# So Long Dr. Do-Little



## lowiron (Sep 7, 2012)

Since my wife and I are switching health care providers, I anguished over the weekend as to whether or not I should my appointment with my present PCP. This morning I decided that I would go because I did not give them proper cancellation notice, and also to see if the road to nowhere would stop, or just continue.

First I will tell the good news.........I have always been a needle coward, and never inquire about the yearly flu shot. Sooner or later the flu shot discussion will take place, and today was the day. I was real happy when nurse Leanne told me that I had an option. I could get the old intramuscular type with the possibility of an aching arm afterwords, or I could elect to get the newer type that has a needle that is shorter and smaller diameter. I opted for the newer smaller version. It was so pain free I was still waiting for the jab when she said "that's it", all done. Prior to getting the injection she told me that the only reaction so far to this type of injection of the vaccine is a slight itch at the injection site a few days later......I can live with that.

Now for the not so good news. After explaining how rotten I have been feeling, all the symptoms (tired, cold, confused, muscle/joint aches, etc), she suspected that the symptoms are more than likely from my iron levels going South. I told her that I agreed that my iron was dropping, but I am concerned about a possible problem with the thyroid. I reminded her of my last labs that did not look too good even if they were still in the normal range using their outdated lab ranges. She told me that the lab results (TSH and Free T4 posted on the introduction page) looked great, and all of my symptoms are more than likely related to the iron and malabsorption problems......Added Lab Results on 09/25/12:

Ferritin...All are 30-400 standard range ng/ml

02/22/12... 8L

03/05/12... 139

04/20/12... 148

06/23/12... 114

08/18/12... 71

Was told yesterday that more treatment will be discussed if/when I get under 50

Free T4 reported on 08/18/12:

Value 1.12 Standard Range 0.93-1.70 ng/dl

TSH: Reported on 08/18/12:

Value 4.42 Standard Range 0.27-5.50 mcIU/ml

She then told me that she recently attended a thyroid seminar/training function, and told me that the so called new TSH ranges are being misunderstood by many people. She stated that the upper range of 3.0 is only intended to use as a range for treating people currently diagnosed with thyroid issues who are taking medication. She then went on to say that there should really be no thyroid issues with me because my labs look excellent. She said she would not consider treatment until the TSH level advanced to the 9.0 range.

I then told her that I had joined a thyroid forum, and the general opinion was that I should have had additional testing. I then gave her a list of lab tests suggested by Andros and others. She stated that unreliable internet blather often makes the medical providers look like villains because of all the half truths and inaccuracies. Basically she told me that no antibody labs were needed because of the accurate, and within range TSH and Free T4 reports. She said it would be a waste of time and money because these tests are reserved for times when there are obvious problems with the TSH and Free T4 tests. In other words the tests can not show something that just is not there.

When I asked her to do a full thyroid panel she replied "absolutely not". She then told me that I appeared to be a little depressed and if I would consider a trial of being put on Paxil..or something like that. I started fuming and told her that maybe I am somewhat depressed from being tired of going to doctors who refuse to deal with the real issues. I then told her that for the last 2 years I have been complaining of severe ankle, leg, and finger cramps, but today she told me the same thing she has been saying for 2 years........."we will keep monitoring it. When I asked her how long they monitor a problem before taking some sort of action, she said everyone is different so they proceed cautiously when people like me have several different issues going on because one treatment may affect other issues.

She must have detected that I was getting a little irritated so she left the room. When she came back she told me that she had just talked with my endo and they discussed further thyroid testing. She said that the Endo said that if I was insistent, she would put the orders in for TSH, Free T4, and Free T3 lab work to be all collected at the same time, and stressed that other than the values changing a tiny bit one way or the other, no mystery is going to be solved. The PCP also told me that no fasting is required, and even though there will be orders for the lab work, it will be up to me whether I really believe they are needed, and under no obligation to get the labs taken..........Oh really.

Before leaving she told me to make an appointment to see her towards the end of December. I then asked her if the appointment was for monitoring purposes, or if something constructive will be happening. She looked at me and stated that she detected a bit of sarcasm, and it reminded her to ask me if I made a decision about the Paxil trial. I told her I would not be taking Paxil or any other mind altering drugs. I then suggested that we had something in common being that we are both PCP's. She said "how's that" I then told her that we were both Pretty Confused People.

I then apologized to her for being so nasty, and told her that I am just getting so tired of many clinic visits, and nothing getting solved. Even when known issues are found, the ball is dropped until .....THE LAB TESTS indicate a deficiency (iron and B12)..........everything seems to be reactive so the roller coaster continues.

Now that I am at home and have had time to think about todays events I feel ashamed for being so rude (maybe I do need the Paxil) At this point ....barring an emergency, I do not think I will be going back to that place...even for the latest lab order. We will be switching health providers at the end of October, and the new insurance will go into effect the first of the year. I really don't see a problem waiting that long since nothing is presently being done. Sorry for the rant, but I feel a little better about advocating for myself (even though I probably could/should have handled it differently)

Take care everyone.

Sorry, I meant to post this in the general area......whoops


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## sleepylady (Mar 18, 2012)

KUDOS TO YOU!

I wish I would have the you know whats to do that!

I pretty much feel the same way.

It is very frustrating feeling like crap and not being able to get anyone to delve a little more deeply!


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## babyrex (Aug 5, 2012)

"She then told me that she recently attended a thyroid seminar/training function, and told me that the so called new TSH ranges are being misunderstood by many people. She stated that the upper range of 3.0 is only intended to use as a range for treating people currently diagnosed with thyroid issues who are taking medication. She then went on to say that there should really be no thyroid issues with me because my labs look excellent. She said she would not consider treatment until the TSH level advanced to the 9.0 range."

I'm a newbie myself. It would be better if you posted your labs (and ranges) before you posted your symptoms. I know you are angry, so am I! But Andros and Octavia will insist upon it.

Really? A 9.0? Good God! How does one even get out of bed at a 9.0. LOL! Read, "Stop the Thyroid Madness".


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## babyrex (Aug 5, 2012)

sleepylady said:


> KUDOS TO YOU!
> 
> I wish I would have the you know whats to do that!
> 
> ...


That's right Sleepy Lady!


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## halle (Sep 7, 2012)

For what it's worth, I know EXACTLY how you feel. And Paxil is not the answer. Why do all these doctors think that doping somebody up on anti-depressants is the answer? It's only a mask for the real problems and doesn't solve anything. Good for you for holding your ground. I don't think you were nasty or rude. Just being proactive!


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## babyrex (Aug 5, 2012)

halle said:


> For what it's worth, I know EXACTLY how you feel. And Paxil is not the answer. Why do all these doctors think that doping somebody up on anti-depressants is the answer? It's only a mask for the real problems and doesn't solve anything. Good for you for holding your ground. I don't think you were nasty or rude. Just being proactive!


I agree Halle!


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## piggley (Sep 15, 2012)

More power to you lowiron,
I'm getting the feeling lately that some Md's feel quite narky about the fact that the internet is increasingly educating all their formerly malleable patients,
If we could trust and rely on them to do their job- 
if their diagnostic skills were up to scratch,
If they kept themselves up to date, 
If they showed some interest and stopped being patronising and assuming we are stupid,
Then we wouldnt be flying to the Internet to get the information and help we should be getting from our Doctors, would we. 
(Perhaps American Doctors are different to ours-hope they're better)


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## Octavia (Aug 1, 2011)

Since any possible thyroid issues are not going to be addressed at this time, then this is a really great opportunity to concentrate on getting your iron and B12 levels up, up, up. What will you be doing about those two issues? B12 is a shot for many people - I don't know the frequency (weekly or monthly, I can't remember). Really, those two things can make a huge difference, fatigue-wise.

It would be great to get your B12 and iron up before you even see your new doctor! It might give you a whole new story to tell. 

:hugs:


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## Andros (Aug 26, 2009)

lowiron said:


> Since my wife and I are switching health care providers, I anguished over the weekend as to whether or not I should my appointment with my present PCP. This morning I decided that I would go because I did not give them proper cancellation notice, and also to see if the road to nowhere would stop, or just continue.
> 
> First I will tell the good news.........I have always been a needle coward, and never inquire about the yearly flu shot. Sooner or later the flu shot discussion will take place, and today was the day. I was real happy when nurse Leanne told me that I had an option. I could get the old intramuscular type with the possibility of an aching arm afterwords, or I could elect to get the newer type that has a needle that is shorter and smaller diameter. I opted for the newer smaller version. It was so pain free I was still waiting for the jab when she said "that's it", all done. Prior to getting the injection she told me that the only reaction so far to this type of injection of the vaccine is a slight itch at the injection site a few days later......I can live with that.
> 
> ...


Not that it changes anything but I found your PCP to be firstly rude w/you. And she is one very scary PCP.

I love your PCP acronym. I was falling off my chair.

These folks intend for you to feel badly. They save money by making you feel badly and convincing "all" to take anti-depressants. This way they can handle all the "little stoned sheep" and lead them to the slaughter!

Glad you got the flu shot. And that is in fact the one and only good thing!

How frightening and denigrating!


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## lowiron (Sep 7, 2012)

Thank you all for the responses. I did go back and add the lab reports I wish I had entered the post in the general area....my Boo-Boo...Sorry

As I stated above, she did put the orders in for a new TSH, Free T4, and grudgingly a Free T3. At this point in time do you think I should get the blood work done just to see the results, or isn't the additional Free T3 going to do/show anything of additional value. Their "Take the test if you want" attitude gives me little doubt that they would act on anything if the need was shown. I did read what the FT3 test is supposed to determine, but I remain a little confused about how it works when combined with the TSH and FT4.

Also, was she correct in stating that the newer upper TSH range of 3.0 is used only for those individuals presently being treated for thyroid problems, and on medication. It seems as though their sense of urgency.....no matter what the ranges are, appear to be less than ambicious........Like when she told me she could not ethically prescribe any more injectable B12 until I showed a deficiency. Her analogies, in a way, remind me of the first Police Chief I had. Dispatch advised me of a death investigation to respond to that the EMT's on scene were reporting a little suspicious in nature. Right after that they also advised me of an accident without injury at a less than busy intersection, but there was lane blockage. I was trying to prioritize and told dispatch I would respond to the death investigation, and could they please ask the County to handle the accident. The Chief got on the radio and told me that we do not need the County, and to take care of the accident first, then do the death investigation. He then said over the radio for all to hear "if she is dead today, she will be dead tomorrow......whats the urgency. I am thinking evidence tampering and all sorts of other rules not being followed......I went to the accident, got names/info, and had help pushing the vehicle out of the way. When I arrived at the death scene, the Fire Chief was livid, and had me fill out a statement about the Chiefs discretions......unsure if anything came of it.

In other words some of these doctors must see so many lab reports and other important medical information on a daily basis that they become immune to all but the very serious issues.

I took last night off from my maintenance tech job, and can't wait to go in tonight. I think dealing with 3 phase electricity, encoders, welding, computerized equipment, variable frequency drives, etc will help clear my mind, and lessen the possibility of too much human contact/interactions. Not that I am always like this, but I think some quiet "me" time would do me wonders...............thanks.


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## lowiron (Sep 7, 2012)

Taking Octavia's suggestion, I went in Saturday and had the lab tests done. Today I received a call from Do-Littles Nurse who advised me that Do-Little looked over the lab results and commented that everything looked excellent, and she was looking forward to seeing me in December. She also stated that since most of the thyroid labs were hovering around the mid-range mark, the fatigue and aches I am experiencing are definitely not thyroid related, and it is doubtful that my iron is low enough to be suspected. Below are the newest labs minus the B12. The B12 test was not ran for some reason.

Lab Tests From 09/29/12

Ferritin: Your Value 53 Standard Range 30-400 Units ng/ml

TSH: Your Value 4.35 Standard Range 0.27-5.50 Units mcIU/ml

Free T4: Your Value 1.07 Standard Range 0.93-1.70 Units ng/dl

Free T3: Your Value 2.99 Standard Range 2.50-4.30 Units pg/ml

I have never been considered a math genius, but I am finding it hard to comprehend her "mid-mark range" theory.

I guess at this point all I can do is wait for the new insurance to kick in the first of the year. I am curious to see what the new clinic will find..............thanks for all the help and suggestions.


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## Andros (Aug 26, 2009)

lowiron said:


> Taking Octavia's suggestion, I went in Saturday and had the lab tests done. Today I received a call from Do-Littles Nurse who advised me that Do-Little looked over the lab results and commented that everything looked excellent, and she was looking forward to seeing me in December. She also stated that since most of the thyroid labs were hovering around the mid-range mark, the fatigue and aches I am experiencing are definitely not thyroid related, and it is doubtful that my iron is low enough to be suspected. Below are the newest labs minus the B12. The B12 test was not ran for some reason.
> 
> Lab Tests From 09/29/12
> 
> ...


OMG!!! For a man, your ferritin is waaaaaaaaaaaaaaaaaaaaaaaaay low and you definitely need thyroxine replacement. I am surprised you had the energy to type this post. Below is a link re ferritin.
http://www.foxnews.com/story/0,2933,196057,00.html

This is just horrible. I am so sorry!

Can you pay out of pocket if you can find a doctor to place you on thyroxine replacement until the first of the year? You could end up seriously ill in the months to come!


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## lowiron (Sep 7, 2012)

Andros,

Thank you for the reply. Yes, I feel tired and the fatigue is very similar to when my iron/ferritin level was down to about 8. But, there are some different twists. I know low iron will make me feel cold, and from what I have read Hypo can also make a person feel cold. Another different feeling is that I have blurred vision (comes and goes) and at times my upper eyelids are slightly swelled, and there is a slight pressure feeling that feels like it is behind my eye(s)....mostly the right eye. I could understand the eye problems if I were taking several different drugs, but presently all I take is B12 injections.

I do not sleep well because I wake up with severe foot, ankle, and leg cramps almost nightly. And it always seems like when I get the cramps it will happen in both legs at the same spot. The shin/ankle cramps are bad, but the worst ones are the ones on the upper inner thigh........I can not straighten up, and after the cramps go away, the next day it feels light I lightly pulled the thigh muscles.

I guess I could go on and on with all the different symptoms I have. But, nothing is going to change until I change Doctors. I guess the part that bothers me the most is that if she believes all these tests are normal, and I have all these mysterious symptoms, why does she not offer to investigate other possible problems that could be causing these symptoms, or at the very least pass me on to a different Doctor. I know at work if I were to say all the readings look good even though the conveyor system is down and will not run, I had better be checking out other possible problems instead of just ignoring it..........kind of like a flow chart for troubleshooting.

As far as paying out of pocket until the new health insurance kicks in, I suppose within reason I could, and this just may happen.........thanks.


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