Posts Tagged ‘Adult Children of Alcoholic Parents’

No flu yet, but it’s coming

December 3, 2016

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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February 24th, 2015, a day that will live in infamy

March 3, 2015

When it comes to the drug they call pot
What is it good for? It’s not.
But they were quick on the draw
To pass a new law
And speed up the memory’s rot.

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. Right now I’m in Nome, Alaska.

Marijuana use runs rampant across the US.

In the early part of the year I asked a patient, a single parent of five and a major pothead, if they would hire a babysitter who got stoned every day, and we agreed that any intoxicant impaired ability to care for children.

My first Monday back brought me to contact with patients running into problems as a direct result of their marijuana abuse.

Mostly hemp excess happens in the context of abuse of other drugs, usually tobacco and alcohol. All three contribute to poor memory, seizures, depression, loss of restful sleep, low testosterone levels (both sexes), low sex drive (both sexes), lowered resistance to infection, poor pain tolerance, social isolation, and irresponsible parenting.

Recently I had a heart-to-heart talk with couples in the maelstrom of dysfunction; the medical problem that brought them in stemmed directly from marijuana abuse. I correctly guessed that both had cold, controlling, distant mothers, and exciting, generous-to-a-fault fathers who failed to follow through on promises and brought repeated disappointments. They readily admitted that each could tell me everything wrong with the other and neither had much of a handle on their own failings. I pointed out that drug abusers can’t exist without enablers, and the cycle can be hard to break because it has roots more than a generation old.

I took a step back and talked about myself. The vast majority of med students, 70%, come from chemically dependent households and most of the rest had other sources of dysfunction in their nurturing families. I skipped the details of my upbringing, but I told them about Alanon and the Adult Children of Alcoholic Parents movement, which use the same 12 steps as Alcoholics Anonymous, and how I went to meetings for 7 years. Every strength is a weakness, every weakness is a strength; it all depends on what you do with them. We agreed that their current approach didn’t work. I replaced a benzodiazapine tranqulizer with Dilantin (most common use=seizure or migraine, but a good second or third choice for almost everything), recommended 12 step meetings for both, and called in Behavioral Health Services.

I learned more about human behavior in dysfunctional families from Alanon than I had from med school.

My last patient requested a back-to-work slip, which I cheerfully supplied. But in the process I uncovered alcohol and marijuana excesses; I accepted at face value the patient’s assertions, and said, “Let me be the first to tell you that nicotine, alcohol, and marijuana will make any medical problem worse and none of them better.”

I could more easily believe that the weed wiped out memory than that all previous docs had missed the chance to educate the patient.

During my two weeks off, the state of Alaska legalized marijuana on February 24th, a date that will live in infamy for those with intact memories, but the pot heads will promptly forget.

I suspect that those in power prefer an apathetic electorate with a poor memory.