What's "Normal"?

                It’s easy to take for granted knowledge of what’s normal.  In the USA a lot of the practice of pediatrics involves knowing what’s “normal,” because parents are worried about a wide variety of things during the normal growth and development of their child.  Here I deal with that a lot too, but I also deal with a lot of things that make me laugh inside.  To me it seems obvious that the patients “symptoms” are normal, but when I really think about it there’s no way they could know it’s “normal.”

                For instance, I had a man in his late 30’s complain that his body gets hot at night for the last 7-8 years. Consequently his wife doesn’t want to sleep right next to him, because he’s so hot.  Upon questioning it turns out he’s been married for 7-8 years.

                I had a 23 year old male complain that his arm veins stick out (i.e. vasodialate) when he lifts heavy things.

                 I had a 30 year old guy tell me that when he walks long distances his body gets hotter and hotter.  The further he walks the hotter he becomes.  And he even starts sweating a lot.  Especially when he’s out in the sun.

                I had a 50 year old obese lady with 5 thick alpaca sweaters, 2-3 pairs of knitted wool pants/leggings, and 3 skirts on tell me that her body sweats A LOT! (I was wearing a polo shirt and a pair of pants quite comfortably in the same room).

                Everyone tells me that their hands and feet are warmer than the rest of their body and that they sweat more than rest of their body. 

                Everyone gets worried when their urine turns from clear to yellow (I guess they’re very well hydrated).

                All day every day everyone complains of low back pain.  On my way to the hospital today I passed by a field (farm). There were 5 adults (4 men and 1 woman).  They were standing with their legs straight, bent 170 degrees at their waist, (I guess) picking weeds out of the field.---My back hurt just watching them.

                The other issue that really wears on my and I need prayers for is their “old wives tales.”  The problem is that I can tell them they are not true, but they are things even the Peruvian doctors tell them.  For instance, working hard, physical labor, lifting heavy objects will cause you to tear your kidney or cause inflammation of your kidney (this is what some of the general practitioners tell them).  The symptom is back pain.  So when they come in from the chakara (the field/farm) with severe back pain they all want ultrasounds of their kidneys.  Some of my patients have even told me the doctors here did a surgery on the micro tears of their kidneys, but it didn’t help the pain.  The hard thing is when I tell them its not true 5 times, they’ll still come in the next day to try to see a different doctor who will order a ultrasound so that they can check their kidneys.

                The Peruvian doctors tell them that cholesterol causes headaches, dizziness and arthritis, so all the thin 30 year old women (and everyone else) want their cholesterol checked.

                The non medical tell the patients that sun damage/lentigo’s on your face are caused by a bad liver.

                The people also think that upper back pain is from bad lungs or water on their lungs (not from the fact that they carry their children, and everything except the kitchen sink on their back).