Horse rescue, poison ivy, and Irkutsk

If your work brings you down in a ditch
Poison ivy can bring a bad itch
For the leaves that are three
You should just leave them be
And Zanfel fills in the niche

Synopsis: I’m a Family Practitioner from Sioux City, Iowa. In 2010 I danced back from the brink of burnout, and honoring a 1 year non-compete clause, travelled and worked in out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand. After three years working with a Community Health Center, I am back having adventures in temporary positions until they have an Electronic Medical Record System (EMR) I can get along with. I spent the winter in Nome, Alaska, followed by assignments in rural Iowa and suburban Pennsylvania. After my brother-in-law’s funeral, and a bicycle tour of northern Michigan, cherry picking in Sioux City, I’m back in Pennsylvania. Any patient information has been included with permission.

From time to time I ask patients to include some of the fascinating details of their lives in my blog. I leave out diagnosis, age, and gender unless relevant to the story, whether the patient gives permission or not.
I had a fascinating conversation that started with my use of a few well-pronounced words in Russian. The patient peered at my name tag, and observed that my last name didn’t look Russian. Perhaps not, I replied, but we had that name for a thousand years in Lithuania; when the Mongol era globalized trade, the king of Lithuania imported Scots traders to try to build a middle class. In short order, I revealed my grandfather’s fleeing Tsarist Russia east through Irkutsk, the patient’s birthplace; and in turn learned of the patient’s Yupik heritage. So I could tell of the man I met in Nome whose family had fled from Stalinist Russia to Alaska in an umiak. At the end, I said “thank you” in both Russian and Inupiaq.
Another patient works on a large animal rescue team. During a lull I quizzed the patient about work, and listened, fascinated. The medical problem was routine, the horse rescue anything but.
I see a lot of poison ivy problems here, and I can always find a story in how it happened. Usually it comes in the context of social stress, frequently marital discord. But sometimes it happens in the course of work. On more than one occasion I said, “If you’re the boss and your crew works outside, it’s worthwhile for you to get a case of Zanfel and hand it out and tell them to cleanse with it if they start to itch. And you can probably get a case of the stuff for less than the price of two doctor visits.”
I’ve had to learn a lot about poison ivy. Non prescription Zanfel does a good job of binding the resin away from the skin (hence my recommendation). Systemic steroid use less than two weeks usually results in rebound itch and a phone call, and is not justified if less than 10% of the skin is involved. Hydroxyzine is a powerful anti-itch medication that doubles as a sleeping pill. And most people can handle the itch during the day, but they come for relief because they can’t sleep.


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