# Had to lay the smackdown on Endo's PA



## minli (Aug 2, 2011)

After my last round of blood work to see if the Methimazole was messing with my blood, we lowered from 30 to 20, the results were (bold are me, parenthesis are ranges):

MCV	*75* (80-98) fL	
MCH	*26.2* (27.0-34.0) pg
Neutrophils	*37* (40-74)%	
Lymphs	*51* (14-46)%

My WBC and RBC were:
WBC*5.5* (4.0-10.5) x10E3/uL	
RBC	*4.97* (3.80-5.10) x10E6/uL

but we had no baseline, so I went in today for a complete CBC and thyroid panel.....again....should have results tomorrow.

Anyways, We lowered the MMA about three weeks or so ago and I reported some symptoms I had started to notice (via email) that were bothering me as this is the preferred way to communicate any issues.

The symptoms are that my pulse has been spiking around 10am (107-115 range) and I become very tired, every single day. Around 2PM my pulse is up into the 120-130 range and I am forced to take the Propranolol early as my systolic also starts to rise, at this point I can barely keep my eyes open. By 6pm my pulse rate isn't reduced enough for my liking (110-117 range) and I have become so irritable. (I take my MMA and Propranolol at 8am every morning FYI)

I let the PA know all of this, also that I have started to drop weight again, my hair is coming out more again, and my moods and emotions have started to become uncontrollable again. I asked her if my T4/T3 (both are still 3 to 4 times higher than the highest normal ranges, but better than the 5 to 6 times when I started this journey) could be coming back up since we lowered the MMA and if the MMA itself could be causing the exhaustion.

Her response was that she would suggest raising the Propranolol if I'd like to and for my mood, I should see a therapist.

I lost it. I responded to her (copied the Endo) that I found her comment offensive especially as I have an illness she should know full well lists mood swings and irritability as one of the most common symptoms sufferers face, so what exactly could a therapist do for me since my issue are biological and NOT mental.

Secondly, I informed her that she might think since she is in her final year as a PA, moving towards becoming an Endo herself, that she knows it all, BUT I am the patient! These are not "symptoms" to me. This is not fun for me. I'm the one who has to live through all of this. I flat out told her the worst thing she could ever do as a doctor is treat a patient as walking, talking symptoms, and that her bedside manor is seriously lacking. I just wanted to know what could possibly be causing these symptoms to suddenly come up and that they're scaring me.

Got and email from the Endo, I am no longer working with the PA and he is working out some form of punishment. He also made her apologize to me. We bumped my blood panels up a couple of weeks so we'd have a better idea of what is going on, especially since these things have been getting gradually worse, I woke up this morning to 148/101 BP (never had diastolic that high, it's normally low as heck) and 133 pulse. The exhaustion has been getting better the higher my pulse/BP has been rising and I'm now getting those constant jitters and fast forward feeling, still exhausted, but now have insomnia 

Endo suspects that my blood will tell the tale of why I've been declining so rapidly, so I'll see them once they're posted on MDBug and discuss with Endo once he sees them.

I just got so infuriated! Attitudes like that are why so many of us end up depressed. Something is wrong with me, something freaking me out. This illness is serious and life altering, it should be treated as such. Sorry it's so long, needed to vent


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## I DClaire (Jul 31, 2011)

I say good for you! I, personally, have little use for PA's - I think they are not what patients expect and deserve when they pay good money to see a physician. I had one tell me I had two "suspicious" lumps in my breasts on a routine mammogram that turned out to be shadows. Needless to say I never had an ounce of respect for her or the physician she worked for.

Then, I was initially diagnosed as hyperthyroid by a PA who assured me I had nothing to worry about because my nodules were cold and anyway most women enjoyed hyperthyroidism.

We've definitely got to advocate for what we believe to be true when it comes to our health. Good luck with the new tests but I have to tell you before I had surgery I was on Methimazole and my results were normal, I was "biochemically euthroid" AND _so sick I thought I was going to die._ I asked my endocrinologist if I could have surgery?

My test results six weeks before having my thyroid removed were *normal* - the surgeon found my thyroid was three times bigger than normal and filled with cysts, nodules and a tiny cancer. My tests had been normal!


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## joplin1975 (Jul 21, 2011)

Just advocating for the PAs out there...as my husband is one...

You certainly run into bad ones (I have myself), but as a profession, you shouldn't dismiss them outright. It was a PA who found my cancer...none of the doctor's noticed. PAs are to "mirror" the care of the supervising physician (my husband works for four surgeons and alters his care depending on who he works for) so likely if you have a bad PA, you have a bad physician.

PAs are generalists who have to pass their boards every six years -- doctors only have to pass them once. So, generally, if you see a PA, you are seeing someone who will take a more broad-based perspective, usually informed by more recent literature (given the frequency of the board tests). Physicians are great for specialist care, but I always, always see mid-levels for routine care to get the wider perspective (and because they often have more time than the doctors).


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## Andros (Aug 26, 2009)

joplin1975 said:


> Just advocating for the PAs out there...as my husband is one...
> 
> You certainly run into bad ones (I have myself), but as a profession, you shouldn't dismiss them outright. It was a PA who found my cancer...none of the doctor's noticed. PAs are to "mirror" the care of the supervising physician (my husband works for four surgeons and alters his care depending on who he works for) so likely if you have a bad PA, you have a bad physician.
> 
> PAs are generalists who have to pass their boards every six years -- doctors only have to pass them once. So, generally, if you see a PA, you are seeing someone who will take a more broad-based perspective, usually informed by more recent literature (given the frequency of the board tests). Physicians are great for specialist care, but I always, always see mid-levels for routine care to get the wider perspective (and because they often have more time than the doctors).


This is a refreshing post and lovely of you to point out what is true. It is sad there are poor ones out there but that is true in any profession or avocation.

People are people. Some good; some bad.


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## Andros (Aug 26, 2009)

minli said:


> After my last round of blood work to see if the Methimazole was messing with my blood, we lowered from 30 to 20, the results were (bold are me, parenthesis are ranges):
> 
> MCV	*75* (80-98) fL
> MCH	*26.2* (27.0-34.0) pg
> ...


Good for you; battle won!!!! And I don't blame you one bit for being angry at this sort of treatment.


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## I DClaire (Jul 31, 2011)

joplin1975 said:


> PAs are to "mirror" the care of the supervising physician (my husband works for four surgeons and alters his care depending on who he works for) so likely if you have a bad PA, you have a bad physician.


This is probably the best observation about PA's I've ever seen or thought about and I tend to agree 100%. Here, a person very well will make an appointment to see a new physician, get there and be told they'll only see his PA. PA's here, or many I know, tend to see themselves *as *physicians.

I used to see a PA who I believe was my first experience with someone in that position. I waited weeks for my appointment, got there and was ushered into an examination room where the PA totally seemed to be introducing herself as my physician. I kept thinking the doctor was going to come in eventually but he never did and when I asked, I was almost laughed at. I NEVER saw that doctor but the prescriptions the PA gave me were in his name and my insurance claims were all in his name. I wouldn't know him if I saw him!

I think the world of my endocrinologist's PA and always have but there has never been a time when there was any misunderstanding about who was my physician. Our cardiologist's PA was like a member of our family after 20 years and we were saddened when we realized she had retired but the new PA has already won our confidence and respect - in part because he seems like a totally knowledgeable and efficient liason between the cardiologist and us, he doesn't ever give the impression he is there to diagnose.

My maiden voyage into all things thyroid would have been _(or might have_ _been different)_ had I not been originally diagnosed by a PA who I honestly don't believe really understood thyroid issues. She, when I finally all but demanded a referral to see my current endocrinologist, left me with the parting words that I wasn't going to stop until I did something I'd regret. She told me she was an expert in cardiology and what I had was obviously heart disease. After a thorough (including nuclear tests) examination by our cardiologist, he said my heart was strong - what I had was hyperthyroidism. When I went back to the PA with that bit of news, she got upset with me!

The whole question probably does hinge on the physician himself/herself. I see my endocrinologist constantly mentoring her PA, we've watched our cardiologist recently sharing professional concerns with his new PA but they truly are good doctors, I don't believe they'd ever want their patients even getting the impression that their PA's were responsible for diagnosis and treatment.


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## joplin1975 (Jul 21, 2011)

Oh, I dunno know. I'd say they are there to diagnose and treat. My husband does both. 

(Full confession, not only is my husband a PA, so is my sister-in-law (cardiology) and brother-in-law (emergency medicine and urology).)

The catch is *how* they diagnose and treat patients is suppose to mirror that of the physician. In NY, they can do everything a doctor can do expect full surgery by themselves. My husband usually does most of the surgeries while the doctor hangs out and does paperwork -- but the doctors trust my husband, he does have lots of experience and our hospital does not have medical residents. (While my TT was technically performed by my surgeon, most of the work was done by the resident.) On weekends when he's on call, he's it. Dislocate a hip? He'll put it back in. Major cardiac issues after a total knee replacement? You've got him.

In rural areas, like where I live, we don't have a lot of physicians. We depend on mid-levels for care. And, yes, while everyone in town calls my husband "Doc" he corrects them every time. He does not want people to think he's a doctor and had no desire to be a doctor. Put he does house calls, goes to farms when someone gets their arm stuck in the grain elevators, and hangs out at a ton of the sporting events, so people just kind of assume.

Unless the PA has a stand alone practice with only weekly drops in from a supervising physicians, laws and/or insurance regulations require PAs to bill under the supervising physician's name because if malpractice occurs, it is filed first against the doctor and secondly against the PA.

Anyway, that's a long winded way of saying, look, there are good ones and there are bad ones, just like doctors. I don't think it's wise to dismiss them as a profession because of a few bad apples. When I go grocery shopping, I am usually swarmed by old ladies who rave on and on and on about what a life saver my husband is and, oh, how lucky I am...I want to scream and say "BUT HE CAN'T SEEM TO PUT HIS UNDERWEAR IN THE DIRTY LAUNDRY HAMPER!!!!" :tongue0013:


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## minli (Aug 2, 2011)

Oh I have no issues with PA's at all, normally. I just email her as she is the typical go to person as she is more accessible than the Endo is.

It was more the attitude of blowing off what should have set off alarms and insulting me I had an issue with. Having your BP and pulse start on an upwards spike, on a daily basis is something to take note of.

Got my blood work back from the lab today and it does tell a story. My T3 went down, but my T4 did indeed go up.

I just wish physicians (in general, no matter what initials follow their names) would listen better to the patient, I mean we know when something isn't right, we're the ones who feel it


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