Road Trip 5: vegan lunch and free advice

Sometimes over coffee or tea
People want my advice, just for free
If they ignore what I say
I ask them to pay
But I’ve never collected a fee.
Synopsis: I’m a family practitioner from Sioux City, Iowa. I danced back from the brink of burnout in 2010, and, honoring a one-year non-compete clause, went for adventures working in out-of-the-way locations. After jobs in Alaska, New Zealand, Iowa, and Nebraska, I returned home and took a part-time position with a Community Health Center. I used vacation time to do two short assignments in Petersburg, Alaska. Currently on a road trip, I left the Community Health Center last month because of a troubled Electronic Medical Record (EMR) system.
Wherever I go, people, on finding out my occupation, will ask me for free medical advice. I tell them if they take the advice, it’s free, but if they ignore it, they’ll have to send me payment.
Lunch today was no exception. I won’t go into the details of the case, even though the patient gave the information in public in front of an audience. The gastrointestinal symptoms had persisted for decades.
I always start with a good history, so as we dug into our gluten-free and vegan fare, I asked the basics: when did it start? Where do you feel it? How bad is it? What happens? What is the character of the pain/smell/discharge/problem? If it comes and goes, how long does it last and how often does it happen? What makes it better? What makes it worse? What have you tried that helped? What have you tried that didn’t help?
The luncheon café setting precluded doing any sort of physical exam beyond that inherent in conversation.
I never prescribe medication in such situations, though sometimes I advise the patient check with their doc to discuss lab or drugs.
Mostly I do non-pharmacologic therapy.
I usually start with ABCD: always blame the cotton-pickin’ drug, thus stop nicotine, caffeine, alcohol and any recreational pharmaceuticals. Then I start into the med list.
Most diseases fall into a spectrum of severity, and proper attention to sleep, diet and exercise can shift almost any medical problem into the less severe range. So sections of advice overlap, because nicotine, caffeine, alcohol and recreational chemicals murder sleep. Some fun pharmaceuticals (such as alcohol and marijuana) bring on sleep but suppress the most restful phases, delta and REM. Thus leading to chronic fatigue and loss of emotional resilience, and thus they make any disease state worse. In particular, I said, if the mind stays out of balance, so will the intestine, as all neurotransmitters (chemicals that carry messages in the brain) have receptors in the gut.
I also recommended a week’s trial of the Prune Water Protocol: put a prune in a glass of water and leave it by the side of the sink till you go to bed, then drink the water, eat the prune, and brush your teeth. Repeat twice daily. A lot of chronic digestive problems come down to chronic constipation (usually from incomplete emptying), and I haven’t met a case of non-malignant constipation that resisted the Prune Water Protocol.
The patient may or may not follow my advice, but certainly won’t pay me.