weighty

I’m down to 132, from 136 the first week of August.  Total since June is a weight loss of about 13 lbs.  And I’m eating, oh believe me, I’m eating.  Even when I’m nauseous – although somewhat less then.  Tonight I had a bowl of sweet potatoes and carrots, about a 1/4 bag of ruffles, M&Ms, and a half a steak sub.  This is not unusual in terms of amount of food for me – although I don’t usually have candy and my protein usually comes from a slightly better source than take out steak bomb.

“It really sounds like you need to see an endocrinologist” Dr. Lasthope at B.A.T.H. said to me early on in the appointment today.

Yes, I agree.  However, my PCP drew a crap-ton of thyroid labs and when I called about a week later, the RN told me that “everything that’s back looks normal”.  This does raise the question of what was back, but I’m fairly certain that what was back in a week included TSH and probably the T3 and T4 levels, although I’m not certain of the last two.  I guess I should follow up, again I mean, on that.

“I did see an endocrinologist here, they focused on my hypoglycemia and told me to keep a food journal and see a nutritionist.  My PCP was not pleased, he said that wasn’t what he sent me for,” I told her.  “Well, I’ll make a note of what it is they should be focusing on,” she said, in fact writing a little note.

She was nice.  I thanked her for being nice.  She thanked me for “knowing what you’re here for.”  And also very much liked that I had pictures of mouth sores with me on my ipad.  Yeah, I wasn’t going to bust that out but she asked about mouth sores and I was in the middle of describing it when I realized I had some lovely shots of them with me.  “How did you get those pictures?” she asked.  “Um, I’ve got a big mouth.  And a little camera.”

More pooping in cups, endoscopy and colonoscopy on the horizon (I’ve had stomach polyps and that plus the week of nausea was enough to make it less of a difficult sell for me).  Following up, etc.  It’s never easy.

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World’s greatest boss?

Still feeling like urgh.

I dragged my ass in for freshman move in day today, late, but there.  My boss came through my office about a half hour after I got in.  “How are you feeling?”  he asked.  “O.k.,” I said.  “You don’t look ok.  You know, if you want to leave and work from home, that’s alright with me,” he said.  I told him that I can’t leave right now since I got a ride in, and that I didn’t feel great but that I had really wanted to be there today.  He responded “How far away do you live?”  After I told him (not far but not super close) he laid the jaw dropper on me:  “I can give you a ride.”

omg.

Seriously.  An offer to work from home and an offer to get me there too?  This has not been an easy transition for him and thus for the staff who he supervises (including me) it has been a bumpy summer, but he seems like a genuinely nice person.  I won’t forget that he was so kind today when I really desperately needed it.

slow going

I’ve been having bad nausea since Tuesday night.  I managed to get into work yesterday, probably not the best idea to drive feeling like that, with a little help from my friend Zofran.  BP 88/43 yesterday afternoon when I got home, feeling like something the cat dragged in, chewed up, coughed up, and then batted around for a bit.

Today though, no work.  Not after a whole day of that yesterday, then waking up today feeling the same.  This is not helping the weight loss problem.  By the time I get in to see the (new) GI at B.A.T.H. (who I’m referring to for now as “Dr. Lasthope”) I’ll probably be down another couple of pounds.  I want to eat, I mean I want to want to eat, but errrg.  Food yesterday included crackers and chips, and not much of either.  I wonder if Dr. Lasthope will give a damn?

I’m hoping this is just a prolonged migraine/migraine prodrome – “just” being a very relative term here.  I’d rather think it’s this than that it’s another rotten trick my body’s learned…random debilitating nausea.  Don’t think nausea is debilitating?  Count yourself lucky, because that means you are blessed enough to be lacking in this particular life experience.

unidentified

A moment ago, I noticed the sound of a plane landing overhead.  I realize I’m noticing them more recently. I suspect it may be that I’m tuned in, and that we all go through periods of tuning in or tuning out frequent, if not regular, non-important stimuli.  I was listening to this plane go over, noticing how amazing that it could convey both massive size and distance, and a looming quality – that it is something coming closer.  Amazing I suppose that our brains are so good at perceiving all of these things about an event or an object.

I remember as a child being terrified in bed at night by these and other sounds.  We lived within a mile, maybe a half mile, of the highway.  Truck brakes (I now know what they are) at the wrong moment on a summer night with the windows open could keep me awake for what felt like terrifying hours, clutching my blanket and scanning the sky outside my window for what I assumed must be the spaceship.  I was young…Like most little human brains, my little brain was already quite good at perceiving qualities like “big”, “moving”, and “coming closer”.  I also had an active imagination, and the only TV my parents watched tended to be Dr. Who and Star Trek.

Because of the nature of who I was and because my parents were useless to worse than useless, I went through these nightly horrors without asking for help or comfort from my parents.  I eventually figured out what the night sounds were – I’m not sure how I put it together.  I would still wake up to the noises and they were still scary, but I would tell myself that although it sounded scary, it was not and I was no longer terrified.

These experiences have informed how I respond to scary stimuli.  Currently, the majority of scary stimuli come from my body.  Because I am not a child, I no longer hide in my bed, paralyzed with fear.  I get up,  I try to investigate the source of the problems so I can identify if it is something bad, something as threatening as it seems to be from my vantage point, or if it is just the physiological equivalent of trucks moving across the pavement at night.  I don’t want to be scared.  I want to be cured…I want the stimuli to go away.  But barring that, if ending the symptoms is as impossible as rerouting the highway, I’d at least like to know what the source is.  There is a lot I can handle if I can understand it – if I don’t feel that extra helplessness of not knowing.

To FNB or not to FNB?

Reasons to include, according to the ENT doc I saw on Thursday:

  • microcalcifications on one of the smaller thyroid nodules
  • size of the largest of the three nodules

I would add, based on my readings (peer reviewed, not just googled web-junk)

  • largest being taller than wide
  • family history of “thyroid” (oh the old ladies in my family were diagnosed with “thryoid” long before doctors felt the need to explain details to patients, especially female patients)
  • my most troubling symptoms of diarrhea (which is in high gear right now, I’ve lost 13 lbs since July) and flushing/”heat intolerance”

Reasons not to include (in addition to all the normal risks of the procedure and the fact that it does not always yield correct results):

  • vasovagal
  • vasovagal
  • vasovagal

I am a “vagaler”.  I explained this to the ENT doctor in the following way:  “Let me tell you about the time the radiology staff tried to place a PICC line.  I asked for sedation because I tend to not to well with needles.  They told me ‘oh it’s not part of the protocol.  No one needs a sedative for this.’  Two sweaty, convulsive hours later, I came out of the suite with the line in the wrong arm since they only got as far as half way to my shoulder before the awful, slow, ugly passing out started.  I don’t go out easy or quickly.  I go out slow and bad, so I remember coming to and going out many times, with nurses and techs laying across me and monitors being hastily slapped on my sweaty body.”

Er, would valium help?  Not sure.  Maybe.  I’m game.  I’ll try it.

He also said I should tell them about this so they will know what to expect.

And now I wait for calls to be made and appointments to be scheduled.  If I didn’t feel like such shit, I’d very promptly say “oh let’s just wait and reimage the thyroid in a few months, ok?”  Few things would make me happier than to postpone or avoid a needle being dug around in my neck.  However, it seems irresponsible given the current state of my body.  I did mention I’d lost 13 pounds.  I’ve been late for work nearly every day because I’m spending so long in the bathroom in the AM, and getting up earlier just means more poop, not finishing it any sooner.  I think the only thing I could do is either not eat dinner or eat very early.  Which sucks because dinner is my only full meal of the day.  AM eating brings horrible pain and diarrhea.  Afternoon eating is at work, and I am delayed and interrupted consistently by work stuff.  So my only real meal is dinner.  The flushing is also totally out of control.  In addition to it dictating that I can wear only skirts, lightweight short sleeved or sleeveless tops and sandal-like shoes; that I can work only in an ice cave (everyone comments on how cold my office is); that I can’t go sit at the beach until after the sun has gone down; that grocery shopping is right out because inevitably I overheat while standing in line near the exhaust from the soda coolers or the heat lamps from the rotisserie chicken bin; I’m starting to have a hard time with sex because of it.  Way to kill a mood = feeling like you’re wrapped in a wool blanket on a 98 degree day.  You just want to lay there and do nothing.

If this is a possible explanation for those things, or conversely, if those symptoms are symptoms of thyroid cancer, I need to get it checked out even if only to rule it out and narrow the field of possible explanations.

And in the meantime, I need to call my PCP to find out about all those damned thyroid function tests.

but if you try sometimes…you get what you need

I didn’t go to work yesterday.  I had a horrible time sleeping Thursday night – it felt more like a series of naps than actual sleep.  So I woke up seeing spots and thought “eeek!  Migraine!”  and since it wasn’t going to be a busy day at work and since my new boss had said he’d be ok with me working from home now and then if I wasn’t well enough to come in but was well enough to do some work (eeep!), AND since I had a bunch of labs to get done and more to schedule, I decided to take Friday as a medical day.  It would give me a chance to get some medical stuff done and I could rest too, to make up for Thursday night’s failure.

My day, however, was a series of confounds.  It started with the donut shop.

The donut shop is at the end of my street, which placement practically requires that I stop there for an iced coffee when leaving the house.  Sometimes they are slow, but my body demands its daily AM coffee ration.  On a possible migraine day, it demands it vehemently.  Yesterday they were slow.  Finally, just when I rolled up to the order/menu board, my cell phone rang.  My PCP’s office.  A few minutes later, coffee in hand, I played back the message in the donut shop parking lot.  The contents were this:  Dr. GI will see you at B.A.T.H. on August 30th.  Dr. ENT can’t see you until October 4th.  He’s away for three weeks in September.  This is a bit of a blow.  Here’s an approximation of my donut shop parking lot internal dialog:

I’m used to delays in progression of assessments, but October?  Really?  And I know that at the ENT appointment, the recommendation might be to wait.  I know this because I’ve been through these assessment steps on other matters.  I imagine how I would say “but guys, it’s been 4 months since the ultrasound already…can’t we just skip the mandatory ‘let’s wait and see’ period?”.  Or maybe the ENT doc might recommend a biopsy, but that would take at least a week to get and then several more to follow up on and now we’re moving into November and….jeezus, November?  Plus, my internal dialog continues, October is a super busy time for me at work!  I don’t need to add this shit to it.  God damn, why can’t we just at least move on to the next step now, when absences for medical crap won’t be as devastating?  God fucking damn it.  I am feeling the deep dark despair lurking around the edges here.  But there is nothing I can do about it just then. I resolve to call Dr. ENT’s office when I get home to ask if they have a cancellation list and in the meantime, I try to tuck away the concern and pull away from the deep dark despair so I can get on with doing what I wanted to do today. And off to the lab I go….

Where I find a room full of people.  When it’s my turn up, I realize that the woman checking me in is in training.  Ah.  So that takes a LONG time.  I eventually go in back and am shown to the chair.  I explain briefly that NO ONE wants me in the high-chair for the blood draw because NO ONE likes to have to get me up off the floor.  No, it doesn’t happen every time but it does happen, so let’s stick with the table.  On the table, I wait and I hear the new tech trying and failing to get blood from another patient.  Oops, oh, darn it, now don’t move, really, don’t move.  Nope.  You’re gonna have a bruise there.  

Now it’s my turn.  I show her my arms and explain I just had an IV in one and a blood draw in the other.  “Why didn’t they add these to that draw?” she asks.  “Well…I had called a while back and reminded them I had weekly blood draws right now and suggested if my primary wanted any thyroid function stuff that he could maybe add them on to those but I didn’t hear back from them and he ended up ordering them yesterday, after my last weekly blood draw.”  I don’t add “and I didn’t follow up on my phone call from a while back because I start worrying that I’ll be seen as (and treated like) a royal pain in the ass when I do things like that”.  I should have followed up because my arms are a mess today.  She doesn’t get it on my historically “good” site, fiddles around, then yay, blood….and then my vein does that thing that feels like a cell phone on vibrate, and the tech makes a bad news sound, then tells me “it stopped”, then starts fiddling around again.

At this point, my hands start sweating.  Sign #1 of an impending faint.  I feel bad for the woman but I say “I think we need to stop for a minute, my hands are sweaty.”

And then she does possibly the single worst thing – next to continuing to fiddle – that she could have done.  She takes the needle out.  I didn’t realize just how bad this was until a moment later when she told me that although the blood had stopped for a second, it did start up again.  Are you kidding me?!  I consider that the next time I am in this situation, maybe I shouldn’t worry so much about sounding peevish and say more specifically “If you need to dig around more, you’re going to have to stop and give me a break.”  This time, I had consciously NOT said it like that because I was trying to be nice to someone who was having what looked like a shit day.  I can’t claim fully altruistic motivations here, I have a general rule that you don’t want to piss off the person into whose hands (literally) your body and well-being will be placed.

Finally, after much waiting and much answering to questions about how I’m feeling, I get drawn off a vein no one’s ever used and which hurt like a mother.  And then for the marching orders…what to put in what cup (oh yes, there will be cups and collections).  The waiting room, which has emptied and filled up again while I was not passing out on the table, is full of grumbly people, lead by one particularly mouthy woman who says to every new person who comes in the door variations on “We’ve been waiting for an HOUR!”

And then I’m off, finally, and thinking about what to say when I call Dr. ENT’s office.  And in doing so, I find I’m reflecting on this whole experience in the car and realizing that there is a common theme here – it’s about trying to find the path between being that whiny woman in the waiting room and being the passive patient who just lets stupid shit happen (or who lets important shit fail to happen) because she doesn’t want to ruffle any feathers.  I do not want to be either.  I don’t like bullies and don’t want to be one but also, I have a special personal contempt for the creampuff/doormat behavior.  Sure, my reasons for not wanting to ruffle feathers have a practical flavor and are not just about wanting to be LIKED by everyone but I cringe at even coming close to being an example of that absurdly dysfunctional feminine stereotype.

When I get home, I call Dr. ENT.  “We don’t have a cancellation list,” the woman who answers the phone tells me.  “You can call every day to see if there are cancellations.”  This is annoying….and this is exactly where I sometimes go wrong.  Ok, here goes.  Resolving to push on in a firm but not dickish way, I say “Does he have any cancellations for today?”  “No, he’s not even in this office today.”  Ah…contrastive stress on “this office“!   I ask “What office is he in today?”

“East Buttf–k, he’s there every Thursday and Friday…”

“Do you think he might have an earlier appointment in East Buttf–k?”

She gives me the East Buttf–k number, explaining that they don’t book for that office.  I call, and YES, I get an appointment for August 18th!  Take that October!  Take that confounded day!  I’ll gladly drive all the way out to East Buttf–k to get seen next week.  Hot damn!  Where is East Buttf–k anyhow?  I look it up on google maps while spelling my full name and giving insurance info to the woman in the East Buttf–k office.  It’s 10 miles down the road from the October office.  No shit.  Well, I got what I needed after all, and it only took some self reflection and the discipline not to sway too far into dickishness or creampuffery.

Feeling immensely self satisfied, I call the October office back to cancel and…..I am told that someone JUST cancelled an appointment for August 16th at the October office.   They ask if I want it.  Although taking it would mean being that patient who made all this fuss about what might just turn out to be totally normal, not hot, not cancerous thyroid nodules, I really want to say “YES”.

So….did I take it?

following up

Saw my primary care doc today.  We followed up.  Mostly on thyroid but I feel I should mention things like having lost 10 lbs since early July and that the overheating/flushing has ramped up again.  And that I won’t see the fussy little GI doc again.

A good appointment.  I wish I could access my labs online (he’s working on that) because it would save him time.  Too many times in an appointment, he says “oh did we get that lab and what was it” and starts the search through my now shockingly large record.  It adds onto an already lengthy appointment and it makes me feel bad.  I would look this shit up in advance and bring a table.  Possibly a chart even.  Like I said, he’s working on it.  He did what he could on his end, now Quest just needs to play nice online and let me see the things.  He told one of the nurses “hey I think I figured out how to let patients see their results online!” all excitedly.  She countered with “Yeah, I’m not sure we should have that for everyone…there are some people who would call if they were one hundreth of a point high or low,”  I piped up with “I promise I won’t do that.” She said “no, I wasn’t thinking of you.  Some people just don’t have good reasoning skills…”

I suppose not.

Anyhow, here’s a summary of Dr. Wellintentioned’s note (which he sends patients away with, which I think is a fantastic idea):

text from doctor's summary of visit, labs. If you want the specifics, please write in my comment section and I will email you with the text.

I know what about 3/4 of those labs are…the rest? No idea.

I had wanted to ask him about ADA accommodation forms, but I figured we were running late anyhow and this is probably something I can ask the nurse (based on my experiences with FMLA for surgery).  So I asked on my way out.  Here’s how I put it:

“I’m thinking of asking for some accommodations at work.  It’s nothing major, and I wouldn’t need to ask for them if they weren’t be kind of jerks about things.  But I looked at the form they want the doctor to fill out and the are awful.  Is there anything I can do to make the process easier on you guys?”  She said “Yes.  Bring two forms.  One, you should fill out.  The other, leave blank.  We can look over the filled out one, see what you need and asked for and if we agree with it.”

This is incredibly sensible and I am glad I asked.

The only difficult part of my appointment, aside from feeling like I am always taking up way too much of this man’s time, was the part where I tried to get a sense of how to talk to Dr. ENT.  See, I’m a little gun shy after the fussy GI doc and his inquisitor bed-side manner.  I don’t want another dismissal, especially not of suspicious lumps in my thyroid which I personally am a bit uneasy about.  I am not someone who thinks “oh my god something’s wrong, I must have CANCER”.  I’m really not. In fact, if this did turn out to be cancer I’d be shocked.  I’ve been sort of figuring if it turned out to be anything diagnosable, it would be autoimmune and/or endocrine (of the itis, not oma) fuckery since that shit runs in my family and I know it can be tricky.  So back to cancer and ENT and asking about talking to him.  It can be an awkward thing to say to a nice doctor “but they aren’t all like you, some of them, who may be your friends or at least respected colleagues, are assholes,”  especially when he’s the one who referred you to said asshole.  But we got through it, and I’m glad we talked about it.

I feel like I should send him and his staff something nice, but what do you send?  Flowers?  “Thanks for being amazing” seems diminished and trite when folded neatly into a card.  How amazing this practice is should be spelled out in sky writing or sung by a choir or something.

one extra large anticholinergic

and a side order of ATTITUDE!

That’s what I got today from Dr. Dumbfuck.  Frequent readers (all two of you) will recall that today I was to see Dr. Dumbfuck, an appointment I had to set up because when I called to see if he could call in a GI script, his office staff told me I had to make an appointment.  Turns out, according to Dr. Dumbfuck, I did NOT need an appointment for that.  Oh good.  So I had a family member take time off work to drive me (because I can’t drive myself today, not in migraine state) to this assbag’s office so I could let him work me over – again.  Fanfuckingtastic.  On the plus side, I got the drug.  On the down side (or rather, the other down side), it is not covered by my insurance and it costs about $10 a pill.  Which is perplexing since it’s an old generic drug that is apparently not worth the manufacturer’s time to put through the process of new FDA approval guidelines.

Well fuck me sideways!

Oh and it seems I am a malingerer when it comes to my migraines.  That pearl is from Dr. Dumbfuck.  I’m going to ask my neurologist to write him a letter since either Dr. Dumbfuck thinks my neurologist is crap or I’m just wallowing in migraines because I like to…. “You STILL have migraines?” he asked.  “Yes, in fact I had one last night and I’m still sort of migrainey right now” I tell him and he interrupts (I noticed today that he does that alot) “well don’t you take anything for them?”  “I take fioricet,” and he interrupts again “That only dulls it,that doesn’t get rid of them.  The point is to get rid of them.”  He then asked if I’d seen a neurologist to look into this.  I told him I had and the best he can do is dulling.

You know, sort of like with “IBS”, where the best you can do is give your patients a ration of unnecessary, patronizing shit and then a medication that isn’t going to get rid of it but which might make it a little better without making anything else unbearably bad.  Like that.

Update:  talked to therapist.  After the last time I saw Dr. Dumbfuck, I had spoken to her about how I felt.  When she and I spoke about it, it was some time after the appointment and I wasn’t feeling as rawly bad by then.  She was concerned with the level of bad I did convey and told me so, and said “if you have another doctor’s appointment that makes you feel like that, I would like for you to call me.  Is that ok?”  So I called.  I’m happy I did.  She was very nice and validating and helped me come up with a plan for how to talk to my primary care about this (and about when/how to see a new GI doctor).  Her statement:  some people just shouldn’t be practicing medicine.  Mine:  He might be able to be a functional doctor for different people.  Her:  Yeah, people who aren’t sick.  Me:  (Laughing) yeah, but also people who are sick but who are also automatically deferential to doctors.  But that’s just not me.  

twinkle twinkle

I have migraine.  It started, or at least made itself known, last night.  Everything was fine!  I was eating and thinking “woo hoo, I ate and I don’t have to poop!” and then I went to check laundry in the basement and on the way up saw the sparkling twirling horror that is one of my most unmistakable visual aura symptoms.  Lower right visual field of my left eye is where it started, and holy cow did it spread fast.  I hadn’t even gotten the top off the med bottle and it was already unfurling a banner of evil sharp edged spectra across the entire field and into the right eye’s vision as well.  By the time I was laying down with ice packs in the dark, quiet bedroom, it had turned into a garland that drifted to the upper right of everything I saw, or didn’t see because with these things, they are there whether your eyes are open or closed.

Then the strangeness started.  I could move my hands but I couldn’t talk or even think about talking without feeling like, well, sick is one word for it.  A better likening is if you are a somewhat sensitive person and you imagine something violent and horrible happening to a specific part of your body…THAT sick horror feeling that is both emotional and physical?  That’s what certain perceptual/action events (and even imaginings of them) feel like when I have a migraine.  Which ones will be problematic varies.  Sometimes it’s motion (usually it’s motion) but this time it was sound, speech, language.  Music was similarly problematic.  This is unfortunate because I usually mutter or hum to myself when I’m migrainy like this and it helps take me out of my body.  Last night, I was stuck with having to do movement to get out, and I’m not accustomed to that.  I found small peripheral motions were better than large central ones, and breathing was a useful tool as well.

Today is a sick day.  I stayed home.  I still don’t feel good, as is also usual when I get a migraine like that.  My sister is planning to drive me to the appointment with Dr. Dumbfuck.  This whole episode raises the stakes on that significantly in that if I manage to drag my carcass there feeling like this, I’d better not be fucked about.

I want an old drug

I used to take this drug called Levsin, or rather the generic (hyoscyamine sulfate).  It helped when the racing rushing intestine is out of control, which it has been on and off now since about mid way through 2004.  When it’s out of control, I’ve lost significant amounts of weight.  My weight went from about 145 to 113 in less than a year of eating as much as I wanted and could.  See, the only thing that inhibited my appetite was the pain and diarrhea I had within 15 minutes of eating anything. That kind of pain so rapidly and so consistently after eating tends to make you not eat.    The levsin helped with the pain, and slowed things down some.  It didn’t entirely stop the diarrhea, but it at least made it so I could eat without fear of being in horrible pain at least.  And then in 2008, I started having problems getting Levsin filled.

In the last three weeks, I’ve had a flare up and I’m losing weight again.  I’m down about 8 pounds by my scale at home. On a whim, I asked at my pharmacy if they had any Levsin and to my surprise and delight, they did.  So I called the GI doctor, yes, the bad one, Dr. Dumbfuck.  Because Dr. Dumbfuck is the only one I have right now and I’m not up for a whole round of researching another.  My primary care’s office didn’t get back to me on my feedback (i.e. “that was a monumental waste of my time”) and I wasn’t in the mood to follow up.  But the truth is, I need a GI doctor like other people need a gynecologist.  Until and unless the intestinal complaints are determined to be caused by some more systemic process, they are fully under the purview of gastroenterology.

The GI doctor’s office staff said he could not write for this script without seeing me, even though I’ve kept it on my list of drugs I take because (a) I’d rather take that than donnatol or bentyl and (b) I had been taking the very few remaining Levsin pills I had up until  I totally ran out this Spring.  But he’s never prescribed these before so I was given an appointment for a month later to see him for them.  I called again last week to see if anyone else at the office could see me sooner and I was told “we don’t like to do that…” Of course not.  But they did add me on at the end of the day this week, so I’ll be getting in a week sooner than they had originally scheduled at least.  In the meantime, I am just going and going and the weight is too.

I don’t have high hopes for this appointment.  I expect it to suck.  And I plan to hit up my primary care if Dr. Dumbfuck won’t just write for the drug.  He shouldn’t have a problem with it.  By his own statements, he doesn’t think there is anything else to investigate with me and that we should just treat symptoms – so he shouldn’t have a problem with me treating him like a medication vending machine.  It is essentially what he has decided his role in my care should be.  But I’ve noticed with the Dr. Dumbfucks of the world that while they may feel comfortable taking on a role in one case, when the patient puts them in that role and says “ok so now at least do that job well” they sometimes recoil and decide to actually try playing doctor/diagnostician.  Here’s what I don’t want:

  • another scope
  • another set of suggested diets/menus
  • another lecture about how my diabolical female physiology is causing all my most troubling symptoms
  • another suggestion for fiber or otherwise treatments that are at best useless and at worst are going to exacerbate my symptoms (or bring on new ones with an ugly side effect profile)

What I want is simple. I want him to weigh me, make a note in my chart that I’m having a flare up, maybe take another quick history (anything changed lifestyle/med/body-wise that might have been responsible for bringing this on), and then a script for Levsin SL 0.125 mg 1-2 tablets q.i.d. PRN.  That shouldn’t be too hard, should it?  Appointment’s tomorrow.  Wish me luck.