A Country Doctor Writes:

When I lived and worked in the Bucksport area, my best friend was the local veterinarian. Sometimes we talked about the difference between animal and human medicine. Animals can’t tell us how they feel, it’s up to us to read them and to know them.

I just had a situation with a horse that I am boarding, Emma‘s best friend. He stopped eating. Was it an early colic? Was it a tooth problem? Was it something orthopedic? Is it something passing or the beginning of a medical disaster?

Step number one, a dose of Banamine paste. This is a strong anti-inflammatory like a shot of Toradol for a human. Slight improvement, nothing dramatic. Phone call to the horse veterinarian: More anti-inflammatory drug, phenylbutazone, like a super ibuprofen. Maybe a little better, nibbled some hay. My thought as a physician playing vet: Maybe this is a primary G.I. problem? I have some leftover omeprazole in horse doses. I take 20 mg twice a day of the isomer esomeprazole, Nexium. The dose for a horse, that’s why they call it a horse dose, is 100 times as much. If nothing else you could protect him from G.I. side effect of his anti-inflammatory medicine.

Less than 24 hours later my guy is eating up a storm, fed him two suppers tonight.

Doctor playing vet.

This gruesome statistic speaks for itself. I love my adopted homeland, but there is a problem here. We have a problem that most countries on this planet don’t have.

Dustin had a history of seizures that were always mild and only happened at night. He took his medication faithfully. But a couple of months ago he had a bad one.

The emergency room workup showed that his phosphorous was critically low. They replenished it intravenously and his level normalized and stayed up.

My reading when I saw him in followup suggested that hypophosphatemia is sometimes transient without explanation, but sometimes related to vitamin D deficiency.

I prescribed vitamin D, which is something I rarely do because I’m very skeptical of D supplementation. I describe D levels as a lab test looking for a disease. Here in northern Maine all mental health professionals tell her patients to take vitamin D for seasonal affective disorder with no scientific backup.

So Dustin got his prescription for vitamin D and his phosphorus level stayed OK for a while but next thing I knew he was in the emergency room again with a seizure and a low phosphorus. I added a vitamin D level to the serum already in the lab and it had not budged at all.

I knew Dustin smoked a lot of weed and the emergency room pointed out the same thing. I realized that I should have been more aggressive with my dosing of his vitamin D but I just had a funny feeling that maybe there was a connection between marijuana use and low phosphorus.

I asked my esteemed colleague, Dr. Google. He instantly brought an article to my attention about a probable connection between marijuana use and low phosphorus.

So I cranked up Dustin’s vitamin D dose and gave him a printout of the article. “You might want to cut back on your marijuana use”, I suggested.

I guess I’m hedging my bets here between the low D and the high THC, and I’m open to other possibilities. The big message here, for what my CEO called a “late career physician”, is (and I’ve said it before): May I never lose my curiosity. (Although in the post below, it seemed like CBD oil did something good – always ask, always wonder, always question…)

Curiosity, Antidote to Burnout

Business owners sometimes do unreimbursed work to promote their business, but most of the time people charge for what they do. In healthcare, doctors are paid for seeing patients but not for reviewing incoming results, giving telephone advice or coordinating care. Those activities are seldom reimbursed by insurance companies.

Since most of us are no longer business owners but employees, the obvious question is why are we evaluating and compensating physicians’ performance based on billable activities but expected to do all non-billables without compensation on our own time?

It’s an upside-down idea: Instead of being thankful for the extraordinary events in our life – vacations, holidays, weddings, anniversaries, career high points and diagnostic victories – we should probably be more thankful for what Dr. Edwin Leap calls the “blurry days”.

In these times of mayhem in our world, from war, mass shootings and natural disasters to economic and medical challenges, we need to remember that days that pass by without fanfare or excitement may be the greatest wish of the people in Ukraine, in hurricane or drought stricken towns, in food pantry lines and refugee camps here and abroad.

We need to be thankful that we are as free as we are, that we have days when nothing major happens, when there is electricity, running water, food, toilet paper (remember the early days of the pandemic) and all the things most of us have been taking for granted most of our lives.

But, yes, I will of course give thanks on this day for my family and dear ones, my animal friends, my home, my job, my health and my holiday plans. But, dear God, help me not be greedy for the extraordinary; help me appreciate the little things, the ordinary things, the normal things that so many people don’t have in their lives.

Another Thanksgiving Reflection