Week 4

Hi all! Hope everyone had a good week and avoided getting sick! Sadly, I did not, and was only on site one day this week. But what’s interesting (the most positive I could make this sound), is even my experience laying in bed the last few days has related to my internship.

On Monday, we saw a lot of patients who were coming in because they were sick. Flu and cold season is hitting later in the year this time, and lots of people I know in and out of the office have been sick. One particular bug we saw two cases of: a viral chest and head cold. This brought on stuffy noses, sneezing, coughing, aches, tiredness, sinus congestion… a combination that obviously makes for a great time. Unfortunately, this was the bug that I then caught!

An accurate depiction of how I felt this week. 

In general, viral illnesses cannot be treated with prescriptions; they just have to run their course. When this is the case, Dr. Barker (and myself at home) focuses on managing and treating the symptoms. This includes antihistamines  and sinus decongestants, such as Benadryl and Sudafed respectively.  Steroids can also be prescribed in low doses to “kick start” the body into healing itself, and also provide an energy boost to make up for the “drag” often seen with viral infections.

One upside to my ample time recovering this week: I made a spreadsheet with data from the surveys that we’ve received so far. It is really interesting reading through what patients value in  a primary care physician, and seeing how these values have been met with different providers.  Unsurprisingly, one of the biggest things patients seem to value thus far is feeling listened to, and not overpowered by their doctor. So far (and I expect this to continue), patients feel this happens with Dr. Barker!

My last exciting update for the week is a conference happening this weekend: the annual Mayo Clinic Women’s Health conference. Dr. Barker is attending all weekend, and I can’t wait to hear the information she brings back! Preventative Women’s care is a huge topic at this conference, so guidelines and regulations for mammograms and pap smears are commonly revised and edited to be the most beneficial they can. Additionally, a good screening test for ovarian cancer has not yet been developed, so I am interested to see if any progress is shared there.

I will share more next week about what comes of the conference, more surveying, and more patients! Thanks for reading!

Week 3

Hello all! Another fantastic week. Exciting news-- I have some updates on surveys and research before we get on that weekly patient grind!

We began administering the surveys in Week 2, and after analyzing Week 2 and Week 3’s responses, I began to notice not only some trends but some room for improvement on the survey itself. Some of the questions (such as the background ones on how long a patient has had a certain condition) were receiving vague responses. To resolve this, I added details and specificity to that and other sections of the survey. I am excited to keep reading through responses and finding some solid patterns; I will start to write about these them once we’ve been administering the surveys for a couple more weeks!

Another great experience I had this week was seeing a patient I had met with earlier in the year. This was the first patient I have now seen twice. It was so cool to be able to follow up with her, and track her progress and life as a whole.

On Wednesday this week, we had a great visit that exemplifies the benefit of Osteopathy. A patient came in with complaints of pain in her left jaw, neck, and shoulder. She was also recovering from a minor car accident four months ago, in which she injured her right foot and ankle (and nothing else). In the past, she has suffered from sciatica (pain in the region where the sciatic nerve is, from the side of the hip to the buttocks/lower back) and borderline high cholesterol and blood pressure.

It would be easy to dismiss a connection between an injury in the right foot and pain in the left side of the neck, or between high cholesterol and chronic left side pain. However, Dr. Barker explained to the patient that both an injury in the right foot and Sciatica pain can lead to a limp. This can lead to misalignment up the spine… and consequent neck and shoulder pain.  Additionally, chronic pain limited to one side of the body can be a symptom of cardiovascular disease. Other symptoms of cardiovascular disease? Elevated blood pressure and cholesterol levels.

Due to the patient’s history and her training, Dr. Barker prescribed both a Stress Test (to ensure underlying heart problems are not causing or worsening the left side pain) and OMT, Osteopathic Manual Therapy (to mitigate the pain and misalignment). So many medical problems are interrelated and influence one another, forming connections D.O.s are specifically trained to notice. Osteopathic training really brings a fantastic holistic perspective, allowing patients and providers to have a complete understanding of all aspects of their health.

So that’s it for this week… Until next time. As usual, thanks for reading! See you soon!

Week 2

Hello all! This week was a truly amazing week on site, and the first week we gave the surveys!. We saw upwards of 15 patients with my time on site, all a variety of cases, ranging from diabetes, to Kallmann’s Syndrome. We also had some establishment of care visits, which is the term for appointments with first-time patients of Dr. Barker. Busy week!

The first type of common visit we saw was diabetes management. Fasting glucose level (where you do not eat for 8 hours before having blood drawn), often called your “sugars”, is another factor in health influenced by both lifestyle and genetics. This should be under 100. 101-129 is pre-diabetic, and above 130 is diabetic.  

We explained this information to patients, and other warning signs of diabetes, such as high A1C levels or imbalanced levels of insulin. (A1C is another blood test done, with healthy values being under 5.7, prediabetic levels ranging 5.7 to 6.4, and diabetic levels being about 6.5).  In general, diabetes patients require more frequent visits to the doctor to manage their condition, so reading their survey responses should be interesting!

A fascinating case of female Kallmann’s Syndrome was something new I was introduced to this week. Kallmann’s Syndrome is type of hypogonadotropic hypogonadism. In layman’s terms, this is a low level of activity of the gonads (sex organs), creating a lack of sex hormones, specifically estrogen and progesterone. It prevents the completion of puberty, requiring hormone supplements that in females can be provided by the oral contraceptive pill. This condition also brings another interesting symptom: anosmia, or the lack of smell. Hearing can be damaged as well.

The connection between these and the lack of hormones is unclear, but it is theorized that the genes responsible for stimulating the hypothalamus (which would in turn stimulate the gonads) are related to those responsible for some sensation.

However, the best part of my week was not related to either of these. It was confirming that a young couple was pregnant with their first child. Seeing how happy they were when they found out more than made my day. This experience has actually stirred interest for me in the OB field, as these happy couples and little newborns would be amazing to work with.

All in all, it was a great week, full of fantastic experiences. I started collecting the surveys, and have only skimmed through them. Thorough analysis will begin once I have more of them completed. Until next time, thanks for reading!

Week 1

Hi all! This week is my first week on site researching, and not just shadowing. I have been coming to the practice a couple times a month to observe since September, but now I will be here twice a week.

This week I saw around 15 patients, with a lot of them being endocrinology appointments. We spent a lot of time going through lab work with the patients, so that they could understand what exactly their current state of health was and how to improve it.

For example, a lot of the patients at this practice have thyroid imbalances, even to the extent of Hashimoto’s disease (hypoactive thyroid) or Grave’s disease (hyperactive thyroid). We sat down and read through full thyroid and hormonal panels to examine their T3, T4, and TSH levels. These show level of thyroid function and level of management of said function by the brain. An underproduction of T3 and T4 is often seen alongside an overproduction of TSH, and vice versa. Low levels of T3 and T4 stimulate the brain to release TSH, to stimulate production of more T3 and T4 in the thyroid.  We explained this mechanism to each of the patients, rather than just stating that the person was hypo or hyperactive.

I noticed how thoroughly Dr. Barker communicated not only the problem, but how to fix it. The majority of the time, thyroid imbalances cannot be treated naturally, and do require a prescription. We broke down the passageway for the possible drugs, and explained to the patients possible side effects, and lifestyle modifications to mitigate such side-effects.

We also did this for different labs, like lipid panels. For these patients, we explained HDL (good cholesterol), LDL (bad cholesterol), the combination and ratio of the two, and triglyceride content in the blood. For those of you who don’t know (and I didn’t until this week), HDL levels should be at least 40 but ideally above 60, in order for good cholesterol levels to actively protect against heart attack and stroke. LDL should be below 130, and total cholesterol should be around 200 or less. If these numbers are met, a patient is considered low risk for heart attack and stroke.

Low HDL is easily fixable with lifestyle changes, such as eating more avocado and olive oil. High LDL however, is usually managed with statin-therapy. We would talk to the patients about their risk factors for cardiovascular problems, and prescribe statin drugs, some of which you may have heard of or used (like Crestor).

This week was a great chance to see how doctors (and osteopaths specifically) manage prescriptions and long-term afflictions. Not only did I learn about specific drug pathways and functions, but how patients feel about them as well.  Can’t wait to be on site next week! Thanks for reading!