Wednesday, October 17, 2007

"I'm going out on an osteopathic limb here, but..."

So here’s the long-awaited recap of the FP rotation. Finally. I know.

I really didn’t think I would love family practice as much as I did.
Maybe its the particular practice I was rotating in. It was just such a
light, fun, unhurried environment. Sure we had non-compliant patients,
and that is frustrating, and we saw WAY too many people for simple
colds. I’m sorry, I still don’t know which antibiotic I should give
just to get the patient to stop bitching. This was a point off on my
eval. Oh well. When there was an indication for antibiotics, here was
another problem:

Me: “She has maxillary sinus tenderness, nasal congestion, and
fluid in the ear all on the left side…I believe it is classic
sinusitis…she does not smoke and is otherwise healthy, so I am not
worried about atypicals, thus I would go with the same thing we used on
the child with sinusitis this morning, Amoxicillin for the infection
and nasal steroids to open up the airway, let’s go with Nasacort.”

Doc: “Go for it! Dosing?”

Me: “Shit”

I’m sorry but I don’t know dosages off the top of my head. My usual
resort was cussing and quickly flipping through my Tarascon
Pharmacopeia. This got me another point off…the having to cheat part,
not the cussing. They thought that was endearing :)

I was happy I got to do OMM. Actually I did lots of OMM, maybe one
out of every five patients. Some of the more interesting cases:

-I did the GI release on a colicky newborn and I’ll to take her
word for it, but the mom said he looked like he enjoyed it. I even
showed the mom how to continue it at home. No word on any exploding
diapers, but no complaints either.

-A cop came in with lower back pain she’d had for 2 years with
no relief. I adjusted her sacrum and cracked her lumbars. The pain was
down to 20% and she was ecstatic.

-A woman who’d had upper thoracic pain since her car crash 1
year ago came in with sever upper thoracic dysfunction &
tenderpoints, and occiput “weirdness” that made her feel a click every
time she swallowed. She’d been to physical therapy, chiropractors, etc
who had fixed it, only to have go back to hurting the next day. I gave
her cranial, then kneed her in the back when I couldn’t get the worst
of her thoracics. They were fixed, but I told her to come back in a
week to make sure. She did come back, and after one more knee-ing, she
has been pain & weirdness free.

-My first follow-up, as in someone who came back just to see me,
not the doc, was an older lady named Coleene. We thought she might’ve
broken her rib the week before, but decided to wait and see how some
muscle relaxants & NSAIDs made her feel. After a week of no
improvement, she came back specifically for OMM. I got an Xray just to
make sure, b/c it was so exquisitely tender. It came back clear, so I
spent like 45 min doing soft tissue, muscle stretching, and indirect
techniques to slowly loosen the area. She was so pleased with the
results and the fact that is was done naturally, that she gave me an
angel pendant b/c she wanted to BLESS ME.

-A woman with long standing chest “discomfort” came in with a
clean Xray, EKG, and specialist referrals. Nothing got rid of this
“weird, fluttering discomfort.” I noticed it was over her left 5th rib
and that she was already on OTC heartburn meds. I approached my doc
with the title line, b/c this is going out on a limb, but I thought she
should try a more potent GERD remedy b/c the 5th rib is a neurosomatic
point for stomach acid. He said that nothing’s helped the chest thing
before, so sure why not. We gave her some samples and told her to call
in for a prescription if the chest pain went away or another visit if
it didn’t. She called in the Rx :)

By the end of it, they let me do a few more things than just H &
P and OMM. I analyzed rapid streps and urine samples; I removed skin
tags; I even did a digital block (before I even learned exactly what it
was I was doing in my anesthesia rotation). And I was officially the
ear lavage queen and the suture bitch. Its nice to have a title.

Generally it was the same old, same old. Not to say that was boring,
b/c I had a great time talking with patients either way, just that
there were generally no big surprises in my day. Except for the whole
blood thing…

-Chief complaint: “I ejaculated pure blood.”

-Differential: 1) Vigorous sex, 2) Prostate cancer, 3) VD, 4) HE’S THE DEVIL!

And so ended my foray into primary care. I promised to return to
rotate 4th year (so like in 2 years!) and left them an ear to remember
me by.


Lavage Queen

aka Suture Bitch

aka the girl who knees people in the back and calls it a VERY direct technique

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