From: bonnie@nmsu.edu (Bonnie Hargrave)
Subject: Re: mitral valve prolapse and need for antibiotics?
Organization: Computing Research Lab
	<BONNIE.92Sep29190907@aigyptos.nmsu.edu>
	<1992Oct5.082050.27991@spdcc.com>
Distribution: sci
Date: Wed, 7 Oct 1992 19:47:36 GMT

In article <1992Oct5.082050.27991@spdcc.com> dyer@spdcc.com (Steve Dyer) writes:
   Sounds like you've got a gem so far (and there's no sarcasm intended.)

I'm not sure this is the best time to reply considering the letter I
just received, but here goes.  I'll try to remain calm.  I received a
registered letter from this doctor today telling me that I have 10
days to find another physician since "It has become clear to us that
we cannot work on a good Doctor/Patient relationship."

I go back into my memory and cannot think of any reasonable
explanation for their action.  I didn't complain when I had to wait 45
minutes on both occasions when I had an appointment with this doctor.
I didn't complain when the EKG "specialist" had to have someone come
in and show her where to plug the cable in.  I didn't complain when
they didn't have all the lab results for my second appointment -- even
though I found out later that the lab had send ALL the results to them
at ONE time and at least a week before that appointment.  
They didn't even have to file insurance on me; I paid in full at both
appointments. 

These are the only things I can think of to piss them off:
	1.  Last week I went to the labs and requested copies of the
results.  Two of them gave them to me, no hassle.  One refused, saying
the doctor would have to do that.  They were gracious in their
refusal, so was I in accepting it.  One lab even spent half an hour
with me going through all the results and explaining the meanings of
all the figures.

	2.  My husband was with me in the second appointment.  He can
be intimidating at times if an answer doesn't satisfy him.  He also
knew, from the CDC, that EBV and CFS are not considered related -- so
he asked her why she ordered the EBV test.  She answered something to
the effect of - because a positive EBV result often is connected with
CFS.  He stated the CDC news to her.  That's all: just stated the
facts as he knew them.

   >But, her _lack_ of knowledge of recent findings by the Center for
   >Disease Control (re:EBV and CFS),

   What recent findings?  EBV are CFS don't have much to do with each other.

See above.

   >her inability to handle basic
   >questions (for example, would ibuprofen or acetaminophen in large
   >doses affect the uric acid level),

   _Basic_ question??  Um, Gordon, David and Ken: is this a basic

Scuze me.  I got this wrong.  Rechecked the facts with my husband
_after_ posting this one, sorry.  What he actually asked is whether
one affects the liver more than the other -- which question was
precipitated by the test results showing high SGOT and one other
related acronym that was high.  Maybe that's also a specialist
question; thing is, she didn't offer to check, didn't say we'd have to
ask a specialist, she just said she didn't know.

   What's the matter with "I'm not sure?"

Nothing at all, if the doctor seems willing to followup or at least
redirect your inquiry to someone who might know.

   >and MOST of all her assumption that
   >my symptoms are merely mental led both my husband and me to believe
   >she is, well, in my husband's word, "hopeless."

   What's wrong with "merely mental"?  Does that make it less of a problem?
   Not that I'm claiming that that's the situation.

If it's merely mental, the symptoms are still there, so no, it would
not be any less of a problem.  What I dislike is this hurried
diagnosis from a doctor who, I feel, has not taken the time to get to
know me in the slightest.  

If she had said something like "You have too many symptoms for me to
figure out the problem without further testing" or if she'd just said
she had neither the time nor energy to help me further when she has
patients with more severe or more easily solved problems beating down
her doors, this I could have understood.  But to tell me I'm
preoccupied with illness is ... words fail me.

   >keep thinking these other symptoms will clear up eventually.  Once
   >they got me to agree that my health was indeed deteriorating I got
   >into gear.

   How is your health deteriorating?

Not sure I want to expose myself to ridicule for yet another
physician, but here goes.  What the hey, it's just the whole Internet,
right? 

	Here are the main problems:  

	frequent headaches, especially on hot days (I live in an area
		where temps reach 117 F in summer) but it happens
		anytime the temp goes over about 75F -- a real problem
		for where I live.

	fatigue: I'm up for about 3-4 hrs, during which time I'm
		productive; then I have to crash for a couple more
	      hours, and even then I don't feel as good as when I woke
		up.  This sounds minor compared to CFS patients, but
	      it is a departure from the norm for me.
	
	headaches don't quit until I vomit; this can often be headed
	     off by ibuprofen or acetominophen if taken early enough.

	gastrointestinal pain almost daily, usually mild, accompanied
		by nausea and often by heartburn.

	alternating diarrhea and painful constipation

	severe PMS symptoms: bloating, cramps, irritibility, and
		        suicidal feelings once a month (now, I agree
			_this_  indicates a psychiatrist could be useful)

	frequent and urgent urination -- getting up 3 times a night is
			usual, much worse during the day

	inhalant allergies, which I never had before -- or at least
		didn't have near as strongly as now -- itchy eyes,
		stuffy nose, runny nose, sore throat most all the time

	severe stabbing pains in joints -- hands, feet, arms, hips, probably
		others.

	frequent earaches -- these don't last long usually, but the
		fact is, I never used to get them.  Ever.

	low libido (not a problem unless you're married to a "healthy"
		person, but I am, and it's a real pain for both of us)

I grant you that none of these symptoms is on a par with an impending
heart attack.  Still, their cumulative effect is taking a toll on my
life.  And the overriding fact is that I had none of these problems
(except the stomach pain and diarrhea) two years ago.  As I said, I'm
not horribly ill, but I do seem to be going downhill, and I want to
stop it.

   >Her reply was that the list indicates a "preoccupation with illness"
   >and that I should be seeing a psychiatrist.

   You seem to think this is an insult.

The psychiatrist? Not especially.  The preoccupation with illness?
Yes, indeed.  Most definitely I view this as an insult coming from
someone who does not know me or my history (this is only the second
time I've sought medical aid in 42 years).  I think it's a quick
solution for her and not a very good solution for me.

   >When the patient loses trust in either the doctor's competence or the
   >doctor's ability to even _care_, that patient starts to question every
   >thing the doctor recommends.

   Well, don't do that.  

Sorry.  Too late.  The doctor has taken that decision out of my hands.

   What makes you think she doesn't care?

I think the registered letter makes that pretty clear.  She didn't
bother to talk to me about it -- whatever her motivation was for
sending it.

   Would it be better for her to have strung you along giving
   you sublingual sensitivity tests to "allergens"?

Isn't there something in between "your problems are all in your mind"
and "great. let's take you for all your insurance company is worth"?
Somewhere in that middle ground, isn't there supposed to be a real
doctor?

Bonnie
--

		bonnie@nmsu.edu         
		Bonnie Hargrave