Sunday, January 5, 2014

A Health Care Partnership

Early spring 2011 at Hoganvillaea Farm: beets, peas, onions.


This is the story of a relationship that triggered a major transformation in my life this past week.  I could call it a doctor-patient relationship, only I wasn’t often a patient.  Over the last twenty-five years it became a partnership for the sake of my health and well-being.

When I was forty-one, I sought out a local family doctor to help me make lifestyle changes.  He suggested more exercise (I got very little) and sent me to UNC Hospital to get a chest x-ray.  I’d been avoiding this teaching hospital because it was so big that it was easy to get lost between all the specialities, and I told the resident this. 
He had to approve the chest x-ray and told me that a new doctor had been brought in to work on this very thing–preventing patients from getting lost as they were referred to various specialists.

I made an appointment with Dr. F, and she was my primary care doctor for ten years.  I argued with her sometimes and she listened. She made sure she negotiated my way in the hospital and prescribed as few tests as possible.  About 1988, when I was fifty-one, she left the hospital and gave me to another internist, Dr. H.  

I remember arguing with him early about hormone replacement therapy.  I’d passed easily through menopause and saw no reason to interfere with my hormones.  He was concerned about osteoarthritis.  Years later he said I was right.  Some of those HRT drugs led to cancer.  By this time I was getting regular exercise and was eating in a healthier way, making my own high-protein bread, and leading a very active life (teaching more than full time under NEH grants, running a small press, and I’d recently given up running the state’s new Writers’ Network, not to mention raising teenagers, who were now leaving the nest).

Normally I saw Dr. H only once a year for a general checkup.  He suggested losing weight, but he never pushed me.  He said, “The more exercise the better as you age.”  By 2006 I weighed close to 190 pounds, and I couldn’t fit into the dress I’d bought for my son’s wedding.  I started eating less and walking more, and I did wear the dress.  I kept up that routine and slowly my weight dropped to 165 pounds.

A few years ago he tested for my cholesterol, which he’d never done as my blood pressure was good.  The test was around 200 and borderline.  He wanted me to take the statin medicine.  I said no, those statins gave other problems.  A year later he had researched alternatives to statin in the People’s Pharmacy books (Joe and Terry Gradon), and he recommended red yeast rice in capsules, and eating oatbran.  I already ate oatbran cereal in the winter and put it in my bread.  After taking red yeast rice for a year, my cholesterol came down.

He never ordered tests unless absolutely necessary.  Around 2007 he said to discontinue the glucosamine I was taking for my creaky knee.  He said my walking was enough.  Then maybe two years later, he said discontinue the multi-vitamins but take extra Vitamin D.  So by 2012, my “drugs” were Red Yeast Rice and Vitamin D. During the year my health problems were usually “normal,” like a poison ivy rash or a urinary tract infection.  

In 2012 I’d noticed my heart beating irregularly and consulted him. He listened to it carefully and said it was skipping a beat.  We went over all the heart attack symptoms.  I had none of them.  He said it was the part of my heart that controlled the beat and not to worry about it.  I decided to stop drinking coffee and to eat more fruits and vegetables (five times a day).  The heart returned to normal beating.

Meantime I had some “dis-connected” (= dislocated) toes on my right foot and was referred to an orthopedic foot specialist, who gave me a little pad for metatarsal support, and I changed to wearing $100 exactly fitting shoes.  I had osteoarthritis in my toes. 
I had heard that sugar aggravated arthritis, and so I gave up sugar and substituted honey.  I lost more weight, down to 158 pounds as of December 2013.  In my 20s I weighed about 150.  This was a good weight, and I hadn’t even expected it to happen. My toes stopped hurting.

I saw Dr. H on December 13, which was supposed to be our last appointment, as he told me he was retiring at the end of March.  I’d been afraid of this.  He let me choose my next doctor.  I knew how rare he was as a listening doctor. I said I was worried they would try to push medicine on me, and he said doctors were supposed to listen to their patients.  I could try one of the other doctors in the practice first and see if that was a good fit.  He told me I wouldn’t have to have any more mammograms and my heart sounded good.

I realize now that over those twenty-five years we had come to trust each other.  What builds this kind of trust with a doctor?  It’s not unlike trusting your mechanic, and I’ve had a wonderful one for even longer.  You have to trust that they’re good, know their business, also they listen to you and give advice when it really matters, when you or your car need something, but not for the sake of getting money or some use out of you.  They can tell and fix the essentials but let the non-essentials go.  You trust their expertise and their judgment.  You trust their word, and they’re honest.  If they don’t know or can’t find anything wrong, they tell you.  Their goal is to keep your car in good working order, your body, healthy. 

They also trust you to take care of your car or your body (I had to learn to do both–now my mechanic tells me I can get more miles out of a car than anyone he knows, and my doctor points to how most people my age take 10-12 prescription drugs a day).

It’s like Abraham Maslow’s idea that the only protection/preparation for life that we can give our children is teaching them to cope with whatever comes along.  A healthy body can also cope best of all with disease and occasional bodily glitches, unexpected changes or events.

I think of how I longed to walk on the neurology ward when I was hospitalized in December for tests because of my “left arm numbness” episodes) (cf blog for December 25, 2013).  The doctors and nurses feared I’d fall, but my body somehow “knew” I needed to walk.  They focused on preventing falls, and I focused on staying healthy and returning to normal health.  Dr. H was focused on healing me.  The neuro docs focused on studying me and trying to find my problem.  They wanted to prevent more episodes, which they called seizures.  Dr. H figured out what I sensed, that the medicine and further tests might set me back.  I needed to summon the resilience of my body, not hamper its healing.

Back in 2012, I told him I was having some balance problems, and he recommended using a cane.  He didn’t want me to fall.  I said, “I can’t farm with a cane.”  In our December 13 appointment, I told him I hadn’t fallen in the last year and was doing “standing on one-foot” balance exercises, and I could catch myself better.  

He told me on Dec 13 that he was going to do some writing after he retired, and maybe he would take a class with me.  Also he wanted to buy some of my healthy bread.  In the hospital they did all those expensive tests and discovered how healthy I was, though they never mentioned this.  Dr. H knew because he had listened to my heart, talked to me, checked my feet for good circulation. 

Following the hospital experience, he studied my discharge report and all those test results, and I told him everything, gave him the blog I published on Christmas Day, described how I’d fought with the doctors.  

He said, “What do you want me to do?”

I said, “Help me with those doctors.  I don’t want them to increase the dosage of the anti-seizure medicine.”

He said, “You did absolutely the right thing.”  He agreed on keeping the low dosage.  He gave me his home phone number. Monday, the 30th, I called and left a message that I’d had only one episode since I left the hospital the Monday before. It happened Saturday night the 28th, but I wasn’t worried.  He called me January 2 and said I should return to my normal active life.  It took me a few minutes to register what he was saying.  “You mean I can drive?”

“Yes, it’s not life-threatening.  You don’t lose consciousness.”  I said I’d told those hospital doctors that I could manage the car and pull over even if I had an episode.  They, however, pulled out the big guns and said DMV wouldn’t let me drive if I had seizures.  Dr. H said he wasn’t sure that seizures was my correct diagnosis.

What a transformation.  I said, “that’s freeing.”  After I got off the phone, I realized that the result of my hospital stay, not being allowed to walk by myself, being sent home with a cane, not being allowed to drive had set me worrying I’d push too hard if I went back to my normal level of activity, which isn’t actually that stressful as I do change activities and take rests regularly.  I’d been setting up arrangements to have people take me to shop, back to the doctor, etc.  I was feeling too helpless.

Then came Dr. H’s words.  “Return to your normal active life.  You may have more episodes but don’t worry about it.  People live with such things.”  I felt almost drunk.  The next day I drove to the post office and to town for groceries and the bank.  I wrote to all my helpers, my kids, and my friends that I was able to drive now.  I took Wag for the walk we both love and had missed for two weeks.

I was tired that night but I slept well.  I’ve had another normal active day this Saturday and no more episodes.  I can tell by my mental state that I’m healing, and I know that Dr. H is a true iatros–healer.  That Greek word iatros is in our language, in psychiatry (mind or soul-healing), in pediatrics (child-healing), and also in a word I didn’t know about: iatrogenic: generated or induced by the physician as in physical or mental ailments resulting from the treatment or from an alarming diagnosis.  Dr. H obviously knew about this, and caught it early.  What a gift!


Orchid and daffodils on Judy's kitchen table, March 2012.

1 comment:

  1. Judy, I have a doctor like yours. I dread thinking he'll retire someday. However, Aetna, my health care provider insists I see him twice a year and get lab tests twice a year and a mammogram every year. I'm not sure if they can make it miserable for me if I deny those things or not. I know they bug my doctor about it.