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Bone Broth

Bone Broth

It is not often that I have the opportunity to write a humorous patient care with a good outcome. However over the last three weeks, one of these uncommon situations unfolded right before my eyes.

Three weeks ago, one of our long time patients had gotten into an automobile accident and fractured her right ankle. She was seen in a local emergency department and splinted appropriately. She was told that she needed to follow up with an orthopedic surgeon because she would probably require surgery to fix her unstable ankle.

This patient is an extremely compliant person. Staying to her character, she went to Campbell Clinic and had an evaluation by one of their foot and ankle specialists. I did not know by whom my patient was evaluated. My patient did not call me for advice or referral. I suspect she looked at the possible providers that her insurance company had listed on the internet and picked one. She most certainly did not use Angie's List.

After her orthopedic evaluation, she traveled to my office with X-rays in hand. My nurse Tammy ushered her back to be evaluated since she needed a medical clearance before the orthopedist would perform the necessary surgery. As she told me what happened to her and how she fractured her ankle, I glanced at the X-rays and affirmed she had broken both sides of her right ankle. The fractured bones looked well aligned, just broken. I affirmed the accepted notion that these kinds of fractures are routinely plated in surgery to assure proper alignment and bone healing.

She said the surgeon was not particularly nice. The surgeon told her that her ankle would have horrible arthritis and it would ache for the rest of her life. I assured my patient that she would most likely heal and the joint might be painful initially, but it would not disable her in any way. High heeled shoes were out for the next six months.
We performed our usual medical clearance blood draws, did an ECG and urine analysis with a culture. Any time a patient requires surgery, a urine analysis and culture allows me to clinically investigate for any kind of occult or subclinical infection that might end up compromising the surgery. She had no symptoms of a urinary tract infection. Bones are particularly susceptible to infection if they are operated on, so the patient having a sterile urine at the time of surgery is imperative.

The patient left our office as she came in, on crutches. Just watching her navigate our office gave me the Willies. I could envision her face planting without warning because she did not know how to use her crutches appropriately.

Prior to her leaving, I had Tammy give her my recipe for beef bone broth as well as Vitamin D3, Strontium, Osseous Appetite and DHEA. We routinely prescribe these in patients who have broken bones, osteopenia or osteoporosis. Bone broth is made from rendering marrow bones for at least twenty-four hours. The broth must be flavored a bit to cover up the rich mineral taste. I drink it every three months or so just to keep my bones healthy. It works wonders for fracture healing.

At the close of the week, her orthopedic surgeon called and insisted on speaking to me. Tammy got me out of a room. Tammy said that Campbell Clinic was burning up the phone lines trying to get our patient scheduled for a Monday surgery. As I took the phone, I was greeted by an intense female voice clearly frustrated with my medical clearance activity. Her tone was on the intolerant side. My first question to her was where she trained. She proudly responded Philadelphia for residency, Campbell Clinic for fellowship. That explained her discourteous and rude demeanor. She insisted that I clear my patient for surgery since the window of opportunity was closing for an appropriate surgical adventure. I informed her that my patient had gram negative bacilli in her urine and until I had confirmation of the exact genus and species as well as a sensitivity profile to treat her condition, she was staying off the operating table. There was a moment of silence, an uncomfortable silence similar to the one that occurs when you tell your mother-in-law during Thanksgiving dinner that her gravy has lumps in it.

The surgeon got louder on the phone, as if I could not hear her already amped up voice. All people get loud when they feel they have not been heard. She insisted that I put her on an antibiotic. I told her that the culture was inconclusive and choosing an antibiotic would be foolish since we had no true sensitivity. She insisted I blindly choose one. I refused. I asked her what her preference was, perhaps she could use her vast medical microbiological knowledge and make an educated guess. She chose Cipro®. Funny thing about Cipro®, the drug retards bone healing. I was not surprised at her choice, she clearly was a surgeon without any concept of medicine as a whole. I told her that would be okay for short term. She told me to get my patient cleared by Tuesday at the latest. I replied with a simple, "We'll see." We called in the Cipro® prescription to a local pharmacy and got a report from our patient, she was drinking her bone broth faithfully.

When Monday arrived, my patient's urine culture and sensitivity was released by the laboratory. The bacteria in her urine was identified as E. Coli. It was susceptible to Cipro®. Escherichia coli (also known as E. coli) is a Gram-negative, facultative anaerobe, rod-shaped bacterium. The preliminary report was incorrect. She did not have a gram negative bacilli in her urine after all. Anyway, I wrote the medical clearance letter, signed it and faxed it to Campbell Clinic.

The surgery was rescheduled for Friday (2 October 2015). As my patient was sitting in the waiting area of the surgery center, the anesthesiologist was in panic mode over my medical clearance letter. He had read that I insisted that my patient's cerebral oxygen levels would be monitored during the surgery to reduce or avoid any post operative cognitive decline from the general anesthesia. The outpatient surgery center did not have the equipment necessary to monitor her cerebral oxygen levels. If I insisted on the monitoring for patient safety, he would have to cancel the case and move her operation to the hospital. Her surgery would be delayed until the following week. I was not going to put my patient in jeopardy for any brain damage even if it would be temporary, so I insisted on the monitoring. He told my office he would have to speak to the orthopedic surgeon about it.

I was glad I did not have to make that call. In response to the anesthesiologists call, the orthopedic surgeon ordered a CT scan of my patient's ankle. The results showed that she had great alignment, and both bones had healed at a super fast rate. She told my patient she would not need surgery after all. I am not really sure about the truth of the matter, but my patient was telling anyone who would listen that she had the greatest doctor in the world, maybe who ever lived and my recipe for bone broth healed her bones perfectly. She did not need surgery because of my care. I could see her just screaming, "Woo Whoo!"

I am sure the entire surgery center staff, the orthopedic surgeon and the anesthesiologist were all wondering who I was and not necessarily in a good light. I inadvertently thwarted her surgery every step of the way, just trying to do the right thing for my patient. First the E. Coli had to be eradicated from her urine and then the obstacle of cerebral oxygen monitoring during the surgery. I may have surprised the anesthesiologist with my knowing about post operative cognitive decline, but that's my job to anticipate the possible toxic aftermaths of a seemingly innocuous surgical procedures and making sure everyone involved takes some responsible for reducing the likelihood of them occurring.

What initially seemed to be a done deal, surgery to fix two broken bones, ultimately ended in a therapeutic adventure consisting of a cast for six to eight weeks and some supplements and bone broth.

Now that's a funny story with a good ending. The Gods of Surgery will have to spin their webs looking to capture the next unsuspecting candidate to rush into surgery. But not this time, nature took its course.

Posted by Amanda Sanders at 9:03 AM
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