Starting the Search Again

Terry had an appointment today with the urologist.  He’s been having some blood in his urine that continues to come and go.  They did labs and a urine sample, and he’ll go back in a couple of weeks to get scoped and look up into the bladder.  Hopefully we’ll hear back fairly quickly on the PSA, and whether it’s elevated from last year.  They’re leaning towards chronic inflammation, or prostititis as the culprit, but have to rule out the chance it’s cancer in the bladder or urethra.

Interestingly, as we waited for the doctor to come in I was reading a magazine article talking about the increasing number of patients who cannot get a conclusive diagnosis.  There are approximately 23 million Americans who cannot get an accurate diagnosis of their medical problem.  I know that Terry has never had a condition that was easily or quickly diagnosed, but the number 23 million seemed staggering to me.

That’s 23 million people, as well as the people around them, who are dealing with chronic health problems of an undiscovered cause.  I know the frustration we’ve endured trying to get a diagnosis, or at least an idea of the cause of Terry’s vomiting.  I know that when they’ve been unable to tell us what he’s experiencing, they’ve attempted to deflect their inadequacies at diagnosis by making it Terry’s fault.  If they can’t figure it out, it must be because it’s psychosomatic, or all in his head. I had no idea there were so many other Americans out there dealing with the same disruptions in their lives, not knowing why something was happening to them.  It’s the type of club you shouldn’t want to join.

It’s a sad commentary, in light of what health care costs are in this country, that there is such a level of substandard care.  The article listed 3 reasons it’s difficult to get a diagnosis in difficult cases.  One is the result of medical school training that says to look at the most common reasons for the symptoms being exhibited.  It also talked about a reliance on labs and testing, and finally, the overuse of specialists.  It’s easy to see how the that trio of actions can work together against the patient if it’s a rare or unusual condition.  If doctors only look at what labs and testing can tell them, and if specialists only consider their discipline, it’s going to limit options.  When a doctor only considers those conditions that are more common, it’s hard to get that thinking out of the box.

I’m sure there are no easy answers, but I do know that it requires extra vigilance on those who have health concerns, and those who care for them, to keep pushing until the diagnosis is made, and correct.  There is no hope for effective treatment when you don’t fully understand what you’re treating.

So as we enter yet another phase of finding out what we’re dealing with, I encourage you to keep pushing when necessary, to get the answers you or someone close to you needs.  We have to advocate for ourselves and the ones we love when it comes to health.  There is nothing more important than your health, and nothing more worthy of your time than making it all it can be.

 

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Doctor, Doctor Give Me the News

Terry had a follow up appointment with the cardiologist two days ago.  Dr. Brown has been really good about seeing him more often post thyroid cancer and pheochromocytoma, so it was a chat about how things are going.  It truly is hard to know how much those two separate conditions played into his overall cardiac health, so I have appreciated the additional visits with him.

It has been frustrating, however, that he has not been willing to consider how the nausea and vomiting that have occurred for almost seven years might be tied to his cardiac condition.  After some discussion regarding theoretical causes, he was willing to consider a problem with either a blockage or potential limited blood flow to his intestinal system.  Dr. Eck, his endocrinologist, has supported that idea with us, so we were able to secure a referral for a dye contrast scan to look at blood flow.  

He gets that scan on Tuesday, the 10th of May.  That gives us the opportunity to get those results to KU Med for his appointment with the GI department the following week.  It was the vomiting that prompted the referral to KU Med last year, but once they found the other problems the vomiting issue went to the bottom of the heap.  Discovery and treatment of the two conditions last year did not have the additional benefit of eliminating the nausea and vomiting, so we have hopes this test may yield information.  There has to be a physiological cause.  End of discussion.  Just because they have not determined what it is yet does not mean it is not real.   

All things considered, his cardiologist is pretty encouraged he’s doing as well as he is.  Terry did admit to him, and had not admitted to me, that he’s noticing he’s getting winded and needing a break if he’s out in the garden or trying to work on something for 30 minutes or more.  There have been several times when I felt he was breathing harder than usual, but he always minimized any concerns.  Listening to him confess to the cardiologist confirmed what I’ve noticed.  He’s not having much swelling to his hands or feet yet, so I hold onto that piece of good news while we have it.  

While it won’t surprise me, it will be disappointing if we find out his nausea is a by product somehow of his cardiac disease.  I realize everything he’s gone through has been difficult to diagnose, which I reminded Dr. Brown, but I have pushed hard on the cardiac side of things for answers for a while now, and we could not get any doctors, much less the cardiologist, to consider the connection.  As long as we finally get some answers I’ll forgive him if it turns out to have a cardiac component.  We just need to know.
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Does Quality of Life Matter?

After Terry had a three day hospitalization earlier this month, we have decided it’s time to ramp up the diagnostic end of things again.  The hospitalization was for the extreme vomiting, which we truly had hoped would abate in time after his surgeries last year.  It has not.  Apparently we are no closer to understanding this than we were in November, 2004 when it all began.

To that end we are headed back to the GI Department at KU Med next month.  There’s a part of me that thinks we need a predetermined amount of time we will invest without answers, and then request the referral to Mayo Clinic.  I had originally believed if we found out the problem locally it would make whatever treatment was deemed appropriate easier if it was all within the same facility.  That no longer is a concern for me.  I, and the rest of our family just want answers.  It has impacted all of our lives for too long, and has taken too much of a toll on Terry to go through this so often.  Aside from those considerations, we would just like some semblance of normalcy in our lives.  With recurrent vomiting that presents the possibility every day, his, and by association, our qualities of life have suffered.

He’s awakened early each day with discomfort that leads to pain, and pain that leads to eventual nausea.  Whether he ends up getting sick or not is anyone’s guess, and we never quite know until he starts feeling like he’s past it whether it will go away or lead to the uncontrollable vomiting.  As a result, he’s uncomfortable riding in the car for very long, and I’m reluctant to make any more air travel arrangements for him given the uncertainty of each day’s potential for vomiting.  Not much fun for him, and not much fun for me.  I’d like this time I’m at home with him to be an opportunity for us to do things together and travel some while we can.  We talk about traveling, and “plan” short excursions, but don’t seem to make it far from home.  When it gets down to it we’re both afraid he just won’t be able to do it.

As frustrating as it is to feel like quasi hermits, it’s even more frustrating to not be understood by medical professionals.  There’s a tendency by healthy individuals to gloss over notions like quality of life.  When someone has faced life threatening situations, multiple times especially, it’s easy for others to think whatever life we have together should be satisfactory, because he is, after all, still with me.  I understand the motivation in telling me that, but being on the receiving end of attitudes that essentially say it doesn’t matter if our lives are less than satisfactory if we are still together, feels a bit like being unvalued.  I don’t care much for that attitude, and think if they could live this life for a while they would understand.  They would want answers, too.

Just because doctors and specialists have not been able to diagnose his problem does not mean we should just give in and accept this way of life.  Terry is still too vital a person, and we are both too young to be expected to just accept this is how life has to be for us.  I refuse to, and am thankful that our primary care physician is on our side and supports what we do.

I spoke with him after Terry’s discharge, and asked about the possibility of a letter from him for Terry’s file at the hospital.  When I take him in, they do not start any fluids or meds until they’ve scanned his abdomen and run labs on his blood.  While I appreciate they have protocol to follow, from my perspective it’s just additional costs to Medicare that are unnecessary.  We have been through this too often to not recognize the symptoms when they rear their ugly heads.  I’m hopeful if they start IV fluids and anti-nausea medications faster than they have in the past, it may help end the vomiting sooner, and that would allow him to go home, rather than be admitted yet one more time.  We received a copy yesterday of the letter our physician submitted to the hospital to be put in his record.  It may not help, but at least it feels like getting a little bit of control.

Control is good, but answers are better.  As he goes through additional testing and diagnostics, I’ll try to keep this up as a chronological record.  It seems like to much to ask for, but if they can’t diagnose and treat, I hope they can at least give him tools to help cope.  Whether it’s a medication or a behavioral change, he needs something.  I may need something myself if he doesn’t get it!! 


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I’d Like a Second Opinion on That Referral

Almost two weeks ago, we met with the oncologist who did the post surgery follow up.  He explained that based on the size of the mass on the thyroid the radiation was a non-discussion item.  The recommended course of treatment on a mass the size of Terry’s is always the radiation.


He was going to refer to an endocrinologist, who will not only oversee the radiation, but will also be responsible for making adjustments on the synthetic thyroid med he takes.  We were told to call the oncologist’s office if we did not hear from the endocrinologist.  I did that, and the nurse for the oncologist let me know she was having trouble hearing back from them as they had requested the paperwork be sent again.


Having seen the slick system KU Med has for utilizing computerized records, I’m having trouble understanding how they don’t have access to the same information all the other specialists from KU Med obtain.  Irregardless of whether they truly do need the paperwork submitted again or not, the simple fact that they have not contacted us to let us know what the delay is has caused me to determine I’d prefer a new referral to someone different.


What we found when he was referred to the urologist and his follow up is that there is a difference with doctors who are in the same facility.  When we receive personal calls from some doctors, and others cannot be bothered to have procedures in place to facilitate referrals, it’s easy to see when there’s a break down in the system.  The urologist’s office took a full week to contact me after I’d called his office asking for confirmation of whether Terry was to discontinue the antibiotic he has prescribed for the prostate issue.  Discharge papers after his surgery said he was not to take it, so it seemed worth clarifying.  I asked his nurse to have him speak directly with the oncologist, because it seemed to be a doctor to doctor discussion to me.  He never did that, and it took a week to get the call back from his nurse.


I’m hoping there is no problem with Terry having a lapse of a week not taking the doses as prescribed.  If not taking it consistently and continually alters the effectiveness, then he needed to know that.  Apparently, the urologist wasn’t worried about a time lapse since the call back took a while.  But whether it mattered or not, it’s bad business to ignore your patients.  I’m entrusting Terry’s life with these physicians, and if they cannot be bothered with his care, I’m not sure Terry should be bothered with having them as a specialist.  


It’s been a holiday weekend, so if I don’t get a phone call from the endocrinologist’s office tomorrow, I’m going to request a referral to a different doctor.  Maybe if I’d been more demanding when this all started it wouldn’t have gone on as long as it did.  If it was a hard lesson learned about self and caregiver advocacy, then I need to not lose the lesson.  If they can’t be bothered to be timely, I can’t be bothered to schedule with them for Terry’s care.  Seems simple enough to me.  

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Oh, The Tangled Web We Weave…

This feels like it’s starting to work its way toward a plan.  There is still too much unknown for my comfort level, but at least we know that by a month from now he SHOULD have one surgery completed, with one to come.  At this point, it may work out exactly opposite the way they originally indicated they wanted to address the masses.  Go figure….


I know that there have to be times when Terry thinks I have too much to say to the doctors, but I hope in the long run he realizes that I truly am only trying to keep them on task where he is concerned.  Today was yet another example of feeling like it makes a difference that I’m there.


The adrenal gland mass is a source of concern as far as Terry and I are concerned.  We both think based on the way he feels, and the symptoms they list as a consequence of having the pheochomocytoma, that he does.  The oncologist has seen two labs, one showing an increase in hormone production, and one that was less conclusive.  From his perspective, based on a 50/50 with the labs and the fact that Terry did not have high blood pressure that there really wasn’t a pheo at work.  He didn’t dispute the mass, but didn’t think it was functioning in the absence of high blood pressure.  


Terry has an ejection fraction of 20%.  The oncologist is not familiar with Terry’s cardiac history, so I felt compelled to ask with an ejection fraction that low, was it even possible for Terry to HAVE high blood pressure.  He agreed that was not a likelihood.  I asked if he had seen labs that had been processed through our primary care physician’s lab.  He had not.  So the report that the PCP, the local surgeon, and Terry and I have seen showing all hormones tested outside the normal range has not been seen by anyone from KU Med. 


This continual dance of one step forward and two steps back is getting very wearisome.  From my perspective, when the oncologist’s office called to verify the thyroid cancer, I told the doctor’s nurse that the surgeon had this concern and had attempted to contact him.  Evidently they still had not communicated.  I do know if the pheo exists that it would have been determined by the time surgery got scheduled.  The day of his prostate biopsy they have a nuclear scan scheduled to check out the adrenal mass.  By raising the issue of his ejection fraction and the other labs he has not seen, the oncologist had some blood drawn before we left KU Med today, and Terry was in possession of the infamous orange urine jug.


Now, if the results of the blood and urine work ups show the adrenal gland mass is functioning, he won’t have to have the nuclear scan scheduled for May 24.  He will have to take an alpha blocker to reduce adrenal production, and a beta blocker to protect his heart, for two weeks prior to his surgery.  By determining this before the prostate biopsy, he should be able to have surgery sooner.  I asked if the thyroid could be removed at the same time the oncologist removes the adrenal gland mass, and he believed that could be accomplished.  The benefits of that are only two surgeries and recoveries rather than three.  Right now it’s looking like that first surgery can happen early in June.  


The bad news, and there always seem to be some, is that based on the ultrasound done prior to the thyroid biopsy there are lymph nodes on both sides of the thyroid showing mass.  The oncologist says there will be a pathologist in the ER to check tissue until all cells are clean, but I’m concerned this means there will be a need for chemo and or radiation now.  I know he was hoping, and I was hoping I know, that he wouldn’t have to go that route.  Now we just need to find out for sure about the adrenal gland mass and the prostate.  That’s all… For now….that’s all.  

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