1/
I've been seeing a patient living with #HIV who has had right hip pain for 5 months.
He is a 33 year old Black man who hobbles around like he's 90.
He just lost his job.
The pain was so great he couldn't sleep at night and was dozing off during his shift.
I've been seeing a patient living with #HIV who has had right hip pain for 5 months.
He is a 33 year old Black man who hobbles around like he's 90.
He just lost his job.
The pain was so great he couldn't sleep at night and was dozing off during his shift.
2/
No one explained to him what was going on. He got an x-ray at an ER five months ago.
He understood that he had a "ruptured" hip.
Doctors who have seen him have only given him ibuprofen and Aleve for the pain.
Both don't touch it.
He cried during our first office visit.
No one explained to him what was going on. He got an x-ray at an ER five months ago.
He understood that he had a "ruptured" hip.
Doctors who have seen him have only given him ibuprofen and Aleve for the pain.
Both don't touch it.
He cried during our first office visit.
3/
He could barely get up on the exam room table without excruciating pain.
I couldn't rotate his right hip due to the discomfort it caused him.
We agreed to try a low dose opiate and muscle relaxants as needed.
Our clinic would request the medical records from his ER visit.
He could barely get up on the exam room table without excruciating pain.
I couldn't rotate his right hip due to the discomfort it caused him.
We agreed to try a low dose opiate and muscle relaxants as needed.
Our clinic would request the medical records from his ER visit.
4/
We also tried daily gabapentin first, then Elavil as non-opiate pain control options.
Neither of them worked.
Last week I started him on a stronger, long-acting opiate twice a day.
I would be lying if I didn't admit I was questioning whether I was doing the right thing.
We also tried daily gabapentin first, then Elavil as non-opiate pain control options.
Neither of them worked.
Last week I started him on a stronger, long-acting opiate twice a day.
I would be lying if I didn't admit I was questioning whether I was doing the right thing.
5/
But a voice in my head reminded me that I didn't have all the information yet, and by my objective exam this brother was in pain with no diagnosis yet.
Apparently no one else was taking his pain seriously.
Maybe he looked "drug-seeking" with his proper grooming and speech.
But a voice in my head reminded me that I didn't have all the information yet, and by my objective exam this brother was in pain with no diagnosis yet.
Apparently no one else was taking his pain seriously.
Maybe he looked "drug-seeking" with his proper grooming and speech.
6/
Today we got the records from his ER visit.
The right femoral head of his hip was collapsed, consistent with avascular necrosis.
In other words, his hip bone was breaking down due to poor blood flow.
This is common in patients living with #HIV and with certain HIV meds.
Today we got the records from his ER visit.
The right femoral head of his hip was collapsed, consistent with avascular necrosis.
In other words, his hip bone was breaking down due to poor blood flow.
This is common in patients living with #HIV and with certain HIV meds.
7/
The diagnosis was as clear as day on his discharge paperwork.
They knew. Yet,
He has had no physical therapy.
No full orthopedic evaluation.
Was told to take ibuprofen and Aleve.
Was given crutches.
Was discharged to "self" and "outpatient follow up."
That was 5 months ago.
The diagnosis was as clear as day on his discharge paperwork.
They knew. Yet,
He has had no physical therapy.
No full orthopedic evaluation.
Was told to take ibuprofen and Aleve.
Was given crutches.
Was discharged to "self" and "outpatient follow up."
That was 5 months ago.
8/
Racial bias in medicine is real.
It's not a fantastical phantom of the past that reared its head once when the US Public Health Service withheld treatment from Black men with syphilis in Tuskegee.
This is 2021.
Racial bias in medicine is real.
It's not a fantastical phantom of the past that reared its head once when the US Public Health Service withheld treatment from Black men with syphilis in Tuskegee.
This is 2021.
9/
It lurks in our ERs and urgent care centers.
Our radiology rooms and hospital floors.
Our front desks and pharmacies.
It's not ok that a 33 year old Black man has been walking around on a collapsed hip bone for 5 months because folks don't believe Black pain is real.
It lurks in our ERs and urgent care centers.
Our radiology rooms and hospital floors.
Our front desks and pharmacies.
It's not ok that a 33 year old Black man has been walking around on a collapsed hip bone for 5 months because folks don't believe Black pain is real.
10/
Conduct all the "anti-racism" sessions you want.
Hire token Diversity, Equity, and Inclusion people at every institution.
None of that shit is gonna matter as long as medical staff and systems continue to see Black people as second class citizens.
I'm exhausted y'all.
Conduct all the "anti-racism" sessions you want.
Hire token Diversity, Equity, and Inclusion people at every institution.
None of that shit is gonna matter as long as medical staff and systems continue to see Black people as second class citizens.
I'm exhausted y'all.
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