Welcome to drdoan.ca!

I will be adding links to some of my favourite resources here.

 

Calculators:

·      Best Science Medicine Cardiovasular Risk

·      BC Children's anthropometric calculator - Excel

·      BMI calculator on diabetes.ca

·      FRAX

·      Duration Date Calculator

·      Dr Bouchard’s synthesis of screening guidelines

·      CDA Screening And Diagnosis

Information:

·      Concussions – Parachute Canada

·      COVID prognosis calculator Aug/2020

·      https://playandlearn.healthhq.ca/en

·      Doc Mike Evans’ Health Videos

·      Rx Files Warfarin Nomogram

·      Dr Brian Lin’s suture aftercare instructions

·      Australian Chronic Pain Youtube video

·      ICD-9 code lookup

·      The Messy Art of Parenting Autism - blog by Sarah Beck

·      Types of Twins – MyLifeInALabCoat by Sarah Turner Phd

·      CDC Yellow Book Travel Information

·      MOHLTC Schedule of Benefits

·      Ontario Antenal 1+2

·      Alberta Referral Directory

·      PHQ-9 and GAD-7

·      Kids Health Parent Information

·      pregnancyinfo.ca

·      Dr Blustein's abdominal information site.

·      Medical Assistance in Dying - AHS

·      Sioux Lookout Zone Nursing Station Phone Number Extensions

·      Interactive Palliative Care Application - BC

·      FACT – frailty scoring system

·      Suicide Prevention Canada

·      HelpGuide.org - US mental health website

·      AOSS Shoulder Exercise Information

·      Fibromyalgia Points

·      Addictions Resources In Orillia And Area

·      ON Routine Immunization Schedule

·      childmind.org page on dealing with explosive behaviour

·      nail fungus treatment advice

·      headsupguys.org mental health specifically for men in Canada

·      https://wikem.org/wiki/Sutures - Sutures_chart

a knot-free subcuticular suture techniqueForms:

·      New 2017 AR ON

·      EAP Forms Ontario

·      opioid contract

·       Sick Kids referrals online https://hinet.echn.ca

NDDS:

·      1 and 2 months

·      4 months

·      6 months

·      9 months

·      12 months

·      15 months

·      18 months

·      2 years

·      30 months

·      3 years

·      4 years

·      5 years

·      6 years

 

Rourke:

·      PDF from rourkebabyrecord.ca

·      WHO Growth Charts Collection

 

S: cold: +rhinorrhea, + nasal congestion, + cough, + sore throat

Felt feverish no measured temperature at home

No nausea, no vomit, no diarrhea, no recent travel

 

O: Generally tired.

TMs normal bilaterally

Nontender to facial pressure over maxillary and frontal sinus areas

Oropharynx normal

Chest clear

S1S2 normal no murmur, no dependent edema

No cervical lymphadenopathy

 

A/P: acute sinusitis:

-counselled re 90% chance viral

-rest, fluids, tea with ginger/lemon, ibuprofen/acetaminophen PRN

-trial Nasonex, saline nasal rinse

 

S:

 

ROS: Generally no malaise, no fever, weight stable

CVS: no palpitation, no chest pain, no diaphoresis, no history of MI/CAD, no HTN, no heart surgery

Resp: no cough, no SOB, no asthma, no COPD

GI: no nausea, no vomit, no diarrhea, no dyspepsia, no abdominal pain

Derm: no rashes

Neuro: no head injury, no loss of consciousness, no change in hearing/taste/smell/vision, no dysequilibirium

 

Family Hx:

PMHx:

Current Medications:

Allergies:

 

Generally well.

TMs normal, oropharynx normal, thyroid normal, no cervical lymphadenopathy

Chest clear, no crackles no wheeze

S1S2 normal no murmur, no extra heart sounds, JVP not elevated, no dependent edema, pulse regular

Abdo soft, nontender, no hepato/splenomegaly, no rebound, no hernia

Derm: no rash

Neuro: CNII-XII normal, gait normal, Romberg normal, no dysdiadochokinesis on rapid alternating movements either hand, upper limb coordination normal on finger-nose test, reflexes normal biceps/triceps/patellar/ankle jerk, Babinsky downgoing.

 

ROS: Generally seems well, no increased irritability or fussiness, weight gradually increasing, no fever.

CVS: no history of congenital heart disease or heart surgery

Resp: no cough, no rhinorrhea, no nasal congestion, no history of asthma/reactive airways disease, no inhalers.

GI: no vomiting, no diarrhea, typically having XX BMs q X day, no recurring abdominal pain.

Derm: no rashes

Neurologic: no head injury, no loss of consciousness, normal hearing and vision per parents.

Development: Meeting milestones, see scanned Nipissing District Developmental Screen and Rourke baby record.

Immunizations: up to date XXor notXX

 

Generally well. Drowsy but roused to touch.

TMs not examined, oropharynx normal without cleft palate, no cervical lymphadenopathy

Chest clear anterior and posterior, no crackles, no wheeze

S1S2 normal no murmur, no extra heart sounds, no dependent edema, pulse regular

Abdomen soft, nontender, no hepato/splenomegaly, no guarding, no hernia

Derm: no rash

Neurologic: rouses to touch/voice, tone normal, moves 4 limbs,

MSK: hips normal Ortolani and Barlow, grossly normal limbs, normal palmar creases

 

S: 1: low back pain:

-no fever, no IVDU, no paresthesias of lower limbs, no saddle seat anesthesia, no urinary retention, no incontinence of feces, no history of cancer

 

O: Generally no distress.

-Squat normal; able to walk on heels and tip toes

-reflexes X+ at patella bilaterally

-straight leg raise: XX

 

A/P: 1: acute MSK low back pain:

-discussed heat, massage, acupuncture, chiropractor;

-OTC acetaminophen, NSAID

-trial of cyclobenzaprine PRN discussed risk of sedation

 

 

A/P: 1: chronic low back pain:

-discussed minimal evidence for benefit with opioids

-for acute exacerbations, consider acetaminophen/NSAID/cyclobenzaprine

-discussed non-drug treatments: exercise, physio, acupuncture, mindfulness-based stress reduction; tai chi, yoga, motor control exercises, progressive relaxation, chiropractor

-discussed NSAID, tramadol, duloxetine

 

Atypical or dysplastic nevi are potential precursors to malignant melanoma. Risk factors for progression include number of lesions, family history, history of blistering sunburns, fair skin phototype, hair colour, increasing age.

 

A/P: 1: biopsies were taken, f/u with pathology results

-we discussed sun avoidance, adequate sunscreen having SPF 30 including UVA and UVB coverage, and the ABCDEs (Asymmetry, Border, Colour, Diameter >6 mm, Elevation or Erosions) of melanoma and dysplastic nevi.

-I have advised the patient to have an annual screening skin examination.

 

Psoriasis vulgaris: sharply demarcated erythematous plaques with surface scale of the skin.

 

A/P: 1: systemic options include UV light, cyclosporine, methotrexate. We discussed renal toxicity with cyclosporine, skin cancer burns and photoaging with UV light, liver with methotrexate.

 

Isolated idiopathic urticaria: each lesion resolved within 24 hours which is a necessary criterion to be considered a hive; 40% of patients have associated eyelid and lip swelling; the hives are not triggered by food, medication or other external factors; the episode is caused by an overactivation of the immune system;

 

A/P: patients go through episodes of chronic hives which will end eventually even without medical treatment; resolution will be more rapid with medication; he has been advised to use fexofenadine (Allegra) 180 mg PO daily PRN in 30 day courses for flares; he may add cetirizine (Reactine) 10-20 mg PO qPM x 1 month; after 1 month of therapy he should discontinue medication to see if the symptoms rebound, and if they do he should continue for another 1 month cycle before a trial off medication.

 

Melanoma Excision Margins:

Melanoma-in-situ: 0.5-1.0 cm

Invasion <1mm         1.0 cm

Invasion 1.01-2 mm 1-2 cm

Invasion 2.01-4 mm 2.0 cm

Invasion 4+ mm        2.0 cm

 

Merkel Cell Carcinoma: 1-2 cm margins

 

SCC: 5-10 mm