Tag Archives: practical

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Covid Morph

So far I have gotten positive Covid tests on one patient a week, all with really different symptoms.

One older person who was short of breath walking, tired, coughing and loose at the other end.

One young one whose only symptom was profuse throwing up.

One with a sore throat, nasal congestion, cough and feeling fairly awful and about to go on a trip, darn it.

There isn’t a nice pattern to tell me what the local strain is doing. It can do any darn old thing. I have also seen someone with strep throat and another couple who had similar symptoms to the others but did not have Covid. It’s morphing like an AI, I swear. I am masking in clinic but so far so good.

The Ragtag Daily Prompt is essential. I think it’s pretty essential for me to wear a mask in clinic, in crowds and on airplanes, since I am quite tired of pneumonias.

I have been the only “provider”, that is, doctor, in the clinic for the last two days. The medical assistants and front desk and I are starting to work as a team. I ask the front desk person how to communicate with her from the clinic room most efficiently. Something was weird about the refill system and it kept refusing refills. On Tuesday I had over 100 “documents” in the computer “box”. Lab work, specialist reports, refill requests, x-ray reports, nursing home things, surgery reports, wound clinic, emergency room, and so forth. I am trying to skim them, but I can’t say that I will remember person A’s dermatology report after skimming 60 others. If you go to your primary care provider and have had some major medical thing recently, remind them. They may have gotten and read the note, but gosh, it’s hard to remember at 100+ per day. Right now I have not met most of the people, so it is even harder.

The photograph is just for fun, taken a few weeks ago on the trail that runs by the Colorado River. Lovely!

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practical medicine

This week I see a patient that I sent to a specialist that I don’t know well.

“How is he?” I like to get feedback on the specialists.

Q grimaces. “He knows his stuff. But…. he’s by the book. I complained about a side effect. He says it is not listed. But I go on line and there are lots of people complaining about that side effect.”

“Hmmm.” I say.

“He doesn’t really listen if it doesn’t fit…. if it’s not in the book.” Q brightens. “But I am going to call the nurse line for the drug and see what they say.”

“Cool.” I say. “Some doctors are very by the book. I’m into practical medicine: use it if it works. Don’t care if it’s witchcraft.”

Q giggles.

“What about the rash?” I say.

Q pulls up a pant leg. There is almost no rash. “He said it wasn’t related to the problem.”

We both look at Q’s leg. “Looks better to me.” I say. “Looks a lot better.”

“Yeah,” says Q. “It does. It looks nearly gone.” The rash was what initially triggered the testing that led to the diagnosis that led to the specialist.

“I use whatever I can figure out for people.”

Once I had an elderly woman with an intestinal bleed. She is transferred to Virginia Mason and goes through every possible test to localize the bleed. Upper endoscopy, lower endoscopy, swallow the camera, CT scan, probably pet scan and bone scan. Can’t find it. It is too slow a leak to use radioactive tagged red blood cells. She comes back.

I transfuse her every three weeks. This is not good. She will develop antibodies eventually.

She goes back to Virginia Mason. They do it all again. The surgeons discuss opening her up. “No.” they say. “Too frail at 88. She will die on the vent.” They send her back.

I am still transfusing her every three weeks. I am grumpy as hell.

Her daughter says, “I have a friend in Canada who knows a scientist. He is studying aloe vera. They said take aloe vera twice a day. What do you think?”

“Well I don’t have anything! Try it! We will test a chem panel in two weeks and watch the blood count!”

She takes aloe vera twice a day. Her blood count stabilizes. No more transfusion. Happy dance. Not absorbed or at least doesn’t bother her kidneys or liver tests….

After a year she says, “Can I try stopping it?”

“Sure,” I say. “We will check a blood count in 2 weeks.”

It drops. She goes back on aloe vera.

Practical medicine. If the book has nothing, try something else…..