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Scent Of The Snake

Scent Of The Snake

As these past few weeks have rapidly gone by during the 2015 Spring season, our new ill patients have become ever more complicated than previous Springs. I am not sure whether our total patient population over the years has reached a critical mass that reaches far and wide or that the reviews about the Stone Institute on the internet and social media has encouraged people who are ill and devoid of answers. Other physicians cannot seem to get to the bottom of their illness although they have prescribed some traditional therapies for specific symptoms. Never the less, the complexities of caring for a patient with multiple complaints are mentally challenging.

One delightful forty-five year-old new mother came into our office for an evaluation at about her four month post-partum. She had bruises and petechiae all over her body, she complained of fatigue and weight loss. She was nursing her baby and wanted to have a child since she was thirty years old or so. Within forty-eight hours of our initial visit, thanks to a compassionate hematologist who performed a bone marrow biopsy on her 18 hours after I spoke to him on the phone, she was admitted to the hospital with the suspected diagnosis of acute myeloid leukemia (AML). I believe she had AML while she was carrying the child throughout her pregnancy. The baby is fine. At the time of hospital admission, she also had a breast mass. She had elevated tumor markers in her blood which sometimes correlates with breast cancer. As I reviewed and explained her potential conditions with her husband, who is a brave and compassionate soul, he used the term hopeless to describe his perception of the situation.

A few weeks ago, a large man showed up from Missouri to be evaluated for a massive sudden weight gain and fatigue over a period of a few months. He had seen probably more than 30 physicians of every size, shape and specialty. He had been absolutely normal until after he graduated from his clinical forensic psychology Ph.D. program. He became profoundly fatigued, gained one hundred pounds or more and had an onset of sleep apnea. In addition, he had a mysterious clotting disorder. As we sat together dissecting his illness and complaints, it was increasingly clear that no one was helping him and his frustration level had almost boiled over. He said, "You are my last hope."

My only living Uncle called the office the Friday before Memorial Day weekend and left a message for me to call his thoracic surgeon because he was undergoing a five hour surgery the day after Memorial Day to repair an enlarged hiatal hernia. What? So I called the surgeon, Dr. Lackey in Royal Oak, Michigan. My Uncle had complained that he could not stop coughing. He was suffering from frequent paroxysms of cough that were extremely debilitating. He couldn't eat, sleep or exercise. I questioned the need for surgery on a hiatal hernia since that anatomical disturbance, rarely if ever caused cough of any kind. The idea of reflux was batted around a bit. But I was firm in my belief that my Uncle's cough came from something other than his hiatal hernia. I told the surgeon I would get back with him. When I spoke to my Uncle on Memorial Day afternoon, he said he thought his condition was hopeless. He was dumbfounded as to why over the last six months he developed an increasingly nagging episodic paroxysms of cough to the point that he couldn't eat, couldn't sleep, and couldn’t talk on the phone. He was miserable. He reiterated, "It's just hopeless. Dr. Lackey says surgery will fix it."

Well, I got this thing about the word Hope. Hope is a word that has both desire and expectation attached to it. And it is a word that is created out of fear. Politicians run their election campaigns on Hope; Ministers keep their congregations paying their tithes on Hope; surgeons and cancer specialists sell their surgical and medical interventions on Hope; and most people who live an unfulfilling and inauthentic life are addicted to Hope. It is a word that is used too frequently in conversation about anything that relates to inability to feel the joy that comes with living in general. It is as though our society has not reconciled the fact that suffering and happiness are two sides of the same coin of Life. Hope is a fear based word. Hope is the most powerful weapon of fear.

Then there is the term Hopeless. When that word is used, usually someone believes that a catastrophe is eminent or they are sentenced to misery, regardless of what action is taken next. Fear has rooted itself so deeply into someone's consciousness that they have resigned themselves to an outcome of bitter sorrow. Each of us have been in places where our personal tower has fallen, perhaps under the influence of a lightning bolt and the devastation to us mentally and physically is profound. That is the cycle of life on Earth. New comes from ruin. Compassion comes from destitution. Health comes from illness. Justice comes from injustice. The general populace has long forgotten that discipline without joy is mere suffering. Bad things happen to good people because bad things happen to people no matter how good or bad one is. Life is not a reward for good behavior, it is a struggle to survive each and every day regardless of what side of the railroad tracks you were born on.

I have tried to erase the term Hope from my vocabulary as I live my life in authenticity. I do my best to look at reality no matter how gloomy my mind has projected it to be, trying to find a solution to desperate situations that is Pareto-optimal when there appears to be no solution at all. Consequently, no difficulty is too high. Most of the time, I find that when patient's operate out of absolute ignorance they are excellent prey for those who wish to make a deal with them, especially when they are trying to remedy a seemingly insolvable or unsalvageable problem. When it comes to illness, many patients are absolutely ignorant of their health problem regardless of the resources they have surrounding them. There is a blind trust of their physician to do the correct and honorable thing. To reach Pareto-optimal, both patient and physician must share and understand the same information about the disease or syndrome. That is very unusual circumstance even now when we have access to medical information on the internet. The practice of medicine in all its forms has turned from a profession driven by excellence and high quality patient outcomes regardless of your ability to pay your bills into an industry which is driven by and large by capitalism and greed.

Those patients who are absolutely ignorant at the onset of a medical catastrophe will embrace a world of decision making based on Hope, not facts. And the facts change based on the perceptions of the public to always steer them back to the Standards of Acceptable Practice promulgated by the drug companies, device manufacturers, insurance industry and State medical boards who are usually appointees of the Governors. I am not aware of a State Medical Board elected by the people who actually benefit or not by the Medical Board's adopted standard practice guidelines. But lobbyists influence the Governor. And the Governors tend to pedal Hope in their campaigns to get elected and re-elected. The medical board usually reflects the sentiments of the Governor or his associates who are almost never a practicing physician or an ailing patient.

So let us get back to the three cases above. In the first case, the new mother had to stop breast feeding and underwent chemotherapy. Her Leukemia seemed to be very sensitive to the chemotherapy and she is almost ready to be discharged from the hospital. She will more likely than not rear her child without danger of another episode or recurrence of Leukemia. It was determined that her breast lump was not cancer. A great outcome in a seemingly desperate and hopeless situation.

The second case is not so simple. The patient has made great strides in recovering from his disturbance. However he is constantly being told different information by different specialists which makes his therapeutic adventure hard to adhere to. He has read a great amount of literature about his multiple problems, each problem individually and he cannot find any information on how each individual problem connects to his overall condition. Each new therapy for an individual problem leads to new complications (side effects) for the rest of his condition. He loses his overall perspective once he is in the presence of each specialist since they claim their treatments are the most important to his overall health. He is better, but still extremely sick and victim to the American medical system of specialized industrial medicine.

My Uncle did not have the surgery. I was able to tease out from his medical history that his primary care physician put him on a blood pressure medication that causes cough six months prior to his symptoms becoming intolerable. I told him to get off of the medication, hung up the phone and spoke to his thoracic surgeon, telling him the surgery was off. The surgeon recognized that cough could have been related to the ace inhibitor, but he could not reconcile the fact that his symptoms worsened over six months. When I told him that my Uncle's medication was switched to a different generic brand six months ago, the surgeon thought that generics were all the same diminishing the importance of the switch: absolute ignorance working at its best. He admitted that a hiatal hernia rarely causes someone to cough. Ultimately he acquiesced to my demand that my Uncle's surgery be postponed. I spoke to my Uncle a week ago, seventy-five percent of his coughing has cleared. I suspect in a month, he will be back to normal. When my Uncle's cough is gone, no hiatal hernia repair for him in his future regardless of the thoracic surgeon's opinion. My Uncle's cough made the hiatal hernia worse, it's not the other way around.

If something tragic happens, don't sit hoping that all will get better. Tragedy requires action and transcendence at the same time. If your health is disturbed, take steps to improve your illness. Be optimistic when optimism is a real option. Become immersed in the knowledge of your infirmity, so that absolute ignorance does not make you vulnerable to snake oil vendors at the flea market. If you choose to hope for the best as your only option and rely on others to guide you in your personal journey, whatever it may be, I suggest you find a pet store that will sell you a mongoose.

Because only the mongoose can smell the scent of a snake.

Doc
 
Posted by Amanda Sanders at 9:16 AM
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