Transcript

Doctor: Hello, Ms. Jones. I'm Dr. Dalton. I think it's the first time we've met. Patient: Yes. Doctor: Good. What can I do for you today? Patient: The specialist told me I needed to follow up with you. Doctor: Okay. That makes me frightened. What did the specialist say to you? Patient: Well, it was one of those bone specialists, the ortho guy. He said that my bones were a bit on the thin side, and so he doesn't deal with thin bones. He only deals with broken ones. So he said I had to see my family doctor, who's retired, so I'm seeing you. Doctor: Okay. I guess he merits his retirement. I'm sorry to hear that you ended up in the hands of an orthopedic surgeon. Did you have some kind of accident or fracture or something like that? Patient: No. It was really minor. I was just climbing down from the forklift truck that I drive, and I kind of slipped a little bit on the last step, and I reached out with my hand, and I guess I put too much pressure on my wrist, and I ended up with one of those, it's like a dog fracture, a collie, you know? So I went to the emergency room and everything, and they took an x-ray, and my bone was broken or whatever, and they put a cast on, and they sent me to this ortho guy, and he said that my bones, like I also had to have a chest x-ray because my back was killing me by the time I got there, and he said, yeah, your bones are kind of thin. You need to see your family doctor about it. So, you know, here I am. Doctor: When did all this happen? Patient: Gosh, six weeks ago, something like that, yeah, maybe a little bit longer. Doctor: Yeah, so it's kind of fresh. Patient: Well, I mean, I've been at physio for ages, and the physiotherapist said it should have been fixed by now, but it's really not. Doctor: Well, it can take a while. I think what was concerning the orthopedic surgeon was that you ended up with a fracture there, which would normally maybe not happen with the kind of fall that you're describing, and did you say you also had a little fracture in your back as well? Patient: Yeah, I did. Like, I mean, I didn't realize it, but my back was kind of killing me, and he said it was like, you know, your spine bones, they kind of got squished a bit. Doctor: It sounds painful, actually. Patient: Yeah, I mean, I don't need the ibuprofen anymore, and it's much, much better. So the pain is pretty much under control. Doctor: You know, his concern would be for something we call osteoporosis, and that's a thinning of the bones, and it happens to all of us with time, but sometimes it can happen a bit earlier in some people, and that's a bit of a worry. In your family, is there any history of thin bones or osteoporosis? Patient: Yeah. Yeah, my mom broke her hip like two years ago, and my sister had a fall. It wasn't a big fall, and she broke her arm a couple of years ago too, so maybe we all have it. I don't know. Doctor: Well, you might come by this naturally. How old are you, may I ask? Patient: 57. Doctor: 57. And when did you have your menopause? Patient: I had it kind of early. All of us have early menopause. I was around 40-ish when I, you know, started. Doctor: Yeah, that is quite early, and it can also lead to thinning of the bones if it's happening pretty early like that. Now, you know, we will have to look into that. The orthopedic surgeon is right. There are some things that we look at in terms of lifestyle that can maybe also cause thinning of the bones. Do you take alcohol at all? Do you drink? Patient: Yeah, maybe a couple of beer a week. That's about it. Doctor: Okay. Smoking? Patient: Yeah, I do. Don't tell me to quit. I smoke about a pack a day, and I have since I was like in my teens. Doctor: I'm going to tell you to quit. Maybe some other day, but we will talk about that, you know. One of the other things that can sometimes cause it is a lot of caffeine use, but I don't think that's as important as some of the other things. Do you drink a lot of coffee? Patient: You do? Yeah, I love my coffee. I have two or three before I even go to work in the morning, and then I have another two or three at work, so yeah. And, you know, it surprisingly doesn't bother my nerves, you know. Like you'd think you'd be wired, but I'm wired up anyways. Doctor: You're wired up anyways? Patient: Yeah, I'm just feeling anxious all the time. Doctor: Yeah? Patient: Yeah. Doctor: Do you think that's because of this accident? Patient: Well, you know, it's partly the accident. Like, okay, so here's the thing. I love driving the forklift. I love it. And, you know, you're zipping around the warehouse. It's so cool. I have all the friends, and, you know, and I'm really good at it. I even won a prize, right? And since I've been off with this fracture, I guess it was longer than six weeks. It must have been a few months. Like I've been on this work thing where the physiotherapist kind of gives you a modified job, right? And she's tied me to this frigging desk, and it's awful. I hate it. And, like, I have to use a computer and stuff, and that just, like, totally freaks me out because I'm really not a computer person at all. And it's so frustrating because I want to get back. And now she's, you know, just last week she had me go through, like, all these physio things where you try and steer, and they have a practice gearbox and all that kind of crap. And, like, I couldn't do it. I couldn't do it with my wrist. And so she's got this big meeting scheduled next week with, like, workman's comp, and they're going to say, you know, I can't drive a forklift anymore, and they're probably going to put me on a desk job. And the only desk job is the receptionist. God, help me if I have to do that job. It's like all computer work and booking products and shipments and crap like that. And I'd lose my mind. I really would. It's got me drove. It really has. Doctor: Well, I can see that. You know, I can hear the frustration in your voice. It really is difficult to look at something like this happening, an accident, that could lead to you having to change jobs. And I guess that's what you're afraid of right now is it might be a permanent change. Patient: Yeah, well, that's, I mean, that's just one thing that's on my mind for sure. But that's a big one. Doctor: Yeah, it would be. It would be. You know, that whole workman's compensation thing is a bit of a treadmill, too. It can be. And it can be kind of difficult to sort all that stuff out. So, you know, if you can see a place where I can help you with that, you should let me know. Patient: Yeah, go ahead. Doctor: No, I was just, like, hoping that maybe you could make my bones better, and then I, you know, then I would be able to do the physio test, and then I wouldn't have to take that job. Right? Doctor: Well, certainly we're going to have to look at your bones. We're going to have to see what we can do to strengthen them. I think you're absolutely right. Do you take a lot of dairy products? Are you? Patient: No. Doctor: No. Don't take any calcium, vitamin D? Do you take any? Patient: No. Doctor: So the only thing you're taking, as I understand, are things for pain, or do you take any other medications? Patient: I don't take anything. I don't even need the ibuprofen anymore. It's good. Doctor: Nothing else? You're not taking any medications over-the-counter, nothing at all? Patient: No. Doctor: Okay, well, you know, it gives us something to work with, I guess. You mentioned a couple times that it's one of the things making you anxious. Patient: Man, I've just got so much going right now. Like, okay, so my youngest daughter just got her GED. That means that she's going out for this better job, so she moved away. Now, she got pregnant really early, and there's two kids, right, my two grandkids. They're, you know, Billy is 10 and Eugenie is, like, 9. And anyways, they're living with me right now, okay? Now, they're great kids. That's not the problem. It's all the school stuff that they have to do. Like, I'm having to teach them their schoolwork, and they're taking these tests all the time. It's like all the teachers do is, like, organize tests, and I've got to tell you, like, I had a real problem with taking tests when I was a kid. Like, so much that I actually had to leave school early. Like, I just couldn't do it. I would get myself up in knots, and I'd just spend the whole time in the bathroom being sick. And now it's, like, it's all coming back. It's, like, it's crazy. I don't even know what to do. Like, I break out into shakes, and I'm just all caught up in knots, and I can't sleep, and I'm having nightmares. And all because of, like, between the job, not being able to go back to the job I love, and dealing with my grandkids. Man, I just don't know. Doctor: Well, it's a lot all at once, for sure. You know, the idea of dealing with, you know, your grandchildren at home, having to tutor them, combined with being off work and not sure what your future is going to be, and the whole combination is certainly very stressful. I can understand that. It sounds like you do have a bit of a history of anxiety. Would I be fair in saying that? Patient: Yeah, yeah. I mean, nobody ever gave me any drugs for it. I never saw a doctor for it. Maybe I should have when I was a kid. But, man, I'm just so anxious now that I was just kind of hoping maybe you'd be able to do something about that. Right? Doctor: I feel overwhelmed. I've got to tell you, I'd feel anxious if I had to teach, do homework with a 10-year-old as well. So I don't think it's easy, you know, getting back into that. It brings back some unhappy memories for you, I think, it sounds like. Patient: It really does. School wasn't the best time for you. Doctor: How long are the grandkids going to be with you? Patient: They could be with me for another several weeks. I don't know. It's up to my daughter when she gets settled in a new place and gets a new job. I mean, I hope it's not much longer, but you never know, right? Doctor: Is your daughter on her own or does she have... Patient: No, she's on her own. Doctor: She's on her own. So it's hard for her as well. She's lucky to have you, really, to be able to look after the kids, you know? Patient: Right. So it's a bit of a mess right now. Doctor: You know, one of the things I would say, though, from what I'm hearing is that some of the things that are happening to you are time-limited, right? And the grandchildren aren't going to be with you forever. This work problem, it's going to have to get settled. It can't go on forever and ever. So, you know, the anxiety you're feeling now is it's going to come to an end. It's going to get better is what I'd like to say, you know? Maybe we can help with that and give you some suggestions. But, you know, in the long run, I think it's going to be okay. What kind of support do you have yourself? Is your husband married? Patient: You've got three minutes. You've got three minutes. Thanks. Yeah, my husband's great. He's a long-distance truck driver. So he's gone for, you know, three, four, five days at a time kind of thing. But he's always been super supportive. And so there's no problem there. And I'm close to my family and stuff. You know, it's not like I'm totally alone. But I'm not going to ask my 80-year-old parents to come and help with the great-grandkids, you know? Doctor: Are you thinking of retirement anytime soon? Patient: Oh, God, I wish. But we've looked at our finances. And I've got at least six or seven years that we both want to get a fair bit of money tucked away before we can. So, yeah, no, no. Doctor: You want to get back to your job. So, you know, in the interest of time, let's talk a bit about the osteoporosis situation, that thinning of the bones. It certainly sounds like you have that. There are tests we would do, like a bone mineral density test to see how thin they are. But, in fact, I can tell you already that you have osteoporosis just from what you've been telling me of these fractures, you know. There are some things you can do without medication, like maybe cutting down on smoking. I know we don't want to go there. Calcium, vitamin D can help. Regular exercise is a good thing to do as well. It would also help with your anxiety, you know. Patient: Oh, yeah. Doctor: It might help sort of calm things down a bit. There are medications we use for osteoporosis. They're in a family called bisphosphonates. But we talk about that after we got these results back and saw what was going on. That just helps the calcium get into the bones, you know, helps strengthen the bones. The anxiety is a different issue, you know. It's really hard. The thing I would say it's temporary. You know, a lot of what's happening to you is because of the situation. Work with a compensation board. Often there is a role for a doctor in that. And if you can see how I could help you with, you know, saying, you know, we hope she'll improve. She's not ready to go back. She isn't suited for this particular job. Perhaps another job would be better. You know, there are things we can work with that. Yeah, perhaps with an occupational therapist as well. You know, I don't think medication is going to help you with anxiety. I don't think that's something you want to deal with. You know, especially since this anxiety I'm pretty sure is going to come to an end once these things start settling down. Patient: Yeah. Yeah. That would be great if you could help with that workers' compensation meeting. That would be fabulous. Doctor: Well, you know, just go in with the idea that the doctor is there if you need medical notes to help you with one decision or another. So, you know, I'd certainly be there to help you with that. We're going to have to meet again because our time is running out. But is that kind of a fair plan for where you want to go at the moment? Patient: That's a great plan actually. That's a great plan. Thanks. Doctor: Let's meet after you have your appointment with the workers' compensation board. We can see how that goes. And we can also make those other plans for what's going on with the bone test. Patient: Okay. Doctor: Okay. Thanks. Nice meeting you and I look forward to seeing you again. Patient: Bye. Doctor: Bye now.