Is there a Dr. House in the house?

August 27, 2006 9:05 PM

After a long battle with mysterious chronic health symptoms, I'd like a "medical detective" to help me get to the bottom of what might be ailing me. But, what kind of doctor do I need? (If you are squeamish, move along...nothing to see here.)

Since high school (I just turned 40), I have been treated for this or that separately (depression, hypothyroidism, unexplained lactation while not pregnant...nice, eh?, ruptured ovarian cysts, excessive sleepiness, stress-induced candidiasis, yadda, yadda). I hate going to doctors because I often think that THEY will think that I am a hypochondriac or something.

I am treated by different doctors for different things. I have an OB/Gyn, a general practitioner who I rarely see, and a doctor that specializes in medical treatment of depression.

I've ignored or just powered through the ups and downs of my symptoms for decades, dealing with individual symptoms as they get unmanageable. But now that I have an 8-month old, I'm beginning to think that I should deal with this more seriously. Especially since I'm noticing effects on my health/mood via pregnancy and nursing.

I'd like to have my prolactin levels and my progesterone levels checked. I'm wondering if I have prolactinoma (there is a long explanation for why I think this might be possible) or something wrong with my pituitary.

What kind of doctor deals with this? Who would I look for? Is there one type of doctor that would approach this diagnosis systemically? Or would I have to (please no, please no) see more than one type of doctor?

posted by jeanmari to Health & Fitness (20 answers total)

Best answer: If I were you I would see an endocrinologist.
posted by fshgrl at 9:08 PM on August 27, 2006

Also, be sure to find a doctor who you like and trust. I realize that it can be difficult with todays FUBAR health care system, but it makes a world of difference.

Your attitude towards doctors disturbs me a little - sounds like you've had some issues in the past. Like it or not, you have to trust them if you want to get better, though.
posted by chrisamiller at 9:24 PM on August 27, 2006

I know you are already being treated for hypothyroid, but I wonder if your levels are still a bit low. Some people feel better at the higher end of normal. Hypothyroid will mess up everything from your period to your mood.

"Like it or not, you have to trust them if you want to get better, though."

Um, no. Obviously, it would lessen the OP's stress if she could find a doctor she likes, but patients get better because doctors diagnose correctly and prescribe appropriate treatment, not because patients "trust" them. I think a healthy amount of skepticism is fine and probably a good idea: it's her health, after all.
posted by Violet Hour at 9:42 PM on August 27, 2006 [1 favorite]

You're talking about an internist/general practioner. You have a lot of symptoms--they know a lot of diseases, and can refer you for more specialty care.
posted by gramcracker at 10:04 PM on August 27, 2006

Could be PCOS. Just an idea. Depression often goes with it, and I know plenty of people who have it without every symptom (excessive hair or whatever).
posted by bonheur at 10:05 PM on August 27, 2006

The "... who I rarely see..." set off alarm bells.

Maybe it's different in the US, but general practitioners around here are supposed to be notified by everyone else you see. A GP is supposed to review these incidences and take them altogather to better administer to your health... and be able to discuss with you what it all means in plain language.

Are you comfortable with your current GP? Do you repsect his competency?
posted by porpoise at 10:20 PM on August 27, 2006

It is different in the US where GPs are rare as hens teeth and don't review crap. A nurse or PA advocate might be a better bet.
posted by fshgrl at 10:33 PM on August 27, 2006

Best answer: Sounds like an endocrinologist is what you want, as fshgrl said. A decent GP would help, but these days, they just seem to be the keepers of the insurance referral forms. If it can't be dealt with in 7 minutes, forget it.

I used to have better luck with DOs, but the last few I saw weren't any different from a bad to mediocre MD (just throw prescriptions at you until you go away).

Unfortunately, what is possible will depend on what kind of insurance you have.
posted by QIbHom at 11:12 PM on August 27, 2006

For a lot of women in the US, the OB/Gyn is the equivalent of the GP. He/she is their primary care physician.
posted by litlnemo at 11:18 PM on August 27, 2006

Best answer: This is a guess, I'm a pharmacologist, not a physician, but perhaps you have a benign growth on your adrenal gland. Hypercortisolism has some of the same symptoms as hypothyroidism.
If you had a high hypercortisolism, it would be obvious to a physician, so I'm guessing something moderate. Are you overweight? That often goes with hypercortisolism or PCOS.

Either way, it would be an endocronologist.
posted by dances_with_sneetches at 6:24 AM on August 28, 2006

another vote for endocrinologist
posted by matteo at 6:28 AM on August 28, 2006

Best answer: jeanmari, are you able to get to Evanston easily? My GP, associated with Northwestern but in an office on Davis, is FANTASTIC. Seriously. She has always been so responsive to me and I bet she would be able to send you in the right direction. I would definitely recommend her. Let me know and I'll drop you an email.
posted by sugarfish at 6:31 AM on August 28, 2006

third (or fourth) the endocrinologist. the symptoms and problems you describe are right up their lane.
posted by mirileh at 6:47 AM on August 28, 2006

With your plethora of symptoms/problems, I would recommend getting yourself to the Mayo Clinic. They are amazing there (my experience was wonderful) and you will be in a room with every specialist from every discipline you can think of - all your bases will be covered. Sounds like a complete evaluation is what you need.
posted by meerkatty at 6:52 AM on August 28, 2006

Response by poster: Sounds like an endocrinologist or neuroendocrinologist would be the place to start. :) And sugarfish, I am about 10 minutes from Evanston so I would love the rec!

More info...I'm not overweight but I've always been pretty thin (genetic) and now I'm not. (My BMI has gone from 19.6 to 23.5). But, you know, I'm 40 now so I don't think that is terribly unusual. I have tested positive for sleep apnea.

The reason why I'm especially interested in finding a specialist? I have experienced the "here is a prescription for that symptom" approach from the three doctors I have. But no one has ever sat down and said, "Let's see if any of these things are related." Plus, (early on), I've had a doctor be very dismissive about my strange lactation. They attributed it to my prescription for antidepressants, but I had been mysteriously lactating for 6 years before I was prescribed any AD's. So, that was really frustrating.

Thanks all.
posted by jeanmari at 8:12 AM on August 28, 2006

Go to an endocrinologist. My mom had some similar symptoms (inexplicable lactations, exhaustion, etc, and it turned out to be a pituitary adenoma), and the endocrinologist was the only one who made her feel like she wasn't crazy (because the GP doesn't deal with specialized things and just kept treating individual symptoms). It'll be worth it just to put your mind at ease that what's going on can be dealt with. :)
posted by monochromaticgirl at 8:19 AM on August 28, 2006

I have hyperprolactinemia, your symptoms sound wildly familiar, so I think you're on the right track. You need a good endocrinologist!
posted by headspace at 8:21 AM on August 28, 2006

I saw Dr. Erica Sinsheimer at Old Orchard when I lived up there-- great endocrinologist.
posted by orangemiles at 9:45 AM on August 28, 2006

It's unlikely that anything specifically diagnosable is wrong with you. Far more likely is that a constellation of issues is at the root of the problem (sleep apnea can turn a person's life upside down if not addressed). A good endocrinologist will be able to tell you all the things that are right with your system (thyroid, adrenals, pituitary, pancreas, etc.) but if there were something truly awry with your body from a physiologic standpoint time would have brought it to light by now. No reason not to keep searching, though, but it may be that no doctor ever felt like they could tell you that there simply wasn't a unified medical explanation for all your various symptoms. The fact that you have struggled with this since high school would suggest that whatever is going on is more a subset of constitutional issues than a specific ailment. But for some patients, it only makes them more frustrated to be told that by the standards and limits of modern diagnostic medicine they are not, in fact, sick.

Good luck.
posted by docpops at 5:09 PM on August 28, 2006

Response by poster: Thank you, docpops. I know. But I feel I owe it to my daughter to at least get checked out. Before, when I would become depressed and exhausted, my spouse could still take care of himself. But I am the one that has to take care of her. So, I'm going to do my damndest to try to find out if something fixable is wrong with me.

Something that has always bothered me? When I had to switch AD's about 4 years ago, I experienced terrible symptoms. Small seizures, intense headaches, trouble putting sentences together, and more. My doctors insisted that there were no withdrawal symptoms listed for this med. That med was Effexor and it was uncovered that Effexor can have severe withdrawal effects for some patients. I was the one who actually found the information online and brought it to my doctors, who are very, very competent doctors associated with Northwestern Memorial Hospital here in Chicago. Very smart folks. However, until I found that info, I felt like I shouldn't be feeling the way I was feeling and that I wasn't "allowed" to have the pain that I had.

Yes, maybe there is no systemic condition and, therefore, no fix. But I'm curious about the link between prolactin, dopamine, cortisol, progesterone, histamine and my thyroid. Even learning more about that in regards to my own body would be something. Maybe I'm asking too much, maybe modern medicine doesn't know about such things yet. But I've never been to an endocronologist, so I think I'm going to give it a shot.
posted by jeanmari at 9:29 PM on August 28, 2006 [1 favorite]