Dr. Google

You don’t have to read medblogs for long to learn that doctors do not appreciate it when patients research symptoms on the internet, then show up for an appointment with printouts.  Irritating the person who’s supposed to be helping us isn’t a good idea, so it makes sense to not take printouts to appointments.

That doesn’t mean patients can’t read reliable websites (Up-to-Date and Mayo Clinic are good places to start).  It just means that we ought not tell the doctor how to do his/her job.  It goes over much better if we don’t provide a diagnosis; patients provide symptoms and let the doctor come up with a diagnosis.  At least that’s what the medblogs say.

But what if the doctor’s diagnosis is wrong?

I’ve written before about the red sores that my rheumatologist and family physician thought might be psoriasis, but my dermatologist diagnosed as nummular dermatitis.  Those &#%$ spots show up if I miss one of my cimzia/mtx injections, and take a couple months to go away — unless I dig into my stash of prednisone, in which case they are gone in a couple weeks.  It’s obviously something related to the RA, but what?

Well, recently I googled another symptom (completely unrelated, I thought) that has plagued me for well over a year.  I find it bothersome, but not something I’d dream of making an appointment about. It certainly would never come up in the course of conversation at the doctor’s office.  However, in reading the differential diagnosis for that symptom, up popped vasculitis.  Really?  Others with RA have mentioned vasculitis, but I didn’t know much about it, so started reading.  The articles include photographs of red sores, mainly on the legs, that look very much like what my dermatologist said is something completely different. Reading about vasculitis is frightening, so I hope that’s not what this is.  But I need to know.

At my next appointment, I think I will ask if it’s possible that those red blotches all over my skin could be vasculitis instead of nummular dermatitis. The trick is finding out without annoying my doctors.

Does It Really Matter What We Eat?

How much do we really need to eat? What kinds of foods provide the best fuel for our bodies?  How do we know?

A year ago, Andrew did an excellent series about metabolic syndrome.  In part 3, he mentioned a book, which I bought.  Like many books, The Insulin-Resistance Diet has a could this be you? list:

A family history of diabetes, overweight problems, abnormal cholesterol or triglycerides, heart disease, or stroke.  yes, yes, yes, yes, and yes

Frequent cravings for sweet or salty, crunchy snack food. no – well, unless you count and skittles and pralines, and… okay, maybe that’s a yes

This was not a happy beginning to the list, but I continued, and before long said, “Wait! How many ‘yes’ answers do you need before this is something to be concerned about?”  Well, it turns out the answer is three, and when I finished the risk-test, I had a whopping thirteen yesses!  Most depressing.  It could, however, explain why all my clothes seem to have shrunk (and I can’t blame prednisone this time).

What struck me when reading the book were the similarities between this diet and the Zone. The Zone, in turn, has some similarities to Atkins.  The biggest distinction between Insulin Resistance Diet and the others is that there are no restrictions on what can be eaten.  You can eat whatever you want as long as you have protein every time you eat.  With Atkins, by the second day people are climbing the walls with cravings for a piece of fruit or glass of orange juice.

After reading The Insulin-Resistance Diet, I re-read Dr. Atkins New Diet Revolution and Barry Sears’ The Zone: A Revolutionary Life Plan to Put Your Body in Total Balance for Permanent Weight Loss.  I own these because I inherited them from my father, who died of a heart attack at age 59.

As I continued looking for more information, I discovered Sears’ follow-up:  The Anti-Inflammation Zone, and a book by neurologist David Perlmutter: Grain Brain: The Surprising Truth about Wheat, Carbs, and Sugar–Your Brain’s Silent Killers.

These books all subscribe to a very different nutritional theory than the USDA and NHS.

NutritionTheoriesGovernment recommendations are that people should consume a significant amount of grains.  Really?  When we fatten up our cows for slaughter (the butcher will be here in a week), we bring them in off pasture and feed them lots of grain.  It should not surprise anyone that a diet rich in grains leads to weight gain — in people as well as cows.

How do we choose which theory to believe?  Lots of grains or no grains?  How do we know the best way to eat?  One thing I did was to look at credentials and motivation.

  • Dr. Atkins was a cardiologist who had spectacular results getting his patients to lose a lot of weight quickly.  Contrary to popular misconception, he only advocated extremely low carbs during the induction phase of his diet.  Long-term, his lifetime eating plan is quite similar to the carbs recommended by both Sears and Perlmutter.
  • Barry Sears is a well-respected researcher who comes from a family in which the men all die of heart attacks in their 50’s; he was searching for the truth to prolong his own life, not dabbling around in the lab looking to support the pet theory of his financier.
  • Dr. Perlmutter is a neurologist who found a common thread between diet and metabolism; he has helped patients with a variety of ailments, and refers to a number of credible studies in explaining the affect of food on our health. Lustig, Phinney & Volek  have similar work that is cited by Dr. Perlmutter.
  • The nutritionist and physician who wrote Insulin-Resistance Diet have helped people lose weight after all other diets failed them.

Those are all much better credentials than a theory based on research done to prove that a vegetarian diet is superior to any other — which (rumor has it) is where the food pyramid came from.  What if the government quit subsidizing wheat, corn, and soy farming, and started subsidizing green beans, lettuce, and spinach? Would that lead to a change in the USDA’s dietary recommendations?

It’s interesting to compare these theories.  What’s the same?  What’s different? What will work?

Zone and IRD both recommend consuming protein and carbohydrates in specific proportions.  7 g protein to 9 g carbohydrate for the Zone, and 7g protein to 15 g carb in IRD.

PCFZone

Atkins takes a slightly different approach, claiming that people whose diet has been drastically out of balance due to overconsumption of starchy foods and under-consumption of protein ought to compensate by first eating plenty of protein and no starchy foods; then, as excess weight comes off, increase healthy carbs to a more appropriate balance between carbs and protein.  Grain Brain, too, starts out recommending very low carbs, then increases after a month

All of these dietary plans reach the same conclusion:  It does matter what we eat.  To be healthy, people need to eat the right foods in the right proportions.

The reason this matters is something that I will elaborate on in a future post. Sears & Perlmutter are both adamant that there is a link between diet and autoimmune diseases.

To be continued…

 

Endurance

Perturbed, frustrated, aggravated, irritated, upset, disturbed, annoyed, bothered, discouraged, disheartened, dispirited, downcast, dejected…  I need a bigger thesaurus.

When I left rheumy #1 for rheumy #2, I was clear about what I wanted:

  • a doctor with whom I had good rapport
  • a doctor in private practice, not owned by a hospital
  • a doctor who saw patients without shuffling them aside to a PA

For a few years things were going well.  Unfortunately, about a year ago my doctor’s practice sold out.

Once they were owned by a hospital, things changed.  First thing to go was the excellent front office staff.  They were moved elsewhere within the system and replaced by lemon-suckers who just seem to be going through the motions.  Next my doctor’s MA (who always managed to process prescription refills within one day) disappeared; it now takes five days to approve refills and there’s a different MA every time I’m there.

To add insult to injury, the hospital brought in PAs.  Instead of seeing my private MD, I now see a hospital-employed PA.  The PA might be a nice person, might be competent after learning to do joint exams without causing pain, might be a lot of things. What the PA is not is the doctor with whom I established a relationship.  I feel betrayed.

Now the office is calling to move my appointment.  It seems that the hospital system has decided to open another clinic at another one of their hospitals.  My choice is to drive an extra 30 minutes or move my appointment to a different day.

I want out, but there doesn’t seem to be any point in finding a new doctor right now, since whoever I find could eventually sell out, leaving me right back in the same position.  Instead, I will show up for appointments as rarely as possible so that my prescription refills will be approved.  My youngest child is twelve; in six years he’ll head to college, and four years after that he should graduate.  That means I just have to deal with this ten more years before we can retire and move away.  If I can get away with follow-up visits every six months, that means I only have to go in twenty more times.  By then, I expect the medical profession to have undergone significant changes, and finding a new rheumy will likely be a completely different situation than it is now.

Twenty might sound like a lot, but I remember how many appointments I had the first few years after I was diagnosed. Twenty is nothing.  Although I was unhappy about things when I started this post, I actually feel better now.  I can endure twenty visits.