4 ms·

I had blood pressure issues of 25 years. “Lose more weight”. “Less sodium.” “More medications. “ (four to control my BP at its peak) Four cardiologists. Thr

by aantix 3y ago

I had blood pressure issues of 25 years. “Lose more weight”. “Less sodium.” “More medications. “ (four to control my BP at its peak) Four cardiologists. Three nephrologists. All have WebMD level recommendations at best. I do my own research. I see hyperaldosteronism as a possibility. Cardiologist didn’t think so. But reluctantly gives an endocrinologist referral. Yes, I have it. Had my left (overactive) adrenal gland removed because of it. Now, BP is normalized with significantly less medication. Your health is in your hands. Do your own research. No one else will save you, including the doctors.

RandomLensman 3y ago
I wonder if these things are somewhat caused by systems that need referrals. Btw., you still needed someone to remove your gland, I take it, so at that point someone else actually did their job, no?
- aantix 3y ago
  The surgeon did her job regarding the adrenal removal. Agree. But even with my consultation with her, I bring up the problematic adrenal and the possibility of it being a pheochromocytoma. She says "For that, I would have to see a scan about 10 years before to see if there's any growth." To which I responded, "You mean like my PET scan from 2008 of the same region mentioned in the first paragraph of your report?" She barely read my report. Sloppiness. Parallels with the software industry - I think doctors could benefit from being paired with a complimentary doctor to act as a team and to check each other's work. I think they simultaneously have a god complex for which their assessments are rarely checked. They need social pressure to probe further.
  - RandomLensman 3y ago
    Would it had mattered prior to surgery if it was a different type of tumor (and rare at that)? Otherwise, I could see why that isn't a discussion worth having anyway.
    - aantix 3y ago
      It may not have mattered. A response of "A cancerous pheochromocytoma is incredibly rare. I don't see any other signs of cancer, so I didn't think to analyze those scans." That would be a completely reasonable response. But a deer-in-headlights, "I had no idea" type of look, is sad. She is a gland expert. Probably getting paid $500/hour for the consultation. The least she could do is know the bare minimum of my history outlined in the report. That is not an unreasonable standard.
      - riahi 3y ago
        Did you have a pheochromocytoma or just a hormonal active adrenal adenoma? Pheos don’t typically make aldosterone. They tend to make epinephrine and derivatives. Different cell lineage; different endocrine responsibility.
        aantix 3y ago
        Benign adrenal adenoma. From the pathology report: "Representative sections predominantly consist of a normal adrenal gland with intermixed adrenocortical tissue and medulla. A distinct nodular area is present with prominent foamy-type clear cytoplasm reminiscent of normal adrenocortical tissue. No significant cytologic atypia, necrosis, or increased mitotic activity is present. These findings are consistent with an adrenocortical adenoma. Note: this area appears to be limited to the adrenal gland although some adrenocortical tissue is present in the adipose tissue outside the capsule that morphologically appears dissimilar to the nodule and likely represents normal/benign tissue. Clinical correlation recommended."
        riahi 3y ago
        Tough case. Adrenal adenomas are common incidental findings. ~15% are hormonally active, which means the vast majority are not. As a radiologist, I sometimes wonder about whether I make too many recommendations to referring doctors (consider endocrine evaluation for a potentially hormonally active adrenal nodule). A FREQUENT attack on us as a specialty is that we "find too many incidentals" (see attacks on mammography, breast cancer screening, other sorts of screening, ad nauseam). Perhaps I'll keep doing the adrenal nodule recommendation, although I usually only make the recommendation if it's 1cm or larger.
  - resource_waste 3y ago
    I agree, the self imposed doctor shortage have caused God Doctors that think they have every diagnosis. We need more doctors, but the cartel limits it.
beoberha 3y ago
That’s great for you! However, what a sad state of affairs that it took effort on your part to uncover your own diagnosis like that. I wonder why. There’s a few levels to it like 1) why didn’t doctor not even think of it 2) why was he so hesitant to give a referral. I try not to be cynical and give doctors the benefit of the doubt
- caeril 3y ago
  > 1) why didn’t doctor not even think of it This is such a strange question. Of course they thought of it. Imagine you're a software developer, and you're not paid on the basis of software quality, responsiveness, features, or any other standard metric. You're paid on number of bugs closed, even if the bugs are only closed temporarily. Your incentive structure is such that if you write a kludge for a bug, close it, and there is a regression on that same bug in 3 years, you get paid twice for the same bug. Now you know what it's like to be a physician. Maybe when you were younger, you idealized making great quality software. But as of now, you'll make way more money putting band-aids on bugs and your lifestyle already requires a $20k monthly nut for your instagram "model" girlfriend's travel requirements, so you do what you have to do. This is the world of medicine. You don't care about the patient, you probably know what the correct diagnosis is, but this other diagnosis will make sure that the Eli Lilly pharma rep will top you off in the handicap stall at your next "meeting" if you hit those prescription quotas, and your patient will keep up your billables, so that's what you choose to do. Also, the last thing you want to do is refer your patients to that asshole gland removal surgeon, because he has a better handicap than you do at the Doctor's Country Club, so fuck him. You will NEVER go wrong assuming the worst of physicians. Keep your BMI on the low side, exercise regularly, and avoid known carcinogens. If you're lucky, this approach will delay you from ever having to interact with these psychopaths until your sixties.

by aantix 3y ago

RandomLensman 3y ago

I wonder if these things are somewhat caused by systems that need referrals. Btw., you still needed someone to remove your gland, I take it, so at that point someone else actually did their job, no?

aantix 3y ago
The surgeon did her job regarding the adrenal removal. Agree. But even with my consultation with her, I bring up the problematic adrenal and the possibility of it being a pheochromocytoma. She says "For that, I would have to see a scan about 10 years before to see if there's any growth." To which I responded, "You mean like my PET scan from 2008 of the same region mentioned in the first paragraph of your report?" She barely read my report. Sloppiness. Parallels with the software industry - I think doctors could benefit from being paired with a complimentary doctor to act as a team and to check each other's work. I think they simultaneously have a god complex for which their assessments are rarely checked. They need social pressure to probe further.
- RandomLensman 3y ago
  Would it had mattered prior to surgery if it was a different type of tumor (and rare at that)? Otherwise, I could see why that isn't a discussion worth having anyway.
  - aantix 3y ago
    It may not have mattered. A response of "A cancerous pheochromocytoma is incredibly rare. I don't see any other signs of cancer, so I didn't think to analyze those scans." That would be a completely reasonable response. But a deer-in-headlights, "I had no idea" type of look, is sad. She is a gland expert. Probably getting paid $500/hour for the consultation. The least she could do is know the bare minimum of my history outlined in the report. That is not an unreasonable standard.
    - riahi 3y ago
      Did you have a pheochromocytoma or just a hormonal active adrenal adenoma? Pheos don’t typically make aldosterone. They tend to make epinephrine and derivatives. Different cell lineage; different endocrine responsibility.
      - aantix 3y ago
        Benign adrenal adenoma. From the pathology report: "Representative sections predominantly consist of a normal adrenal gland with intermixed adrenocortical tissue and medulla. A distinct nodular area is present with prominent foamy-type clear cytoplasm reminiscent of normal adrenocortical tissue. No significant cytologic atypia, necrosis, or increased mitotic activity is present. These findings are consistent with an adrenocortical adenoma. Note: this area appears to be limited to the adrenal gland although some adrenocortical tissue is present in the adipose tissue outside the capsule that morphologically appears dissimilar to the nodule and likely represents normal/benign tissue. Clinical correlation recommended."
        riahi 3y ago
        Tough case. Adrenal adenomas are common incidental findings. ~15% are hormonally active, which means the vast majority are not. As a radiologist, I sometimes wonder about whether I make too many recommendations to referring doctors (consider endocrine evaluation for a potentially hormonally active adrenal nodule). A FREQUENT attack on us as a specialty is that we "find too many incidentals" (see attacks on mammography, breast cancer screening, other sorts of screening, ad nauseam). Perhaps I'll keep doing the adrenal nodule recommendation, although I usually only make the recommendation if it's 1cm or larger.
- resource_waste 3y ago
  I agree, the self imposed doctor shortage have caused God Doctors that think they have every diagnosis. We need more doctors, but the cartel limits it.

beoberha 3y ago

That’s great for you! However, what a sad state of affairs that it took effort on your part to uncover your own diagnosis like that. I wonder why. There’s a few levels to it like 1) why didn’t doctor not even think of it 2) why was he so hesitant to give a referral. I try not to be cynical and give doctors the benefit of the doubt

caeril 3y ago
> 1) why didn’t doctor not even think of it This is such a strange question. Of course they thought of it. Imagine you're a software developer, and you're not paid on the basis of software quality, responsiveness, features, or any other standard metric. You're paid on number of bugs closed, even if the bugs are only closed temporarily. Your incentive structure is such that if you write a kludge for a bug, close it, and there is a regression on that same bug in 3 years, you get paid twice for the same bug. Now you know what it's like to be a physician. Maybe when you were younger, you idealized making great quality software. But as of now, you'll make way more money putting band-aids on bugs and your lifestyle already requires a $20k monthly nut for your instagram "model" girlfriend's travel requirements, so you do what you have to do. This is the world of medicine. You don't care about the patient, you probably know what the correct diagnosis is, but this other diagnosis will make sure that the Eli Lilly pharma rep will top you off in the handicap stall at your next "meeting" if you hit those prescription quotas, and your patient will keep up your billables, so that's what you choose to do. Also, the last thing you want to do is refer your patients to that asshole gland removal surgeon, because he has a better handicap than you do at the Doctor's Country Club, so fuck him. You will NEVER go wrong assuming the worst of physicians. Keep your BMI on the low side, exercise regularly, and avoid known carcinogens. If you're lucky, this approach will delay you from ever having to interact with these psychopaths until your sixties.