Wednesday, January 24, 2007

Diagnostic Rant

I want to preface the following rant by saying that I have no idea how to fix the health care system. As a rule, I truly admire those of you who spend countless hours caring for patients who may or may not appreciate it. I realize that medicine is not an exact science, you have to do the best with what you know. And since no two people are the same, inherently no two afflictions will be the same despite an overall “diagnosis” that may be present in a text book.

Now, all that being said, I am going to tell you about a several-month long ordeal Dean has been going through. I didn’t want to bring this up any earlier because we had no idea what was wrong with him. There is no point worrying everyone I know when there is no information I can give people one way or another. After today it looks like he is going to be fine so now I feel like it’s appropriate to give an overall assessment of his experience.

Back in October, Dean went to the clinic because he had a bad cough. He was coughing every morning, sometimes so hard he was vomiting. They gave him a chest x-ray, didn’t see anything and they diagnosed him with pertussis, or whooping cough. They gave him hard core antibiotics (which came with the usual side effects such as nausea and an order not to drink while taking them), which didn’t do anything. In the meantime he kept coughing and vomiting and after afew weeks he said there was “blood in it.” Now I’m still not sure if he was coughing up blood or vomiting up blood. I asked him several times if he could tell if the blood was from his lungs or his stomach. He said it felt like his lungs. He went back to a different clinic and that doctor (Dr. P) ordered (1) blood tests (2) stool sample (3) new chest x-rays (4) pulmonary examination and (5) tuberculosis test. All but the chest x-ray and the TB test had to be done outside of the clinic.

(1) was done at a special lab where they drained him of several vials of blood (after fasting, of course). He was sent home with instructions and a kit for doing (2). (3) was done on the same day as the initial visit with the new doctor. They said they would call him to schedule (4). They never did. When he went to get his TB test read (negative) he finally called the people that were supposed to call him about (4) and got in that same day. Meanwhile a week later he went back to Dr. P to discuss (1), (2), (3) and (4). Oh yeah, and he’s still been vomiting up blood every day. Not to mention, he’s had to take several hours and half days from work at this point just to get the tests done. (1): normal. (2): normal. (3): normal. (4): normal. The blood work said normal cholesterol, normal white blood count. The stool sample ruled out a stomach ulcer. Dr. P had recommended some Pepcid in case it was an ulcer that somehow got past the stool sample. (My understanding is that if the ulcer is in the smaller intestine, the blood doesn’t always make it into the lower intestine and into the stool. Correct me if I’m wrong, Nurses). Don’t get me wrong, I was thanking God she had ruled out cancer or any serious respiratory diseases.

She poked around his tummy for awhile and was surprised when he found it very painful for her to touch up near the ribcage and on his right side (Why didn’t she do that earlier?!). So, she ordered (6) more blood work to check for the organ functions (which apparently weren’t checked in the first gallon of blood he gave) including gall bladder, liver, kidneys and pancreas. She also ordered (7) an ultrasound to check for gall stones and/or a stomach ulcer (again). By this time it was mid-December and he was still vomiting everyday. It was clear he wasn’t coughing up blood, it was coming from the digestive tract. His next round of blood work and the ultrasound had to be done while I was in Minneapolis. We joked that neither of us would have guessed he would be the first one between the two of us to get an ultrasound!

He did the blood work and ultrasound while I was out of town and went back to Dr. P a couple days after I returned from Minneapolis. I wasn’t with him for his consult, but apparently Dr. P said she didn’t know how to read an ultrasound. Lovely. She needed help interpreting it and told him it was all clear. No gall stones. Definitely no ulcer. She had also gotten the blood work back which revealed a high count of liver enzymes but nothing else out of the ordinary. She gave him samples of a new acid reflux medication. Next stop, (8) CT scan of the abdomen.

He scheduled the CT scan for last Tuesday. Saturday he had to go pick up the barium sulphate contrast agent. Monday he fasted except for drinking the barium sulphate which tasted like total crap (I know because I was dying to try some). In the meantime, the acid reflux medication seemed to have helped. As of today he hasn’t vomited in two weeks. He was almost ready to just let it drop if it weren’t for the pesky liver enzyme levels.

So this morning we went to see Dr. P again, who was 45 minutes late for the appointment. Dean was tense because every minute he spent at this appointment he was going to have to tack onto the end of his day. He taken so many half days, long lunches or late starts that he really didn’t want to use up any more sick time. She was late to the appointment not because she was behind schedule taking extra care to explain things to a patient or calm down an anxious family member. She simply showed up for work 45 minutes past her first scheduled appointment. The CT scan gave us the answer we had been looking for for two months: steatorrhoeic hepatosis or fatty liver. It is reversible with diet and Dr. P said that anytime there is something wrong with the liver, the whole digestive tract can get cranky, sometimes causing acid reflux. Not that I believe a whole lot of what she has to say at this point. But colon, kidneys, pancreas, spleen and gall bladder all look healthy. He should keep taking the acid reflux medicine, lower the fat in his diet (read: NO MORE FAST FOOD!) and get his blood tested again in a few months.

This was all a great relief. But my question is why did it take a total of three months and 8 tests to correctly diagnose this? Why did my husband vomit up blood every day for several weeks before he something worked? Why doesn’t a general practitioner know how to interpret an ultrasound? I know that our insurance has been billed several thousand dollars (I know this because our co-pay on it is 10%). It seems like such a waste of money and our time when a CT scan could have been done much sooner had thorough blood work been done immediately. I am aware that there are hoops one has to jump through regarding health insurance so that not everyone is getting CT scans, but what if there was something seriously wrong that the CT scan could have revealed much much earlier? Dr. P said if she hadn’t found anything today she would have referred Dean to a GI specialist. Ummm, ya think?! That could have been done sooner as well. Thousands of dollars have been billed to our insurance for pretty much no reason, and we wonder why health care is so expensive. Dean had to miss several hours of work not to mention working while being ill which probably decreased his productivity. I can’t help but think that if the very day he went saying “I’m puking/coughing up blood” and they would have bit the bullet and admitted him to a hospital he could have gone home that same day knowing what was wrong. I know it’s idealistic and that the system doesn’t work like that. But why not?!


greensunflower said...

I would get a new doctor. What who knows what he/she doesnt know, so they can send to a specialist early. And really vomiting blood can mean liver easily, so I dont see why the liver enzymes werent tested from the get go.

I am glad he is doing well though.

greensunflower said...

I would get a new doctor. What who knows what he/she doesnt know, so they can send to a specialist early. And really vomiting blood can mean liver easily, so I dont see why the liver enzymes werent tested from the get go.

I am glad he is doing well though.

greensunflower said...

I would get a new doctor. What who knows what he/she doesnt know, so they can send to a specialist early. And really vomiting blood can mean liver easily, so I dont see why the liver enzymes werent tested from the get go.

I am glad he is doing well though.

magnetbabe said...

Thanks, greenie. I was curious what you had to say about it. Partially then I blame myself because he wanted to switch docs immediately and I thought it would be too much of a hassle with insurance and stuff. But good to know for next time.

Hot4Teacha said...

I'm so glad they figured out what was wrong. That sucks about the time & expense - I hear you. Took me 3 surgeons and several radiologists to get my thryoid stuff figured out and actually scheduel the surgery. Which, by the way, was $12K. Glad I have good insurance!

Runner Girl FL said...

It's probably one of those things where guys that young don't usually have this problem....but then HELLO! guys this young don't vomit blood everyday for months either!! HUMPH!!!

I'm glad he will be ok!

Poor fast food. (I know you are secretly not unhappy about that part.)

Jackie said...

uggg uggg uggg, I can relate to the vomiting everyday, but not the blood part, I can't imagine how scarey that would be!

I'm so glad he got things straightened out now though. I don't understand why they didn't just do a COMPLETE blood test to begin with. And I don't understand why the doctor wasn't more concerned with the fact that he was vomiting blood, nothing good can every come from that! Dang.

gabrielle said...

I am glad to learn that Dean is essentially ok and that you are both past the gnawing anxiety that uncertainty about our personal health breeds. I’m sorry about your ordeal. Unfortunately, it seems to be the norm—even for those of us who are fortunate enough to have health insurance. Why? Special interests, too many hands in the cookie jar. A fragmented delivery system top heavy in administrative costs (some estimates as high as 40%), an unbridled pharmaceutical industry, for profit hospitals, the AMA’s restriction on the # of physicians. So there are restrictions on time spent with patients, limitations on diagnostic tests, drugs carelessly prescribed often for unapproved applications. The arrogance and disregard of providers who believe that their time is intrinsically more valuable than ours is part of an unspoken caste system we have all bought into. I have thought about submitting bills at my hourly rate for time lost in waiting rooms, from work and on hold. Really it is not as absurd as it may seem once you begin to scrutinize the line items on your invoices. Also, call me a luddite, but I think practitioners’ diagnostic skills are not being cultivated due to an over reliance on technology. The art of medicine winds up suffering. Anyone who has had a healing experience with a caregiver can easily attest to medicine being a hybrid of art and science. And because of time constraints and sheer lack of practice, this time honored art is sadly disappearing. Our health care system is truly in crisis. The U.S. has the 2nd worst newborn mortality rate in the developed world and the life expectancy of Americans is #29 (below Croatia).
In summary, “The American healthcare system is at once the most expensive and the most inadequate system in the developed world.” (The NE Journal of Medicine, January 7, 1999.
Thanks for putting up with my rant. Take care and be well.

lefty_grrrl said...

Have you ever read about Exposed's many health issues? Dude - she's been seeing doctors for YEARS and just recently started getting answers. And her illness has been, at times, completely debilitating. Not that vomiting blood is pleasant or acceptable, either.

The medical industry - because that's what it is - sucks. It pisses me off. I hate insurance companies. They're completely unethical and they're charging more and paying out less than ever before.

Oh, and you guys need to get a competent doctor. This one is borderline - not reckless, but she definitely isn't paying attention to the details. Did she even apologize for being late that day? Most doctors are so f*#@ing arrogant.

DearOldDad said...

Did you hear the one about various doctors taking 5 years to diagnose gallstones?!?!?! They came up with everything from overeating to “you just need to get your digestive tract moving “, at which point I was essentially told to walk it off.
BTW – Gabrielle; okay, you’re a luddite. :-)

Scott said...

Maybe the answer to health care reform is to remake it in the image of a system that actually works. I haven't done any research whatsoever, and I am impressed by the comments of your other readers, but if were are #29, then who is number one? And more importantly, why are they number one?

Man this country is in sorry shape.

Minnesota blue said...

The only function General Practioners have is to take vital signs, listen to you lungs and heart and then make referals to other specialists! Never use a GP, start with an internist. They are a bit better trained. Of course, they will also send you to a specialist, take blood chemistries or order xrays. I agree, our health system is in a sorry state. The advise I have given throughout the years to patients is to be your own advocate and make your demands and expectations known. If you are not satisfied with your Doctor, find another!! Drs are not Gods[altho they may think so] and they are not always good, even tho they may have a degree.

Anonymous said...


lefty_grrrl said...

I feel for those that suffer under poor socialized medicine, but there are ways to do it and be successful. Perhaps a partially socialized system is the way to go.

For the amount of money flowing in and out of the US - especially when being compared to Mexico - the US really should have better healthcare. We really are the richest nation with the worst health care system among completely industrialized, capitalist societies. Mexico is more second world. You can't compare a crabapple to a giant Braeburn apple. They're different.

Scott said...


I can see how our complaints would fall on deaf ears in countries that are worse off than ours. We are very fortunate compared to what you describe. That is in no way a reason to be content, however, with a system that is clearly broken.

Anonymous said...

We can spend billions upon billions of dollars fighting an unjust war, maiming and killing our soldiers who in turn we will have to spend millions to put them back together but cannot have affordable health care for our own citizens. How much also are we spending on all the innocent citizens of Iraq who have been maimed and injured? We are the Greatest country in the world so we should be able to figue this out!!!