I know you are not my doctor, but right now, no one is!

September 12, 2008 5:44 PM

Over the last few years, a number of health problems have flared up that I suspect might have something to do with each other: weight gain, fatigue, acid-reflux/loose stools (possibly related to gluten intolerance) and irregular periods. What kind(s) of doctor should I see? I'm in Minneapolis.

I'm 30 years old, female. Oh, and my insurance ends at the end of the year, so there's a deadline.

Weight gain: In 2002, I weighed 200 lbs, now I'm up to 248. This is a lot of weight to gain in 6 years, especially given that I was already quite overweight. There have been some lifestyle changes (went from working outside to a desk job) and my eating habits haven't been the best, but they haven't been the worst, either (whole grains, avg of 4-5 fruits and veggies a day, some junk food, some fast food). I also seem to have a harder time now losing weight: I did Weight Watchers two years ago and lost 15 pounds in six weeks by staying within points and following a Mediterranean-style diet. But this last spring I went back, tried to do the same thing, and lost nothing.

Acid-reflux/loose stools: this has been a problem for a while, but recently has gotten painful enough for me to cut out gluten. I had noticed that my heartburn was much, much worse about an hour after eating anything with wheat in it several years ago, but was sort of in denial and didn't want to give up gluten. Anyway, I started a gluten-free diet this week and poof! No heartburn, and my stools are all nice and firm.

Fatigue: I've been feeling easily fatigued and a bit mentally fuzzy for the last few months. The fatigue is actually helped a LOT by the lack of gluten - I've had a ton of energy this week. But the mental fuzziness is still there. I've always been scatterbrained, but it's reaching ADD levels now.

Irregular periods: this is the part that is freaking me out most and thinking I need medical attention stat. My periods used to be extremely regular - you could set your calendar to them. But this winter they started getting all screwy. After I moved and entered a very stressful phase at work, I skipped one month and then had a super-heavy flow the month after that. Then I quit my job and moved across the country for a new one. I skipped two months and then had a period that lasted, intermittently, for 3 weeks. I know I should have gone to the gyno, but I was hoping this was all due to stress. Well, again I had a long stretch (6 weeks) between periods, and am now in the middle of another long period (2 weeks so far). And these periods are quite heavy, with mucousy chunks in them.

So of course I've been googling my symptoms like mad, and scaring the hell out of myself. According to what I've seen, it could be celiac's (which would address all my issues), a thyroid condition (which would cover the weight, fatigue and menstrual stuff but not necessarily the gastro issues) or - eep! - diabetes (which covers the weight, fatigue and menstrual stuff but not the gastro/gluten issues). And then there's PCOS, which seems to be sort of a catchall.

So now I really want to get this stuff resolved. But it seems like I need to see a gastroenterologist, a endocrinologist, AND a gyno. I got an appointment with a gastro RN for the week after next, but the others have months-long waits. And that's where the time issue comes in: the job I moved here for is just till the end of the year (it was a contract position but they gave me benefits). I can get COBRA after that, and probably will, but I will be moving again, this time to be closer to family and look for a new job. So I'm hesitant to start a rotation of seeing different kinds of doctors, only to have my quest interrupted at the end of the year and have to start all over again.

So, after that long and rambly set-up, my question is: is there one kind of doctor that I can see who will be able to help me address all of these issues? Perhaps some sort of holistic MD? I don't want to go the homepathic route to the exclusion of traditional western medicine, but it would be great to find a doctor that would work with me across sub-specialties and would be knowledgable about stuff like diet and lifestyle in addition to perscriptions. I realize this is the role primary care physicians are supposed to play, but I don't have one with my current plan, and can't get an appointment with a GP till...January (I called several).

And yes, before people jump all over me for this, I do realize it's possible that all these things could be discrete, unrelated symptoms. But given that they have all gotten worse at approximately the same time, I'd like to see someone who will be able to see those patterns if they are there. From talking to friends and other research, I know that these symptoms are often related.

So does anyone have thoughts on the kind of doctor I should be looking for in general, and maybe some recommendations in Minneapolis? Here's my throwaway email:[e-mail].

posted by anonymous to health & fitness (14 comments total)

The problem with trying to identify the specialists you need is that many of them will not see you without a referral from a "gatekeeper" primary care physician, often for good reason. In light of what you have described, the one answer is: internal medicine, a primary care specialty. From there you will branch out, as she directs.
posted by yclipse at 5:53 PM on September 12

These are really general and common symptoms. I had most of what you had at one time and it turns out it was sleep apnea. Who knew? I think going through a generalist is the best thing you can do.

Also, I dont know if youve realized this yet, but you are hunting for a diagnosis. Thyroid is tempting because now you can write everything up to that bad thyroid. These are diagnosis people on the internet like to give themselves. Suddenly managing your weight and diet is the thyroid's fault, not yours! This is the equivalant of doctor shopping for specific prescriptions. Do you think youre not doctor shopping? I noticed you dont plan to call an oncologist.

Chill out. Forget everything you learned on the internet about your health. Find a GP who can see you before your insurance runs out. Do this before you become a full blown doctor shopper and hypochondriac. Lastly, the body you had at 20 is not the body you have at 30. A lot of this stuff is natural.
posted by damn dirty ape at 6:10 PM on September 12

Stop googling your problems - you're not a trained physician and can't correctly diagnose yourself. Go see your regular doctor and stop freaking yourself out. Ask the doctor about going to a gyno, too, or go to one yourself (may or may not be necessary.)

Your health issues, while issues, aren't huge red-flags for me. You gained weight on top of an already significant amount of weight - you've had trouble loosing it. You're tired. You've had a lot of stress and irregular periods. There's also heartburn, which you think is probably linked to your diet.

None of that strikes me super unusual and I agree a lot of it is probably tied together, but I wouldn't look at that and immediately thing "terrible disease!" So yes, they're related - but they all read to me like things that can happen when you're stressed out or have gained extra weight or have a diet that isn't working for your body.
posted by Solon and Thanks at 6:31 PM on September 12

Start with a primary care doctor - probably internal medicine. Many of these can be ruled out by a series of blood tests which a general practioner will be able to order and evaluate. At that point, things may be narrowed down enough to know what to do next or your doctor can help you figure out which specialist(s) would be most likely to help. So, I guess, my advice is to see if you can find a gp who can fit you in. Try both internal medicine and family practice. Sound panic-y but be polite. (Please, please, I'm really worried, Things are getting much worse and I can't wait until January) Also, although you might need a physical, you will probably have better luck just getting a regular appointment and then having the doctor decide if he/she needs you to come back for more. Doctors have only a few time slots reserved for physicals and those do get filled up quickly.
posted by metahawk at 6:32 PM on September 12

Doh, I missed the part about not being able to see a GP right now. What doctors do you have access to on your plan?

A gyno would also be a good choice, I think, since they're used to being the only doctors many women see on a regular basis.
posted by Solon and Thanks at 6:36 PM on September 12

IANAD, but if I was one, I'd diagnose you with the same thing as me: polycystic ovarian syndrome (PCOS) combined with insulin resistance/prediabetes. and a carbohydrate intolerance (or two or three - mine is specifically fructose intolerance). These things are often related to each other.

Before my diagnosis: rapid weight gain, check; fatigue, check; gastrointestinal distress, check; irregular periods, check.

It took years to get dx'd correctly, but once I did, I lost weight, got over the fatigue, my stomach calmed down, and my periods became predictable if not really regular.

I had to change my diet, per my endocrinologist: from vegetarian/low fat to high protein (read: meat), no starches, no grains, no sugars. Basically I eat protein, green veggies, nuts, and a minimum of dairy products, and little else. Additionally I take a couple of meds, but some people are lucky enough to be able to manage these conditions with diet alone.

You would ideally see a reproductive endocrinologist. Most GPs, and many endocrine specialists for that matter, are not familiar with the relationship between PCOS and insulin and weight. Finding a good one is really hard.

The good news? There's tons of PCOS info online, much of it good (and some of it bunk, meant to sell products) and if you think it sounds like you, you can experiment with your diet and see if that helps. Good luck to you!
posted by chez shoes at 7:36 PM on September 12 [1 favorite]

For what it's worth, my gluten intolerance, which showed up out of the blue in college, manifested itself initially as extreme fatigue, unexplained but persistent weight gain, cystic acne, and a messed up menstrual cycle (up to 45 days between periods! and it used to be 31 days like clockwork) before finally moving on to the more classic symptom of stomach cramps. Turns out that the gluten intolerance had messed up my thyroid, a not-uncommon side effect, and my TSH did not return to normal levels (according to two blood tests) until I was at least six months gluten free.

If I were you, I would get a gluten antibodies test from a gastro-enterologist and a detailed thyroid workup from either your primary physician or an endocrinologist. And stay off the gluten!

Hope you feel better soon.
posted by Asparagirl at 8:07 PM on September 12

Keep calling around for a primary care physician, and also get an appointment to see a gynecologist. You should be going to both for a year checkup in any case. Explain to them that your insurance is running out, maybe they can fit you in or will call you if there's a cancellation. People cancel appointments all the time. If you have to see one after your insurance runs out, tell them that you are "self-pay" and they will usually discount the amount charged.

Also, RELAX. Stop googling your symptoms and diagnosing yourself with all the crazy stuff. It really could be anything, but stressing out about only makes it worse. The best thing you can do for yourself is to focus on taking care of yourself instead. Go out and take a walk around the block, get some daily exercise in to relieve stress, and make sure you're eating a balanced diet (take a multi-vitamin, too).
posted by hooray at 8:38 PM on September 12

It doesn't matter what kind of doc you see; it matters that it be a good doc. I'd probably go to a GI doc or an endo guy if I were in your shoes.

I would not waste time with an RN unless something about your health plan requires the RN to gatekeep, in which case your job is to convince the RN to get out of the way and let the doctor at you. Your symptoms are vague enough that you need to see a doctor.
posted by ikkyu2 at 9:30 PM on September 12

It doesn't matter what kind of doc you see; it matters that it be a good doc.

This is such good advice. To find a really good doctor in your area, ask the people who work with them. When I worked in a retail pharmacy I realized that the more experienced pharmacists knew exactly who the good doctors were. Now I work in a hospital, and realize how much the nurses know about who's good around here. If you know a nurse, definitely ask them for recommendations. If not, you could always go into a retail pharmacy (at a slow time, please!!!) and ask to speak to the pharmacist. Make sure it's a pharmacist, not the pharmacy technician, because the pharmacists have likely had more direct contact with the doctors. Tell them what your situation is and ask if they know of a good doctor.

Good luck! I feel for you. I had similar symptoms. For me it turned out to be my hormonal birth control causing the problem, which only got identified by an absolute rock star of an obgyn who I heard about via the pharmacy where I worked.
posted by selfmedicating at 8:35 AM on September 13

your gyn can order the same tests as an internist and since some of your symptoms do seem to be hormonal/gynecological, it's a reasonable place to start. i would go ahead and get an appointment on the books for an internist, too. they usually keep some appointments open for "sick" visits (people who woke up with a fever and need urgent care)--i would be sure to let the scheduler know that you have acute symptoms. the long wait times are usually for routine checkups. just say you have recently and suddenly had a lot of unexplained weight gain, stomach issues and irregular periods, and you are worried enough to want to see a doctor soon. don't mention that it's happened over years, and they won't ask. the clinic may also have walk-in times, so ask about that. be prepared to take the first thing they offer you, and get the time off work to wait for a walk-in if necessary.
posted by thinkingwoman at 9:09 AM on September 13

I would say that you need to see two kinds of doctors: a gastro (who will test you for food intolerances) and a gyno. It's possible that the period irregularity was caused by the weight gain and fixing one might fix the other--or it might not.

If I were you, I would get a gluten antibodies test from a gastro-enterologist and a detailed thyroid workup from either your primary physician or an endocrinologist. And stay off the gluten!

Actually, though, you should keep eating gluten until you see a gastro, as painful as it might be. Depending on how long you've been off gluten and the sort of test that the gastro uses, you might no longer see any gluten antibodies even if you're intolerant/have celiacs sprue--because there's no gluten in your system for your body to react to!
posted by PhoBWanKenobi at 10:00 AM on September 13

Clarification from the celiacish boyfriend: "It's not the antibodies; the damage to your intestine won't be visible in a biopsy if you're not eating gluten because it will heal, and that's the smoking gun for celiacs disease. Everything else is just building inductive argument, whereas the biopsy will tell you deductively if it's really going on."
posted by PhoBWanKenobi at 10:02 AM on September 13

The (anti-endomysial IgA) antibodies also can disappear if you go off gluten for a while.
posted by ikkyu2 at 12:39 PM on September 15