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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 100 to 124 of 129. Go back in thread:
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
Posted by Susan47 on July 23, 2004, at 20:27:40
In reply to (FYI) http://members.aol.com/intwg/trolls.htm#WCBD (nm), posted by shadows721 on July 23, 2004, at 20:16:23
Posted by Susan47 on July 23, 2004, at 20:45:41
In reply to It's about time...where've *'you* been? (nm), posted by Susan47 on July 23, 2004, at 20:27:40
Posted by shadows721 on July 23, 2004, at 21:19:02
In reply to And thank you. (nm), posted by Susan47 on July 23, 2004, at 20:45:41
I am so sorry for not posting the link. I can see where my message would not be clear. Thanks again for helping me clear the smoke to others too.
Posted by Larry Hoover on July 24, 2004, at 8:00:14
In reply to Brain food » Larry Hoover, posted by TofuEmmy on July 23, 2004, at 19:42:00
> 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<blush>
> P.S. Do you need meat to live happily ever after?
Yes. <sigh>
Posted by JenStar on July 24, 2004, at 12:49:15
In reply to Re: somatoform disorder(s), posted by fires on July 23, 2004, at 11:32:32
Fires,
I was reading up on somatoform disorder on the web. Reading about it made me mad. Most of the articles seemed to insinuate that any unidentifiable problem a person might suffer MUST be 'all in the head' even if the patient wasn't 'deliberately' causing sypmtoms. It reminded me of how I feel sometimes when I have real symptoms/real problems and the doctor acts kind of patronizing and assumes I'm just exaggerating (b/c of my past history of hypochondria.)You're right - many REAL conditions were thought to be stress-related or all in the head until we learned more, like ulcers caused by bacteria (not stress). I've read articles too that stated some people have much higher pain thresholds than others; folks who complain of chronic pain might NOT be somatoform sufferers, they might have real pain that is just more severe to their body even if a physician can't identify the cause.
Bodies are complicated, and although doctors like to think we know everything, we really don't.
Anyway, I'm sorry if you're been falsely diagonsed, esp. if they hid the diagnosis from you. That's horrible. I would be so mad and frustrated.
How are you feeling these days? Any luck with a new doctor?
Also, I really don NOT post under any other names. This is just me, JenStar!
JenStar
It does seem that doctors and scientists need to partition everything into a little box. If this, then that; if a, then b. If not a, then --- must be all in the head!
> 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!!
>
> 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.
>
> Perhaps you aren't too familiar with the medical field, 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.
>
>
>
> Thank you
>
>
Posted by fires on July 24, 2004, at 13:59:02
In reply to Re: somatoform - trying to be friend w you!, posted by JenStar on July 24, 2004, at 12:49:15
> Fires,
> I was reading up on somatoform disorder on the web. Reading about it made me mad. Most of the articles seemed to insinuate that any unidentifiable problem a person might suffer MUST be 'all in the head' even if the patient wasn't 'deliberately' causing sypmtoms. It reminded me of how I feel sometimes when I have real symptoms/real problems and the doctor acts kind of patronizing and assumes I'm just exaggerating (b/c of my past history of hypochondria.)
>
> You're right - many REAL conditions were thought to be stress-related or all in the head until we learned more, like ulcers caused by bacteria (not stress). I've read articles too that stated some people have much higher pain thresholds than others; folks who complain of chronic pain might NOT be somatoform sufferers, they might have real pain that is just more severe to their body even if a physician can't identify the cause.
>
> Bodies are complicated, and although doctors like to think we know everything, we really don't.
>
> Anyway, I'm sorry if you're been falsely diagonsed, esp. if they hid the diagnosis from you. That's horrible. I would be so mad and frustrated.
>
> How are you feeling these days? Any luck with a new doctor?
>
> Also, I really don NOT post under any other names. This is just me, JenStar!
>
> JenStarI have no choice, but to believe that you don't use other names because my evidence was entirely circumstantial.
RE: All in our heads. Years ago an MD told me to agree with people who say "It's all in your head" --- because our brain is in our head -- so they are technically correct.
Also, I know of several good Pdocs within 45 miles of my home, but they don't take my insurance. They would definitely not Dx anyone with Somatoform D. without first trying nearly every brain altering med. in the PDR!
Also, re: hypochondriasis. I had a link to a good article a while back that said that it's just as legit. as any other "brain disorder", unfortunately I can't find the link. Here's some info. that I'll bet Ts aren't telling too many hypochondriacs: (from www.bio-behavioral.com)
"WHAT MEDICATIONS ARE HELPFUL FOR HYPOCHONDRIASIS?
Current research indicates that anti-depressant medications when used in conjunction with psychological treatment may be quite helpful for hypochondriasis.
Some commonly used anti-depressant medications for hypchondriasis:
Sinequan
Tofranil
Elavil
Anafranil
Prozac
Anti-psychotic medications have also been indicated. "Good luck
Posted by JenStar on July 24, 2004, at 15:40:11
In reply to Re: somatoform - trying to be friend w you!, posted by fires on July 24, 2004, at 13:59:02
I've been taking Lexapro and it helps a bit with the hypochondria and anxiety. What's frustrating, though: Since some people know I'm a hypochondriac, I'm afraid that they'll NEVER believe me anymore when I really get sick. Kind of like the boy who cried wolf!
I agree that hypoch. IS a real disease, and stuff "in the head" is as real, in a sense, as a broken leg. After all, SOMEthing is going on with nerves and neurotransmitters and all that stuff to make someone think they're ill when they're not, right?
It's just that some docs are so condescending about hypochondria. They act as if it's a personal decision to be weak, to be stupid, to be needy - unlike the wonderfully strong and lovely 'rest of the population.' And I hate it when people think that things like allergies or gastric reflux are caused by 'stress' and that if I (or others) were just "stronger" we could "beat it."
My own sister admitted that she used to think all people who complained about heartburn and indigestion were just weak whiners, until she got pregnant and discovered what hearburn really is. Then she apologized for making light of it all these years!
Anyway, I just felt like griping!
How are YOU doing? Tell us a bit about yourself, Fires? What's on your mind these days?
JenStar
> > Fires,
> > I was reading up on somatoform disorder on the web. Reading about it made me mad. Most of the articles seemed to insinuate that any unidentifiable problem a person might suffer MUST be 'all in the head' even if the patient wasn't 'deliberately' causing sypmtoms. It reminded me of how I feel sometimes when I have real symptoms/real problems and the doctor acts kind of patronizing and assumes I'm just exaggerating (b/c of my past history of hypochondria.)
> >
> > You're right - many REAL conditions were thought to be stress-related or all in the head until we learned more, like ulcers caused by bacteria (not stress). I've read articles too that stated some people have much higher pain thresholds than others; folks who complain of chronic pain might NOT be somatoform sufferers, they might have real pain that is just more severe to their body even if a physician can't identify the cause.
> >
> > Bodies are complicated, and although doctors like to think we know everything, we really don't.
> >
> > Anyway, I'm sorry if you're been falsely diagonsed, esp. if they hid the diagnosis from you. That's horrible. I would be so mad and frustrated.
> >
> > How are you feeling these days? Any luck with a new doctor?
> >
> > Also, I really don NOT post under any other names. This is just me, JenStar!
> >
> > JenStar
>
> I have no choice, but to believe that you don't use other names because my evidence was entirely circumstantial.
>
> RE: All in our heads. Years ago an MD told me to agree with people who say "It's all in your head" --- because our brain is in our head -- so they are technically correct.
>
> Also, I know of several good Pdocs within 45 miles of my home, but they don't take my insurance. They would definitely not Dx anyone with Somatoform D. without first trying nearly every brain altering med. in the PDR!
>
> Also, re: hypochondriasis. I had a link to a good article a while back that said that it's just as legit. as any other "brain disorder", unfortunately I can't find the link. Here's some info. that I'll bet Ts aren't telling too many hypochondriacs: (from www.bio-behavioral.com)
>
> "WHAT MEDICATIONS ARE HELPFUL FOR HYPOCHONDRIASIS?
>
> Current research indicates that anti-depressant medications when used in conjunction with psychological treatment may be quite helpful for hypochondriasis.
>
> Some commonly used anti-depressant medications for hypchondriasis:
>
> Sinequan
> Tofranil
> Elavil
> Anafranil
> Prozac
> Anti-psychotic medications have also been indicated. "
>
> Good luck
>
Posted by TofuEmmy on July 24, 2004, at 18:30:20
In reply to Re: Brain food » TofuEmmy, posted by Larry Hoover on July 24, 2004, at 8:00:14
Lar - Alone with me... I'm quite sure that pot roast would be the last thing on your mind. :-)
e
Posted by Larry Hoover on July 24, 2004, at 18:44:12
In reply to Re: Brain food » Larry Hoover, posted by TofuEmmy on July 24, 2004, at 18:30:20
> Lar - Alone with me... I'm quite sure that pot roast would be the last thing on your mind. :-)
>
> e<very big grin>
Posted by fires on July 24, 2004, at 18:59:35
In reply to Re: Brain food » TofuEmmy, posted by Larry Hoover on July 24, 2004, at 18:44:12
Posted by fires on July 24, 2004, at 19:00:37
In reply to Re: One small step for me (nm), posted by fires on July 24, 2004, at 18:59:35
Go forward in thread:
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Dr. Bob is Robert Hsiung, MD,
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