Plenty going on here, not sure where to start prattling...
January provided me yet another opportunity for travel, this time a side trip (three days) to Hong Kong prior to visiting family in south India. Despite being ever-so-careful IN India, I believe I picked up a gut-bug either during lunch at Hong Kong airport or perhaps something I ate on the flight. Within one half hour of arriving home, the diarrhea started, and took close to 2.5-3, plus two different courses of antibiotics (bactrim first, flagyl second) weeks to resolve.
On an upnote, from beginning of the trip until current writing, I managed to lose 13 pounds, with 6 of the 13 being since arriving home on 1/22.
My Valentine's Day was a double-header: two appointments, 1. Bariatric guy; and 2. Endocrinologist. I must be a latent masochist, because both of these appointments were long-overdue, and both required a weigh in.
Bariatric guy seemed happy enough with my results, though of course pushing the idea of getting more active (which is something I am working on, first by getting a handle on my pain issues--see another post regarding this), and second by finding a pool that's local and has a schedule conducive to my work schedule.
In keeping with the previous appointment with the bariatric guy nearly 18 months prior, he seemed fixated on my symptoms of depression, and was too quick with expressing an interest in writing an Rx for phentermine or wellbutrin or... well, you name it. Each Rx promising magical weight loss--I've sworn off "the junk" since my bypass in 2011, and choose to manage my depression (or is this just my personality?), such as it is, in ways that are unique and suitable for myself and my needs/lifestyle.
The visit with the endocrinologist left me with the inescapable awareness that perhaps our doctor-patient-relationship has come to its natural conclusion.
Last year, there was the issue of the two hour glucose tolerance test he should NEVER have performed. A test which had the potential to either leave me in a coma or dead, and just because neither of those things happened, this does not negate how dangerous that test was for me. Even my bariatric guy said, "He should have known better." Indeed.
Then this most-recent visit, with me showing (according to his records) an 8 pound weight loss, plus all my blood chemistry (minus my uric acid and my DHEA sulfate, both are elevated) ALL MY blood chemistry was pristine. No. Not just pristine. FUCKING PRISTINE. I even showed my labs to a friend who is an MD and she showed it to a colleague (who is in integrative medicine) who said she has TEENAGE patients whose blood chemistry isn't this perfect.
So, 8 pound weight loss, plus pristine blood chemistry--what is to complain about?
Well, two things:
(1) For starter, the Endo informed me that despite the weight loss and the pristine blood chemistry, he wants to put me back on Metformin. Yes. A diabetes medication, despite the fact I am not diabetic, nor am I even BORDERLINE. See also: PRISTINE BLOOD CHEMISTRY.
He promised magical weight loss, and commented briefly on it helping inflammation--but nothing further, nothing conclusive, and no studies on PubMed were referenced.
Of course, I balked. The blood chemistry doesn't indicate I'm even remotely borderline for it, and my weight loss, all things considered, I cannot see where he justifies this. And I refused, and inquired if there was a supplement we have not explored or considered.
Long story short, I am incorporating myo-inositol in my daily regimen. He suggested it, but did not suggest a dosage.
(2) Then there's the sordid matter of coin. I am a long-standing, established patient. I have been seeing him 3-4x a year for going-on-13 years. Each and every time there has been an increase in his office fees (he does not participate in insurance), there is no discussion ahead of time, perhaps when I am scheduling my next appointment, that the fees are going up. Each and every time, I am informed when I am settling up during the current visit. His office fee now, I am ashamed to say, is $540. I remember 13 years ago, I paid close to $600 for just the consultation--and the office fees went from mid-$300+ on up to $540 where it is currently.
I'm a state worker, and I'm not rich. And I've come to the point where I can no longer financially sustain going to this doctor. Not only the economics of money, but also TIME. Four times a year--that's a lot of visits, perhaps two visits more than is necessary.
I am in the same position I was in last January--left with the prevailing awareness I need to change doctors. Last year's OGTT was a red flag, and I rationalized staying on with this doctor given the amount of time and money I have invested. But now, the notion of him trying to strong arm me into taking a chemical that did nothing for me, and of course, being shaken down to the tune of $540 for each visit now, has left me feeling ... I don't know exactly how I'm feeling. It's complex. Vulnerable, foolish, angry, and at a minimum, I feel as if I can no longer keep my trust in this doctor.
It might seem ageist, but he's in his mid-80s (to be honest, I thought he was closer to 90 or over), and perhaps I should just see someone else.
He touted his son-in-law being a "big deal" at a hospital system where most of my other doctors are, and his son-in-law is an endocrinologist too (though his focus I think is diabetes--and I want to go to someone who is an exceptional thyroidologist if such a thing exists). And given that the particular hospital system participates with my insurance, it's very alluring to think of spending $15 a copay, perhaps twice a year, versus what is now $540 for four times a year.
But before I can even have the discussion wherein I ask for his blessing for me to have his son-in-law be my endocrinologist, I have to schedule a thyroid sonogram and FNA for the multitude of nodules on my thyroid.
This is the year I am downsizing. As much as I love my neurologist who I see for my migraines (which also seem to be managed and less frequent now), I want to consolidate doctors. I also see a neuro-ophthamologist for a weird collection of cells on my optic nerve, so if a neuro-ophthamologist can manage both concerns, all the better.
I've hit my saturation point with this scenario and others, and am dedicating 2017 to minimizing and consolidating what doctors I can. Running hither-and-yon from one doctor to the next is not a lifestyle I want to perpetuate.
January provided me yet another opportunity for travel, this time a side trip (three days) to Hong Kong prior to visiting family in south India. Despite being ever-so-careful IN India, I believe I picked up a gut-bug either during lunch at Hong Kong airport or perhaps something I ate on the flight. Within one half hour of arriving home, the diarrhea started, and took close to 2.5-3, plus two different courses of antibiotics (bactrim first, flagyl second) weeks to resolve.
On an upnote, from beginning of the trip until current writing, I managed to lose 13 pounds, with 6 of the 13 being since arriving home on 1/22.
My Valentine's Day was a double-header: two appointments, 1. Bariatric guy; and 2. Endocrinologist. I must be a latent masochist, because both of these appointments were long-overdue, and both required a weigh in.
Bariatric guy seemed happy enough with my results, though of course pushing the idea of getting more active (which is something I am working on, first by getting a handle on my pain issues--see another post regarding this), and second by finding a pool that's local and has a schedule conducive to my work schedule.
In keeping with the previous appointment with the bariatric guy nearly 18 months prior, he seemed fixated on my symptoms of depression, and was too quick with expressing an interest in writing an Rx for phentermine or wellbutrin or... well, you name it. Each Rx promising magical weight loss--I've sworn off "the junk" since my bypass in 2011, and choose to manage my depression (or is this just my personality?), such as it is, in ways that are unique and suitable for myself and my needs/lifestyle.
The visit with the endocrinologist left me with the inescapable awareness that perhaps our doctor-patient-relationship has come to its natural conclusion.
Last year, there was the issue of the two hour glucose tolerance test he should NEVER have performed. A test which had the potential to either leave me in a coma or dead, and just because neither of those things happened, this does not negate how dangerous that test was for me. Even my bariatric guy said, "He should have known better." Indeed.
Then this most-recent visit, with me showing (according to his records) an 8 pound weight loss, plus all my blood chemistry (minus my uric acid and my DHEA sulfate, both are elevated) ALL MY blood chemistry was pristine. No. Not just pristine. FUCKING PRISTINE. I even showed my labs to a friend who is an MD and she showed it to a colleague (who is in integrative medicine) who said she has TEENAGE patients whose blood chemistry isn't this perfect.
So, 8 pound weight loss, plus pristine blood chemistry--what is to complain about?
Well, two things:
(1) For starter, the Endo informed me that despite the weight loss and the pristine blood chemistry, he wants to put me back on Metformin. Yes. A diabetes medication, despite the fact I am not diabetic, nor am I even BORDERLINE. See also: PRISTINE BLOOD CHEMISTRY.
He promised magical weight loss, and commented briefly on it helping inflammation--but nothing further, nothing conclusive, and no studies on PubMed were referenced.
Of course, I balked. The blood chemistry doesn't indicate I'm even remotely borderline for it, and my weight loss, all things considered, I cannot see where he justifies this. And I refused, and inquired if there was a supplement we have not explored or considered.
Long story short, I am incorporating myo-inositol in my daily regimen. He suggested it, but did not suggest a dosage.
(2) Then there's the sordid matter of coin. I am a long-standing, established patient. I have been seeing him 3-4x a year for going-on-13 years. Each and every time there has been an increase in his office fees (he does not participate in insurance), there is no discussion ahead of time, perhaps when I am scheduling my next appointment, that the fees are going up. Each and every time, I am informed when I am settling up during the current visit. His office fee now, I am ashamed to say, is $540. I remember 13 years ago, I paid close to $600 for just the consultation--and the office fees went from mid-$300+ on up to $540 where it is currently.
I'm a state worker, and I'm not rich. And I've come to the point where I can no longer financially sustain going to this doctor. Not only the economics of money, but also TIME. Four times a year--that's a lot of visits, perhaps two visits more than is necessary.
I am in the same position I was in last January--left with the prevailing awareness I need to change doctors. Last year's OGTT was a red flag, and I rationalized staying on with this doctor given the amount of time and money I have invested. But now, the notion of him trying to strong arm me into taking a chemical that did nothing for me, and of course, being shaken down to the tune of $540 for each visit now, has left me feeling ... I don't know exactly how I'm feeling. It's complex. Vulnerable, foolish, angry, and at a minimum, I feel as if I can no longer keep my trust in this doctor.
It might seem ageist, but he's in his mid-80s (to be honest, I thought he was closer to 90 or over), and perhaps I should just see someone else.
He touted his son-in-law being a "big deal" at a hospital system where most of my other doctors are, and his son-in-law is an endocrinologist too (though his focus I think is diabetes--and I want to go to someone who is an exceptional thyroidologist if such a thing exists). And given that the particular hospital system participates with my insurance, it's very alluring to think of spending $15 a copay, perhaps twice a year, versus what is now $540 for four times a year.
But before I can even have the discussion wherein I ask for his blessing for me to have his son-in-law be my endocrinologist, I have to schedule a thyroid sonogram and FNA for the multitude of nodules on my thyroid.
This is the year I am downsizing. As much as I love my neurologist who I see for my migraines (which also seem to be managed and less frequent now), I want to consolidate doctors. I also see a neuro-ophthamologist for a weird collection of cells on my optic nerve, so if a neuro-ophthamologist can manage both concerns, all the better.
I've hit my saturation point with this scenario and others, and am dedicating 2017 to minimizing and consolidating what doctors I can. Running hither-and-yon from one doctor to the next is not a lifestyle I want to perpetuate.
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