Archive for October 2016

Direct Primary Care Presentation and Open House

I will be hosting the next presentation on Trinity’s Direct Primary Care program this Saturday, October 29th at 12:30pm at the Trinity Medical Associates of Hardin Valley office located at 10437 Hardin Valley Rd.  Feel free to come hear about the program, ask questions, and view the new office.  Overflow parking will be at the church next door, Hardin Valley Church, which is just east of our office.

In this time of year as so many people are having to change their health INSURANCE coverage, this is an opportunity to hear how you can obtain lower cost, personable, and relational healthCARE regardless of which insurance you might have.

If you have more questions feel free to call 244-1800 to reach the Hardin Valley office or email me directly at




Labors, Mercies and a Gift of Projection

When someone’s voice would rise above all the rest and be heard across the room, my wife’s family, the Davises, would remark knowingly, “He has the gift of projection.”  A little after nine in the morning a week ago Friday, a man who had, and I would say still has, the gift of projection, died in our home.  That man is my father-in-law, better known to most as “Grandpa”.

He passed into the next life at 91 years and 1 day old, or as he would have said it, 91 years, 9 months, and 1 day old.  When I say he had the gift of projection, I don’t mean that he spoke loudly, though he certainly could make himself heard.  What I mean is that his words projected an uncommon weight and influence.  They did so because, by the grace of God, they emanated from a life so well-lived.

A retired dairy farmer, Grandpa lived with us for some fifteen years. He tended to burst out of his room as if shot out of a cannon, ever on a mission.  At 90 years old he was still delivering meals-on-wheels to “the old folks”, staying active in church, keeping up with politics, quizzing us from the newspaper on where the highest and lowest temperatures in the country were, reading his Bible at length, praying for his 27 grandchildren and their parents, mowing the land on an old Massey Ferguson tractor, and working with the hands made large and strong by decades of working a dairy farm.

But I believe there was even more power in his words than in his hands; In the evenings Grandpa’s voice could be heard as he made daily calls to buoy old friends, encourage grandchildren on their birthdays or any other time he thought they might need it, and reconnect with a host of other people from a life lived stitching together warm human bonds.  He would meet strangers and inform us later that they were joining us for Thanksgiving dinner.  Four months ago he gave the toast at my second oldest daughter’s wedding.  His godly words were a centerpiece of the celebration.

But only a couple weeks later he emerged from his room limping badly with no remembrance of a fall – turned out to be a cracked hip.  That was the start of a steep three-month free fall, from limp, to cane, to walker, to wheelchair, to bed.  The hip would get better, but then other things would go bad.  This vigorous vibrant man suddenly grew weak, shrinking before our eyes until finally, even the booming voice became only a dry whisper. Yet Grandpa’s words, though they became fewer, quieter and more halting, somehow, if anything, grew in impact.

After some initial testing to rule out treatable problems it became clear that there was nothing substantial that we could medically fix.  Grandpa was dying.  In his case, sending him to the hospital would only add misery and isolation to the process. We were able to keep him home as my wife was able to stay with him and many family members and folks from church pitched in to help.  The months carried many labors, many tears, many messes, but also many mercies.  After several days of unresponsiveness, Grandpa would suddenly wake up clear-headed and bless, guide, or express affection for someone in simple words given mass because of the man from whom they came.

There was a certain soul-satisfaction in meeting his basic needs.  And though there were sharp words on rare occasions, Grandpa was mostly humble and appreciative.  I am well aware that for many caring for aging or dying parents it is not that way.  These were great mercies to us.

In Grandpa’s case we were very thankful to be able to keep him home and let him spend his last weeks surrounded by people he loved and who loved him.  His final passing was gentle.  Though death is almost never pretty, his was at least peaceful.  Over his final few days, Grandpa became almost completely silent except for his increasingly labored breathing.  Then one morning he lay in his bed in our home watched by his oldest daughter and finally there was a breath not followed by any more.  He was wholly silent… but not really. It is not just wishful poetry to say that Grandpa’s voice still projects to us.  His life and words resonate in our mind and heart.  God gave this humble, hard-working dairy farmer much mercy and an unusually powerful gift of projection, and I can still hear him loud and clear. And the temporary labors and messes of the past months are more than outweighed by the memorable mercies.


Gout and Pseudogout

I don’t remember doing a thing to my foot; I didn’t stub it, I didn’t drop anything on it, but holy cow it feels like a boil in my big toe.  I woke up and it’s big and red and throbbing.  What do you think is going on with it?”

Indeed the base of Mr. Stoddard’s big toe was swollen, red and very tender to touch or put weight on.  In the end, it turned out to be the age-old malady, gout.  Gout was first identified by the Egyptians over four thousand years ago and then was recognized by Hippocrates in the fifth century BC and referred to as “the unwalkable disease”.

Gout is caused by uric acid crystals which precipitate out in joints.  In up to 90% of individuals with gout, the base of the big toe is involved.  However, other joints such as the wrist, ankle, fingers, knees and elbows may be involved.  Also, another similar condition, often called pseudogout and caused by calcium phosphate crystals, can cause very similar symptoms.

Besides a red, painful, warm joint, gout can sometimes produce a low-grade fever and occasionally involves tophi which are deposits of uric acid crystals in the soft tissues of the ears, fingers, toes, or other joints.  Over time, especially if untreated, gout can ravage joints and can damage other organs such as the kidneys.

Why does someone get gout?  Like with most illnesses, it starts with a built-in genetic tendency.  Add to that certain foods and drink.  Gout used to be called the rich man’s disease because it was mostly the rich who could afford the food and drink which triggered a gout attack.  Traditionally, large meals of meat and beer are considered a common trigger for gout.  The reason is that these kinds of meals cause a spike in uric acid levels which then precipitate out in a joint causing the pain, redness and swelling.  But other foods such as high fructose corn syrup, seafood such as shrimp and scallops, sugary drinks, and organ meats such as liver are also potential triggers for gout.  Also, certain medicines, such as diuretics, and certain conditions such as obesity and cancer will also increase the likelihood of gout attacks.

Gout is not uncommon, affecting about 4% of the adult population.  Pseudogout, officially named calcium pyrophosphate disease (CPPD), affects a higher and higher percentage of individuals the older they get.

So, if you ever awaken with a painful, red base of your big toe, or perhaps some other joint, with no recollection of an injury, what should you do?  The pain is usually enough to motivate you to head to your doctor.  The diagnosis can generally be made by the clinical appearance, usually with a little help from blood work.  Less commonly x-rays may be obtained. The definitive test is aspirating fluid from the painful joint and sending it for analysis to see if crystals can be identified.  Because this is often very painful and difficult, especially if the joint is a toe joint, it is done somewhat infrequently.

Once the diagnosis has been established, anti-inflammitant medicines such as steroids, colchicine, or non-steroidal anti-inflammitants are prescribed.  If a person has repeated episodes of gout, preventive medicines such as allopurinol or probenecid may be used to ward off future painful attacks.

Reading some of the accounts of individuals struggling with painful gout over decades in the days prior to effective medicines makes you thankful for the many available treatments today.  So if gout or pseudogout looks like it has attacked you, get it checked out and fight back.


Direct Primary Care Presentation and Open House October 29th at 12:30pm

The next presentation on Trinity’s Direct Primary Care program will be on October 29th at 12:30pm.  Dr. McColl will offer a short description of the program benefits and list of services including how the DPC program works regardless of a patient’s insurance coverage.  There will be plenty of time to ask questions in this informal, conversational setting.

The presentation will be held in the ‘waiting room’ of Trinity Medical Associates of Hardin Valley located at 10437 Hardin Valley Rd.  Please call the office at 244-1800 with any questions.

When quality healthcare has been secured, the uncertainty of health insurance is less worrisome.