let's get some stuff that's more current in this and he'll reorder it that comes back next week and he'll be back in sixty days again see this vicious cycle so look at those lab sheets and see what you see going on with the lamp shades w bcs quite like a rock where goes up people are infected read like a rock where it goes down people are anemic my mom goes through this on a red blood count and no reason for it all of a sudden her red blood count all drop down to three point nine four point one she gets lethargic she calls me and says i'm just not feeling good i'm going to go to bed for about two weeks and see if i'm feeling better than when you're eighty-seven years old you don't go to bed for two weeks you won't be feeling better you probably won't come out of there walking dangerous keep moving catherine used to say life's great if you don't weaken do whatever you can to stop yourself from weakening going to bed for two weeks doesn't do that finally she happens to going to see ur position for an annual review and they find this percent lower red blood count so position puts royer so she's on iron for a couple of months perks right up and about once a year she tends to go through that they've been sculptor the other day they can't find anything bleeding so who knows what she's losing the red blood count but she does from time to time have a patient right now one of the facilities icm_ uh... weaker etc up with times a month when i'm in town the reason i receive the initial consul is that his wife is on the nursing home site and he was just really interfering with the nurses providing care for her over there so i got a console to try to get him to back off well that's been successful this is a fairly sprite old guy matter fact about six seven months ago we wanted to try to take a train trip to chicago to seize old neighborhood i have some doubt about his ability to do that but i was supportive and i said see if you can't sell your family or well sure enough he couldn't i mean i wouldn't know way what i want to see this man wandering chicago on its own but if someone would've gone within a python was a great idea when you were so the gold of chicago i'll help you get there i come back from the my last trip to texas new mexico and i find out that he's on the nursing home site and i said what happened he just stopped doing he just stop doing for himself we sent to the hospital yet he did have your own track infection we say in the hospital for that but he's back from the hospital they've cleared even this is not doing for himself so i go back to cnn_ i said what's going on in his first armenian just prior to just can't get together to do anything and i said will we want to do with the tiredness to only to endorse it that's ok to be tired which you want to keep him god because you know i mean if you're tired readied all you need me hassling you i mean i'll be supported or whatever you want to do tell me the goal and he says only and keep me in the bottle change this please kick me so he wants to test kit as a setter looking at him he looks an awful hot like my mom when she's having one of her episodes so the lab work horrified i find that his white blood count was eleven point eight they sent him into the hospital on arrival in the hospital just thirteen point one and on discharge from the hospital is twelve point nine which was their evidence that the other articles working his red blood count what's normal five to six and a half okay were making numbers up i think that not a physician i release values it's the ones with the elderly have to worry about his red blood count is he one of the hospital was uh... four point eight in the hospital they draw it again and it's four point one unknown discharge was three point nine okay cisco following falling rbc_ there so i mention this to the nurse the nurses when he was just in the hospital in if they were thought anything needed to be done with that they would have done it really thank not today twenty years ago maybe but not so much today so i said well call the doxie if you'll get another set of cbc complete blood count and maybe get the guy started on some wire okay she calls the doctor docs as yet a good idea let source more blood work in two weeks so it's putting on lasix at the guyana lasix over the next week he's related to the hospital for dehydration he's now setting in a hospital i have no idea what he's rbc_ years but see i'm trying to fulfill up on this to get something done for this guy now this week the word also came back to me that's not good news yeah they have decided that he's in the mic but they think it's probably related the fact that he has a softball size tumor hanging off of the left kidney hoops so that made well also be accounting for the tires you've got a look at lapd work because you may be the only person that's due in part and the reason that i'm harping on the stock is that this is treatable this is treatable this that death sentence if you're overwhelmed in your practice diagnose all of your patients with dementia that will take all the pressure off because no matter what you do doesn't matter anyway that they're gonna progressively get worse in the going to die but if you are all i would like to believe that somebody is going to treat me heavily for this investigate fully for this and accept this only when they have to and that's the way i try to approach things and also keep in mind that it's very difficult to distinguish these even with the most sophisticated means i had a case about six months ago a rehab hospital i doubt you waited this woman i did a lot more neuro psych test in the nine or only do in these cases and then i looked at the family and i said you know i do a lot of older adults and i know a lot about neuropsychology and you all don't know this about me but i mean the clinician in town that is 