Wednesday, July 14, 2004

Kwentong doktor

Yesterday I went to Mom's house to see how beet greens that are ready for harvesting look like. We had a brief chat, and she told me about a friend's dilemma.

Mom: You see, Lory, my friends, upon learning that Gary's wife is a doctor, call me all the time to talk about their illnesses. Guess I'm expected to relay them to you to get your opinion for free.

Me: It's okay, Mom. I am actually glad to be of help in any way. It also stimulates my mind anyway.

Mom: Yeah, my friend, not yet in her 50's, she has been suffering from enlargement of her breasts that she went from 34A to 36DD! She has been having a hard time looking fo a bra to fit her, and has difficulty breathing. She has seen 5 doctors and no on her 6th. The last 5 said they don't know what is happening to her.

Me: Are there any discharges? Is the enlargement symmetrical?

Mom: Yes, there is discharge.

Me: How does it look like? DOes it seem to be milk or pus or blood?

Mom: Well she didn't say...but she is terrified of her condition.

Me: Did they perform diagnostic tests like ultrasound and mammogram?

Mom: Yes. She did undergo there and the doctors saw nothing wrong. No cysts, no tumors. But her breasts are so big! She is really uncomfortable with it. And the doctors said they don't know what's causing it.

Me: And the doctors said they did not know what is happening to her? Didn't they have the sense to refer her to a specialist? If I were them I would refer her to an endocrinologist. Seems to me that the symmetrical enlargement is secondary to a systemic problem, and that the discharge, if it looks like milk, might be secondary to a hormonal problem, most probably prolactinoma, a tumor in the anterior pituitary gland. Did they suggest any Cranial CT Scan?

Mom: Well, one referred her to a plastic surgeon for mastectomy....

Me: What???!!!! That would be addressing the symptoms and not really getting to the root cause. No matter if they removed the breasts the problem would still be there unfixed! What is it with these doctors? Do they have licenses?

Mom: Oh, that would be frustrating, we pay so much for the doctors and we don't want them to say they don't know. My friend said the plastic surgeon would do the surgery but that won't be covered by the insurance because it is only for aesthetic reasons. My friend says she is willing to pay for the procedure IF that will solve her problem. They did some blood tests for the thyroid, but the results are not out yet.

Me: What I will do is just I will research on the topic on Prolactinoma and I will bring it to you. You can discuss it with her on the phone so she could ask her doctor the proper questions, and she will study more about the symptoms, if there are similarities.

Mom: I could bring it to her. Maybe it would be better if you can also come with me.

Me: Sure. Just tell me when. I remember one instance in the Philippines when a man in his 40's came to our clinic saying he has been troubled because of easy fatigability. A short walk and he would be gasping for breath. He had been to two doctors prior to us, and ECG and X-ray were done, revealing negative results and the doctors told him there was nothing wrong, implying that he was malingering probably to make disability or sickness benefits. But he said there was something wrong that's why he is desperate to know what it was. I told him if easy fatigability was the problem, then there is something wrong with his oxygen transport system. If lungs and heart were normal, the only thing left to do is check the blood. I requested for complete blood count and his red blood cell count was half the minimum of the normal range. So I dug out further his history, asking whether there was a blood-losing incident, perhaps a chronic bleeding in his GIT, an ulcer, etc. He suddenly answered that he had been having bloody stools everyday that it made him afraid to go to the bathroom every morning. There, I told him...chronic bleeding leading to severe anemia resulting to easy fatigability because the blood can not cope up wit the oxygen demand. I then referred him to the gastroenterologist for some endoscopic exams after requesting further basic tests related to his condition and precribing some drugs to help his anemia. So, your story just tells me that people are the same everywhere. WE have such useless doctors in the Philippines and you have some here too.

So we made the arrangement by Thursday. I did my research when I came home and when Gary came home, while we were having supper I told him about the story of Mom's friend. I haven't even gone to the point where I explained the supposed course of diagnosis when he quipped that it was probably hormonal. I told him, "See? That's what I told Mom! That would be my consideration! You could have been a better doctor than those that she went too!"

Oh...I really admire my husband...He's so intelligent sometimes I am afraid he might even know about medicine than I do...


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