For just one day

gummyAlthough I’m in avoidance mode, I still have so many things to say. Last week’s daily post “Freaky Friday” got me thinking – oh and how I wish I could swap this whole situation with someone who actually deserves to understand it (why am I being so nice?). Continue reading

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Don’t intimidate the doctor

My home town

Moving back to my home town meant having to find new doctors and in the process of doing so, I met a few interesting physicians – one odd psychiatrist who has since left town, a narrow-minded pediatrician, an open-minded family physician from France, an OBGYN who is very caring but intimidated by me, a brilliant surgeon who is comfortable with me asking questions, an endocrinologist that is very kind but leaves me feeling like something is not quite right, and many other health care professionals with their own baggage.

I was always able to tell if a doctor didn’t make sense in what he said; perhaps I have a full blown sixth sense for medicine or science. In my early twenties I asked a doctor I was working with a question that caught him off guard. It had to do with the difference between two similar skin lesions and he was flabbergasted. Instead of taking my question as “good question… let’s look into it” it was in the order of “how do you know that????” with a look as though I had stabbed him.

Then, in my thirty’s I decided to go back to University to become a biologist. I figured it would be a good incentive to satisfy my constantly growing curiosity as I could arrange my classes around the needs of my two little girls – while remaining a stay at home mom. Med school was not an option for me as it was virtually impossible to get into where I was.

While I was at it, I couldn’t get enough from my science classes. I ended up graduating with double the number of science credits I needed for a degree in biology. Many of the courses were graduate level ones because that was all that was left for me to do – I had already been credited all of the other required art classes from my previous studies.

I didn’t graduate with straight A’s. I did however learn a lot because I was feeding off of everything I had access to. Sometimes, the lab teachers would tell other students to see me about writing good lab reports or papers and then other times, the teacher and some students would gather around me to see what I thought because I had a way of coming up with interesting hypotheses. That was that –  I never got the drift that I was talking too much or controlled the situation in any way.

So back to the local doctors here who (I only realized this week) feel intimidated by having me in their office; they assume “I go back home to double check” what they said (two of them used these exact words)

The thing is I DO NOT double check – at least it hasn’t happened yet. When speaking with a doctor I discuss the topic and I ask questions that are in sync with the knowledge I have acquired over the years – I am a biologist and medical writer and it comes naturally. Occasionally, when I’m on my own, I read articles pertaining to various subjects I may find interesting or of useful/essential knowledge – that is what people in my field of work do. I read quickly and don’t analyze everything. However, I do keep in mind that research results and information can be unreliable for different reasons – as I have learned while studying and working in research. Furthermore, the information I rely upon IS NOT from patient information websites simply because, as a principal medical writer, I have edited and reviewed work from other writers and I can say that misinterpretation of information and data happens. I am not saying we shouldn’t trust these sites, but we don’t know much about the writer nor the editor (who by the way may change the information unbeknownst to the writer). We must keep things into perspective and in line with our needs. Talking about perspective, I have however, and I must say on more than one occasion, noted that physicians rely on Wikipedia for medical information. Wikipedia is usually considered a tertiary source and is not suitable for use in a doctor’s office simply because the findings or information reported would need to be reviewed for accuracy given the context. Besides, doctors have other reliable sources they can use.

In my field of practice it is virtually impossible for me to know everything and quite frankly, if I thought otherwise my knowledge would be saturated and I couldn’t bring anything more to my work. That would be awful of course because scientific advancement is a never ending story. Medicine, in my opinion, works the same way because it is based on scientific knowledge.

The physicians I appreciate most are the ones that don’t assume they know everything – they are in sync or try to keep up with the advancement of science and medicine and have a curious mind or at least are interested in what they do for a living.

Let us look into a few moments where I may have somehow or somewhat directed the conversation (and intimidated the doctor) in the hope of having the right treatment for my daughter.

TSH levels: It seems to be common knowledge among physicians in Canada that a TSH of 5.0 is normal (based on our medical guidelines). So yes, I understand and perhaps that level doesn’t cause symptoms in some people. Apparently (because I didn’t check – but the information actually came to me from a reputable source), in the US and France the upper limit considered acceptable are much lower than that of Canada (2.5 and 2 respectively). I brought this up when a doctor told me that my daughter’s TSH of 5.7 was not significant enough to cause her to be so fatigued. I said: “I understand, but in certain countries (stating which) a TSH of 2.0 and 2.5 is considered the upper acceptable limit”. Note that I didn’t tell the pediatrician she was wrong. There is also evidence out there that some patients are most comfortable when their TSH is set at the lower end of the range. Let’s try to be open minded here – a range (I assume) is determined from average results obtained from long research and analysis processes. Of course there can be variations.

Aldosterone levels: From listening to treating physicians, it appears that as long as the aldosterone renin ratio is within the acceptable range, high aldosterone is not a cause for concern. So once I asked a physician “What about secondary aldosteronism?”  Ouch.  Note that again I asked about this, I didn’t assume they were wrong. I thought perhaps there may be another explanation to my daughter’s very out of range results for aldosterone. The pathways of hormone synthesis are simply confusing and secondary pathways can offer other explanations on disease processes. When in doubt, why not tell the patient (or mother of the patient) that you will look into the results and speak to a colleague?

Thyroid and mood disorders: There is significant evidence out there that shows that treating patients with thyroid hormones alleviates mood disorder symptoms when all else fails, even with normal TSH. My daughter had received a cocktail of mood medication and I was worried given her young age and overall physical state (low blood pressure and blue mottling of the skin). I told the psychiatrist about the thyroid disorder that was not yet controlled – which could also affect her anxiety level. He responded by telling my daughter “It must be difficult to have such an over analytical mother?” This question resulted in making my poor child uncomfortable and feeling bad for her mother who was sitting next to her.

Low blood pressure in children: “It’s normal”. Yes, but my daughter’s toenails and fingernails are blue. The reply: “Oh well, bring her in next time that happens”.

Those are just a few times when I asked questions.

Right at this moment, sitting on my own, I have other ideas on Ehlers-Danlos Type III (EDS). These ideas come naturally to me following years of study and given my interest for molecular biology. EDS is a connective tissue disorder. Here is a simple definition pertaining to connective tissue function: Connective tissue functions not only as a mechanical support for other tissues but also as an avenue for communication and transport among other tissues. 

For the longest time, I thought anxiety in EDS patients had to do with more than neurotransmitter/receptor function. Recently, I came across an article that supported that possibility. EDS patients (at least some of them) show a difference in the brain structure involved in emotions.

Here is my next question: What about EDS and thyroid disorders? My daughter has “fluctuating” TSH results that confuse doctors every time I bring it up. Now look back at the definition I copied above on connective tissue function. What do you think? We may not have the answer, but perhaps there is a “logical” explanation that we should at least keep into consideration based on the fact that she has a connective tissue disorder. I have seen her being tested time and time again when it appears obvious that the answer doesn’t lie in a simple, common blood test or diagnosis.

Should I stop with the possibly “intimidating” questions? I may clarify my position before I start talking next time, but I certainly won’t stop with the questions.