“If you carelessly squander your jing then you create a situation of potential harm to your health and longevity. Eastern medical schools all say this.”
William Bodri
”So, you need a referral to a pulmonologist?”
“Yes, I’ve been to the University Health Center almost every month since August and they’re getting tired of seeing me there.”
“Did you have much trouble with your asthma when you were younger?”
Kaitlynn and her mother exchanged a quick glance and a mutual head shake. The young woman continued:
“No, they called it exercise-induced asthma then, and I just used an inhaler before sports.”
“And now you’re on Pro-Air, Claritin, Advair and Singulair?” She nodded yes to my rhetorical question as I finished my thought: “And you’re still miserable.”
I knew all she seemed to want from me was a pulmonology referral for when she got back to the University after break, but I was intrigued and I wanted to do a good job facilitating the consult.
“What’s your best and worst peak flow?”
“400 on a good day, 200 when I’m sick.”
“Did you ever have a chest x-ray?”
“Yes, the clinic sent me for one.”
“Do you know what it showed?”
“My lungs were too inflated, I think.”
“Are you exposed to cigarette smoke?”
“The guy I live with smokes, but not inside.”
“You have an apartment?”
“Yes.”
“Any pets?”
“Two cats.”
“Did you grow up with cats?”
“No.”
“Do you have wall to wall carpeting?”
“Yes.”
“Any mold problems?”
“I don’t think so.”
“Is there anything you think might be bothering your asthma?”
“Well, my best friend has a dog and I think I’m worse around the dog.”
I started my physical exam while continuing to ask Kaitlynn questions. I noticed the ‘allergic shiners’ under her eyes. Her nose was congested and she had coarse, sonorous rhonchi and higher-pitched wheezes in both lungs.
“Do you ever have heartburn?”
“Actually yes. I was diagnosed with a hiatal hernia when I was very little and there was some problem with my swallowing.”
I finished my exam and sat down across from Kaitlynn and her mother.
“I think definitely you need some testing”, I began. “You could have some other, rare, lung disease, but this is probably asthma. The question is what caused it to get worse. You could be allergic to your cats, because no amount of medication can stop you from reacting to your own cats who live in your apartment if you have a severe allergy to them.”
She looked down. I continued:
“You may have stomach acid going into your lungs while you sleep, or you could be aspirating small amounts of food or fluids and your lungs could be reacting to that. Or, maybe your childhood asthma just got worse – it sometimes does that in your age group.”
Mother and daughter were both nodding. I felt I had achieved a fair amount in just a few minutes. As my eyes met Kaitlynn’s, she looked amused. She turned toward her mother, who was almost grinning. I thought I must have really somehow impressed them with my quick analysis. I cleared my throat.
“Here’s my suggestion: Let’s get a blood test today to screen you for some common allergies like cat and dog, and let’s pick a pulmonologist near the University…”
Kaitlynn and her mother exchanged looks again.
“I already had a blood test. Doctor Freese did that the first time I saw him, but I haven’t heard the results yet.”
“Who is Doctor Freese? The Student Health doctor?”
“No, the lung specialist.”
I raised one eyebrow and squinted with the other eye.
“Have you already seen a lung specialist?”
“Yes, and he said the same thing you did”, Kaitlynn giggled.
I sighed.
“So you didn’t need me to refer you to a lung doctor – you needed an insurance referral, so his fee will be covered by your insurance…”
“That’s right. We thought you knew that.”
“I didn’t, but we’ll take care of it.”
The two of them got up from their chairs simultaneously, gave each other another bemused look and said good-bye as they left the room.
There I stood, watching them leave and thinking I had just spent some jing I could have used better somewhere else.
A Country Doctor Writes: 
Yes, I agree your jing could have been better used elsewhere…