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?!