Ongoing Education

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I couldn’t believe THAT was the cause of my patient’s chronic cough!

Caroline came to me as a new patient in April with a 2-month history of nagging cough. Over the next few months it didn’t respond to the typical cough meds, antihistamines, or other treatments I could think of.

After the first visit I drew some routine labs. I was surprised to find she had severe anemia, with a hemoglobin of 8.7 (normal is 12 to 15). Normally I would have ordered all kinds of tests, but Caroline didn’t have any insurance. She makes enough money that she wouldn’t qualify for medical assistance. How were we going to investigate this in a cost-efficient manner?

We managed to find lower cost colonoscopy and EGD (stomach scope), but it still cost thousands. Nothing showed up as a cause for her anemia.

At least I could help her with bloodwork – her cost as one of my patients is quite low, $70 or $80 for a full panel of labs. But what about some IV iron to help as her hemoglobin dipped down to 6.9 despite taking iron supplements? She checked with the hospital to find out how much IV iron might cost without insurance. It would be $8400.00!! Nope, not an option.

Meanwhile she continued to cough. We arranged for a lower-cost CT scan in Bloomsburg. I wondered if we would find lung cancer. But instead we found a huge right-sided kidney tumor. With the major medical issues showing up, she finally qualified for medical insurance. The referrals began, and she was quickly evaluated and scheduled for surgery.

I can’t imagine how I would have handled Caroline’s situation in my previous traditional medicine practice, where I was booked solid with patients. I saw her in my office 10 times since April, working on this puzzle. We drew blood several times, answered her concerns, and made referrals a priority. Sue, my employee, was instrumental at getting tests and referrals scheduled.

I saw Caroline today for followup from her kidney tumor removal. She looks good. And her cough is gone!! The kidney tumor had been causing her cough!

I love my DPC (Direct Primary Care) practice, where I can provide prompt personalized health care. Medicine the way it should be!