I have spent several nights in emergency rooms the last few days. My faith in the ability of the medical system to diagnose serious medical problems is rapidly declining.
UPDATE: Progress. It does appear to be an ulcer; at least, Carafate, which coats the stomach lining, protecting it from acid, is allowing her to do well enough to sleep. My guess is that there was a complex interaction here:
1. Severe nausea and stomach pain almost entirely at night. Reason? Stomach empties out, and acid attacks the lining.
2. Once nausea and pain are part of the equation, and keep happening, stress causes more stomach acid to be produced, aggravating problem 1.
3. Nausea makes food unattractive. So the stomach is now empty most of the time. Loop back to problem 1.
4. The anti-nausea medicine they gave her on E/R trip 1, Zofran, seemed to cause a panic attack. And what does panic cause? Stress. Loop back to 1.
5. Nausea and pain prevent sleep. Concern about not being to resume classes on Wednesday, and the uncertainty as to what was really the cause, causes stress. Loop back to 1.
6. A poor choice of food once she was really hungry caused the stomach to rebel, causing nausea and pain that were probably not related to the ulcer. More stress; return to 1.
I feel so bad for her. At least there is a three day weekend so that I stay home and nurse her back to health.
I don't mean this as criticism of our family physician or the four emergency room doctors. This was a complex constellation of symptoms and feedback loops. I am not sure any of them figured it out in full; I was only able to see the feedback loop in its broad form because I know my wife so well.
One problem is MD's think they are scientists when they really are highly trained pattern recognizers. A doctor with less than about 10 years of experience has to analyze what he or she is seeing. A more experienced doctor sees and is reminded of what he has seen before. You may want another doctor.
ReplyDeleteSounds like a GI specialist needs to be consulted. Probably some more dietary changes will be required.
ReplyDeleteNot being able to eat or sleep sure ain't fun!
We'll all be praying for a speedy and full recovery.
Windy, there is much to agree with in your comment. I used to attend grand rounds at the university hospital that is close to my home. The chairman of the department, an old friend, once told me that they liked my skepticism of the resident's ideas based on my 40 years of medicine. The older docs my age are all retiring because of the coming changes in medicine. I don't think it will be helpful but what do I know ?
ReplyDeletePlease say they're also treating the bacterial infection that causes the ulcer to begin with! It's usually not stress, or food, it is almost always H Pylori.
ReplyDeletephil
If they're going to have her on Carafate for an extended period at the same time as on acid blockers, make sure they coordinate the administration timing of the various drugs as Carafate will block the effectiveness of the acid blockers if given at the same time or in the wrong order. This was a big problem for my 88-year-old Mother last year (and took us days to get straight between the doctors, pharmacy, and assisted-living facility staff). Best wishes for a speedy recovery.
ReplyDeleteThey tested for H. Pylori at the very start. The other cause of ulcers is prolonged NSAIDs use--which was the case for a couple of years to deal with shoulder pain, before surgery to fix it.
ReplyDeleteThanks for the warning about Carafate and acid blockers!
ReplyDeleteBest wishes for her fast recovery.
ReplyDeleteOne problem is MD's think they are scientists when they really are highly trained pattern recognizers.
ReplyDeleteThis is very true, and I agree with the above poster that they get better with experience. In fact, I'd be willing to bet a good doctor and good auto mechanic have many of the same similar thought talents in common.
That's not to say medical school is important, but I think one of the reasons they probably require some practical experience from doctors before licensing them to practice is so they don't go through the default thing people do when they search on Google for symptoms... default to the wrong thing based on symptoms. You go with the mix of symptoms that matches what is most commonly seen.
So in that sense, it's surprising it took them that long to get to ulcer. The H. Pylori negative result probably confused the diagnosis, but the past history of NSAID use should have also supported that.
Unfortunately, the Carafate only helped for a couple of days. Now she is getting worse again. It doesn't look like the doctors have a clue what is wrong with her. She has an endoscopy scheduled for Thursday.
ReplyDeleteI wish her the best Clayton
ReplyDeleteSorry to hear of your wife's problem, Clayton. I will mention her in my prayers tonight. I hope you get a good diagnostician on the case!
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