Adventures in telemedicine
Written some time ago
Last week we were invited to a get
together at a neighbor's home. One of our good neighbors said that her
grandson was riding a bicycle and went over the handle bars and suffered
a fractured clavicle. The parents were to fly to the East and our
neighbors were tend the boy and the other children. She wanted to know
if the grandson would need to have surgery and the parents would have to
postpone their trip. I said I would need to look at an x-ray to tell.
Our
friend said she had a copy of the x-ray on her phone. She texted me a
copy. I looked at the break and it was widely separated and fragmented. I
sent by text the x-ray to Dr. Ogilvie who is an orthopedic specialist.
He looked at the clavicle and called me and said that there was a good
possibility that there was muscle between the fragments and that the boy
should have an open reduction and a plate to fix the fragments.
Our friend later informed us that the boy was taken to surgery and they found the fragments separated widely and soft tissue interposed. The parents canceled their trip and their tickets were voided, but because of a storm they were given a voucher for the whole amount.
My daughter-in-law called about her father who had fallen in the shower and was somnolent and unsteady. He had been checked by the doctor and went to a week long family reunion but did not participate actively. They made an appointment to see his family doctor, but other family members were pushing to have him go to the emergency room and get an MRI. She called for my opinion. I listened and told her to go to to the appointment and to avoid the emergency room. He is claustrophobic. I suggested that he probably had received a subdural hematoma. She went the appointment and the doctor was explaining what the CT scan he had received previously showed. When my daughter-in-law asked him if it was a subdural, he responded in the affirmative.
The crisis with the family was averted.
I received a call when I was working in the missionary department from a mother who had a son with back pain in Taiwan. He had been seen by a local physician and a MRI was obtained. The mission president's wife uploaded it to Novorad and she was informed that a doctor here in Utah had read it. Nothing was in the Elder's medical record. I could not find out who was consulted. I found the study on Novorad, but I don't know how to read MRIs. The mother called me the next day saying she had gotten the disc and no one could open the files to view the images. I could not help her with that. I told her I would call Dr. Oglivie and have him look at the study. In the meantime I opened the files on my computer and using the cropping tool in Onenote I copied the study into a Word document and then emailed it to the mother. Dr. Oglivie looked at the MRI and phoned me to report that the Elder had scoliosis and he could not see any disc impingement on the nerves. I copied the sheet of instructions from missionary medical and sent it by email to the mother with the information obtained from Dr. Oglivie.
My wife got a call from a sister that we minister to. She told my wife that she had iritis and we should not come to our appointment that day. In the conversation the sister said that she had recurring episodes of iritis over the last number of years. For some reason I thought of Sarcoidosis and the fact that it was associated with the pollen of loblolly pine. I called her and suggested that she mention this to her doctor. She had lived in the south and on a street lined with loblolly pine trees.
