Wernicke without the Korsakoff, don’t hold the thiamine.


I tell you in Barrow there’s a need

For independents of the medical breed                         

     And, what is more,

     They need a drug store.

Do I have to appeal to greed?

Labs this morning included a folic acid deficiency, another hyperthyroid, and a hyperparathyroid.

Folic acid deficiency should be as rare as snowy owls eating black-footed ferrets but it isn’t.  Left untreated, folic acid deficiency is fatal.  Treatment runs a few cents a day for a simple pill.  I find the diagnosis and treatment of this problem very gratifying; not only do I get to save the patient’s life for little money but I get to make them feel better.

A call from Anchorage led to a discussion of Wernicke’s encephalopathy.  Neurologic problems happen from thiamine deficiency and carbohydrate excess.  As all food stuffs containing flour have thiamine supplementation, the worst carbohydrate with no thiamine (one of the B vitamins) is distilled alcohol.  A person has to drink very hard and keep a strictly rotten diet to get Wernicke’s.  Thiamine deficiency more often gives rise to Korsakoff’s psychosis, where a person loses short-term memory.  Med school vitamin discussions featured Wernicke-Korsakoff syndrome, and in med school I learned but I scoffed.  I shouldn’t have.

Vitamin D deficiency gives rise to hyperparathyroidism which in turn gives rise to osteoporosis, and the vitamin D level on the patient with the abnormal parathyroid is pending.  I will be very surprised it the vitamin D level is normal.

For reasons of confidentiality I cannot go into details about the people the abnormal lab results are associated with, but they are living, feeling human beings who suffer and who hurt; they live in families; they make good decisions and bad; each one has stories to tell, full of drama and irony. Each wants to be done with illness and move on with their lives.

I still had paperwork to fill out for my hospital appointment, the deadline loomed, and the completion took up much of the time freed by clinic no shows. 

The Indian Health Service started the hospital in Barrow.  The Arctic Slope Native Association took over the operation in 1995, and in the process started delivering health care to the non-Natives.  I suspect that out-of-pocket expenses for an Urgent Care visit are like prices for everything in Barrow, that is, very expensive.  The non-Natives come for work physicals, workman’s compensation, coughs, colds, and the occasional head scratching mystery.  Sometimes they require services that are not available in the entire North Slope, and arranging follow-up becomes very difficult

Barrow would also be a good place for a doc to open up shop and serve the non-Native population, almost all of whom have very good insurance.  Such a doctor would do well here from first day.

It won’t be me.  I’m having too much of a good time being an employee, not being an owner, working at a reasonable pace.

A retail pharmacy would also do well here.

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