I’m a naturally curious person which greatly affects how I evaluate a patient. I see signs and symptoms as the language of the body. This is how your body tells you and me there is a problem. Symptoms represent a reactive compensation of the body to an underlying process. Once I understand the process that caused the symptoms, I’m in a better position to formulate a plan to correct the problem.
When physicians don’t truly understand the nature of a disease, they’ll often describe it and then add “syndrome” to the end. For example, the cause of Chronic Fatigue Syndrome is not known but there is a typical clinical picture. By giving it a label, everyone understands what we’re describing. This is also the way insurance companies categorize patients to determine payment for physician services. This process can be useful but it is also problematic when the patients become merely labels and all therapy is aimed at simply treating superficial symptoms. For example, giving amphetamines to a patient with chronic fatigue may give them short-term relief but it is rarely a long-term solution and does not address the cause of the symptom.
Betty, a school teacher in her thirties, had an obvious tremor in both hands. She was an attractive, young woman but she was sitting there with a fine tremor that got worse when she tried to do anything with her hands. She had difficulty holding a coffee cup or even writing a check so you can imagine how disabling it would be for a teacher who has to write on the blackboard and grade homework. I was very concerned that someone so young would be having such symptoms. Therefore, I ordered a number of tests to try to determine if there was some underlying disease or unknown exposure to toxins that could be damaging her nervous system. The patient didn’t return for a follow-up so we called to inquire about her. She said she’d gone to another physician who diagnosed her immediately on her very first visit. I eagerly asked what he had diagnosed. With great pleasure, she announced, “I have Essential Tremors Syndrome and I was given a medicine (anti-seizure medicine) that made it go away.” I worried that taking this medicine for years would delay discovery of the underlying process causing the tremors.
I was also concerned because chronic medication use can result in adverse effects. Adverse effects from chronic medications may not show up for years. Most people don’t know that when a new drug is released, it has usually only been tested in a few thousand people for less than three months. It isn’t until the drug has been used in millions of patients for many years that the serious side effects become apparent. Phen/Fen and Vioxx should be keen reminders to us all. However, Betty didn’t want to hear any of this discussion. She had been given a “diagnosis” that completely satisfied her. All I could do was wish her well.
To me, the Endocrinologist is akin to a systems analyst for the body. The body is a highly complex system of interlinked processes constantly changing within a delicate balance called homeostasis. Signs and symptoms often indicate underlying disturbances in that balance so when you correct the underlying problem, you resolve the symptoms. Giving a pill that simply masks the symptom is like “killing the messenger.” I prefer to relieve the symptoms by correcting the underlying process that causes the symptom. Many patients who see me are searching for these kinds of answers. For example, deficiency in thyroid hormone can cause many symptoms including fatigue, dry skin, hair loss, constipation, depression and weight gain. Each symptom can be treated by a myriad of medications each of which carries side effects. However, most of these symptoms are relieved with the right dose of thyroid hormone. What could be more elegant?
Excerpt from “Outliving Your Ovaries” © 2012 by Marina Johnson MD.
Dr. Johnson has no financial conflicts of interest or ties to any pharmaceutical company.
Her only objective is determining the most effective, safest therapy for patients.