DEAR DR. GOTT: My doctor has told me that I have lymphedema and should take a water pill. When the 20 milligrams wasn’t sufficient, she put me on 40 milligrams. Because I wanted to know more about my condition to better educate myself about things to do and not do, I looked online. It appeared to me that my doctor should be looking for the cause of the swelling, not just treating it. So I pressed her into doing more. She ordered a CT scan of my pelvis, a heart echo and a venous Doppler. My CT scan showed a lesion on my liver and no abnormalities of the kidneys. The Doppler was negative, and I don’t have the results of the echo, even though it was done more than a month ago.
Because my doctor didn’t discuss my lab work with me, I requested a copy from the front office of the clinic. I then looked up each value online and became concerned over several of the numbers. My GFR was 71. My BUN and bili totals were high. When I asked her about these numbers, she said she wasn’t concerned. When I pointed out that the National Kidney Foundation says my GFR level indicates stage 2 kidney failure, she told me that she doesn’t look at that number, and I shouldn’t worry because I was probably just dehydrated on the day of the blood drawing. She proceeded to ask which office worker had given me a copy of my lab work — as if I didn’t have a right to see it. She didn’t outright say that I shouldn’t have it, but it was clearly implied that I should not have gone online for information.
Should I be concerned about the results and continue to press my doctor into ordering more tests? Or should I just take her word for it that those numbers don’t really matter?
I believe that I should be proactive in my own health care, but am I pushing too far? I’ll add that over a year ago, I complained to her of horrible stomach pain each time I ate. It took me several visits with the same complaint before she finally ordered tests, which were positive, and another six months before further testing was done.
The pain had resolved before the tests were done, but I was told that I had to undergo them any way. They were negative, so I was told I probably had an ulcer that resolved itself.
Should I wait and see if my liver and kidney test results resolve themselves? Do I have any reason not to trust this doctor? Or am I just being paranoid?
DEAR READER: I have reduced the size of your letter owing to space restrictions but will attempt to cover all your concerns.
In my opinion, your physician is failing to provide adequate, timely medical advice. I recommend you sit down to discuss your concerns and disappointments regarding how she is handling your medical care. Express your desire for her to take your complaints more seriously, and if she is unwilling to change her habits, seek out a new primary-care physician who meets your standards.
As to your stomach pain, I am inclined to agree that it was a spontaneously resolved ulcer, but because of the delay in getting proper testing, you may never know. If your physician was truly concerned about your symptoms, she should have gotten into testing sooner.
Bilirubin is caused by the normal breakdown of red blood cells in the liver. You claim to have a lesion on your liver and an elevated bilirubin, which may indicate liver damage. This is reason enough for referral to a specialist or at least further testing to determine what the abnormality is.
Both blood urea nitrogen (BUN) levels and glomerular filtration rates (GFR) are related to the kidneys. The BUN indicates how well they are functioning, with high levels, suggesting reduced function. The GFR is an indicator of what stage kidney failure a patient is in. Lower GFR numbers imply greater damage and lower functioning. Because you are on a diuretic, this could be causing your abnormal results. With both these tests pointing toward kidney damage, you should undergo further testing or be referred to a specialist just to be on the safe side.
In my opinion, you should not wait to see if your numbers resolve on their own, because both kidney and liver damage can be extremely detrimental to health. The sooner a proper diagnosis and, if necessary, appropriate treatment are received, the better the outcome is likely to be.
I applaud your belief that you should be proactive in your own health and wish that more people believed this as well. I do not believe that you are being paranoid, given your remarks about your physician’s past behavior. Talk to her about your dissatisfaction or find a new physician who will work with you.
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