This week I saw a patient with several common issues that I want to post to warn others. Take-home messages are:
Doctors almost never consider that the patient's current complaint and symptoms are due to a medication they are on.
Second is that doctors who do procedures (which are far more profitable than consulting with a patient) have a strong tendency to do their procedure on patients for whom there is no justified reason to do so and blindly overlook glaringly obvious causes and simple inexpensive treatments to help the patient due to their hyperfocus on doing the procedure. "To the man with a hammer, everything looks like a nail"
An example is a young woman who presents with nausea and lower cramping abdominal who also has the intrauterine device (Mirena) or other Progestin eluting IUD. The family doctor does not even consider the Mirena as the cause for these common side effects of Mirena and instead refers the patient to a gastroenterologist. The gastroenterologist similarly does not even consider Mirena and instead gets her on the schedule immediately for an upper endoscopy (an invasive test using a fiberoptic scope which is stuck down the patient's throat into their stomach; also called an EGD or esophagogastroduodenoscopy). The test is not indicated and as expected comes back normal as do most of them. The patient is discharged by the GI doctor as "sorry, it all looks normal but take an acid suppressor like Nexium as it looks a little red down there". This does not help when tried. The patient like many, then sees me after thousands of dollars are spent often including ultrasounds or CT scans of the abdomen.
This patient like many with Mirena is suffering from the GI side effects and nausea of the Progestin containing IUD and a careful easy history reveals the temporal relationship between the Mirena and the symptoms! In my medical training, I learned that a good history and physical is more important than just jumping to tests! This old school medical training has been replaced with excessive tests and procedures with the main goal being the 'bottom line".
Another common "post normal endoscopy" patient I have seen is an otherwise healthy patient who comes in after CT scans, upper endoscopy (EGD) and colonoscopy, ultrasounds and often repeat endoscopies!! The patient sits down with me for 2 minutes and it is clear to me: classic lactose intolerance. The patient was never told by her family doctor or the GI doctors who performed the normal EGD and colonoscopy that it could be all resolved by avoiding dairy. Numerous times, I have charged the patient ten dollars to go home and avoid all dairy except butter for 2 weeks and then call my office. Every time I did this, the symptoms all resolved by simple milk avoidance. The patient could have been spared the expense, anesthesia, and possible death due to intestinal punctures!
I encourage all women with the IUD Mirena to google the side effects and law suits involving this drug and ask your Gyn about the copper IUD PARAGARD which does not have any Progestin hormone in it. Youtube has some fun video done by patients reporting side effects of Mirena.
See the below CBS news story/ video I just found regarding unnecessary upper endoscopies (EGDs). I'm glad it is not just my observation!
In Good Health,
Dr. Adrian Hohenwarter, MD.
Office: 717-832-5993 www.DRAdrianMD.com