Clinic Vignettes July 2006

yesterday we saw 23 patients, today (saturday) 15... we are too busy. patients are now waiting up to 2 hours to be seen, some are leaving before being seen. part of me feels bad, i hate for someone to have to wait so long, but at least here the prices are fair and we stay as long as we need to in each visit, ensuring the person is heard and cared for as best we can, once they get to their visit. i would love to see five more clinics like this in Albuquerque, at least. we need a resurgence of independent, local, fair-trade, neighborhood health clinics.

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chronic pain - i have about 14 patients on chronic pain medications from narcotics to benzodiazepines for anxiety/panic. Many doctors won't do this because they feel like they are promoting addictive beavior. I have similar concerns and I pay attention to the issue but i'm finding that my patients on chronic meds, with loving encouragement and some alternative medicine tools, are finding their way off of the meds within 3-9 months. i have had to send away two patients over the last year who were manipulating to the point where it felt unhealthy to me to even try to help them, but otherwise, i am really comfortable with the progress my chronic pain patients are making. It is a process of empowerment, phsychology, learning self-care and new behaviors in an environment of non-judgement that seems to be stimulating these transformations. people seem genuinely happy to have someone take their pain seriously at first and then work to help them find simpler, natural ways of dealing with it.


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Obesity - overweight and obesity are some of the fasting growing problems in the U.S. population. Why are people overweight? why isn't there a simple cure? one case this week highlighted the reality for me quite clearly. a 35yo woman, obese, with multiple physical complaints. she has been fully studied and all results are normal yet she continues to feel like something is wrong. upon further exam and questioning we determine she has alot of anxiety about her physical health. she has fairly good information about foods. she works in a bakery and loves her job, but only has one day off every two weeks and two small kids at home. she states that when she tries to quit eating sugars and fats, two things happen. 1. she is okay for 1-2 weeks and then she hits a major craving and satisfies it by binging. she is definitely dependent/addicted to sugar. 2. she works in an environment where everyone drinks coffee and eats sweets for breakfast and when she changes her diet she is castigated and punished by her peers who pick on her because of their discomfort.

it's a mess. we did some education work around healthy foods, flax seeds and aloe to help with her constipation and a full exam of her diet to remove all of her milk products. she knows she gets bloating and constipation with milk but thinks that if she isn't "drinking" milk directly it doesn't count, like in ranch dressing, milk in cereal, chocolate milkd and oatmeal, etc...

what i think is really going to help her is addressing her sugar addiction and the peer pressure, along with gentle encouragement to "follow her gut" around dairy use. we spent alot of time together and helped her find some behavior tools and flower therapy to strengthen her resolve against these two forces. sometimes just being conscious of the forces working against you is enough to empower you to overcome them. we'll see. obesity is not a simple problem, there is no simple cure.

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had a patient come in towards the end of thursday night. she had continuous vaginal bleeding for 3 months. she did a good job at home waiting to see if the symptoms would resolve but the bleeding was actually getting worse. she is 45yo and of course concerned that it might mean she has cancer. we were able to do a uterine biopsy during the same visit and arrange for a pelvic ultrasound within 1 week to evaluation for fibroids or cancer. I am proud of that. no hassle, fast, affordable service even for fairly complex medical problems. It's happening. We don't need big systems, or misManaged Care to attain quality and efficiency in healthcare. We need networking, collaboration, fair distribution of resources, affordable tools and medications, accessible hours for patients, safe places for people to come with their worries and fears, a focus on reducing pain with medical procedures... patient-centered care. not system-centered care. not lawyer-centered care. not research-centered care.

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AMAZING CASE:
35 yo man came in six weeks ago and was diagnosed with diabetes. this was new information for him. at the time, he seemed interested, so we did a complete dietary counseling session, started him on one medicine (metformin), and got some labs to see how bad his diabetes was. his hemoglobin A1C came back at 18. for those who don't know, below 6 is normal. 18 is the highest i've ever seen in my life. the patient came back to the clinic two days ago. he had truly changed his diet, cut out all sodas, started on flax seeds, nopal (cactus) and regular oatmeal (without milk). he was doing a great job recording his sugars and his average was already down to 130 which is just about the most remarkable improvement i've ever seen in six weeks. we ordered another A1C test for a week and i'm very excited to see what it comes back as. this is as close to a cure of diabetes as i've ever seen so far. and you could feel the man's pride during the visit, he was so happy with his success. it certainly helped that i was seriously so floored that i kept saying "WOW." he's hispanic, very into futbol, so at one point i looked right at him and said, "GOOOOOOAAAAAAAL." he loved that. :>

andru
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