View from a Wolf

“You’re having trouble urinating? Here’s a script for OxyContin.  Won’t help the problem, but you won’t care anymore.”

You wouldn’t trust a doctor who treated you this way, and neither would I.  Some patients are looking for just such treatment though – and for them, a doctor who did this would be a god-send.  There are likely as many different motivations for a visit to the doctor’s office as there are patients.

Unfortunately, the first visit to the doctor’s office about a single symptom (or usually, a combination) might not be as simple as one would hope.

A friend of mine – who happens to be a medical doctor – has been branching out into the alternative medicine area.  Normally, this is forbidden territory for doctors, as there are a great many quacks out there, touting their substandard snake oil remedies.  However, in amongst the frauds are those folk who have re-discovered traditional remedies from other cultures, notably Indian and Chinese, some of which appear to work.

The cynic would suggest that maybe some of these remedies work because of their placebo effect, and I would tend to agree.  Then the question is:  what’s wrong with placebos, if the patient gets better, or his symptoms begin to subside?  It doesn’t necessarily suggest he was psychosomatic, or was faking his illness.  It speaks to a fundamental truth (well I think it’s a truth, though really it’s just a good guess or opinion) that the body has an amazing ability to heal itself.

Full disclosure:  though not a cynic, I tend to lean that direction.  People who complain about illness all the time bore me, mostly because I have a hard time believing their ailments are real.  I know that sometimes they are, but I know that for every person with a legitimate complaint, there’s another one right behind him who is subconsciously looking for attention.   I’ve been privy to their conversations too, which go something like this:

“I’ve got a headache”

“Oh yeah?  Well I’ve got a headache and a backache. ”

“Well that’s too bad, but guess what?  I’ve had my headache for two weeks.”

“I know what you mean.  I’ve had this backache since I was born.”

“Really?  And the doctors haven’t figured out why?”

“No.  I’m supposed to go in for an MRI next week.”

“Wow.  Yeah.  The doctors haven’t figured out why I have so many headaches either.  My great-grandfather had them so it’s probably genetic.  My kids will probably have them too.  I keep asking little Cindy if her head hurts.”

“You shouldn’t do that.  You’ll get her thinking she should have a headache.  That she’s not normal unless she has one.”

“I’m not worried.  I do see her putting her hand to her head sometimes though.  Just like I do.  It’s why I ask her.”

“Well I—OWW!”

“What?”

“My back.”

“Oh.”

“Yes, see you later.  I’ve got to get some pills into me.”

“Oh?  What kind?”

“Demerol”

“That’s kid stuff.  You should get your doc to prescribe Oxy.  It’s the BOMB, man.”

“Huh.  Maybe I will.”

(a.k.a. Dance of the Aching Fairies)

My doctor friend, in pursing the road less travelled, is exhibiting all kinds of courage, I think.  She has given credence to the fact that modern medicine doesn’t have all of the answers (though it often pretends to), and that some alternative remedies have been proven to work, above and beyond the placebos effect.   Her belief is that modern medicine has its place, and that non-traditional medicine should not be so easily dismissed.  I believe her, actually, even though I don’t always agree with what she has to say about some things.  More on that later.     Her blog, by the way is here:   http://www.bloomingwellness.com/

Today, she wrote a status update on her Facebook page – http://facebook.com/BloomingWellness – which pointed to an article about how some bizarre behaviours might be indicative of internal organic issues, rather than mental problems.    She had this to say:

I just finished an interview for Alternative Mental Health with Attorney Beth Maloney, who was recently featured on this segment of The Doctors and author of the book, Saving Sammy. We talked about how her son was misdiagnosed with OCD, put on SSRIs, when in fact he had PANDAS- an autoimmune disease caused by an antibody to Strep. Pneumo. that attacks the basal ganglia in the brain. Parents should be aware of PANDAS, a disease we don’t really learn about in medical school ( we don’t) , because certain behavioral issues in kids ( like ADHD ones, OCD, Tourettes, etc…) can actually be due to PANDAS, and doctors miss it all the time. A simple blood test may differentiate a true psychiatric issue from an autoimmune one so your child can receive the right treatment instead of a mess of drugs that are wrong.

It seems to me that the root of the issue – not about such an innocuously named condition called PANDAS, but about the initial wrong conclusion – has its basis on a culture which likes to speed everything up.  Got a problem? See a doc and get a diagnosis so that you can get some pills and get rid of it.   Most of us want that – though some would prefer a prescription of exercise or a change in diet over taking pills.  Not many of us consciously wish to remain bound by a condition or disease which limits us.  Even those who subconsciously enjoy the attention, really are miserable, and know they’d be better off if they were well.

I’ve heard stories from a few doctors about patients who come to their office, pretty much demanding antibiotics because of a scratchy throat.   In addition to a fast-paced society which can’t tolerate downtime due to illness, this presents yet another problem:  patients who think they’re doctors.  We can probably blame the internet for this, and sites like Google and mayoclinic.com .

We have all heard stories about teachers with imagined qualifications in psychiatry who diagnose ADHD in their children.   Many people use this abhorrent behaviour to cast doubt on ADHD altogether.  I can’t tell you how many times – since receiving my own diagnosis – people have said “oh EVERYONE has ADHD” – by which they mean that no one does.  My doctor friend and I have disagreed publicly about a lot concerning ADHD but to be fair:  she’s a medical doctor and I’m not; and some of her objections are I think quite valid.

She worries that too many people are looking to medications to resolve their issues with ADHD, and she wonders about the motivation of drug companies in this respect.  The same could be said of cancer and drug companies for that matter – and I’ve already heard a repeated cynical comment about this:  “the cure for cancer is already out there but isn’t being shared because too many organizations will lose money.”   I’m not sure I completely disagree.  I truly believe everyone has a motive for what they do, and that no one spends money building products without expecting some kind of return at the end of the day.

This does not equate to non-altruistic motivations though.  A doctor needs to make a living and gets paid accordingly, yet many often come close to burnout in doing so.  The extra mile they take often has nothing to do with money, and has everything to do with patient care.  Ditto those doctors who travel to remote parts of the earth to volunteer with Doctors Without Borders (or Médecins Sans Frontières).   I have to believe the same kind of ethic holds true for many in the drug companies too.

Some doctors and drug officials are of course totally in it for the money.  I’m just not convinced the paint brush is that wide.

When it comes to mental issues, there’s a harder diagnostic road to travel.  Unlike cancer or an enlarged prostate, you can’t open the brain and say “oh there’s the problem.  This part of the brain is green while the rest is gray and so that’s why this patient is schizophrenic.”  Instead, doctors must look at a whole host of reference material, which includes but isn’t limited to patient behaviours.   In my case, the hours of testing included looked at my childhood, genetic factors, and behaviours that everyone has experienced on one occasion or another.   The testing was designed to eliminate other factors or conditions or medical problems, in order to come to a robust conclusion.    This was NOT a case of my family physician hearing my complaint in one session and then coming to a diagnosis.

Much had to do with my own motivation as well.  The first surprise was realizing that everything I thought was normal – and something that everyone struggled with – was not normal.  Until then, I was convinced that my problem was a combination of laziness and even early onset of Alzheimer’s.   I had no idea why others in school progressed so quickly and retained so much, while I struggled along, barely making it.  I knew I was intelligent but you know – for a while there I thought I was incredibly stupid.   I learned how to work around my symptoms, and found creative ways to avoid circumstances and work that would highlight my deficiencies.   Really creative – which is how I figured out I wasn’t stupid.

Ultimately, it was the body of behaviours that indicated a deviation from the norm.  Whether we call it ADHD or “Yellow Pickle” is immaterial.  The issues are:  what’s the cause; and then, what’s the treatment?

Even this seems to vary, depending upon the patient.  Some fellow ADHDers swear by increased exercise, copious amounts of coffee and stern attention to diet.  Others have taken the behaviour therapy route, which goes like this:

• I have trouble focusing, which means:
• I often lose my keys; or
• I am late for appointments; or
• I forget I even have appointments; or
• I can’t remember important details in a work project; or
• I often look for stimulants, like illegal drugs; or
• I put myself in harm’s way too often, because I need the rush; or
• ….any number of other behaviours (there’s quite a list, actually)

Any of these can be mitigated by any of the treatments mentioned above.  Some of the behaviours might be rooted in causes other than ADHD.  There could be chemical issues.  The science on this is not yet perfected.  About the only thing doctors seem to agree is the body of behaviours.  Thank God for that.

The bottom line is what I told my doctor friend:  the path to diagnosis and treatment is neither as quick or as easy as patients (and occasionally doctors) would like it to be.  It’s not simple, and much depends upon the expertise and experience of the doctor (which is why my own GP didn’t want to treat me – she had neither), and upon the willingness of the patient to wait until all of the facts were in.

Your comments are invited:  have you or anyone you know (no names please, let’s keep it anonymous) struggled with getting a diagnosis about anything?   What are you thoughts about people who diagnose themselves?  What about alternative medicines – what are your thoughts on that?