Northwest Nurse Practitioner Associates

The Importance of a Hands-on Physical Exam

admin — Mon, 31 Aug 2020 20:54:08 +0000

NORTHWEST NURSE PRACTITIONER ASSOCIATES

The Importance of a Hands-on Physical Exam

A Proper Clinical Exam Can Make the Difference

It is no secret that I (and other experts agree) that a diagnosis is 90% history, if a thorough history has been taken. However, that 10% can be the life changing action needed in your case. During a physical exam the Nurse Practitioner (NP) takes the patient back to the room, this means the initial exam begins at “Hello”. With no middle person, the NP observes gait, voice, body position and mannerisms from the start. After the history is taken the real physical exam begins. From your head down to your toes we are searching. Searching for clues that can tell us about acute symptoms, chronic illnesses or benign anomalies. Is the “simple urinary tract infection” just that or a new ovarian mass or perhaps renal cancer (those are real diagnoses that we have seen) just from what was stated as a “simple” urinary tract infection by the patients making the appointment. Are the white spots or ridging of your nails just bad luck or a vitamin deficiency? Is the mild shortness of breath you feel the heart, the lungs or mild anxiety? Is the mild abdominal discomfort normal? Is your brain fog just a passing event?

Obtaining accurate vital signs, being able to perform a neurologic exam, palpating the abdomen, listening to the heart and lung and visualize the skin, tongue, nails and hair are big clues in to the body’s function and should not be forgotten. Being able to see the whole person and not just the part on camera can make a difference. A complete Physical Exam done properly is still key in prevention and diagnosis.

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So, What Health Care Issues Can Be Treated on a Virtual Medical Visit?

admin — Mon, 31 Aug 2020 20:49:16 +0000

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So, What Health Care Issues Can Be Treated on a Virtual Medical Visit?

Relationship Based Care Can Make the Virtual Visit Effective

Our practice was fortunate in that we had started HIPPA compliant Virtual Visits long before COVID-19. While it is not the most ideal way to conduct medical visits for some types of issues, for many it can take the place of in-person appointment. Virtual Medical Visits are made more challenging when you do not know the patient. When you know a patient’s baseline (their normal healthy baseline) you are much more likely to know just how sick they are when seen. It also helps fill in many of the gaps that a Virtual Medical Visit can miss. If you do not know their expression, appearance, voice, gestures, intonations and then you are only seeing a patient from the (usual) waist up view, this can cut out some useful diagnostic data. This can make a provider concentrate on a part of the visit that is known to be your “normal” and be concerned it is an abnormal, or not realize the “normal” is actually abnormal for you.

So, what can be addressed? Examples on our Primary Care side for established patients: uncomplicated colds with no shortness of breath or high fevers, urinary tract infections that are not recurrent and also without a fever, mental health follow up appointments, minor injuries, some skin lesions, lab test review, some types of medication refills, allergies, back pain without any illness. On our Functional Medicine side: Either the Initial Consult OR a follow up appointment (at least one needs to be an eventual in-person visit for a thorough evaluation). Functional Nutrition Consults. Wellness Coach Visits. On our Travel Medicine side – patients that are established but have a new trip itinerary requiring no vaccinations. Again, being established with a provider that knows “you” can make a Virtual Medical Visit a safe and alternative mean of providing quality care for many health care complaints.

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Why Choose Functional Medicine?

admin — Mon, 31 Aug 2020 18:04:58 +0000

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Why Choose Functional Medicine?

Finding the Root Cause(s) Using An In-Depth Analysis

Functional Medicine (FM) should be Primary Care (PC), meaning that it allows us to treat individuals in a way that often leads to less prescriptions, less testing over time and better physical and mental health. In Primary Care, prevention can often be overlooked other than standard recommendations on diet, exercise, smoking and alcohol. Many of the treatments are at one diagnosis or are one-dimensional. For example, Irritable Bowel Syndrome (IBS), one of the most common complaints that presents to either a Primary Care Provider or a Gastroenterologist, is usually treated by telling the patient to increase fiber containing foods. And if that does not work, maybe a FODMAP diet and then maybe an eventual prescription medication. Many patients do not respond to these treatments, usually months are going by while each stage of “treatment” gets recommended one at a time. In Functional Medicine, providers see there are often multiple imbalances and the IBS was just the presenting symptom at the top and treating the causes underneath are the curative treatment. Did you know that around 70% of your immunity is in your gut? Making these changes not only helps the gut, but also the gut/brain axis and other feedback loops in the body. This often improves both physical and mental health and prevents other chronic illnesses.

How does a FM Provider evaluation differ from PC? The history taken with Functional Medicine patients allows the Provider to see the connections in a matrix of the patient’s own timeline from birth. Once those connections are evident, we can dig deeper utilizing specialized testing/biomarkers unavailable in a conventional PC setting. The treatment plan may consist of: correcting gut imbalance, nutrient deficiencies, adrenal fatigue, hormonal balance, identifying food allergies or pushing/inhibiting bio-chem pathways based on genetic testing towards wellness, and not disease. Nutrition recommendations are directed at your own test results, nutraceuticals are often used, and lifestyle recommendations are made that are directed at self -healing care that is pertinent to you. In Primary Care, history before the first visit is summarized in your Past Medical History (PMH) and connections are not often made as to the relevance of your health now in the present. In Functional Medicine individual past life experiences, such as: trauma, grief, injury, travel, environment, genetics, exposures to toxins or even toxic stress, it all matters and connects to your Current and Future health status. Ready to address the root cause(s)?

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Day 13 – Walking Tour of Medical Botany

admin — Sat, 05 Mar 2011 03:44:23 +0000

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Day 13 – Walking Tour of Medical Botany

March 4, 2011

On our last day of the expedition, we drove to the Jozani rain forest and have a walking tour of medical botany. The rain forest is such an important part of our medicines and ecosystem. We see the Colobus red monkeys. They allow us to get fairly close to them. Our guide says, “It’s because we treat them with love”. It is a fantastic way to end this expedition with such a simple sentiment. The expedition was a success in that as a group we saw firsthand many tropical diseases and we learned more about Africa and their health care delivery then we had hoped and even learned about each other’s health care in our respective countries; it was exactly what we had sought. Our group was wonderful and diverse and as they say frequently in Africa, “We leave as friends”.

Africa is a contrast in so many ways. Between the most amazing landscapes I have ever seen to the poverty and disease to the resilience of the people and joy of the children in the smallest of things. I leave Africa with the hope of returning one day; my clinical knowledge of tropical medicine improved but even better my soul more fulfilled. Africa is truly amazing.

Colobus Red Monkey

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Day 12 – A Lecture on Lymphatic Filariasis

admin — Fri, 04 Mar 2011 03:38:21 +0000

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Day 12 – A Lecture on Lymphatic Filariasis

March 3, 2011

Today we had a lecture on lymphatic filariasis, some know this disease as elephantitis. There are three species of this worm. Transmission occurs via the bite of a mosquito to the human and it moves into the lymphatic system causing lymphoedema, here usually in a limb such as a leg. We drive south of the island to the Kizimkazi/Dimbani Health Center. Here two nurses run this center and they concentrate on treatment for this disease as well as leprosy. We see both types of patients and I am so impressed on their assessment, documentation and treatment records of cases.

We next visited a community in Jambiani on the East Coast of Zanzibar. They have a community malaria control project here and they presented their data to us. They had a high rate of malaria here and they instituted a malaria project to get the community involved. As a community they took action and made rules to increase mosquito avoidance and decrease breeding such as: decrease trash around the homes, take care of standing water, clear debris, keep toilets and outhouses clean and gave bed nets to all families. The data was impressive and it reminds you how much can be achieved when a whole community gets involved for the greater good.

The nurses who run the Kizimkazi/Dimbani Health Center

Lymphatic Filariasis

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Day 11 – Dermatology in Zanzibar

admin — Thu, 03 Mar 2011 03:38:16 +0000

NORTHWEST NURSE PRACTITIONER ASSOCIATES

Day 11 – Dermatology in Zanzibar

March 2, 2011

This morning we returned to the government hospital in Zanzibar for dermatology rounds. We see many cases of tinea, also known as fungus. Fungus is common around the world but likely more prominent here due to the weather/heat, lack of resources and other infections. This hospital faces a large number of challenges, but due to the volume of patients it has the potential to do the greatest good. Earlier in my blog I make mention of a stellar woman doctor who makes the statement of, “trying to change this place before it changes her”, I repeat it in my head and again I hope she can make a difference here.

Areas of Poverty in Zanzibar

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Day 10 – Schistosomiasis in a Muslim School

admin — Wed, 02 Mar 2011 03:33:48 +0000

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Day 10 – Schistosomiasis in a Muslim School

March 1, 2011

Today we visited a Muslim school of almost 900 children. They scream for us as if we are celebrities. We ask why and we are told they were hoping the Mazungos (white people) were bringing them pens. Yes, just simple pens to write. We are introduced as “doktores” and unfortunately we are here looking for schistosomiasis, a water born parasite. This school has a high rate of infection. There is a stream nearby and the children bathe and urinate in the water there perpetuating the cycle. In order for this parasite to live it must have a fresh water (slow moving) stream, snails and a human. The snail is the host until the human arrives, then it penetrates human skin and eventually makes it way to the liver. It matures here into adult worms and eventually migrates to other areas including the bladder. Symptoms can vary based on the infection from rash, fever, diarrhea to blood in the urine. Screening for blood in the urine is the first step in looking for the disease in these children. In Swahili the teacher asks one classroom if anyone has had blood in their urine. Eight boys raise their hands and step forward to give us urine samples. The children are use to being screened, every six months the entire school is treated for the parasite because the infection rate is so high. If left untreated, the parasite can cause inflammation and damage to multiple organs, increase the rate of bladder cancer and eventually can cause death. We test the boy’s urine and all eight tests are positive for blood, an early sign for the disease. We then went to the river and collect the snails from the water. At the lab we see the parasite in both the boys’ urine and the water from the river.

Boys at a muslim school giving a urine sample for testing

Collecting samples of snails from the nearby Stream

The Parasite Schistosomiasis

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Day 9 – Ward Rounds in Zanzibar

admin — Tue, 01 Mar 2011 03:29:59 +0000

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Day 9 – Ward Rounds in Zanzibar

February 28, 2011

Zanzibar is predominantly Muslim. There are approximately 1.2 million people on this island. We were awoken this morning by the Muslim prayer in the distance. We went to visit the largest hospital in Zanzibar. It is government run and now having seen private, non-profit, and government hospitals, it is clear that the government hospital is not as well organized or efficient. The female doctor in charge is young and impressive. We rounded through some very crowded wards, sometimes 25 people to a room. We see typhoid and many issues of overlapping dysentery and HIV. There is one ventilator for the entire island, let me repeat that one! It is not in use on this day and not one person was in the ICU (intensive care unit), not one. The ICU doctor greets us in scrubs with no shoes on and tells us he prefers to not have infectious diseases in his ICU (If you are reading this blog then at this point you know that most of what we are seeing is infectious and tropical diseases). The female doctor had said she is “trying to change the system before it changes her”. I think about this statement and wish her so much luck.

We completed our rounds and went to see the Spice Farm. Zanzibar is known for their spices such as curry, nutmeg, and cinnamon. We tour through and learned what spices treat certain conditions and get a dose of entertainment from the “butterfly man” (He is already on You Tube for his ability to climb a coconut tree unassisted, while singing and gathering coconuts).

No working sinks on any of the wards.

Ward Rounds in Zanzibar

Ward of a Hospital in Zanzibar

Nutmeg in the Spice Farm

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Day 8 – African Trypanosomiasis

admin — Mon, 28 Feb 2011 03:25:48 +0000

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Day 8 – African Trypanosomiasis

February 27, 2011

We left at 6:45 am to make it to a government hospital that is treating African Trypanosomiasis, or “African Sleeping Sickness”. We rounded on a few patients with this disease and learn about the treatment and complications that can occur. It is a rare disease amongst short term travelers to game parks or safaris. The treatment is dependent on the stage of the disease and can be complicated. I am unable to show pictures of these patients.

We leave the hospital and fly from Kilimanjaro airport to Zanzibar.

Looking through the microscope at Trypanosomiasis

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Day 7 – Hadzabe Tribe & the F.A.M.E Hospital

admin — Sun, 27 Feb 2011 03:20:27 +0000

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Day 7 – The Hadzabe Tribe & the F.A.M.E Hospital

February 26, 2011

Today we visited the F.A.M.E (Foundation for African Medicine and Education) hospital. This is one of the most organized and functioning hospitals. It was put together by an American named “Dr. Frank”, a pediatric cardiac anesthetist and his wife. He had attempted to climb Kilimanjaro years ago with his wife and developed pulmonary edema – a high altitude induced medical emergency. He was treated in Tanzania. After hearing how much they needed doctors, he and his wife sold everything and moved here to establish the hospital (You can see a video of the work they are doing on You Tube by visiting their web site , www.fameafrica.org). They are really making a difference and I find them the most inspiring for their passion for their work and care.

Next we visited the last tribal medicine group known as the “Hadzabe”. The tribe has only around 1,200 tribesmen left. They move in small groups still hunting and gathering for food and to live off the land. We learn how they get to water by digging holes and what they are using for herbal medicine to treat colic, fever, malaria. They speak a kind of “cluck” language. Their highest mortality rate is under the age of five, there is a high rate of miscarriage. There is a strong possibility that they will disappear sometime in the next decade.

Visiting with the Hadzabe

Hadzabe smoking a traditional homemade pipe

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Northwest Nurse Practitioner Associates

The Importance of a Hands-on Physical Exam

The Importance of a Hands-on Physical Exam

So, What Health Care Issues Can Be Treated on a Virtual Medical Visit?

So, What Health Care Issues Can Be Treated on a Virtual Medical Visit?

Why Choose Functional Medicine?

Why Choose Functional Medicine?

Day 13 – Walking Tour of Medical Botany

Day 13 – Walking Tour of Medical Botany

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Day 12 – A Lecture on Lymphatic Filariasis

Day 12 – A Lecture on Lymphatic Filariasis

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Day 11 – Dermatology in Zanzibar

Day 11 – Dermatology in Zanzibar

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Day 10 – Schistosomiasis in a Muslim School

Day 10 – Schistosomiasis in a Muslim School

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Day 9 – Ward Rounds in Zanzibar

Day 9 – Ward Rounds in Zanzibar

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Day 8 – African Trypanosomiasis

Day 8 – African Trypanosomiasis

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Day 7 – Hadzabe Tribe & the F.A.M.E Hospital

Day 7 – The Hadzabe Tribe & the F.A.M.E Hospital

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