NIRVANA

Nirvana is having a warm house. The repair guy, Bernie, came today and fixed the furnace. Bernie loves to talk and I am glad Chuck was here to listen to him. Bernie made it work and told Chuck in about five years we would be needing a new one. The one we have was made in 1991 so the parts are on the way to obsolesence. The weather outside has been in the fifties, and down to the thirties at night.

We had two space heaters, one for the princess so she would not be cold while studying for her GI test, which she got an A by the way. Emily has two patients tomorrow, that is a step upward in Nursing School.

Work today was orthopedics, we did shoulder scopes. First done is an interscalene block, which numbs the shoulder, and also provides post op pain control. They make three 1" incisions and do all the work thru there. They had rotator cuff tears, which are now fixed. At one time the procedure was to open the shoulder and repair it, but now it is minimally invasive and much better recover for the patients.

Tomorrow I will be doing eyelid surgery. These are usually older patients who need this done because of visual problems caused by the sagging eyelids. They will pay for it is there is a medical necessity. What I will do is get the patient very sedated for the local injection and then let them wake up so they can breathe on their own. They will do well with this technique and will not remember the shot.