In dog years I turned 413 this week. Where did the time fly? I can still put on my socks in the morning standing on one foot, but that is about the last vestige of my youth that remains. Gone is hair, vision, and sanity.
Years ago I remember reading (I think it was in the History of Civilization) that there are some Sumerian clay tablets from 2000 BC complaining about the decline in standards, that kids don't respect their elders and don't have any work ethic. I keep that in mind when I want to complain the everything is going to hell in hand basket.
Because it is. Well some things are.
What would you do if you had people with no education in science-based medicine, instead having an education mostly grounded in pseudo-sciences like homeopathy, acupuncture, and hydrotherapy? People with little or no post graduate training, when the bulk of medical education and training occurs in reality-based medicine.
In Oregon the legislature has made these under-educated, untrained pseudo-science practicing primary care providers. And I am starting to see the results.
My patient had traveled to Asia a few years ago and came back with a bump on his abdomen. It had waxed and waned in size over the years and he is concerned it may be a parasite of some sort.
Perhaps. I have seen a few odd subcutaneous parasites over the years, those that have wandered into the skin where it did not belong. I have seen a gnathostomiasis and a cystercercosis that caused a chronic subcutaneous nodule. There are a variety of other parasite that can cause the same symptoms:
Nematodes are roundworms that cause diseases with cutaneous manifestations, such as cutaneous larval migrans, onchocerciasis, filariasis, gnathostomiasis, loiasis, dracunculiasis, strongyloidiasis, ascariasis, streptocerciasis, dirofilariasis, and trichinosis. Tremadotes, also known as flukes, cause schistosomiasis, paragonimiasis, and fascioliasis. Cestodes (tapeworms) are flat, hermaphroditic parasites that cause diseases such as sparganosis, cysticercosis, and echinococcus.
So may be it is a parasite, although the exposure history is not impressive. I will try to get it biopsied, which he has been hesitant to have done.
Before me he has been seen by an ND, and by the patients report had a negative saliva test for parasites (!), but did have a positive test whereby the ND held a variety of glass vials against the bump and that diagnostic maneuver was positive for parasites (!!).
"That is how she diagnoses parasites" my patient said.
Why didn't they teach me that in fellowship? Sounds like a version of the wackaloon SCAM (Supplements, Complementary and Alternative Medicine) known as applied kinesiology. And since the test was positive, the patient was given a prescription for metronidazole (!!!). Look at the list above, there are not many parasites that treatable by metronidazole? It's a parasite, don't you know.
But standard ND practice and part of why ND should really be short for Not Doctor.
I sometimes get the impression that ND's do not understand that parasites have life cycles, exposure risks, and specific treatments. Like toxins, parasites are a nonspecific evil humor treated with antibiotic, again with antibiotic being a generic idea, not a specific drug with specific activity.
Thanks to EPIC, the electronic medical record, I could look at the ND notes, but they were unrevealing concerning parasite diagnosis and treatment. Perhaps it was a different ND, perhaps even they were embarrassed to document such nonsense. Nahhhh. The only documentation I could find suggested the patient had congestion of liver and kidney relieved by acupuncture. As if that is any better than parasite diagnosis by applied kinesiology.
I have been seeing a slight uptick in these kinds of consults as people with travel exposures are seeing ND's first rather than reality based providers, with all kinds of creative tests and treatments. And I expect to see more.
See. Some things really are going to hell in hand basket.
Naturopathic Diaries. http://www.naturopathicdiaries.com/ The truth ND's do not want you to know.
Disingenuous: Deconstruction of a naturopathic white paper. https://www.sciencebasedmedicine.org/disingenuous-deconstruction-of-a-naturopathic-white-paper/
Am Acad Dermatol. 2015 Dec;73(6):947–57; quiz 957–8. doi: 10.1016/j.jaad.2014.11.035. Mucocutaneous manifestations of helminth infections: Trematodes and cestodes. https://www.ncbi.nlm.nih.gov/pubmed/26568338
Cross posted, with editing, from sfsbm.org.