# Wow... how to tick off your doctor



## Enigma (Jun 13, 2011)

I think I am going to write a book on this.

I went to my PCP yesterday for gastro problems I have been having (waking me up with pain in the middle of the night and happening all day). My husband went with me because I was feeling so horrible I couldn't drive and I wanted to make sure that someone else heard what the doc had to say (since I was so out of it).

First comment from the doc, "So, you brought reinforcement?" Sure, if that's what you call my husband?!?

Then, I showed him the NeuroAdrenal/Cortisol test that the women's clinic had done. I wasn't showing him for any particular reason- I just wanted to keep him updated on the testing the other office was doing. Well, that test TOTALLY sent him off. He lectured me on how it is BS (his word), went on how you can't measure neurotransmitters this way, there is no way to prove the cortisol levels are right... I mean, he went ON AND ON. I felt like crap already, then to have him go on about this and how it's all BS... was NOT the right time.

Then he started going on about "whole thyroid" and how it is not reliable... blah blah blah. Then he asked my husband and I, "So what has your research shown?" And we started to say how many people have done better on it or at least synthetic with addition of T3... and then he started criticizing our research. Really? If I wanted to feel even more like crap I would have stayed home and skipped this wonderful visit.

Then he started going on about my ADD meds. (They have helped me immensely and I only feel normal when I take it and my anxiety is gone. I've been on anti-Ds and anti-anxiety meds for a while until Dxed ADD and it has changed my life). When I go to his office I tend to have a high pulse (who wouldn't when he is so annoying?) and he always blames the ADD meds. However, when I went to the women's clinic and ER, my pulse was fine. hmmm... Anyway, he again mentioned it and again went on his tirade about stopping the meds. That's when I told him that I hadn't taken it before seeing him. My pulse is high without any meds. That ****ed him off.

So he told me to "READ THE PAMPHLET" about the ADD meds and it says right there that they can cause anxiety! Well, they don't in me. I've always been an anxious person my whole life, and the ADD meds have helped that. But maybe I should just read the pamphlet!?!?

Then he tried the, "well, we should stop the meds to take out one variable" angle. I told him no- unless he really just wants me to fall apart.

Then he recommended Zoloft. Really??!? What about "fewer variables"?!?! And what about THAT PAMPHLET?!?! That one tells me that I may want to kill myself after taking zoloft!! He has problems continuing a med (that he Rxed) that may cause anxiety (which doesn't for me) but feels fine giving a med that may cause suicidal tendencies (all according to the ALL-HOLY PAMPHLETS, of course).

Oh, and according to him, there are dangers with using T3.

He then promptly faxed a copy of the cortisol test to an endocrinologist I have never seen and asked him what he thought. My doc called me later and said "I asked the endo if he thought it was bogus, and this is what he said..." Pretty much that it is bogus. Really??? You called me to tell me that??? Do you really like rubbing people's face in stuff?? Then, during the call, he went on again about whole thyroid, T3, and how synthetic is much better, and T4 only.

Of course, arguing with me over this when I couldn't go to work, had 2 hours of sleep and felt like crap was much more important than the actual reason that I went in- oh yeah! My bad gastro problems! He did schedule an endoscopy and colonoscopy and ultra sound. Yay.... Friday is going to be a FUN day!

So I will be switching soon. I couldn't believe how RUDE he was to me... ok, maybe he doesn't "believe" in some of these things, but be NICE about it! Don't make me feel like crap when I already feel HORRIBLE!!! I was so angry. I am pretty sure I am DONE with him.


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## lainey (Aug 26, 2010)

Do I have the right doctors and time line:

This is the GP that prescribed the synthroid (that needed to be titrated up yet in the summer) that you left for the women's clinic because you thought you would feel better on Armour, yes? One of the other reasons for leaving was that he was focused on getting you off the ADD meds (and I guess he still wants you to), correct?

The women's clinic that prescribed the Armour (that is not sitting so well with you) is who did the saliva tests, yes?

Shouldn't you be following up with the women's clinic first on those results?

Did you read the link I left you in the other post you had on cortisol results?

http://www.drlam.com/articles/adrenal_fatigue.asp

If you google "adrenal fatigue" and read what the Mayo clinic website says, you'll pretty much see what your doctor told you. The concept falls outside of the recognition of most general practicioners and endocrinologists. If the women's clinic ran the saliva test, they should be able to follow through with the necessary serum hormone tests to follow this up, no?

And why didn't you go to the women's clinic with the gastro issues?

It is the T3 that often causes people problems. Am I correct in remembering that you seem to be struggling with the T3 medication that you are taking--why would you ask to switch back to synthetic plus T3? It has been the opinion of several people here that you try to go back to T4 only meds...

I'm not excusing the doctor acting like an a**. But, if you are going to play musical doctors, don't take results from one place back to the first and expect decent service. You might make them ticked off at you.


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## Andros (Aug 26, 2009)

Enigma said:


> I think I am going to write a book on this.
> 
> I went to my PCP yesterday for gastro problems I have been having (waking me up with pain in the middle of the night and happening all day). My husband went with me because I was feeling so horrible I couldn't drive and I wanted to make sure that someone else heard what the doc had to say (since I was so out of it).
> 
> ...


I am so sorry to hear about your horrible horrible experience with this doctor.

On your last labs, where was your FREE T3 at and what is the range your lab provided.

Many people who have ADD respond extremely favorably T3. If your thyroid numbers are not "just right" for you, you can have all sorts of symptoms as you well know.

Probably your best bet would be to stick w/ the Women's Clinic (provided you are happy with them) or find another doctor who is not hostile, is willing to think outside the box and is someone with whom you feel comfortable.

I am curious as to what your hubby thinks about how this doc went off on you!

Anyway, dear one........................I do hope you find someone who can provide the care you deserve and need. It is no fun being sick so I find it inexcusable that any doctor would talk to a patient in that manner.

Professionals in any field should be able to rise above that type of behaviour. Humble opinion.


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## Enigma (Jun 13, 2011)

lainey said:


> Do I have the right doctors and time line:
> 
> This is the GP that prescribed the synthroid (that needed to be titrated up yet in the summer) that you left for the women's clinic because you thought you would feel better on Armour, yes? One of the other reasons for leaving was that he was focused on getting you off the ADD meds (and I guess he still wants you to), correct?


Yes and no. I didn't "leave" him- just wanted to switch thyroid care to an OB/GYN office that was more familiar with it and looked at all angles, including Armour and T3. He has always mentioned stopping the ADD meds (though he was the one who Rx'ed them) but I keep explaining to him why they work, etc. etc. My husband said the same things to him that I have said in the past (re: ADD meds and how they're working) and his was response was, huh, that's new information. Although I said the same things each time. He just didn't listen.



> The women's clinic that prescribed the Armour (that is not sitting so well with you) is who did the saliva tests, yes?
> 
> Shouldn't you be following up with the women's clinic first on those results?


Yes, they Rx'ed Armour and did the saliva test. I have had problems since starting the Armour and have called them numerous times regarding hunger and other related problems, and they responded with giving me a supplement each time. When I asked about seeing somebody for some of the problems I was having, they said they don't do things like that (refer people) and they are not a PCP office so they don't do sick visits- only follow ups every few months. They brushed me off each time and were not willing to follow through with meds they had Rxed and supplements they strongly suggested I take. I honestly didn't feel safe.



> Did you read the link I left you in the other post you had on cortisol results?
> 
> http://www.drlam.com/articles/adrenal_fatigue.asp
> 
> If you google "adrenal fatigue" and read what the Mayo clinic website says, you'll pretty much see what your doctor told you. The concept falls outside of the recognition of most general practicioners and endocrinologists. If the women's clinic ran the saliva test, they should be able to follow through with the necessary serum hormone tests to follow this up, no?


No I haven't looked at it yet. Yes they should, and it is my fault for not going. By this time, I didn't feel safe there and decided I would hold on to my tests until I found someone who is more responsive.



> And why didn't you go to the women's clinic with the gastro issues?


See above. They only gave me supplements and wouldn't see me for more acute issues such as this. My husband and parents were really worried and tired of them just giving me more supplements and not helping. I wanted to stay with them and just hoped that everything in my body would "work out". It didn't and it kept getting worse, so I finally broke down and went to my PCP when I could no longer sleep/function.



> It is the T3 that often causes people problems. Am I correct in remembering that you seem to be struggling with the T3 medication that you are taking--why would you ask to switch back to synthetic plus T3? It has been the opinion of several people here that you try to go back to T4 only meds...


I took Armour for 1.5 months and my doc started me at 90mg. At the time, I trusted her and thought it would be fine. So I am not sure what part of the medication did me in- starting way too high, something in the medication itself, or the T3. So I would like to find a doctor that is open to talking about this if not working with it in the future. That doesn't mean I will try T3 again (and I won't try Armour again!), but at least it would be an option and at the very least a different doc would keep an eye on my FT3 numbers should it be necessary. I am going back on the T4 only meds for now, and I'll wait it out and see how the numbers go over the next year or so.



> I'm not excusing the doctor acting like an a**. But, if you are going to play musical doctors, don't take results from one place back to the first and expect decent service. You might make them ticked off at you.


I wasn't playing musical docs- the women's clinic wouldn't treat my acute gastro problems, swelling tongue and lips, or severe skin problems, all of which I started developing since starting Armour. I had to go to my PCP if I wanted any kind of relief within the near future. He also wanted to be kept in the loop on what tests they have done and what my numbers looked like, so I brought this in to keep him up to date. I wasn't expecting him to do anything about it but just add it to my file and use it should he find the results pertinent to what he was helping me with.


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## lainey (Aug 26, 2010)

The women's center doesn't sound so terrific now as it did originally. Part of the follow-up is to monitor the patient having issues. I don't blame you for being uncomfortable with them, it definitely sounds like they fell off the wagon there.

Okay, so then if memory serves, this GP wasn't horribly off the mark on the thyroid treatment last summer.

It was his "issue" with the ADD meds that was bugging you. Correct? Is he making this the deal breaker, or is he willing to accept, "the meds seem to work for me, I am not willing to change that with so much else going on"?

However, he is obviously not going to go the naturopath route, based on his response to the cortisol testing and suggesting the T3. Not to justify his position, but he wasn't done adjusting your thyroid meds the first time, and it is still hard for you to say that you need T3 when you weren't properly titrated on T4 medication. If you want to stick with him because you trust him for acute care, I would consider dropping the subject until you reach a point where your meds are optimized and your labs truly show that you are T3 deficient. Then he may be a little more willing to listen.

That is, providing that you will deal with him in spite of his insulting behavior.

Because you are feeling so awful, starting over with another doc has plusses and minuses. In the end, you want someone, at least for the short term, who is going to manage your care. He doesn't seem incompetent, even if he is somewhat obnoxious.

What's the plan?


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## Enigma (Jun 13, 2011)

lainey said:


> It was his "issue" with the ADD meds that was bugging you. Correct? Is he making this the deal breaker, or is he willing to accept, "the meds seem to work for me, I am not willing to change that with so much else going on"?


He hasn't made it a deal breaker yet, but I think he is close. I just hate his constant nagging... he may be right, but this is not the time to push it. Recently weaned off Effexor, started thyroid meds, bump in the road with Armour, stomach problems, etc. I am pretty sure if I stopped ADD meds now I would self destruct. They are the only things keeping me functioning mentally. Plus, the "problems" from ADD meds come and go all the time- all my life, actually, and I've only taken these meds for less than a year. To say that the ADD meds are causing these problems is to ignore the other problems- mainly, my thyroid is still out of whack.



> However, he is obviously not going to go the naturopath route, based on his response to the cortisol testing and suggesting the T3. Not to justify his position, but he wasn't done adjusting your thyroid meds the first time, and it is still hard for you to say that you need T3 when you weren't properly titrated on T4 medication. If you want to stick with him because you trust him for acute care, I would consider dropping the subject until you reach a point where your meds are optimized and your labs truly show that you are T3 deficient. Then he may be a little more willing to listen.
> 
> That is, providing that you will deal with him in spite of his insulting behavior.


You're right, he wasn't done titrating and I myself threw the speed bump in there of Armour. At the time I was planning on staying with the women's clinic for a good long while, whether it ended up being Armour or synthetic, but that just didn't work out.

I don't want to deal with his insulting behavior. I know I was not the ideal patient, by far, but I never once was rude to him, never pushed him, and even asked him what he thought of me going to the women's clinic for thyroid treatment prior to going down (he thought it was a great idea). The only thing I put my put down with was the ADD meds. He used to go on and on about my high blood pressure (supposedly as a result of ADD meds), and that got much better over the past few months, and is not a problem now. Now my pulse has become a bit fast, and he is now attributing that to ADD meds again. He probably doesn't like that I have put my foot down there. Not sure.



> Because you are feeling so awful, starting over with another doc has plusses and minuses. In the end, you want someone, at least for the short term, who is going to manage your care. He doesn't seem incompetent, even if he is somewhat obnoxious.
> 
> What's the plan?


I will stay with him for the next month to three months, at least. He is not incompetent, just an a**. However, I do have two new docs that I am considering. I met with an endo on Thursday who seems ok. He hates Armour (of course) but I am ok with that now. He prefers to start with synthetic T4 and titrate to a low TSH (his goal is .5 - 1.5) then, depending on symptoms, test FT3 and if it is low, supplement with a bit of Cytomel. He seemed reluctant to ever use T3 but was open to it as a possibility. He explained that my dosage will need to be tweaked often, even after become stable, due to progression of the disease, my own body, seasons, etc. He is very straight forward, no wiggle room, and very much "I'm the doctor, you're the patient." Since my dad is a doctor as well, and I grew up around doctors all the time, I find this attitude very frustrating, but can deal with it if they are good and not rude. He is also on T4 meds himself, so maybe he understands better than some? So that is one option.

The other is a naturopath I went to. VVVERY awesome appointment- felt very much like he listened to me, and he wasn't at all condescending, and SO knowledgeable without being pompous. We went through my history and all of my labs. He did a little checking for adrenal fatigue (sitting/standing blood pressure, eye dilation, etc.) which a typical doc wouldn't do much less think of. He was not very "oomy-goomy" (much less than the women's clinic) and valued both the traditional and natural approach- didn't bad mouth the "other guys". He said some things that I thought were interesting:

-I shouldn't have been on Armour due to the autoimmune nature of my thyroid problems. Probably sent my antibodies skyrocketing (in addition to being too much too soon, over stimulating, etc.) and could have accounted for my crazy allergic reactions to almost everything I used to eat once I started Armour.

-Wants to use synthetic T4 and get my thyroid stable, TSH wise. His goal is .5 - 1.0 TSH and symptom free.

-Wants to check for insulin/blood sugar abnormalities, especially given my family history of type II diabetes. Also wants a low-glycemic diet.

-Only wants to test TSH until that gets even then only check TSH and FT3. I think this is a little weird, but I'm pretty sure I can ask him to do FT4 just to make me feel better. I am so sensitive to meds that I'd like to know my FT4 in case I am having any weird hyper symptoms. He is also open to supplementing with T3 when we are done titrating up the t4.

-He also targeted the ADD meds and said that I could use vitamins and supplements instead. However, he did say that we won't discuss it now because it would be too much and that we would only discuss it once my thyroid levels were evened out. I asked him if he would still be willing to have me as a patient if I didn't follow his advice and stayed on the ADD meds. He said it was no problem, he is just trying to recommend what he sees as a good move, and he is only a coach, not a dictator. He also gave me permission to tell him to "shove it" (his words!) if I don't agree with him.

So, I think my plan now is to stick with my PCP until I can research some others and get stable. I can put up with his crap until then, but just don't want to stay there long-term. I think I will stay with the naturopath since he seems the most open and easy to talk to, and honest. I'll go to the endo if the naturopath becomes too oomy-goomy or expensive. I am also going to see someone who specializes in adult ADD so my other doc(s) don't have to feel overwhelmed with that side of things.

Thanks again for "listening".


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## Lovlkn (Dec 20, 2009)

I want to mention that having too low of thyroid hormone in your body like you do can cause all sorts of digestive issues.

Do you have any labs with you being on Armour?


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## Enigma (Jun 13, 2011)

Yes... forgot to update my signature.

TSH was .042 (.4-4.0)
FT4 1.1 (.7-1.9)
FT3 4.1 (2.8-5.3)

the free's were too low, but the side effects of the meds were not endurable. something was wrong with my body and I couldn't handle it. Plus, my doc at the time wanted to drop my dose of Armour because she didn't like these numbers, so I didn't have a choice. But, by last week, I couldn't eat any foods that I used to be able to eat, I was having allergic reactions to all of them including swelling tongue and lips. It really sent my body for a loop. So I need to go slower with T4, check that along the way, the reevaluate whether I need synthetic T3 or not. But no more Armour for me.


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## namebug (Sep 22, 2011)

This is why I am afraid of doctors.


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## lainey (Aug 26, 2010)

Actually, the labs you posted were about right for Armour. You are supposed to have suppressed TSH and Free T4 when on it, and higher free T3. How unfortunate that the doctor dosing you wasn't aware of that.

The naturopath made some good points, yes.

I will just say up front from my experience on these boards that many such doctors push their own supplements, etc so just be careful in that area, because it can be a conflict of interest.

I'm a little skittish about his thyroid testing plan. He should be running all three--TSH, FT4 and FT3, or just TSH and Ft4 to make dosing decisions.

Thyroid-wise, the current PCP is actually pretty much on the ball. I would let him know that he insulted your intelligence with his reaction--it's sounds like you do have a fairly open relationship with him, so he might take that for what it is, and listen to you about the ADD meds. That said, seeing a doctor that specializes in that might be a better approach to the problem on a lot of levels.

BTW, hypothyroidism can result in high blood pressure and rapid pulse (it is a lesser known symptom, because in most people it works the opposite). Lack of thyroid hormone stiffens the arteries, causing the heart to work harder to pump the blood. The good news is, about 50% of the time, patients return to normal when they are treated to euthyroid levels. So, it may not be the ADD meds that are the cause of that, or your pulse rate (other than the dr. being obnoxious, which would raise both). That would also explain why, as you have been treated for hypo, those are changing.....

A "perfect" doctor would be nice, but is not always something you can find. In the end you want a doctor you can work with, one that gives you confidence that they will take positive actions towards your treatment.


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## Enigma (Jun 13, 2011)

lainey said:


> Actually, the labs you posted were about right for Armour. You are supposed to have suppressed TSH and Free T4 when on it, and higher free T3. How unfortunate that the doctor dosing you wasn't aware of that.
> 
> The naturopath made some good points, yes.
> 
> ...


Yes, I was surprised that the doc (from the women's clinic) wanted to drop my Armour dosage. She said that it was suppressing my thyroid too much. I was feeling terrible anyway, so I dropped it a few days later, but didn't feel any better.

I am going to be careful about supplement-pushing. The women's clinic was bad about that, but this doc didn't try to sell me anything last time. Recommended things such as calcium/magnesium citrate, B--complex, D3, but didn't try to sell me his version of it.

I am very skittish of his testing plan, too, and it seems a little odd. But I am not sure which is better - a doc that I can talk to and present ideas, studies etc, to or an endo that is very cut and dry and doesn't budge?

I am so frustrated with this whole thing (I know i haven't made it any easier), and I feel so terrible, I just don't know what to do. My brain fog is so bad that I get confused so easily and don't even feel safe driving.

I will look into the heart palpitations with hypothyroidism. Thanks.


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## Enigma (Jun 13, 2011)

i am getting very discouraged. I feel so horrible, and know that I should, and will, feel horrible for a while. But how can I get through the days? I can hardly sleep at night, and have no energy/stamina during the day. My brain is so fogged that I can hardly do basic tasks let alone work, or drive to work. I want to find a doctor that I can just sit back and relax with and not worry about what they'll test, etc. I am so stressed out and feel so sick. I just don't know what to do anymore, or until I feel well.  I'm not trying to look for sympathy, but just some ideas of how to make it til I feel better. At this point, I feel like I will need to leave work soon, which we cannot afford.


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## lainey (Aug 26, 2010)

Pretty much all of us have been there so yes we know the feeling.

The hardest part is trying to relax to let the meds do their work.

They will, and they do. For the moment the doc doesn't matter until you get to the fine tuning stage.

It seems impossibly slow at times, and there really isn't anything you can do to make it better, except to accept that it is impossibly slow at times.

It does get better. Your body has been through a lot of shifts and changes and stresses, and the healing takes time.

I realize that yes, life still goes on during this, and it is a monumental effort to reach in and find even the minimum to function through it.

It does get better. It helps to believe that. It does, and you'll get there.


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## northernlite (Oct 28, 2010)

I think you are on the right path so just try to hang in there. Save your energy for the must do's in life and let everything else slide. Rest frequently and try to recharge. I really had the feeling that I woke up with a finite amount of energy each day so I took as many steps as possible to make sure I didn't burn through it. Always been a stair climber, took the elevator. Asked some of the energizer bunnys at work to do some leg work for me and spent more time sitting. Did the must do's as soon as I got home and then camped on the couch.


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## McKenna (Jun 23, 2010)

> Pretty much all of us have been there so yes we know the feeling.
> 
> The hardest part is trying to relax to let the meds do their work.
> 
> ...


What Lainey wrote above is so true and worth printing out to help you remember on rough days.

It can take a while to get meds sorted out and it is a rough road sometimes. I had my TT nearly a year ago, and I was up and down on thyroid meds for a few months before that. In all, it took me a year on meds to even start to feel better and then two more after that to feel well. 15 months in all to get my meds where they are now. I'm not telling you this to discourage you, but to give you a realistic perspective on how slow it can go sometimes.

Everything you wrote could have been my words a year ago, 9 months ago and even 6 months ago. I wish I had some advice for you but I can only echo what the others have written. Stay strong! You will get though it but don't lose hope.

And just to give you an idea of Armour labs; you wrote:



Enigma said:


> TSH was .042 (.4-4.0)
> FT4 1.1 (.7-1.9)
> FT3 4.1 (2.8-5.3)


These are my most recent labs on Armour, (fasting in the morning from Armour)
TSH .04 (.358 - 3.74)
FT4 .75 (.76 - 1.46)
FT3 3.2 (2.0 - 4.4)


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