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McDonald's

Last week, I had the honor of meeting a delightful young woman as a new patient. She was fifteen-years old and movie star pretty; tall, slender, high cheek bones, gray piercing eyes, dark thick brunette hair, and living at the peak of her adolescence. Sadly, she was very ill. Although no one could see her illness from her physical attributes, she was in fact significantly sick. She came to the office several weeks ago to have her blood drawn. When we received the partial results of her testing, it was clear she was profoundly anemic and had rock bottom low iron levels in her body.

Even before she was seen formally, we contacted her mother and arranged an iron infusion. She had to travel five to six hours to come to the Memphis so arranging an iron infusion hundreds of miles away was difficult. Tammy, my right hand nurse, came through for her. Many other of her test results were significantly abnormal also. She had a rheumatologic disease of the first order, not typically identified in a young woman.

We met for our first visit this past Thursday. Usually Thursday is my day off. On my days-off, my ritual is to wear dirty, tattered and torn blue jeans, an old tee-shirt, and a doo-rag on my head. Those are my real clothes. I stayed true to myself and my ritual. I was not sure how the patient would feel about my attire when I walked into the room wearing my latest blue-collar fashion, but I guess I did not care. Michigan State was proudly displayed on my chest on a forest green long sleeved tee shirt, my head was covered with a white doo-rag. The young woman looked puzzled at first and so did her mother and mother's cousin. It was a kind of a “You’re the doctor?” look.

My new patient was shy. She was sitting between her mother and her mother's cousin, who had a great knowledge of supplements and healing practices. It was at the insistence of her mother's cousin that the young woman traveled to Memphis to see me and get my perspective on the young woman's illness. "Good morning ladies. Let's get started."

After the formal introductions, we just sat and chatted about Corvida's (not her name, but I am using it to protect her confidence) life. She enjoyed school, was on the dance team, and rarely missed school days or practices. She was frustrated over the fact that she had been on medication, methotrexate injections for over six weeks, and had no significant relief. She felt tired, her joints were swollen and tender, her skin had patches of psoriasis. She was extremely sleepy.

As I listened to Corvida's mother and cousin, they were extremely frustrated over the lack of communication from the physicians and their lack of concern for their daughter's well-being. I stopped the conversation a few times to help them understand the way traditional allopathic physicians handle rheumatologic cases. I told them that they were only using methotrexate because the insurance company mandates a trial of the medication before they could move on to another drug. I also told them that the drug they would use next would most likely be Humira® because it's the newest, sexiest drug they typically use. They looked astonished, as if I predicted the fall of the stock exchange in the recession.

When I recited each and every step the rheumatologist made as well as their plan for future treatment, the two older women looked at themselves as if I had recited a complicated recipe out of one of Julia Child's French cook books. They said, "You're right. That's their plan. They don't care she's anemic. We saw two different rheumatologists. They both said the same thing."

I looked at the three of them, "Have you ever gone into a McDonald's in California? Surprisingly, you'll see the same menu as Memphis. The food tastes identical. The food service workers are in the same uniforms. The lay-out is the same. It's uniformity they care about. Always. Rheumatologists are practicing uniform medicine. Just like McDonald's. Same thing. Big Mac, French Fries and a Coke. Rheumatologists prescribe a NSAID, methotrexate, and then Humira®. They have created a standard of care. Anyone can follow it. They've all trained themselves to be uniform. One method fits all. Just like McDonalds."

Both women looked at me, "We wanted a second opinion and got the same opinion." I responded, "That's the only plan any of them have." "So what do you think?", they replied. "I'm your second opinion. I'm not a rheumatologist."

It took three hours of more to go over everything. All three were very engaged in the conversation. All had different ideas and thoughts about what might work and what would not. At the end of the session, we changed almost everything. The methotrexate was not working. It was suppressing her bone marrow's production of red blood cells and it had to be stopped. Cold turkey. And, her diet had to change, as well as her prednisone dosage. She had secondary hypothyroidism from all the stress of her disease as well as cortisol and other sterol hormone changes. Stress was causing most of her menstrual irregularities. They left the office with a second opinion, one different than the traditional occidental allopathic rheumatologist. They were excited another care strategy had been proposed and put into action.

As they gathered their things and made their way to the front desk to check out, I looked at that young woman. She was attractive and full of life. Just looking at her, one would never know how truly ill she was. Just looking at her might cause a physician to overlook her severe, potentially crippling disease and just say, "She's fine. Just look at her."

Just goes to show, you can't judge a book by its cover. But more important, if you want a second opinion, don't go back to a McDonald's because all they have to offer is a Big Mac, Large Fries and a Coke.

Doc
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