Friday, October 23, 2009

SBFTs and Poor, Confused Gastroenterologists

I'm having fun.  And more importantly, I think the hospital is having fun.

The results of my SBFT are as follows:  Dr. P sees strictures in the small bowel, but they aren't very tight, so he's not concerned that surgery is imminent, but he is concerned if I are still on 40mg/d prednisone... (which I am) 

The problems with this response are as follows:  1) Dr. P is the on-call doctor who is the surrogate for Dr. W who is my not-on-call surrogate for Dr. S who remains incommunicado until next week.  So basically, I have access to nobody who has a "complete" understanding of my history.  I may not be a doctor, but I was close enough to becoming one  four months ago that I can tell you that medical history is kind of important when interpreting the results of any medical test.  Sorry, that's just how it works.  2) Since Dr. P followed up his interpretation of my SBFT with the questions, "are you still on prednisone?" and "what are your current symptoms?", I have deduced that being on-call he did not feel compelled to look at my history before telling me what my SBFT meant.  Therefore, I can more accurately tell me what my test means than he can.  'Ya ready?

My interpretation is as follows:  I think that I was correct in predicting stricture(s) of the small bowel based on the observations that the location is new, and that the pain has been persistent despite the prednisone, which, were this a normal inflammation would have slaked the flare and turned it to scar tissue.  I think that the very slow evolution of nausea/emesis/bloating since April of this year to incredible new pain/back-up supports the idea that a stricture has been developing.
"Patients may not know that they have an intestinal stricture. The stricture may not cause symptoms if it is not causing significant blockage (obstruction) of the bowel. If a stricture is narrow enough to hinder the smooth passage of the bowel contents, however, it may cause abdominal pain, cramps, and bloating (distention). If the stricture causes an even more complete obstruction of the bowel, patients may experience more severe pain, nausea, vomiting, and an inability to pass stools." (1
I think that Dr. P's suggestion that I begin tapering off of prednisone is excellent, considering how long I've been on it and how little it's done to help the problem.  Finally, I think that Dr. P's suggestion that I go back on "soft foods and liquid diet and see if that improves things" is bullshit.  Had he looked at my recent history, he would have seen that I just started reintroducing solid foods, and he would have made the connection that it was probably not a good idea to tell me to take a step backward without suggesting how to help me move forward.  Am I wrong? 

Disclaimer: I know that being a doctor is hard.  I know that insurance companies and Big Pharma have infiltrated the world of medicine in the most destructive and back-breaking ways.  I know that 90% of a doctor's non-patient time is spent dealing with the utter nonsense draped before them by the two monsters that dictate the way they practice medicine.  However, I have absolutely no tolerance for the inability to take ten minutes to figure out what is going on with the patient before making a diagnosis.  The Bernstein paper I cited the other day says something about SBFT's being so ancient that very few are read properly unless they are read in a radiology center with a SBFT specialist.  This observation in concert with Dr. P's seemingly confused and half-assed diagnosis... has me concerned.  But I'm having fun.  Truly.

In other news, this is Lamar.  Due to the extrusive nature of the PPR-face this year, he is part of my Halloween costume.  What.

1 comment:

  1. Know thyself, man. I really think that despite doctors' best intentions and abilities, to a certain extent our judgments are almost always better than theirs. (Call me an elitist, so sue me.) Your analysis sounds perfectly reasonable to me. Besides, the worst that happens is you keep eating solid foods and decide you want to go back to liquid. There's always another option.

    PS. I love Lamar. I'm afraid that if I don't get something together soon, I will become my own Halloween costume this year, which might, frankly, be scary enough.