Party medicine and the three week rule


At parties they come up to me,

For advice that I give out for free.

     The elbow from tennis,

     That overuse menace

Comes up at week number three.

 

I cannot go to a party without being asked for medical advice.

Sometimes a person will approach me and, smirking, say, “I’m gonna hit you up for some free medical advice.”

My usual reply is, “I’ll give you the advice.  If you take it, it’s free, and if you don’t take it, I expect to be paid.”  Which is another way of saying that I enjoy my work, but I don’t like being jerked around.  Then, frequently, I’ll launch into my standard recommendations about nicotine, caffeine, alcohol, diet, exercise, sleep, and seatbelts.

I don’t mind the intrusions for the most part, I see it as part of the job, part of the warped perspective you get on life from going to med school. 

Actually, it goes back further than that.  People have always turned to my for advice.  Probably just as well; I give out much better advice now than I did  before I got my degree.

In 1993,  mourning my mother’s death and short on sleep, when a person approached me at a gathering.  I lost my temper.  I said, “I’ve just been up for 36 hours, I’m up to my neck in grief, and you’re the fifth person tonight who just can’t seem to get to the office.   I’m telling you no.  No free medical advice at a party.”  Then I stalked away.

It’s the only time I can remember being rude about it.

One of the many physicians I’ve admired over the years said, “Anyone who asks for medical care in the hallway deserves what they get.”

Party medical complaints are pretty mundane for the most part but occasionally you get the really great stories.

Tennis elbow comes up a lot.

I have seen a lot of tennis elbow, but I have not seen a single case of tennis elbow that came from playing tennis.  I’ve seen it from weight lifting, excessively heavy purses, computer/mouse use, meat-packing, baseball, gardening, carrying a shotgun, swinging a hammer, paddling a kayak, martial arts, archery, musicianship, and bass fishing.  It’s an overuse injury, and like most overuse injuries, it starts about three weeks after the onset of activity or increase in frequency, duration, or intensity.  Symptoms can be improved with ice, compression, and elevation, but resolution depends on decreasing the stress by a third (whether duration or intensity) for three weeks, then increasing ten percent per week, but no faster.

Not surprisingly, when we did a lot of workman’s compensation medicine we saw a lot of overuse injuries.  Back when Aalf’s, a local industrial concern, made blue jeans for Levi’s, I would regularly see tennis elbow three weeks after they started sewing size 54’s.  Packing plant new hires would come in three weeks after they started on the job.

The three-week rule applies to the immune system, as well as well as the neurological system.  Thus people are most likely to get an infectious disease, or to trip and fall three weeks after making a change.

I’ll have to keep that in mind for myself.

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