Poverty and the Search for a Diagnosis – Hidden Costs of Healthcare. Plus RWNJ News.

Sorry, had to update after initially publishing because a certain cat was trying to eat my laptop cord and I accidentally hit “publish” too soon.

Very brief lesson in parathyroid glands, calcium, Vitamin D, and doctors who don’t give a crap.

Health update:  Latest test results revealed a parathyroid hormone level (PTH) of 233 pg/ml, which is way over the upper limit of the range (13.2-98.4 pg/ml, which is somehow different at UPMC Altoona labs than the oft-cited 10-65 pg/ml that everyone else has).

My calcium was 9.2 (normal).

My Vitamin D levels were an extremely low 8.7 (normal range is 20-50 ng/ml).

In January, my calcium was 10.4 (too high for someone my age).  My PTH was 60.3.

The problem with that was, as your calcium levels rise, your production of PTH is supposed to shut off – so in this case, it wasn’t “suppressed” and it should have been somewhere around 20 pg/ml or lower.

When I asked Dr. Asshat about this, in January, he just shrugged and said my calcium “isn’t high”.  I tried asking him – 3 times – why the PTH was so high (60.3) when the calcium was high (10.4), and he just kept changing the subject, or said, “I don’t see anything abnormal, your symptoms don’t fit.”

When I asked him this past Monday why the current PTH level was so high (233), he responded as I guessed he would: “Your Vitamin D is too low.”  Yes, Vitamin D deficiency can cause high PTH levels, but then I asked ok why did I have the high calcium and normal-high PTH levels last time?  Those aren’t indications of a Vitamin D deficiency.

He just kind of looked at me.  Now you know why I refer to him as “Dr. Asshat”.

I knew he was going to mention Vitamin D, because it’s the easiest explanation if you disregard the January test results.  He reiterated, as he decided to order 2 more tests, that he doesn’t see an endocrine basis for my symptoms.  Here, then, are some of the symptoms of hyperparathyroidism that I have:

Loss of energy

Sleep problems

GERD (gastric acid reflux)

Kidney stones

Labile hard to control blood pressure

Nausea and vomiting

Heart palpitations

Headaches

Facial flushing (hyperparathyroid crisis)

Diarrhea

(“Symptoms of Hyperparathyroidism”, www.parathyroid.com, and “Hyperparathyroidism Symptoms”, www.uptodate.com)

When pressed, he asked me, “Are you on Metformin?” which is a diabetes drug.  I do not have, nor have I ever had, diabetes.  When I answered with a fairly stunned “no”, he then asked me if I “had anxiety”.

This guy, sitting at his laptop, doesn’t even know what’s going on with the patient sitting in front of him.  He can’t remember and I guess he doesn’t take good notes because he still asks stupid questions with the medical record open right in front of him.

I told him, “No, no anxiety”.  He replied, “Oh yeah, your metanephrines are low so, no, no anxiety.”

I then asked, “Yeah, about that…the last 3 tests indicate my epinephrine (adrenaline) is too low to measure – is that abnormal and why is that?”

He told me “they should bottle your blood, you’re so mellow”.   He wasn’t kidding.  He then regaled me with a story about highly anxious patients who “sit there and tell me they aren’t anxious when their adrenaline is off the charts”.

Then he told me to go get a test for diabetes, and one for vipoma (cancer test for digestive issues).  And to take 50,000 IU of Vitamin D once a week.  I followed him out…

“But wait!  What if my calcium spikes too high after taking the Vitamin D??”

His response?  “Oh, someone’s been reading! Ok, if it makes you feel better, I will test your calcium in 8 weeks.”

Dirty look from me.

“Ok, 4 weeks then!” he said, somewhat testily.

High calcium levels can cause strokes.  Giving someone Vitamin D whose PTH levels are high due to screwed up parathyroid glands can result in dangerously high calcium levels.

Got my diabetes test back last night – normal.  Vipoma is not back yet but I bet it was normal, too.

I see a doctor in my PCP’s practice next Friday (Dr. Wonderful is, as usual, all booked up for September).  Since I know this man will sit with me until every.single.question I have is answered, I am looking forward to it.

And I will ask him for a referral to another endocrinologist.  I really hope there is another one in Altoona who takes Medicare, because if there isn’t…well, I don’t know what I am going to do.

Can’t travel – no car, and no way to pay expenses of train, etc.

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