Manic Medicos, Nitwit Nurses, and Fernando

I found this quite alarming.  Yes, she still could be just drinking too much coffee….I hope.

She looked at my negative test results that my primary doc had FAXed over as a courtesy, and asked me had anyone explained the results to me.  I told her “no”.

She exploded.  Not literally, of course, but she may as well have done, it was that shocking to me.

Throwing up her hands, she angrily stated, “This isn’t how it’s supposed to work!  They should have explained the results to you before you came here!  It doesn’t work this way!”

Then she turned to me and demanded, still angry,  “Why are you here?”

Me: (visibly shaken) I saw the test results – they were emailed to me – and I see that they are negative but that’s why Dr. ______ sent me to you.  We were hoping you could figure out what’s wrong with me.

This sudden change in mood, from elevated to angry, is called “lability”.  It is another very clear symptom of bipolar disorder.

So now my head is reeling.  I am talking to, I believe, a doctor who is having a manic episode.  And who is now angry.  And who is, by the way, about 6 ft tall and appears very fit.  She could leap out of that chair and grab me before I could blink, if she chose to do so.

I don’t usually interact with manic people in a room with a closed door.  Not unless there is also an aide or a nurse in there with me.  I subtly shifted my chair a little closer to the door.

Suddenly, as quickly as the anger came, it went.  She continued to scroll down through the test results at an impressive speed, if she indeed was able to read as fast as she was scrolling.

MM (for “Manic Medico”): You don’t have an autoimmune disease.  Your tests are negative.  Why do you think you have one?

Me: I was diagnosed with lupus 30 or so years ago.  I had severe joint pain, malaise, fevers, and a malar rash (see a pic here).  He gave me cortisone shots and I felt better.

MM: (tapping her foot and looking at me in a scrutinizing way) Symptoms?

Me: Hair loss, nightly low-grade fever of 100.6, malaise, malar rash after I go out into the sun, muscle and joint aches, dry eyes and mouth…

MM: Dry eyes?  Did you get an exam for that?

Me: Yes, he did a Schirmer’s test (info here).

MM: What was your score?

Me: Umm, I don’t remember but he said I had dry eyes and…

MM: (exploding again) What kind of eye doctor was it? Was he an opthamologist, an optometrist, an optician??  Is he a real doctor or just someone who sells glasses?? Why don’t you know your score?? What brand of eye drops do you use??

She asked all this in one angry breath.  I had now pushed myself so far back into the chair by cringeing that I hoped I would just magically disappear into it.  Because she was scaring me.

So I did what any normal person would do – I looked at her in horror and said, “Well, umm…I don’t remember…over-the-counter…whatever is on sale…”

MM: (interrupting my brilliant response) Never mind.  I am going to examine you.  Put on this gown, I’ll be right back.

She practically ran out of the room.

I swear, I had only gotten 1 boot off when she knocked on the door.  That was, what, a minute since she had left??

Me: I’ll be ready soon.

I may have a lot of physical issues but getting undressed is not a problem for me.  It is a problem for me if I am trying to do it under 2 minutes, however.

She knocked and came back in just as I was slipping the gown on.  That was what?  5 minutes, total, from when she left the room to when she came back?

Very hyperactive, this one.  Looking at this situation now, I am wondering why I allowed her to examine me.  I should have just left.

But examine me she did.  The crunching and clicking I had heard just last night in my knees was strangely absent today.  I could feel the grinding in my shoulder when she moved it, and the “catching” in my finger joints (it’s when you try to move them and they ‘stick’ briefly), but she declared, “there’s no crepitis”.

Crepitis: A clinical sign in medicine that is characterized by a peculiar crackling, crinkly, or grating feeling or sound under the skin, around the lungs, or in the joints ( website, no date given).

I could hear it.  I could feel it.  She couldn’t and didn’t, I guess.  Crepitis can be an indication of wear-and-tear on joints, or of joint inflammation.  I bring this up because my primary care doc (to whom I will refer from now on as “Dr. Wonderful” because I like him that much) made it a point to have his intern palpate my fingers to feel the inflammation.

My fingers, which intermittantly swell and tighten, weren’t doing that during the exam – traitors!

I won’t go into the full exam but basically she told me she didn’t find anything – no inflammation, no hair loss (!), and concluded by saying…

“And go see a dermatologist.  You have dandruff.”

She’s a charmer.

She told me to get dressed, and left again.  This time I managed to get everything on except my boots before she skittered back in.

She sat down and told me that I had nothing autoimmune, and asked if I had Raynaud’s (Why she was asking that at this time, who knows?  An afterthought, I guess).  I told her why yes, as a matter of fact I do.

I told her the symptoms and fortunately she didn’t see the need to stick my hand in a bowl of icewater to see for herself (doctors have been known to do that).

She told me I have “Primary Raynaud’s”, which has an early onset (true), doesn’t lead to anything more severe, autoimmune-wise (also true), and that, since I didn’t have gangrene or evidence of ulcers on my fingers, she had no advice for me except to ‘wear gloves’.

Which I do, everywhere.  Raynaud’s causes your fingers – and also toes, in my case – to turn white, then red, and then blue when exposed to cold.  Very patriotic-looking.  If left untreated, you can lose your fingers and/or toes.  It’s a circulation issue.  It’s often treated by vasodilators. I am not big into medication so I am not fussed she didn’t prescribe anything.  It was her cavalier attitude that bugged me.

So she pulled up my test results again, and my chart, and stated (again)..

“You do not have an autoimmune disorder.”

Then she said something that upset me…

“Since there is a history of cancer in your family, I suggest you go back to your doctor and have him test for that.”

Having one sister with breast cancer is “a history of cancer in the family”?

She continued, “there are more likely things to explain your symptoms than autoimmune diseases.”

Me:  But what about the joint pain?

MM: Everyone gets aches and pains as they age.

Me: Dry eyes and mouth?

MM: Aging.

Me: Hair loss???

MM: Also aging.

Me: By the handful?? Suddenly, over 3 months’ time?

MM: (shrugs)

Me: But my mouth has gotten smaller, I know this because I can look at it and see.  And I have no wrinkles, and I get a malar rash when I go out on sunny days. (scleroderma and lupus symptoms)

MM: Your mouth isn’t getting smaller.  Enjoy the fact that you have no wrinkles.  Whatever rash you think you get from being in the sun, it’s not a malar rash.

Me: Low-grade fever?  Sudden and severe weight loss 2 months ago?

MM:  That’s why you need to be tested for cancer.  When was your last mammogram, last pap smear?

Me;  Last year!!

MM: You also might just have a new temperature set pont.  Maybe that’s your new normal.

Me;  From a normal of 97.8 to 100.6????

MM: (shrugging) Happens as people get older.

She then told me that she doesn’t just go by labs, she goes by the exam too.  And she saw no evidence of skin tightening anywhere.  The fact that I told her I did have that, just that it was intermittant, didn’t mean anything because she clearly didn’t believe me.

She said she would send my doctor a note.  I was thinking I would do the same thing.

I left, but forgot my cane (which I use when my back is troublesome).  She picked it up and asked, teasingly, if she could keep it.  Then held it back as in ‘keep-away’.  Which, when you think about it, is pretty cruel.  I snatched it and left.  She was giggling.

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