogel

See you are closer than you think to Stephen King. Now you are using metaphors in your posts.

Hi Bert,

Due to my previous incarnation teaching freshman English, I appreciate your point, but am forced to call it a simile instead of a metaphor.

Meanwhile, the new nurse took one look at me squirming like a grub on a griddle (a simile) and said restless leg syndrome.

Judging by the Mayo Clinic's attempts to explain medicine to the masses, she's right on the money (a dead metaphor).

Fortunately, my unruly legs have quieted down, leaving me to hope that this spring of my discontent will be made a glorious summer, not by any son of York, but by growing enough bone to stand on my feet again (a famous metaphor twisted to suit my situation, with no apologies to the author of Richard III).

I'm already making vague plans to try a tadpole tricycle (metaphor), since I will be as graceful on a road bike as a chimpanzee pedaling in a circus act (simile).

I'm recovered enough to feel put upon because I'd just replaced the chain, the front and rear gears, and the rear wheel before the accident, and now the bike probably looks like a modern art mobile (simile).

I apologize for taking flight off your friendly post (pedantic correction is simply rude), but scribbling like this takes my mind off the current slings and arrows of outrageous fortune.

The only Stephen King book that I remember is 'Salem's Lot, an early novel that I thought walloped the hell out of the vampire genre, a far better read than the excruciatingly bad writing of "Varney the Vampire" or the deadly dull diary exposition of Bram Stoker.

Good heavens! I may be feeling good enough to pick up a book off my electronic pile and read something more than internet jottings.

Cheers,

Carl Fogel

I have to ask did your ninth grade class like you? J/K We were just learning prenons, subjux and objecx in ninth grade. Carrie and Salem's Lot were both written in the laundry room of his rented trailer.

Carl,

Your musings are terrific! Thanks for our English lesson. I admire those who can write, I struggled through my freshman college English to get papers written.

Are you typing all of this, or using any voice dictation?

I am very glad to hear of your improvements.

Hi Bert,

My 9th grade class adored me, of course, since I was just another 9th grade student serving the 9th year of a 12 year sentence with no time off for good behavior.

My college students, on the other hand, did not suffer me gladly, since I gave them spelling tests in hopes of getting them to understand that the written word distinguishes between two, too, and to, as well as it's and its and there, they're, and their.

Such pedantry was resented least by the scholar athletes, who appreciated my point that anyone trying out for the football team would be expected to run, jump, and do a few push-ups before being allowed to attack someone on the gridiron.

Our friend the apostrophe is, after all, quite simple, with only two jobs.

First, an apostrophe shows missin' letters--they are becomes they're, it is, becomes it's, and so on.

Second, an apostrophe shows possession with an -s- unless it's a pronoun.

Carl's post and Bert's reply are easy, but words that already end in -s- are trickier--Moses's tabletscan also be Moses' tablets.

Pronouns, do not use apostrophes to show possession. When in doubt think of my dog, her comb, our house--they use no apostrophe, and neither do its title, his father, or their cattle.

If you make a mistake, remember that no one can hear the difference if you read what you wrote out loud.

It is in fact the pedant who fails to read things correctly. I blush to admit that I read "oncet" as one-set for years because that's how it looked to me on the page. My ignorance was eventually shattered when I read a book that tried to spell out the colloquilalism as "wunst"--that's how it's pronounced in casual speech in the South. "I wunst thought that I knew how to say 'oncet.' but I was dead wrong,"

Don't get me started on how Old English had singular, dual, and plural forms for nouns because that's how they saw the world.

Cheers,

Carl Fogel

Hi Donna,

I've been typing for almost fifty years.

I started on manual typewriters in junior high school and pounded their individual keys through undergraduate school.

In graduate school, I learned underhanded tricks to get on the main office's IBM Selectric, whose whirling ball replaced the separate keys that often stuck together if you typed too fast and whose electric motor provided the same whack on the paper whether you hit the key hard with a forefinger or just tapped gently with your pinkie.

When I began teaching, I fell in love with the crude word processors available at the university terminals, though it took me a while to understand why I needed a password in addition to logon, and even longer to understand why I would need folders to organize things.

Then came the personal computer--mine was a dual floppy CP/M KayPro portable about the size of a modern desktop with a 9 inch green monochrome screen and WordStar 3.3.

I switched to the MS-DOS world and modern PCs and have been typing happily since 1986, when I found that I could prey on medical offices that either had computer problems or else were planning to acquire them.

So far, no voice dictation, but my brother-in-law is urging me to try it and I have nothing else to do, so maybe I'll take a stab at it.

Cheers,

Carl Fogel

Carl,

I find the voice dictation much quicker, I’m a slow typist. It might be easier for you since the laptop and keyboard set up on the bedside table is so clumsy.

I have been trying for years to get my secretary to properly use the apostrophe for the possessive. She seems recalcitrant to my lessons. Any suggestions on how to make my teaching stick?

And, who would put a grub on a griddle?