WILTIMS #380-4: Family Med catch-up Part 1

I'm ok! Apologies for the unplanned hiatus; I apparently needed a break. Family medicine has been a lot of fun and the hours are superficially better, so one would reasonably assume that blogging through this clerkship would be no sweat after Peds or OBGYN. But though it's true that I'm no longer working 10-11 hour days and getting up at 4am, every minute of my 8 hour shift I am either in a patient room or running to the next one. 15-30 minute appointments are exhausting when you have 27 of them a day!

The clinic I'm working at for this rotation is frequented by the uninsured and underinsured. Most of the patients are immigrants, very few speak English, and almost all have chronic health problems exacerbated by their socioeconomic status and their previously sparse access to health care. I have already learned and revisited an amazingly diverse amount of medicine, and learned even more about the community I'm helping serve.

I will try to catch-up over the coming days and we'll see if I can stay up to date from here on out!

TuesdayIL: Chondromalacia patella is the erosion of the cartilage behind the kneecap. The only treatment is to limit activity (by cutting down on knee-strenuous activities, or losing excess weight).

WednesdayIL: When a patient is having an acute gout attack and reporting that indomethacin (an NSAID) and colchicine aren't helping, make sure to check the dose of the colchicine before adding a corticosteroid like prednisone. Many gout patients are on a maintenance dose of 0.6 mg colchicine daily, but an acute attack can be treated with up to 1.8 mg. So, make sure that they have tried that full dose before risking the complications of a whole new medication.

ThursdayIL: There are several ways of calculating whether a patient has left ventricular hypertrophy (LVH) based on a 12-lead EKG. Anyone who has studies EKGs knows a massively hypertrophied heart when they see one, but when it's a borderline case, how do you decide if it breaks the threshold? Here are some of the competing criteria:

• If the sum of the amplitude of the S wave in lead V1 and the amplitude of the R wave in V5 or V6 is ≥35 mm
• If the sum of the amplitude of the S wave in lead V3 and the amplitude of the R wave in aVL is >28 mm for men or >20 mm for women
• Other criteria break it down lead by lead (but you have to account for axis deviation).

FridayIL: Many people think that there exists some combination of vitamins that will give them strength and health at any age. Over the past week, we had several people - young, old, fit, obese, healthy, disabled - come in for a physical or because of some fairly benign health maintenance follow-up and ask for a "super-vitamin." Many of these same patients are against vaccines and traditional medications, and are very bad at watching their diet and exercising like we recommend. I'm sorry, but we have yet to discover a magic pill to make the 75 year old landscaper feel as strong as he did in his twenties, or allow the morbidly obese 40 year old to more easily walk down the street, or help the 92 year old not feel like an otherwise healthy 92 year old.