No flu yet, but it’s coming


I await the arrival of flu

But still, there’s plenty to do.

There’s joy that is pure

That comes with a cure

Or from following up on a clue.

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, traveled 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 went back to adventures in temporary positions until they have an Electronic Medical Record (EMR) system I can get along with. A winter in Nome, Alaska, assignments in rural Iowa, a summer with a bike tour in Michigan, and Urgent Care in suburban Pennsylvania stretched into the fall. Since last winter I’ve worked in Alaska and western Nebraska, and taken time to deal with my wife’s (benign) brain tumor. After a moose hunt in Canada, I am back on the job in western Iowa. Any identifiable patient information has been included with permission.

 I had a very good clinical week, despite the fact that it didn’t start till Wednesday.

A front line doc like me doesn’t get the chance to save a lot of lives, and when I can do so, especially with a small, inexpensive intervention, it makes my day. My two favorite diagnoses, vitamin B12 deficiency and hypothyroidism, bring a smile to my face and a bounce to my step whenever the lab comes in.

OK, the truth is that I break into a happy dance, and I stay annoyingly cheerful for a couple of days.

I also really like finding a problem I can legitimately treat with antibiotics, and, as time goes on, fewer and fewer people meet the criteria for applying those agents in cases of ear infections, tonsillitis, urinary tract infections, and pneumonia. But this week I saw more than a half-dozen.

A surprising number of people came in with back pain, the problem arising, not in the back, but in the bursa at the point of their hip. I make this diagnosis of trochanteric bursitis easily by pushing on the point of the hip and saying, “Does this give you the same pain that brought you in?” I recommend ice and anti-inflammatory drugs. But I also search for the root cause, which, more than half the time, turns out to be footwear or a change in activity, or both working together.

I drew on my own experience in Adult Children of Alcoholic Parents to help a patient deal with some pretty heavy drama and irony. I established credibility by describing two family members I’d never met as cold, controlling and distant. And I observed that, if a parent dies, the child most distant geographically, also the most distant emotionally, will make the most trouble because they have the most unfinished business.

Three patients came in with fever, aching, and cough, and not one of them came up positive for influenza.

I uncovered the cause of significant liver pathology, only by careful and empathetic questioning.

I examined a toddler with pain and fever and didn’t use force to look in the ears.

At the end of the week, I got into the car as darkness gathered and the snow started to fall.

 

 

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2 Responses to “No flu yet, but it’s coming”

  1. Jacks Uniforms Says:

    ​Thanks Doc, for the ACOA knowledge. After almost 10 years since my dads death what you said helped me make sense of my brother and his choices. *Many gratitudes* to you. Mary W.

    On Sat, Dec 3, 2016 at 10:11 PM, Walkaboutdoc’s Blog wrote:

    > walkaboutdoc posted: “I await the arrival of flu But still, there’s plenty > to do. There’s joy that is pure That comes with a cure Or from following up > on a clue. Synopsis: I’m a Family Practitioner from Sioux City, Iowa. In > 2010 I danced back from the brink of burnout, an” >

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