I fell in love with my doc today

I had to have a little physical today so I could renew a prescription for a year. It was fine, really, because I was able to share with my primary care physician the biometric screening results I got a few weeks ago – without another blood draw. I have been iffy about my doctor in the past – I thought she was a little too hands-off about a persistent problem I had over the summer. But today, she was just what I needed.

She looked over my results. My cholesterol is a little high, but that’s mostly driven by my high good cholesterol. My cholesterol ratio is great. My triglycerides are a little high, but not worrisome. These are things to watch, she said, especially when menopause hits and affects cholesterol. She asked about any major medical events in the last year – any surgeries, hospitalizations, etc. Nothing like that, I said, but I did start therapy a few months ago because I’m a caregiver for a mother with Alzheimer’s. Whoa, she said – that is significant. I mentioned that I have considered asking for some extra anxiety meds from her, but that for now I think I am managing OK. And she said: Watch that, because you may need them in the future. I liked that support.

She listened to my heart and lungs and belly sounds, looked in my ears and mouth. Checked my skin – just freckles, no skin cancer. Asked about other family history information. Since my dad’s need for a heart transplant was caused by an idiopathic disease, meaning the cause is unknown, I am probably not at higher risk of heart disease in relation to his heart problems. There are no cancers in my immediate family, thankfully. And then we talked a little about Alzheimer’s. Her grandfather had Alzheimer’s, and was diagnosed after she became a doctor. He had worried for much of his adult life that he would end up having Alzheimer’s, and sure enough, he did. My doctor said it tends to skip generations – something I had not heard – which gave me comfort, but does not make her feel so great about her own outlook. She said she is like her grandfather in many ways. She said she hopes that if she gets it, the drugs will be better by then. Amen to that.

I brought up my weight since she hadn’t – a happy sign in itself for me. It is higher than it has ever been. But I told her I seriously try not to worry too much about it and try not to obsess about the number on the scale – that I pay attention to what I eat, try to keep it relatively healthful, and that I go to fairly intense gym classes about three times a week. But I can’t deny I’ve hit a high point. And I wondered if it makes her worry. She said controlling weight is a common problem as women get older, even for her, and she comes from a family with a history of high metabolism. She said she gets immense pleasure from eating and she has a good appetite, so she recognizes that as a quality of life issue. She said she is tired after work and all she wants is dinner and a beer. She said, essentially, try to move more. It doesn’t have to mean a trip to the gym. One can always move more. And I know that is true. Don’t gain, she said. Don’t cause stress in an attempt to lose, but try not to gain.

And then she said: The stress of being a caregiver is intense. It is unforgiving. It can do a number on the body. “How often do you think about your mom?” she asked. “It’s 24/7, right? So give yourself a little break. In fact, if you’re not worried about your weight, that is probably a good thing right now.” That validation goes a long way. I am not off the hook with regard to my own health, but I should not be ashamed, or embarrassed, or self-loathing, or further stressed. And a health-care professional says so. And she acknowledged how tough it is. It made me a little teary just to get that support.

She also cracked me up. In response to something I said about the last time I saw her, she said people often worry about exposing certain parts of themselves to her. “It is a body part. Butts, boobs, penises, vaginas. That’s my day.” I just thought that was funny, and that kind of mentality works for me. It takes some of the embarrassment away from various things that need to be checked from time to time.

And let me take this opportunity to point to another primary care physician’s outlook on life that makes me laugh. And think. It is expressed in a blog, called Medical Marginalia. My friend the doctor writes about “Primary Caresville,” as she calls it, under the name “Iced Latte.” And she writes about being a doctor, and a mother, and a wife, and the balance she tries to strike in her life. I love her blog, and in reading it, I have opened my mind a bit about what primary care physicians go through when their own patients show signs of Alzheimer’s. I thought my mother’s longtime doctor was fairly distant about the whole thing as Mom showed signs of disease and after she was finally diagnosed. I was frankly offended by her demeanor. But now, I wonder if it’s best for doctors to maintain a distance so they don’t become overwhelmed with sadness about this turn of events in a long-term patient’s life. It makes sense if that’s what they do.

About a patient she saw recently, Iced Latte made these observations:

He can’t always remember how do to simple tasks, for example, make a grilled cheese sandwich. When he walks into a room often he can’t remember what he wanted to do there. Later, he still can’t remember what it was he wanted. His family thinks he’s repeating himself a little. He says that often he’s afraid to talk to his family because he’s afraid they’ll realize his terrible secret–he can’t remember whom he’s spoken to, and he loses track of his conversation so easily. He’s embarrassed. He’s ashamed, and he’s fearful of what is happening to him. I am too. I’m checking this and that in his blood, hoping kind of against hope that there will be something I can fix, or at least tweak to make his memory a little better. It’s not just his memory which is suffering, however. He’s having problems with his ability to carry out executive function: planning; abstract thinking; selecting and acting appropriately upon relevant sensory information. He’s having trouble meeting his independent activities of daily living: finance management, food preparation, house-cleaning. This isn’t good.

And she also said this: When I’m moving through the work-up for dementia and eventually reach a diagnosis, while I’m terribly sad for the patient, I’m in some ways more concerned about the caregivers. The patient will eventually reach a point when their diagnosis doesn’t matter to them; the caregiver never has that luxury.

For much more, consider visiting her blog: http://www.medmarg.com

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