Week in Review - September

this was an exciting week at the Topahkal Family Practice Office. Last weekend we participated in a health fair with the traditional medicine practitioners. The event saw about 200 people show up. We presented four different discussions in the morning - 1. diabetes 2. stress reduction 3. Ventosas 4. Environmental Health and Natural Soap Making. In the afternoon local residents signed up for various healing sessions from traditional medicine (limpias) to reiki to reflexology to massage. I got to hang out with some cool volunteer nurses who were doing blood pressure and diabetes screening for my clinic. and the next booth over were two local midwives, awesome folks, who just purchased a home nearby for doing home-style births for low income members of our community. they had a wonderful, explicit display of birth pictures showing a hands-off successful home birth. the display attracted alot of attention, particularly from young girls who were wide-eyed curious about this narutal process that many of them will go thru at some point.

later in the week, at the clinic, we were busy almost every day, seeing from 8-15 patients per half day. on the financial side, i made $800.00 during my four half day shifts. that's getting close to the mark for making a total of about $35,000/year after overhead and taxes. if i was working locums (or moonlighting) for the same amount of hours (22 including admin time) i would have made $1100 before taxes with no overhead cost. there are a few outstanding bills from during the week, but probably not more than $75. So far, the clinic is debt free from all the startup expenses and have a small buffer to buy meds and supplies without too much hassle. I'm feeling pretty good about this state of affairs for being only 9 months old and in a location that can only be described as "hidden," and "off the beaten path."

there were a few interesting cases worth ruminating about. a young mom came in with her son who had an injury to his pinkie. after evaluating and treating him, she mentioned that she had chronic flank pain right side and had already had her appendix removed with no relief. i like trying to figure out chronic pain so i offerered her a consultation. she mentioned that she was under eval by a gynecologist who was ordering another ultrasound (she had already had a ct scan and ultrasound a few months prior) and it was going to cost her $75 minimum up front. i did my exam on her right flank and found that she had point tenderness in the muscles between the 8-9, 9-10, 10-11 ribs, right over the liver/gallbladder and ascending colon. she also had pint tenderness at the upper part of her right hip where the muscles and ligaments attach. no organ pain that i could appreciate, no symptoms whatsoever of the GI tract, liver, gall bladder, or uterus/ovaries. the pain was slightly relieved with some accupressure held for 3-5 minutes over the muscle bellies. she mentioned that this was the first time a doctor had touched her aside from a quick push on her belly by the gynecologist. he elicited right lower quadrant pain because he was pushing on her right hip as well... who knows what it will turn out to be. i gave her the diagnosis of chostrochronidritis (rib inflammation) and heat/ice with motrin treatment for a few weeks. she needs to decide if she will followup with th gynecologist or not. it's not my style to block another doctor's workup. the thing i want to learn is this - if you elicit specific muscle tenderness on the chest of ribs or back, is that specific enough to rule out internal organ pathology? certainly organs can refer their pain to parts of the body like the back or arm or chest... i'll have to ask my colleagues their opinions on this. the unfortunate reality is that i suspect most of us doctors wouldn't really know since we don't touch our patients. perhaps some old old old timers...

the second case i'd like to muse about was a middle-aged woman with newly diagnosed breast cancer. she was in a state of shock but coping with the news and proactively trying (almost desperately) to find an immediate cure. her surgery was scheduled in 10 days and she was doing every alternative remedy or therapy conceivable. she came to me upon a recommendation of a friend of hers to see what we might have to offer. i was able to teach her about intestine and liver cleanses which will surely give her body a boost in the right direction in terms of detoxing, and at very affordable prices.

there were two aspects to this case that were intrigueing. first is that this woman presented herself to us in a very vulnerable state and if we were pushing expensive supplements or therapies, she probably would have paid anything to take them. that makes me uncomfortable. i'm sure the people pushing all these rememdies (including cancer chemo) truly believe their therapies make a big difference but the profit makes me quite suspicious. i wanted to advise her strongly to avoid expensive remedies and to try to work with a naturopathic doctor or chinese medicine doctor to make sure she was integrating the various therapies in a rational way. she had already looked into magnets, various herbs, coctions and acupuncture. this leads to my second line of thought. this was a really sweet woman feeling like there was no end to what she would do to keep herself alive. a very appropriate response. but the flip side is that she was out of balance in terms of pushing herself so hard and incorporating any suggestion that held an ounce of potential. i wound up trying to reassure her and tell her that she was doing enough already, that between now and the surgery she could relax, continue her current regimen and then assess after the biopsy results returned. i think my advice fell on deaf ears, and i completely understand why.

andru