I need some advice. Per your recommendation, I went to see a cardiologist regarding my occasional episodes of crushing chest pain and possible Prinzmetal’s angina.
Yesterday I saw Dr. C.
Upon reviewing my medical history, Dr. C stated that he felt he had to be honest in saying that a patient with my health issues— paresthesias, IBS, pelvic pain syndrome, pain with menstruation and/or heavy periods, previous depression, post-herpetic neuralgia, and other difficult-to-verify conditions—most likely has no actual illness other than mental illness. He said that it would be my task to demonstrate that his “doctor’s bias,” as he called it, was wrong. He also stated that any American doctor probably stopped listening to anything I was saying once he or she got half-way through my medical history. I am sure that my (dubious) diagnosis of bipolar disorder also greatly damaged my credibility as a patient not only yesterday, but with all doctors I've seen in the past few years. I am keenly aware of the stigma associated with it.Dr. C said that regardless of his bias, he would still perform due diligence and send me for blood work, a stress test and echocardiogram. Angiograms are no longer used to diagnose angina.
I am not sure what to do. Part of me is overwhelmed with dismay at the thought that all this time I have been referred from doctor to doctor because nobody wants to deal with a patient like me. Dr. C strongly implied that this is what doctors do when they are too polite to tell a patient they think she’s nuts.
I’ve spent a tremendous amount of time and money trying to address what I perceive as very real discomfort (all of the conditions mentioned above). It’s emotionally distressing to have a doctor tell me that what I am actually dealing with is rampant mental illness and attention-seeking, and all I really need is to pursue meditation (and the reason that hasn’t worked for me thus far is that I just haven’t tried hard enough).
My understanding of Prinzmental’s is that half the people who have it don’t have atherosclerosis, high blood pressure, or high cholesterol—the things Dr. C will measure and conditions I’ve never been known to have previously. At this point, I need some guidance. If the tests don't show a blockage, then I assume this means I wasted everyone's time with my (I will assume) imaginary chest pain.
Is it even worth me emptying my vacation savings account for these tests? If I've never had the precipitating factors for heart disease that are going to be tested, does this mean that Dr. C is right and the episodes of non-stress-related chest pain are nothing more than a manifestation of mental illness?
Should I just stop worrying about the chest pain and all of the other things that make my life difficult and ignore them from now on?
I’m having trouble accepting the time and expense of Dr. C’s tests if, in fact, he has already concluded that he’s only doing it to indulge me.
My thought is that if he is right and all of the doctors I’ve seen in the last couple of years have been surreptitiously treating me as a hypochondriac, then maybe I should stop now with being concerned about things like transient chest pain and the rest of it. I don’t feel that I need to have tests just to satisfy my curiosity, especially if there’s no valid medical reason for it. However, I'm just the mentally ill patient, so what do I know?
I’m just not sure how to proceed. Are the tests worth the time and expense given my apparently spurious medical history?
I will articulate my concerns to Dr. C, as well, but I would appreciate knowing your thoughts.
Thank you.
May Voirrey
4 comments:
It's called 'somatization'. Though it is a form of dissociation, it's a far cry from being nuts. You're NOT nuts. If it turns out that there is no medical cause, then you could set about trying to figure out what it is that is being somatized and find another way to express it.
The thing is, back in December when I was being evaluated for MS, I talked to my psychiatrist about this very thing. He said,"I think I've known you long enough and I'm familiar enough with your condition that I can tell you very assuredly that you do not have somatization disorder and you do not have conversion disorder. Trust me, May, this is my thing to know!" And then he had a good-natured chuckle about it.
But he also went along with the BP dx. You can't just take someone's word (as you know) when it's one of those things that has no proof. That is when *sigh* we have to take our time and really dig in an try to figure stuff out on our own.
(Want to hear what the cynical side of my head is saying? It's saying the shrink could not use a dx of somatization to load up more drugs, therefor you don't have it. -- Told ya it's cynical.)
You are the only person qualified to figure this out.
I like my psychiatrist and I trust his opinion, especially after he undid all of the wrong medication choices that other doctors had made on my behalf.
If anything, Dr. B has always encouraged me to concentrate less on the dx and more on how I feel and how I'm functioning in the world. He has always told me that he can make medication recommendations and write prescriptions, but only I will know what works best and which things I don't need.
He's not a big ego guy. Very laid back, in fact. He gives me a lot of control over my own care.
He does, however, insist that my history indicates an accurate dx of BP, even if it was once latent and is now invisible. Apparently, once you have a big, melty breakdown, it's on your permanent record.
That being said, he treats me like a well person trying to stay well, not like a sick patient trying to get well.
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