[Medicine-for-people] How to Talk to Your Doctor, Flu Vaccine,
Vitamin D
Douwe Rienstra
medical at olympus.net
Thu Nov 1 11:50:39 PDT 2007
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Medicine for People!
November, 2007
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Contents
- How to Talk to Your Doctor
- The Medical Mystique
- How Doctors Think
- How Not to Talk to Your Doctor
- "Just the Facts, Ma'am"
- Diagnosing Yourself
- Case Report: Osteoporosis
- Am I a Hypochondriac?
- I Do My Job; You Do Your Job
- Winter and Vitamin D
- Clinic News - Mercury-Free Flu Vaccine
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How to Talk to Your Doctor
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=== The Medical Mystique ===
When I was a child, I had a great respect for doctors. I viewed them as a
slightly different species (What do they eat, anyway?)
Medical school showed me that they were human, but still I sensed they knew
much more than I did, not just about medical science, but about life in
general. I enjoyed medical school, but I never imagined it would turn me
into a higher life form. The last few months I began to get nervous. I
counted the weeks, thinking, "My God! I graduate in June, and I don't know
squat. The medical school is making a big mistake."
A month later, the first day of internship, five of us began the pediatric
rotation. Thankfully, I was not on duty that first night. I looked at the
intern who had been chosen. He stood there calmly, and I thought, "This guy
is a hero." Now I think the patients were the heroes, for putting up with
our bumbling and insecurity. Fortunately, there were real pediatricians
backing us up, but I for one was scared to death I wouldn't do a good job
and some innocent person would die as a result.
It seemed to me then an amazing thing to be so young and, by virtue of
having a medical degree, to be treated with so much respect. As time went
on, of course, I settled in as did all of us. What was asked of us was not
impossible and, looking back, I knew more than I thought at the time. As
the first few years went by, I sometimes wished I could write a book to let
people know that underneath it all, a doctor is an ordinary person.
=== How Doctors Think ===
So, let me tell you a bit about how this doctor thinks. When you come in
with a problem, I don't deal with it using any magical techniques. I
gather all the information I can from your story and your physical
condition, decide what probably is going on, and then tell you what I think
is the best approach.
Even though I'm ahead of the average patient by virtue of spending so much
time learning from my medical predecessors and practicing medicine, I'm
still an ordinary human being. So there are better and worse ways for you
to relay information to me so I can sort out the relevant facts and arrive
at a diagnosis.
=== How Not to Talk to Your Doctor ===
A patient may come in and tell me something like this: "I've got an
infection in my sinuses. It was there for a few days, and then I got
bronchitis. So I was telling this to my neighbor, and she said maybe it
was pneumonia. Because I had this fever. And then it went to my throat."
The questions that come immediately to my mind from the above story are:
- What symptoms did you experience that made you think your sinuses were
involved? What set it off? Has it changed over time? Did it happen last
year this time? What does it feel like? If I know those things, I'm on my
way to determining whether it is allergic, bacterial, viral, or fungal.
- When you say bronchitis, what do you mean? Are you having trouble
breathing? Coughing? Sputum coming up?
- Did you feel hot or did you actually get out your thermometer? If so,
what was your temperature?
- When "it" went to your throat, what was "it"? Pain? Mucous? A tight
feeling? Dryness? Itching?
=== Just the Facts, Ma'am" ===
What helps is for you to tell me, as objectively as possible, what you
experienced. Here's an example of helpful information:
"Ten days ago I developed pain above my right eye with some mucous in my
nose on the right. I measured my temperature at 102 degrees. I wasn't
feeling too bad otherwise and was busy at work, so I just hoped it would go
away. But then I developed this cough, which kept me up at night. And it
sounds strange, but I noticed this fruity smell on my breath. Now I'm
really tired and need help."
I am still going to ask more questions, but the information you've given me
helps me with the detective work. Even something that doesn't seem to make
sense, like the "fruity smell", can be a helpful clue. Often we have
symptoms that don't match anything you'll find in the medical textbook.
With hard facts about what you feel like from the inside, I'm closer to
knowing how to give you proper treatment.
I understand that sometimes we just have to tell our story the way we tell
it. We're upset, confused, or not sure what is important. In that case, I
definitely want to hear your story, any way you can tell it.
=== Diagnosing Yourself ===
Sometimes patients tell me what they think is wrong. They say, "I
shouldn't be diagnosing myself." Don't worry; everybody has a go at
self-diagnosis. It's natural to try to figure out what's wrong with you.
In fact, several surveys have shown that the great majority of the time
people analyze and treat their own symptoms, usually correctly. Those
surveys covered people dealing with ordinary minor illnesses. My
experience is that even with more serious or chronic conditions, your
hunches and conclusions can be very useful.
=== Case Report: Osteoporosis ===
Here's an example of an ongoing case (I relate with the patient's
permission). My patient, a middle-aged woman, has been consulting me about
osteoporosis. Osteoporosis can result from low levels of vitamin D, and
sure enough, hers were low. She took 5000 units vitamin D daily, but tests
showed she was still losing bone. We measured her vitamin D levels and
again they were low. That can result from malabsorption, a common cause of
which is gluten sensitivity, so we tested for that; she didn't have it.
She took a pancreatic enzyme to help absorb vitamin D, which is a fatty
vitamin. Now the latest tests had just returned showing that her vitamin D
levels had not improved. I hadn't seen her in several weeks, and as I
entered the examining room prepared to suggest a new plan of treatment, I
noticed her face appeared much younger, not as puffy as before.
"You know," she said, "even though the test we did for gluten sensitivity
was negative, I remembered your saying that I could still have wheat
allergy (which is different from gluten sensitivity). So I stopped eating
wheat products. Within a couple of weeks I lost four pounds and two inches
off my waist, and really feel more clear-minded."
I immediately realized that the wheat intolerance could be preventing her
from absorbing nutrients, including the vitamin D.
Her self-diagnosis has opened a door. Instead of going forward with the
new plan, we will test her bone turnover and vitamin D levels again in a
couple of months to see if our collaboration has borne fruit.
So, go ahead. Diagnose yourself. Tell your doctor about it. Just don't
let it get in the way of accurately relaying what your feelings and
observations to the doctor. Many doctors will interpret "I have sinusitis"
as "I want antibiotics." You're paying them to figure out what illness you
are suffering from, not just to accept your best diagnosis and write a
prescription that may or may not be appropriate. They'll do best when you
give them a clear, accurate report of what you have experienced.
=== Am I a Hypochondriac? ===
Sometimes people hear or read about a disease and start wondering if they
have it. Often people tell me those worst fears followed by "I know I'm
being a hypochondriac." Not really! It is normal and very reasonable to
ask ourselves what the worst case could be. It is OK to tell the doctor
your worst fears, to make sure he or she agrees that they are unrealistic.
Even though your fears may not bear on the diagnosis, expressing them is
still valuable. After all, the whole purpose of the office visit is to
bring comfort to you - physical comfort through accurate diagnosis and
appropriate treatment - and emotional comfort by addressing fears and
concerns.
== I Do My Job; You Do Your Job ===
My job is to figure out what's wrong and help you get better. Your job is
to care about your health and the health of your family. Your job is to
seek help when you need it.
When I was an intern, I remember many times listening with dispassion to a
mother describing how her child had been up all night vomiting and crying.
I'd ask the proper questions to determine was wrong, but have no real
understanding of what this young mother was going through. Today, I know
how worried she's been, how tired she is, how many responsibilities she has
in addition to this sick child. So now when a mother tells me "I'm sorry
to bother you. I know I shouldn't worry." My response is, "If you don't
worry about your children, who else on this vast earth is going to? That's
your job and I honor you for it."
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Winter and Vitamin D
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It's winter in Port Townsend, a good time to remind you that living at this
latitude leaves you at greater risk of vitamin D deficiency. Vitamin D
protects you from osteoporosis, breast cancer, colon cancer, and prostate
cancer. A Bulgarian study indicated that vitamin D improves sugar
handling in people with adult onset diabetes. And there is considerable
evidence that vitamin D lack may contribute to depression and decreased
mental function. For more information, see our in-depth articles on
vitamin D in our February
http://www.rienstraclinic.com/newsletter/2004/2004Feb.html, and March
http://www.rienstraclinic.com/newsletter/2004/2004Mar.html 2004 newsletters.
At this time of year, I recommend you take cod liver oil. Frequently
patients ask me whether fish oil contains mercury. The best suppliers of
fish oil will test it for mercury, lead, heavy metals, and pesticides. The
best quality cod liver oil is safe.
While we are on the subject of mercury, here are government figures of how
much mercury you are likely to find in different kinds of fish.
http://www.cfsan.fda.gov/~frf/sea-mehg.html
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Clinic News - Mercury-free Flu Vaccine
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Many vaccines, including the flu vaccine and tetanus, are preserved with
thimerosol, a form of mercury. While medical authorities report finding no
harm from the thimerosol used to preserve vaccines, debate on the subject
continues.
To be on the safe side, we use only vaccines without thimerosol. Such
vaccines are packaged in a way as not to require thimerosol preservative,
but still retain minute traces of mercury from the manufacturing process.
As of the time of this newsletter, we have some influenza vaccine
remaining. I suggest it for anyone who has been hospitalized in the past
year, has a chronic disease, cares for someone who is elderly or has
chronic disease, or who thinks that their ability to bounce back from the
"hard flu" might be impaired. Read more about the flu at
http://www.rienstraclinic.com/newsletter/2005/2005Nov2.html .
=====================
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Medicine for People! is written by Douwe Rienstra MD, edited by Carolyn
Latteier, and published at Port Townsend, Washington.
Copyright November, 2007.
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