Head, Shoulders, Knees, and...

Yesterday, our patients seemed to be singing that song as they came in with their complaints:

Head - mom on guided kayaking trip with family, playing "kayak tag" when the instructor tagged/whacked her in the side of the head with the edge of the paddle!
* Note: when playing kayak tag, try to tag the *kayak*, not the person

Shoulders - guy who peels logs for a living, helped a friend move over the weekend and developed left shoulder pain
* Note: for all those who think peeling an orange can be tough...we've seen people with the most interesting occupations out here

Knees - older gentleman in his 60's was out hiking with friends in the mountains, slipped on a rock and tumbled down 3-4 feet, landing on his shoulder and knee; he got a big bump on the leg that swelled up to the size of his fist, but we weren't too concerned when he told us that he'd been fine hiking out of the mountains *18 miles* back to his house.
* Note: it's remarkable how healthy and fit everyone is out here. back in CT, it seems that 1 out of every 3-4 patients is obese and/or has diabetes. Out here, not only have I not seen a single person with diabetes, but even the octogenarians hike and bike regularly and are generally fit as fiddles. I attribute the difference partially to selection bias (i.e., healthier athletic types like living/vacationing in these parts), but partially to the environment itself (i.e. since everyone hikes and bikes and stays fit, newcomers are more likely to adapt by becoming/staying athletic and fit - kind of like the recent research suggesting that obesity is "contagious")

and Toes - young guy jumped out of his big truck wearing only flipflops and misjudged the distance to the ground.
* Note: just a quick word about footwear - everyone out here wears Keen shoes, my favorite brand of hip multi-purpose waterproof footwear! yet another reason why I heart Montana.

So...that was yesterday. We also saw a bunch of Eyes and Ears and Mouths and Nose(s), and joked that after all of that extremity stuff, today would bring stomachaches and other core complaints. And wouldn't you know....

My first case of this morning was a boy who was having pain around his bellybutton that migrated down to the lower right part of his tummy, with nausea and pain upon movement...it was as if he was reading right out of the textbook! I almost second-guessed myself because the diagnosis seemed so obvious. And indeed, when we sent him up to the surgeons in Bozeman, they confirmed...my first diagnosed case of appendicitis. But it didn't stop there; I also got a recently released convict with classic peptic ulcer disease, a vacationer with classic urinary tract infection, and a college student at the end of her week on spiritual tour with a Native American shaman who had classic viral gastroenteritis with dehydration. Stomachaches, indeed!

Brad (our uber-helpful bearded mountain man who serves as clinic manager, nurse, X-ray technician, and a million other things, and reminds me a bit - in an endearing way - of Al from Tooltime, but taller) was planning on taking me and Jen (the leggy blonde ER resident working/living with me, who's passionate about public health, has done an Ironman, and bears a passing resemblance - in all the right ways - to Jennifer Garner) out for a mountain bikeride after work today. But...the air is pretty smoky from all the forest fires, so not sure if it'll work out. Until soon!