Over the counter and in the kitchen....

Remedios Caseros... Home remedies...

- in community clinics, our clientele is rich with remedies, many helpful, many not so helpful, and some a bit comical culturally speaking.

Today, my elderly client with impetigo came in for a re check, bactroban and septra are certainly clearing up the lesions well.. but his arm was covered in a thin layer of a dried red substance...

"Sir, what did you put on your arm here" I asked
"why, tomato juice, they tell me it's good for itching"
- apart from a theoretical use for dogs sprayed by skunks, can't say I've seen this one used as a remedy before.. asked him to d/c use for now so the bactroban can penetrate well without any interference.

- That being said, a quick google search showed multiple sites including "Dr Granny" that claim that tomato and it's acidic PH can help with pruritis.

Sometimes, remedios, and our Latino communities openness to using them can come in handy, for example;
- Te de Manzanilla (Chammomile tea); good for "calming nerves" and soothing/rehydration of the sorest viral pharyngitis patient

- liquado (smoothie) good for constipation especially during pregnancy;
- yoghurt (natural low fat) ; probiotics and calcium
- a few prunes or dates; fiber, laxative action
- papaya; natural digestive enzymes
- flax seed (grind fresh); fiber, laxative, omega three action
- Nopalitos (cactus leaves); research shows that they can be good for glucose control and may help with insulin resistance.. this being said, they often aren't a full substitute for other diabetes treatments, but are worth a shot!

any other favorite remedies out there? Would love to hear about them!

worried well

I have had a week of many worried well patients coming into the clinic... post holidays there is always a rush of panic attacks, anxiety and depression as many lonely patients seek help for ongoing stress related conditions, but I can't recall a week of such interesting and random worried well complaints. This being said.. I have had a huge influx of questions... ranging from "is it ok to take vitamin C with my antibiotic" to "can you just check my blood pressure, I feel fine, but just want to know what it is".. to my favorite, "do you know of a person that would come to read to me in my house while I recover from the flu?" (Uh... no, sir, I do not.. but ask your local library... librarian is probably cursing under his/her breath at me right now). In addition, I have seen an increase in the "phantom phone call" visits.. patients receive a phone message, aren't sure from whom, or what number, but are convinced their primary care clinic might be the origin of this call, or know of the details.. i have not had ONE case where I have been able to track down any clarification of said supposed call.. nor a patient that has saved a voicemail message for me to even listen to. Sometimes I suspect that it may be an automated message from our new clinic phone system... but then a re check of a non-up-to-date phone number quickly confirms that this could not be the case.

Take home message(s);

- your doctor or NP knows a lot, but not everything...
- we appreciate the respect that your assumption that we DO know everything communicates, and are glad you feel well cared for
- save phone messages, and write down names/phone numbers.. hell, when you call us, listen to our voicemail that asks you to do the same, an kindly comply
- when you change your phone number and/or address, update the clinic please.. we need to reach you sometimes, and make sure you know your phone number as well.. especially if it has changed (and we recognize the unique life scenerios that necesitate frequent contact info changes).

that is all. Happy Friday!

super vaccine?

Most creative question of the day;

will my flu shot prevent dengue fever?

- hmmm, wish we had a super vaccine, but this only includes three strains of influenza protection, kudos on the interesting question though :)

it's a digital world...

Saw a lovely twenty something new dad in the clinic today, walk-in visit for Tdap to protect his sweet new son against the woes of pertussis... asked for a photo of the baby, and was treated to a video of his scheduled repeat C-Section birth. Wow... in all detail. As a former labor and delivery nurse, I felt honored to share in the viewing, and also quite struck at the place that digital recordings have come to take in our lives and in medicine. I'm sure the Mother greatly appreciated Dad's recording so she could re-live the action on the other side of the OR drape later.. and I feel special to have been offered a peek at the special moment as well.

not what she said...

you may remember a prior post on selective English T-shirt wording which patients sport unbenounced to the actual meaning of the wording.

Today, I saw another choice example of why an English-Spanich Diccionary may come in handy at your average San Francisco thrift store;

Walking on the corner of 19th and valencia, a kind tiny older hispanic woman was seen sporting a shirt reading "expert cougar hunter".... hmmm, something tells me the meaning is lost on her, and i expect her cougar hunting skills are minimal if at all existant :)

Not clinically related, but thought it was worth posting before the weekend to put a smile on a few faces!

resources shmescources

This NP was recently seen at a large conglomorate hospital in the area (think socialized albeit private quality medicine with a name that correlates), using insurance I have paid for through work although I waited over 90 days for it to "kick in", I was seen for a procedure (which luckily amounted in nothing abnormal, yeah!). The experience reminded this provider how broken our medical system is.

Patients are usually not seen in Community Health Centers by choice, and there is a reason why... understaffed, underfunded, with long lines and limited resources... (although to be fair; our spunk, drive, commitment to social justice/equality,creativity, and NHSC obligations are second to none!)... it's nothing like a trip to your friendly concierge service MD.

While a friendly radiologist inserted an uncomfortably long and shockingly low gauge needle into my neck, a friendly radiology tech followed instrutions on a quality ultrasound machine, and a very peppy tech complied with the provider's every need. Wow, posh... and it was only a relatively minor procedure.. I've put in hundreds of IUDs (a sterile procedure nontheless) singlehandedly without even an MA, so this treatment felt like a day at the spa (medical-resource wise).

Ok, I'm not saying we should all be signed up for some high priced, private HMO...and if you are a billionaire and want to use some of your wealth to pay for an ultra-private service, so be it... what I am saying is that every citizen, from the uber rich to the hoi polloi deserves basic, quality, accessable and appropriate health care as a human right... you can always pay extra to access your botox, fancy additional procedures, or brand name medications without generic equivelent, but there is something majorly broken when such huge disparity exists.

I don't have all the answers, but the basic starting point seems quite simple... it's broke, needs fixing... start at the beginning; basic affordable health care access for all.

Folie à deux

Folie à deux, "a madness shared by two"... not exactly a classic case, but remarkable nontheless...

Working triage today, a patient walks in requesting a medication refill... normally this involves review of a patient's medical record, but given he is a new patient, it would involve patient subjective history, a pharmacy med list, or prior medical records.

A list of common question/answers ensue; with one commonality... see if you can spot it;

"what medication" - not sure
" what for" - not sure
"who prescribed it" - not sure
"where was it prescribed" - not sure
"did you bring a list or the bottles" - no, I lost my backpack which they were in, not sure how or where
"how long have you been off the medication"- (no joke) one hundred weeks
"one hundred weeks is over a year..." - well, at least since August (August was two months ago)
"do you know the month/year today" - got this one spot on!

ok, so we were not getting very far with this questioning. A set of vital signs later ensured that the patient was at least not going to drop in the office, saving us some time for investigation.

"so", I commented "there seem to be a lot of details you aren't clear about, can I ask who helps you remember to take your medication?"

"Sure" he replied "my friend steve or my mom"

Excellent, this NP thinks to herself, I may be able to solve this case yet!

"Can you bring your mom or Steve to the next visit?" I inquire.

"no, they are REALLY crazy" our fairly confused patient comments... ahhhh... Folie à deux


Hopefully our lovely social worker will be able to make heads or tails of the case next week, as I called EVERY major pharmacy in the area, and no record of this kind patient exists.

gotta love the creativity of community health, and the opportunity to occasionally feel like your life is a strange movie that never ceases to somehow entertain...