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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 89 to 113 of 129. Go back in thread:
Posted by AuntieMel on July 23, 2004, at 14:52:13
In reply to Re: I'm with TC and PC..., posted by fires on July 23, 2004, at 14:47:26
Actually TexasChic is having a very bad day today. And she, too, is a very nice person. I'm sure she didn't intentionally try to offend you.
I'm one of those that believe intent is just as or more important as the action itself.
Posted by fires on July 23, 2004, at 15:06:27
In reply to Re: somatoform disorder(s) » fires, posted by Larry Hoover on July 23, 2004, at 13:07:02
> > I don't think you attacked me in the near past with ad hominem messages, so I will repond.
> >
> > >>What sets somatoform apart (there are a number of different sub-types, but you don't further specify) is that following a series of diagnostic tests and assessments, no underlying disease state can be found.<<
> >
> > You so eloquently stated above the problem with Somatoform: It assumes that there are tests and assessments currently available for all disorders/diseases. That's an incorrect assumption!!
>
> No, there is no such assumption. Doctors not finding anything that corresponds to their current state of knowledge is not the same thing as assuming they know everything and how to find it.
>
> > Stomach and duodenal ulcers were once considered to be of "psychosomatic" etiology, but along came "better" science, and a bacteria was demonstrated to be the cause of ulcers. So all the ulcer victims were suddenly no longer victims of their own psyches.
>
> Stress is still a factor, and treatment is still symptomatic. Knowing "why to do" is better than knowing "what to do", but apart from adding antibiotic therapy, what to do hasn't changed.
>
> > Perhaps you aren't too familiar with the medical field,
>
> Careful, lest you stray into ad hominem land.
>
> > so I will give you another example of how one can test/be assessed neg. for a med. problem yet still have one/it.
> >
> > My sister (ECG tech) has told me many stories of people who have come into the ER with MI symptoms, only to test negative for MI. Then they die of a massive MI on the way home.
>
> ECG is not 100% sensitive to AMI (false negatives are possible), nor 100% specific for AMI (false positives are possible). Cardiac enzyme levels (myocardial troponin T) are generally very sensitive and specific to ischemia. In any case, anecdote is not really of predictive value. "The exception proves the rule."
>
> >
> >
> > Thank you
> >
> >
>
> You're welcome.Well. Where to begin? I do believe that you have contradicted yourself.
>>> No, there is no such assumption. Doctors not finding anything that corresponds to their current state of knowledge is not the same thing as assuming they know everything and how to find it.<<
Then why don't they consider that a patient might have such a disorder instead of Dxing Somatoform Disorder?? I had/have such a disorder.
Thank goodness I didn't buy into the Somatoform Dx!!>>> Stress is still a factor, and treatment is still symptomatic. Knowing "why to do" is better than knowing "what to do", but apart from adding antibiotic therapy, what to do hasn't changed.<<
I will refrain from posting links, but my research indicates that your statement contains errors. 1) Stress *may* be a factor in *some* patients with ulcers. If you have scientific data to the contrary I would like to see it.
2)What to do has changed. Not only are antibiotics given, but Pepto Bismol(sometimes), and the newer PPIs are also used (nearly always) for ulcers.
>>> ECG is not 100% sensitive to AMI (false negatives are possible), nor 100% specific for AMI (false positives are possible). Cardiac enzyme levels (myocardial troponin T) are generally very sensitive and specific to ischemia. In any case, anecdote is not really of predictive value. "The exception proves the rule."<<
Thanks again for so eloquently making my point !! Re-read the above , then apply that same logic to the Dxing of Somatoform. Is there a blood test for Somatoform? or do Pdocs rely on anecdotal and subjective info. to Dx it? "The exception proves the rule"
Thanks
Posted by TexasChic on July 23, 2004, at 15:13:20
In reply to Re: I'm with TC and PC... » fires, posted by AuntieMel on July 23, 2004, at 14:52:13
I knew you didn't direct that at me. It just made me want to reinforce my intent.
Posted by Dinah on July 23, 2004, at 15:29:04
In reply to Re: I'm with TC and PC..., posted by fires on July 23, 2004, at 14:47:26
Posted by Dinah on July 23, 2004, at 15:33:20
In reply to Re: Thanks Mel!, posted by TexasChic on July 23, 2004, at 15:13:20
Please don't feel that this is a problem with you. :) You're communicating just fine.
Posted by AuntieMel on July 23, 2004, at 15:38:42
In reply to Re: somatoform disorder(s), posted by fires on July 23, 2004, at 11:32:32
It's good to have you back, Lar.
I could be way, way off on this, and confused. It *is* friday.
It seems that we have an apple/oranges problem here. Or you are trying to say the same thing in different ways.
Ulcers and MI are things that can be tested for and diagnosed, notwithstanding false negatives. The theory of the *cause* of ulcers was found to be erroneous, but ulcers themselves could be diagnosed.
Somatoform Disorder, and others, are convenient labels that get applied when all other tests fail to show anything. There is a good chance that new technology will find, or help narrow down the diagnosis even further.
But the biggest point here, in my opinion, was that fires was diagnosed with it, without his (or is it her? please tell) knowledge. And that the diagnosis was done by a shrink, and without any testing to rule out other things first. That seems to me to be a HUGE assumption.
And putting it on a chart as if it was based in science seems totally irresponsible.
Fires set the record straight, and for that should be commended.
Posted by AuntieMel on July 23, 2004, at 15:46:19
In reply to Re: Off topic digressions, multiple ids » fires, posted by Larry Hoover on July 22, 2004, at 16:15:38
We don't want to lose you. You're far too valuable here.
Posted by AuntieMel on July 23, 2004, at 15:48:09
In reply to Re: Thanks Mel!, posted by TexasChic on July 23, 2004, at 15:13:20
Posted by Larry Hoover on July 23, 2004, at 16:35:24
In reply to Re: somatoform disorder(s), posted by fires on July 23, 2004, at 15:06:27
> Well. Where to begin? I do believe that you have contradicted yourself.
Nope.
> >>> No, there is no such assumption. Doctors not finding anything that corresponds to their current state of knowledge is not the same thing as assuming they know everything and how to find it.<<
>
> Then why don't they consider that a patient might have such a disorder instead of Dxing Somatoform Disorder??What disorder? When you say "such a disorder", what are you referring to? If a doctor looked, and didn't find anything, there is no diagnosis. Do you want me to copy and present the diagnostic characteristics of Somatoform Disorder? It can't be proven, but it can be diagnosed, according to the nosology in use today.
> I had/have such a disorder.
An undiagnosable disorder?
> Thank goodness I didn't buy into the Somatoform Dx!!
Why?
> >>> Stress is still a factor, and treatment is still symptomatic. Knowing "why to do" is better than knowing "what to do", but apart from adding antibiotic therapy, what to do hasn't changed.<<
>
> I will refrain from posting links, but my research indicates that your statement contains errors. 1) Stress *may* be a factor in *some* patients with ulcers. If you have scientific data to the contrary I would like to see it.I reiterate. Stress is still a factor, but I will go on to say....in the etiology and treatment of ulcers.
> 2)What to do has changed. Not only are antibiotics given, but Pepto Bismol(sometimes), and the newer PPIs are also used (nearly always) for ulcers.Acid reducing meds, all. There are newer categories (You left out H2 blockade.), but not novel treatments, apart from antibiotics. And even that category was actually in use, by serendipity, as bismuth salts are antibiotic.
> >>> ECG is not 100% sensitive to AMI (false negatives are possible), nor 100% specific for AMI (false positives are possible). Cardiac enzyme levels (myocardial troponin T) are generally very sensitive and specific to ischemia. In any case, anecdote is not really of predictive value. "The exception proves the rule."<<
>
> Thanks again for so eloquently making my point !! Re-read the above , then apply that same logic to the Dxing of Somatoform. Is there a blood test for Somatoform? or do Pdocs rely on anecdotal and subjective info. to Dx it? "The exception proves the rule"Nothing is 100% in medicine, or any scientific enterprise. Just because no one can prove beyond a shadow of a doubt that you have somatoform disorder does not mean that you do not. You are committing the logical fallacy of denying the antecedent.
> Thanks
You're welcome.
Posted by Larry Hoover on July 23, 2004, at 16:36:07
In reply to Re: Please be careful » Larry Hoover, posted by AuntieMel on July 23, 2004, at 15:46:19
> We don't want to lose you. You're far too valuable here.
Thanks, but I've got a handle on things. ;-)
Posted by fires on July 23, 2004, at 16:46:26
In reply to Re: somatoform disorder(s) » fires, posted by Larry Hoover on July 23, 2004, at 16:35:24
I was DXed with Somatoform which was wrong. I have POTS. (Objective proof).
I suppose according to your logic: just because they failed to substantiate Somatoform doesn't mean I don't have it?
Maybe I also have MS, MD, ADD, ***MPD***, etc..
bye
Posted by chemist on July 23, 2004, at 16:47:41
In reply to Re: Please be careful » AuntieMel, posted by Larry Hoover on July 23, 2004, at 16:36:07
> > We don't want to lose you. You're far too valuable here.
>
> Thanks, but I've got a handle on things. ;-)
>
>
larry, just a quick hello...and that's all...be well, friend, tjm
Posted by Larry Hoover on July 23, 2004, at 16:51:35
In reply to Re: apples oranges Lar and fires, posted by AuntieMel on July 23, 2004, at 15:38:42
> It's good to have you back, Lar.
Thanks. Feeling stronger as time goes on.
> I could be way, way off on this, and confused. It *is* friday.
>
> It seems that we have an apple/oranges problem here. Or you are trying to say the same thing in different ways.I think we're saying something different entirely.
> Ulcers and MI are things that can be tested for and diagnosed, notwithstanding false negatives. The theory of the *cause* of ulcers was found to be erroneous, but ulcers themselves could be diagnosed.
Chronic pain can be diagnosed, too, but pain can't be measured. There are many different kinds of assumptions in medicine. Diagnosis is often "proven" by the success of treatments suggested by the tentative diagnosis.
> Somatoform Disorder, and others, are convenient labels that get applied when all other tests fail to show anything.I would never call them "convenient", although they can be prematurely applied by some clinicians. Med school and residency are lengthy for good reason. But 50% of each graduating class was in the bottom half.
> There is a good chance that new technology will find, or help narrow down the diagnosis even further.
The average time to get an accurate diagnosis of Chronic Fatigue Syndrome is greater than 6 years (and takes 11 doctors). It also doesn't help that's it's called the Yuppie Flu. There will always be these "shadow diagnoses", where objective evidence and diagnostic specificity just can't (yet) be found.
> But the biggest point here, in my opinion, was that fires was diagnosed with it, without his (or is it her? please tell) knowledge.
There is a school of thought that believes it is deleterious to inform some patients of their diagnoses, based on a judgment of the individual's character traits.
> And that the diagnosis was done by a shrink, and without any testing to rule out other things first. That seems to me to be a HUGE assumption.
If I recall, the diagnosis was by a psych resident. That means that *all* cases would be supervised by senior staff. It wouldn't be just this one doctor's opinion.
> And putting it on a chart as if it was based in science seems totally irresponsible.
Why is it irresponsible? Any newer physician would take that under advisement, but perform new diagnostic tests of their own. It would be malpractise to do otherwise. Doctors themselves are just as aware of the subjective quality of such a diagnosis. The uncertainty is not lost on doctors.
> Fires set the record straight, and for that should be commended.Set what record straight? I'm confused by that statement.
Lar
Posted by AuntieMel on July 23, 2004, at 16:52:10
In reply to Re: somatoform disorder(s), posted by fires on July 23, 2004, at 16:46:26
That's funny. I'm still working on one.
Posted by Larry Hoover on July 23, 2004, at 17:03:00
In reply to Re: somatoform disorder(s), posted by fires on July 23, 2004, at 16:46:26
> I was DXed with Somatoform which was wrong. I have POTS. (Objective proof).
Interesting. Postural Orthostatic Tachycardia Syndrome. It's nice to post the long version of an acronym, at least one time.
From: http://www.potsplace.com/how_is_pots_detected.htm
"POTS is a disorder that can easily be overlooked or misdiagnosed. Some patients have had to wait years before their condition was properly labeled. POTS is sometimes misdiagnosed because of the wide array of symptoms that accompany this syndrome. The symptoms of postural orthostatic tachycardia often mimic other illnesses. Entities such as thyroid disease, pheochromocytoma, hypoadrenalism, cardiac disease, autonomic neuropathies, medication side effects and anxiety disorders need to be ruled out before a patient is labeled with POTS."Sounds a lot like how they diagnose somatoform, except they found something.
> I suppose according to your logic: just because they failed to substantiate Somatoform doesn't mean I don't have it?No, that is a different logical error, one you have created. What I would say is, "Absence of evidence is not evidence of absence."
> Maybe I also have MS, MD, ADD, ***MPD***, etc..
>
> byeMaybe.
bye-bye
Posted by AuntieMel on July 23, 2004, at 17:04:33
In reply to Re: apples oranges Lar and fires » AuntieMel, posted by Larry Hoover on July 23, 2004, at 16:51:35
Well, you are right. Diagnosis is often proven by treatment. And alzheimers is proven by autopsy.
50% in the bottom half. That's too, too funny. I always say the chance of rain is 50% (maybe it will, maybe it won't)
It doesn't matter at this point *why* they kept the diagnosis to themselves. The important thing right now is that fires disagreed with the diagnosis because some symptoms went away with a med change, and there were tests that explained the others.
He stood up for himself by telling the new doc that if she believed the diagnosis, despite the evidence to the contrary, that he would find someone else.
I know I would have a hard time getting up the nerve to do that.
Posted by Dinah on July 23, 2004, at 17:05:28
In reply to Re: somatoform disorder(s) » fires, posted by Larry Hoover on July 23, 2004, at 17:03:00
Posted by fires on July 23, 2004, at 17:08:00
In reply to Re: somatoform disorder(s) » fires, posted by Larry Hoover on July 23, 2004, at 17:03:00
I believe I did.(post what POTS stands for).
bye
Posted by fires on July 23, 2004, at 17:19:51
In reply to Re: apples oranges Lar and fires » Larry Hoover, posted by AuntieMel on July 23, 2004, at 17:04:33
>>I know I would have a hard time getting up the nerve to do that.<<
When I was hospitalized for MDD in 1988, I had 2 MDs. My primary care MD handled my meds because he was an expert in psychopharmacology.
My hosp. Pdoc told me, at my first visit, that I had to do everything he said or that I would not be his patient. I had to go to all group meetings (depressives of other Pdocs got to sleep the day away, etc..)and not play any games, like trying to fool staff about taking meds.(why would I want to do that!?)
Anyway I liked him.
I see my internist on Monday, and unless my plans change, I plan to ask him if he saw my records from *****. If no, I will tell him what the Resident there DXed (MDD, GAD, Somat(NOS)). Then I will tell him that if he now, or anytime in the future believes that I have Somatoform D., he needs to let me know ASAP, so that I can find a new internist.
bye
Posted by Larry Hoover on July 23, 2004, at 17:26:46
In reply to Re: somatoform disorder(s), posted by fires on July 23, 2004, at 17:08:00
> I believe I did.(post what POTS stands for).
> byeNot in this thread, and certainly never to me. Given the diagnosis, how are x-rays and biopsy results relevant?
Posted by shadows721 on July 23, 2004, at 18:03:20
In reply to Re: somatoform disorder(s), posted by fires on July 23, 2004, at 16:46:26
The ONLY way to deal with trolls is to LIMIT your reaction to reminding others NOT to respond to trolls.
Posted by fires on July 23, 2004, at 18:12:54
In reply to Re: somatoform disorder(s) » fires, posted by Larry Hoover on July 23, 2004, at 17:26:46
> > I believe I did.(post what POTS stands for).
> > bye
>
> Not in this thread, and certainly never to me. Given the diagnosis, how are x-rays and biopsy results relevant?
>Well, as Steve Martin said: Exxxccccusse Me! :) If people wouldn't change the subject lines, I could follow threads with less difficulty. Since POTS is a truly systemic illness, it is quite conceivable that there could be a relationship between my x-rays/biopsy and POTS.
Posted by TofuEmmy on July 23, 2004, at 19:42:00
In reply to Re: somatoform disorder(s) » fires, posted by Larry Hoover on July 23, 2004, at 17:03:00
I LOVE the way you can clarify issues. It positively makes me quiver.
"Absence of evidence is not evidence of absence." I like this, even if it made me think of ...ewwww...yucky....Donald Rumsfeld.
If I may quote KK, "Will you marry me?"
Emmy
P.S. Do you need meat to live happily ever after?
Posted by Susan47 on July 23, 2004, at 20:08:06
In reply to ***********TROLL ALERT***********, posted by shadows721 on July 23, 2004, at 18:03:20
I can only guess at what "Troll Alert" means to you honey, but it sure as heck didn't sound very nice.
If you are trying to stop others from expressing the way they feel about issues, and think that's okay, think again.
If by *troll* you are referring to an actual human being, that was really awful of you.
If it was innocent, and *troll alert* just popped off your keyboard all by its little old self, then y'all forgive me, you hear?
Posted by shadows721 on July 23, 2004, at 20:16:23
In reply to To shadows721, posted by Susan47 on July 23, 2004, at 20:08:06
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