Friday, February 7, 2014

My Incompetent Doctor (Part 2)

A couple of weeks after meeting my doctor and getting my blood taken*, I got a call from the clinic, informing me I needed to come in to discuss the results of my tests with the doctor.

My first panicked thought was that the blood test had been negative, and that the at home and in clinic pee tests had been false positives.  Then I thought (unlikely as it would be) that one of the STD tests had come back positive, and I was going to have to make a series of phone calls, telling people to get tested.  And then I realized, it's probably my thyroid.

So I went to meet Dr. Crazypants.

The first thing she asked me, was if she'd seen me before.  I get it.  I'm terrible with names and faces. But since my medical history - including which doctor I'd seen last (her) - is readily available to her, and was in fact, open on her computer when she asked, I felt my confidence in her drop even further.

It turned out that it was my thyroid she wanted to talk to me about.  My thyroid levels, as I'd mentioned they likely would be, were low.  I had told her on my last visit, but I mentioned again, that when I had been living abroad, I'd had my thyroid checked a few times, always with the result that my levels were low, and they would test me again in a few months. which point she asked me if this (as in, right then) was the first time I'd known about my thyroid levels being low, and if I'd ever had this before.  I told her, again, I haven't ever been diagnosed with a thyroid disorder, but that they'd been checking my levels over several months, that they were always low, and that (as I'd told her on my previous visit) my mother has severe issues with her thyroid and has since before I was born.

She decided (and luckily, I've done enough research about this to believe she made the right decision, since I honestly wouldn't feel comfortable just taking her word for it) that I should be medicated immediately.  I asked her if there was any risk to the baby, and she kind of half-laughed and said the risk would be a lot worse if I wasn't medicated.  She started to tell me what the risks were if I didn't get medicated, then stopped herself, told me she didn't want to scare me and suggested I google it.  Because we all know there won't be any hyperbolic, half-assed, fear-mongering articles about this online.  It's much better for me to get my information there than from, say, an actual doctor.

(I did google it, and it is scary.  Unmedicated, I could end up with a baby with severe developmental delays and poor motor skills.  Just makes me realize how lucky my siblings and I are, since my mother wasn't medicated for three of us)

The next step was figuring out the dose I should be on.  She asked my weight and I told her (136 lbs), and said that, although I wasn't sure if it mattered at all, I had lost 4 lbs in about a week.  Her response?  Since I've had more than a 20% weight loss, I should definitely be medicated right away.

A couple of things.  The reason I mention my specific weight on here, and the amount I lost, is to illustrate that this is in no way (and no one who has even a basic understanding of fractions could think it was) anything close to a 20% loss in weight.  Even without a calculator, and sucking at math myself, I can tell you it's a less than 4% loss.  With a calculator, 2.86%.   The other thing, Hypothyroidism (which is what I have, though Dr. Crazypants seems like she'll be damned before actually uttering anything approximating a medical term in front of a layman) is a result of my thyroid gland not producing enough thyroid hormone, which is what regulates one's metabolism.  My metabolism therefore runs slower than it should, and the most obvious symptom of this is, in fact, weight gain.  A 20% weight loss (apart from bringing me to an entirely skeletal 112 lbs) would suggest that putting me on medication to help my metabolism work faster, would be pretty much the worst thing anyone could ever suggest.

Luckily, the doctor decided to do exactly what I would have, and I what I consider reasonable, which is to put me on the lowest dose of thyroid boosting drug, then get bloodwork done ahead of my prenatal visit, so they can reassess and increase the dose if necessary.  She told that the side effects are dizziness and palpitations, and that since I'm on prenatal vitamins, I should talk to the pharmacist about when the best time to take them would be.

Next she asked about morning sickness and if it was interfering with my day to day life.  I explained that it was, but I would rather not be medicated unless it gets really bad, because I'm paranoid after the whole thing with Thalidomide. She had no idea what I was talking about.  For anyone who doesn't know, you can read all about it here.  The Teal Deer version is that it is a drug used for a bunch of different things, but prescribed as a morning sickness drug in the late 50s.  It caused massive birth defects, including children born with missing or deformed limbs. Apparently, only about 40-50% of children born with these defects survived.  I can understand why someone might not know that, but I can't really wrap my head around why a doctor wouldn't.  I mean, isn't that a cautionary tale they tell people in their first year of medical school?  It is seriously disconcerting to have to explain something like this to the doctor who is supposed to be helping you through your pregnancy.

Once I had explained it to her, she looked horrified and asked, "But why did they give it to them, then?"  So I (I think remarkably calmly) explained that they didn't know that it caused birth defects yet when they were giving it to pregnant women.

After all of the previous insanity, I was ready to get out of there, but she asked if I had any questions, and since I'm concerned that I'm not getting enough calcium in my diet, I asked about this.  The reason I don't think I get enough calcium is that I can't have dairy without getting sick.  Her solution? Yogurt.  When I explained I can't eat yogurt, her next suggestion was cheese.  When I finally managed to convince her that no, I can't eat any dairy, she looked puzzled, and eventually suggested I eat more chicken.

Sometime after I left, I headed over to the pharmacy to pick up my new drugs.  I was so happy to get the gentleman pharmacist from my last visit.  He mentioned a few things which Dr. Crazypants had neglected to. The main one being that hypothyroidism is a life-long condition and I will likely have to be medicated for the rest of my life.  Also, he explained what the thyroid gland does, and how the medication effects it, what the side effects are (interestingly, he told me different ones than she did, though so far I haven't had any that I've noticed).

One thing he didn't mention (although he did give me a helpful hand out with this info on it, which is how I found out) is that one of the main things that the drug I'm on (Levothyroxine Sodium) causes is... wait for it... calcium deficiency.  So, yeah.  After that whole, pointless conversation wherein I expressed my concern that I'm not getting enough calcium (interestingly, whether I get enough or not, the baby will get enough.... it's just that if it's not in my diet, it will come directly from my bones), the doctor didn't think to mention that the drug I'm about to start taking - and keep taking for the rest of my life - could cause a normal person, one who does get calcium in their diet, to become calcium deficient.

 Again, I can see two possible explanations as to why she omits as much info as she does.  Either she doesn't think I need to know or that I can understand these things - or she doesn't know them herself.

Yeah, definitely time to switch doctors.

*I said before that the male pharmacist was the only professional I've dealt with that I've been happy with, but I completely forgot the very helpful, friendly and professional lab technician who took my blood etc. the day after I met the doctor.  She had dreadlocks down past her ass and spacers in her ears, which I mention only because you would never see that in my home town or in any other town where I've had cause to visit a hospital and it's nice that she has that freedom here.  When I explained that I fainted the last time I had my blood taken sitting up, she had my lie down, and even used a butterfly (they use these for babies, and they barely hurt at all).  I'm don't actually have an issue with the idea of having my blood taken, the fainting thing took me completely by surprise, but she kept up a steady stream of chatter and had me wiggle my toes, to keep me distracted while she was taking it, then kept me lying down for a couple minutes afterward, to make sure I stayed conscious.

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