It was interesting how easily she was weaned off the advair. That suggests she was on a medication she didn't really need, which is somewhat typical for older patients. I'm one who feels I can't get along without advair to treat my asthma. Generally I'm grateful for it, but I've never believed my doctors assurances that medication doesn't get absorbed outside the lungs. I even recognized my own symptoms of lightheadedness, and was quite surprised by the advair connection. Would love to find an alternative.
4
I am glad this women was given the proper blood tests and her medical issues resolved.
Addisons is in fact a rare disease,rare enough that my 18 year old daughter died from never being diagnosed and exhibiting all the symptoms.
I urge doctors to think outside the box for the sake of all.
Sally D
Addisons is in fact a rare disease,rare enough that my 18 year old daughter died from never being diagnosed and exhibiting all the symptoms.
I urge doctors to think outside the box for the sake of all.
Sally D
8
Sally - so sorry about your daughter. Physicians are taught to concentrate on the horses, but rarely consider the zebras. That is the true secret tragedy( especially for the rare dx patients) in the medical system.
2
For those who might have issues similar to the asthma element of the case, I would like to point out a natural alternative, the Butyeko breathing technique. Here is a link to Jane Brody's NY Times article which introduced me to it:
http://www.nytimes.com/2009/11/03/health/03brod.html
Brieftly, the technique involves holding one's breath every tenth breath, to allow carbon dioxide to build up in the lungs, which causes them to open up. Detailed information about the technique and where to find classes is available online.
I have not needed inhaled steroids since I started using the technique. Jane Brody reported that the technique helped people for whom traditional asthma medicines were starting to fail. I know these are considered anecdotal reports, but the technique is free, so if you want to, or need to, avoid inhaled steroids, it seems like an obvious option to me.
http://www.nytimes.com/2009/11/03/health/03brod.html
Brieftly, the technique involves holding one's breath every tenth breath, to allow carbon dioxide to build up in the lungs, which causes them to open up. Detailed information about the technique and where to find classes is available online.
I have not needed inhaled steroids since I started using the technique. Jane Brody reported that the technique helped people for whom traditional asthma medicines were starting to fail. I know these are considered anecdotal reports, but the technique is free, so if you want to, or need to, avoid inhaled steroids, it seems like an obvious option to me.
13
Thanks for this story. It is a gentle wag of the finger to the habit of overmedicating patients without regard to potential side effects. Some can be quite alarming, even leading to events such as this lively 8l year- old woman was experiencing. I especially appreciate that a link was strongly drawn between a normal stress response (hunger, daily upsetting events, psychological upheaval) and the depressed adrenals ability to function optimally to meet the body’s needs. My hunch is that All of us are asking too much of our adrenals, taking for granted that they are providing enough hormones to rescue us in times of fight or flight as we age. To add medications that tax the adrenals even more is not helpful. It might be, in fact, dangerous. As for the three kinds of BP medication, that is just wrong and unjustified. Many doctors only respond to numbers and a snapshot in time in the office when the BP is taken as the whole picture, and add another drug on the spot. Thanks for just a straight “story” this month, that places the burden of thinking like a doctor on the prescription pad ever at hand as the only answer.
5
One of the changes with steroid asthma inhalers is that it's very difficult to get high-dose inhalers. I used oral prednisone for years (asthma is not my only health problem) and had effectively no side effects. I got to where I could manage the other physical problems without oral steroids, but I have asthma from allergies to everything.
It's alarming to learn of adrenal shutdown with low-dose "nanoparticle" inhaled steroids because I found they are not strong enough to control my asthma, especially on bad days (some elevated pollens, any freshly cut grass, various molds, mild food reactions--bad food reactions require EpiPens). My asthma is not terribly severe; I haven't had bronchitis or pneumonia in nearly 20 years.
Since the high-dose steroid inhaler I used has been unavailable for a number of years, I've been toying with asking to go back on oral steroids. For now, I'm in bed with doors and windows shut when I have an asthma attack. I used to be able to manage strong food reactions with a significant dose of prednisone, benadryl, and my inhalers, if I got ahead of them. Now I get to buy more EpiPens. That's another racket. EpiPens are probably hard on anyone with high blood pressure.
PharMA and its foundation really disgust me.
It's alarming to learn of adrenal shutdown with low-dose "nanoparticle" inhaled steroids because I found they are not strong enough to control my asthma, especially on bad days (some elevated pollens, any freshly cut grass, various molds, mild food reactions--bad food reactions require EpiPens). My asthma is not terribly severe; I haven't had bronchitis or pneumonia in nearly 20 years.
Since the high-dose steroid inhaler I used has been unavailable for a number of years, I've been toying with asking to go back on oral steroids. For now, I'm in bed with doors and windows shut when I have an asthma attack. I used to be able to manage strong food reactions with a significant dose of prednisone, benadryl, and my inhalers, if I got ahead of them. Now I get to buy more EpiPens. That's another racket. EpiPens are probably hard on anyone with high blood pressure.
PharMA and its foundation really disgust me.
1
I am an elderly woman who had episodes of feeling light headed & 2 fainting episodes. As a result of fainting I fractured a spinal disc and a bone in a foot. Before the fainting my doctor told me my blood pressure was great. Although I asked him if this meant the blood pressure dose should be lowered, he said no and continued it.
Now I realize doctors don't know as much as they think they do, which makes them dangerous. And my medical providers refuse to acknowledge that the doctor's failure to monitor caused my injuries.
I don't take blood pressure medicine now and am fine. No more light headed episodes and my blood pressure is fine. I no longer automatically agree to take all medicine doctors prescribe or do the other things they think I should.
The problem with modern medical practice is it is based on statistics. But each real live human being doesn't necessarily fit the statistical profile. Yet that doesn't stop doctors from taking the easy way out in their treatment of their patients.
Now I realize doctors don't know as much as they think they do, which makes them dangerous. And my medical providers refuse to acknowledge that the doctor's failure to monitor caused my injuries.
I don't take blood pressure medicine now and am fine. No more light headed episodes and my blood pressure is fine. I no longer automatically agree to take all medicine doctors prescribe or do the other things they think I should.
The problem with modern medical practice is it is based on statistics. But each real live human being doesn't necessarily fit the statistical profile. Yet that doesn't stop doctors from taking the easy way out in their treatment of their patients.
9
Something similar happened to an elderly friend. From being active she became so breathless she couldn't walk a block and was constantly cold, no matter the room temperature. Her doctor's initial advice was just to shrug and say that she was getting older. We finally nagged her into asking for specific tests, on the threat that one of us would come with her and insist if she didn't do so herself. Turned out she had severe anemia traceable to a new and stronger drug for high blood pressure. She went back to previous drug, and in 2 months was back to herself. Problem solved.
6
Please don't replace the 'Think Like A Doctor' format. Thanks.
5
My mother suffered so much the last year of her life because the doctors could not get her meds right. Every change in medicine made her so sick and the doctors thought nothing of the side effects.
I dont take meds and never will. My mother was a health nut before the doctors convinced her to be on all these meds that didnt work. She was on 22 meds before she died. This is no way to live.
I dont take meds and never will. My mother was a health nut before the doctors convinced her to be on all these meds that didnt work. She was on 22 meds before she died. This is no way to live.
8
Bring back Think Like A Doctor!
10
When I first was diagnosed with asthma at age 55, I was prescribed 3 puffs Qvar (an inhaled steroid) twice a day.
I can tell when my lungs get tight, and Qvar works for me within 8 hours. If I wake up with wheezing and take a couple of puffs the next day, I am good for a few days or more. I keep albuterol for these episodes, which works within minutes. Strong coffee is a brochodialator too.
My present doc is okay with my self-dosing. By using the inhaled steroid only when really needed, I am averaging only a couple puffs a week. Sometimes I can go a whole month without it. Thats my experience, and of course yours may be different.
I can tell when my lungs get tight, and Qvar works for me within 8 hours. If I wake up with wheezing and take a couple of puffs the next day, I am good for a few days or more. I keep albuterol for these episodes, which works within minutes. Strong coffee is a brochodialator too.
My present doc is okay with my self-dosing. By using the inhaled steroid only when really needed, I am averaging only a couple puffs a week. Sometimes I can go a whole month without it. Thats my experience, and of course yours may be different.
3
I am 89 years old and on several meds for different conditions - essential tremors, blood pressure, thyroid, acid reflux, and some minor issues. Every once in awhile, I develop a rash or hives and itching on most of my body. In every case, the rash has been an allergic reaction to my blood pressure medication. After the medication was changed, the itching gradually disappeared. After the first diagnosis, my doctor changes the medication when a new episode occurs. I am lucky that he listens to me.
16
I hope this isn't a permanent replacement for Think Like A Doctor.
53
Kind of feels like it is the replacement of 'Think' which greatly enjoy! NY Times,
bring back Think Like A Doctor!
bring back Think Like A Doctor!
1
This is a great case, thanks. I had a wonderful professor in medical school (the late Aldo Rossini, an amazing endocrinologist and teacher), who taught us, "if you're looking for the problem, look in a mirror," meaning many causes of patients' problems were things we doctors had done or prescribed ourselves.
16
Dr. Rossini lived across the street from me! I can't wait to show your lovely comment to his wife.
3
Something that isn't generally considered when treating elderly or small-framed people is that they cannot withstand dosing that is meant for 200lb males. It took what felt like a near death episode with blood pressure meds, my first ever, to convince my doctor that I am drug sensitive and can only handle the smallest doses. I overheard an elderly woman in the cardiologist's office the other day say that she was on four (!) different blood thinners! She was just a tiny little thing and starting to bleed from her nose. Who in their infinite wisdom would do a thing like that?! The protocol should be to give the lowest possible dose first, and work up from there, but it seems that most doctors want to come out of the gate with all guns blazing.
41
My father's GP was especially good with elderly patients. He preached "low and slow" when it came to prescribing meds. He'd start on the lowest dose available and would only increase incrementally over a long period of time.
4
This Canadian woman received excellent care in the public health system and recovered well. She did not pay a penny out of pocket for the medical attention she received and so obviously did not have to go bankrupt because she fell ill. She did not have to put off seeing a doctor for fear it would cost too much or try to find a physician who was in her network and would agree to see her. She will not have bills arriving in her mailbox for the next six months from doctors in the hospital who may have cast a eye her way and are out of her network. She will not be charged $65 for the box of tissues she may have asked for while in emergency. Her medications will be affordable.
She can go home healthier and live her life free from these worries. Imagine that.
She can go home healthier and live her life free from these worries. Imagine that.
192
It was free to her because someone else paid for it - the tax paying Canadian public. She wasn't stressed individually, because the stress was distributed over millions of people. Sounds like the Affordable Care Act.
34
Karen, Insurance under the Affordable Care Act usually involves high premiums, high deductibles, and co-pays, all of which the individual pays. I don't participate in paying for those costs. For those individuals whose incomes are low enough to qualify for Medicaid, it's true that those costs are distributed. But it's not true for those who bought insurance on the exchange. I have no idea what your point was, but your facts are fiction.
1
Canadians pay for healthcare primarily through their taxes but would rather pay bit by bit over healthier years than be whacked by bills and high insurance costs when least affordable.
This person also pays taxes: specifically gas tax, GST, PST and probably some income tax. She appears to have worked in the past and presumable paid taxes then when she may not have needed healthcare so much.
Your comment shows a lack of understanding of how universal health care works.
This person also pays taxes: specifically gas tax, GST, PST and probably some income tax. She appears to have worked in the past and presumable paid taxes then when she may not have needed healthcare so much.
Your comment shows a lack of understanding of how universal health care works.
3
Great case. Thanks for sharing. Dr. MM, Emergency Medicine
12
I so resent the attitude I get from Physicians when I question them about the medications they want me to take. I see they are thinking "another crazy lady" or as one Physician told me "I don't want to see pts. that do not want to take drugs".
I worked in Psychology for 20 years seeing pts. from 20 to 70 and was always stunned when I had a pt not on any drugs. This is not how it used to be .In the last ten years everyone seems be on some drugs and I am not including birth control.
When I used to work in a Psychiatric Hospital I I quickly learned that many pts. had been self medicating and arrested then hospitalized and forced to take "our" medications. Really who is crazy here. Take drugs that make you feel good and maybe even happy well you can go to jail/committed to a hospital but if you take these very dangerous medications we give you then you can be released.
Do you know more people die from complications of Psychiatric drugs than opioids or street drugs. Look it up...
I worked in Psychology for 20 years seeing pts. from 20 to 70 and was always stunned when I had a pt not on any drugs. This is not how it used to be .In the last ten years everyone seems be on some drugs and I am not including birth control.
When I used to work in a Psychiatric Hospital I I quickly learned that many pts. had been self medicating and arrested then hospitalized and forced to take "our" medications. Really who is crazy here. Take drugs that make you feel good and maybe even happy well you can go to jail/committed to a hospital but if you take these very dangerous medications we give you then you can be released.
Do you know more people die from complications of Psychiatric drugs than opioids or street drugs. Look it up...
50
I'm disappointed that this case isn't presented as a mystery diagnosis. I've always enjoyed that approach and ready readers' comments.
45
I agree. I have been checking for this months "Think Like A Doctor" column. Is this it...?
18
Actually, I like this format better. I got really annoyed with almost all the "winners" being doctors, medical residents, or some other form of medically knowledgable person.
Additionally, I got really disgusted with the comments from people when a woman patient presented with unusual symptoms. Quite a few "answers" were, well, it's a psychiatric illness, anorexia, depression, anxiety, etc. even when the patient had multiple physical indicators.
This is a much better format, imo.
Additionally, I got really disgusted with the comments from people when a woman patient presented with unusual symptoms. Quite a few "answers" were, well, it's a psychiatric illness, anorexia, depression, anxiety, etc. even when the patient had multiple physical indicators.
This is a much better format, imo.
7
What happened to the set up with diagnostic information and time to try to figure it out for ourselves? I love trying to think like a doctor! Please bring back the usual format (but you could insist that people who have won recently should sit on their hands and let someone else have a chance for a change)!
49
Yes, please, please, please bring it back!! :) Also, it is called "Think LIKE a Doctor", therefore, I don't think real doctors/medical residents should be eligible to win. Though obviously, I understand why doctors would be game to rise to the challenge of solving the medical mystery. Maybe there could be a non-MD first to solve winner, with notable mention to the first MD to offer correct diagnosis? Regardless, I just hope the old format returns, because it offers a great challenge to readers, and most often the case illustrates some important factors that remind us how important it is to be informed as a patient or caregiver. Also, how vital it is to let doctors know as many details as possible about lifestyle changes, medications, symptoms, health history notes as possible in times of medical crisis. You never know what seemingly insignificant detail could be the cause and/or clue to solving a mystery diagnosis.
24
On an aside to this article, it appears that Government supported Health Care works just fine in Canada, this patient may have another very disturbing outcome in regard to Health Care in the United States.
98
Is this replacing Think Like a Doctor?
9
So many "benign" meds seem to have unexpected downsides, with extended use or in the elderly.
Do the steroid sprays - fluticasone for one - when used regularly for allergies instead of asthma - pose the same potential for depressing adrenal function ?
Do the steroid sprays - fluticasone for one - when used regularly for allergies instead of asthma - pose the same potential for depressing adrenal function ?
29
I'm was wondering the same thing, Cheryl. I was actually about to try Flonase nasal spray for the first time today, but now I am hesitant. If there is a negative side effect to be had, I seem to end up with it, unfortunately.
16
This is so true, Cheryl, about many "benign" meds sometimes having unexpected downsides with extended use. Some prime examples would be Proton-Pump Inhibitors and sedative-type sleep medications.
9
Cheryl, please get a couple of qualified opinions on this, and ask critical questions.
Personally, I deeply regret getting prescribed and taking daily, over a course of several years, an Rx for an '-one' allergy medication, while in my early-mid 50s.
Had never taken ANY type of steroid in my life, and knew they were tricky, so asked my doctor ... really, right up and into my nasal passages? Don't worry, I was told, it's not the same mechanism. It doesn't affect other areas. Naively, I believed.
True, I could breath easy and never had a sinus infection again. However, when my next bone density came back in the osteoporosis category in all areas, and I realized my mind had dulled significantly, the damage was done.
My internist insisted, repeatedly and to this day, there is no relationship, but a GYN (in the same medical group) took me through the osteoporosis risk questionnaire (avail. online) and it has a special category for 'steroid use,' and yes, Rx inhaled steroids count as steroids; they are a risk factor/work against one.
I feel use of this accelerated the shriveling of my bones -- and my brain. Now I just use a saline spray daily to keep sinuses clear. Easy, no-drug component and non-damaging.
I continue to feel deeply cheated by what the Rx took from me. Especially when an OTC saline spray was an accessible, cheaper and easier first-line approach that might have spared me, but was never suggested and I didn't know at the time that they existed.
Good luck.
Personally, I deeply regret getting prescribed and taking daily, over a course of several years, an Rx for an '-one' allergy medication, while in my early-mid 50s.
Had never taken ANY type of steroid in my life, and knew they were tricky, so asked my doctor ... really, right up and into my nasal passages? Don't worry, I was told, it's not the same mechanism. It doesn't affect other areas. Naively, I believed.
True, I could breath easy and never had a sinus infection again. However, when my next bone density came back in the osteoporosis category in all areas, and I realized my mind had dulled significantly, the damage was done.
My internist insisted, repeatedly and to this day, there is no relationship, but a GYN (in the same medical group) took me through the osteoporosis risk questionnaire (avail. online) and it has a special category for 'steroid use,' and yes, Rx inhaled steroids count as steroids; they are a risk factor/work against one.
I feel use of this accelerated the shriveling of my bones -- and my brain. Now I just use a saline spray daily to keep sinuses clear. Easy, no-drug component and non-damaging.
I continue to feel deeply cheated by what the Rx took from me. Especially when an OTC saline spray was an accessible, cheaper and easier first-line approach that might have spared me, but was never suggested and I didn't know at the time that they existed.
Good luck.
5
I am 82 years old and in great health. I attribute a lot of that good health to the fact that I take only two prescription meds - a natural thyroid supplement and eye drops for glaucoma. I take OTC drugs only rarely. My younger sister, on the other hand, regularly took over a dozen meds. She just died at age 75. I am convinced that the drugs helped to shorten her life.