Feet First

“It is much more important to know what sort of a patient has a disease than what sort of a disease a patient has.” - Sir William Osler

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    Tuesday, May 30, 2006
    "I'm Going Out Dancing Tonight!"

    Once in awhile a simple treatment change makes a big difference in someone's quality of life. This happened to me just the other day.

    I had a patient who'd been having respiratory symptoms for three weeks, whom I had not seen but who had been seen in our Urgent Care. I'd also called in a prescription for her over the phone. She had a known history of asthma but was not getting better despite her meds.

    Finally, I got her back into the office. You can only do so much over the phone; when somebody fails treatment, it's time to bring them in and take another look.

    She sat there and told me about her persistent cough, her hoarse voice and the pain in her throat. Her lungs were clear and she was not congested. I flipped through the chart and suddenly noticed that eighteen months before she had been taking medication for acid reflux. A lightbulb went off over my head!

    I asked more questions. Yes, she had been under more stress recently. Yes, she'd been eating dinner later. Yes, the pain felt like burning and sometimes it was worse at night. The conclusion: her GERD had returned and she was aspirating stomach acid. The acid was irritating her vocal cords, causing her hoarseness and her cough.

    I gave her some samples of Prevacid (a proton pump inhibitor that decreases stomach acid secretion) and asked her to call me in 48 hours. The call came before the end of the day; the message slip on my desk read as follows:

    "Patient says it is stomach acid and she feels much better. She is going out dancing tonight."

    Damn. A cure!