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About 10 days ago I had a visit with my new PCP at the VA. I went in at 0700 to do a blood draw for hormones, what I thought would be a blood panel and a urine tox screen as is protocol for getting an opiod Rx.
I made it to my 1130 appointment and waited, of course, and finally the nurse came out. I have had a good relationship with this nurse for years and he seems to be a good guy. He took my vitals and then asked if I wanted the COVID vaccine. I declined and he asked if I ever intended to get one. I said "No". He then asked if I wanted the Flu vaccine and again I stated "No". Then he said I was due for a tetanus booster. I found this sort of odd so I said that I would wait until my next visit. The vibe changed significantly from there on.
A bit of back story first:
My previous physician was incredibly knowledgeable about nutrition and supplements. We frequently discussed mitigation of some of my blood test numbers using things like Red Yeast Rice, CoQ10, Omega/EFAs and resveratrol, etc. He understood I prefer to take no medication and prefer to manipulate my health through more natural ways. He never spoke down to me or in an authoritative manner and seemed to enjoy discussing these sort of things as most of his patients were not exactly health conscious.
Unfortunately he became ill two years ago and I have had to deal with several stand ins who were very distant and detached, as one might expect with a physician who has no investment in their patients. Dr. Le became healthy again and to my disappointment, retired.
I finally see my new PCP who appears to be a healthy, fit guy in his late 30s to early 40s.
The start of our conversation is my mentioning to him that I saw a skin cancer specialist in Cabo who spent nearly an hour inspecting every inch of my body (pretty much) and that he burned several AKs off but prescribed Efudix cream, which is a chemotherapy drug, for the persistent ones. The nurse brought in the liquid nitrogen dispenser but the doctor seemed totally disinterested in it. I mentioned that when I last saw a dermatologist at the VA in Houston, she only looked at my torso, unlike the head-to-toe the Mexican doctor did.
This guy starts to tell me that studies have shown that burning off AKs was not proven to be necessary and only mildly prevents skin cancer. His suggested course of action was to use this chemical cream vs. burning off the spots right then and there.
Next to my blood work. He states that I have hyperlipidemia and asks why I refuse statins. I tell him why and he makes a scoffing sound and face. He also says my liver function is off based on my blood work. My previous physician KNEW that people who engage in weight resistance training have muscle damage which skews the numbers and it is perfectly normal (to an extent).
He asked if I exercise. Probably the stupidest question I have heard a professional ask. But, I take it in stride and tell him that I do 30 minutes fasted cardio every morning or at least 6 days a week and spend 4 days a week, for one hour lifting weights. He immediately blurts out "That's too much!" He continues with studies have shown that anything over 6 hours per week is counterproductive...repetitive motion, etc. I explain to him that I use the acute pain of training and muscle soreness to mitigate my chronic pain. He says a few things more about too much exercise and the like.
He uses the pain conversation to segue into my ongoing Norco Rx. He states that studies have shown that chronic pain treatment is not effective using opiods and that they do little to ease the pain. He then says that this new approach has nothing to do with abuse of these drugs and that the VA is no longer prescribing opiods for chronic pain. This part made me a bit emotional, not because I could see where he was headed to, to NOT renew my Rx, but because I immediately thought of all of my brothers and sisters who are dealing with incredible pain from horrific injuries and how they might fare in the future. I immediately think of the "22 per day" suicide rate. I got a bit choked up and told him it had EVERYTHING to do with abuse on the street. In the decades I have been dealing with chronic pain, I have seen the entire spectrum of "Free willy" prescribing to total "gate keeper" shut off, all depending on the politics of "medicine".
I made it clear that I didn't use Norco for chronic pain but for days that I just couldn't get "over the hump" of dealing with my pain in other ways. I told him "Fine, I will just learn to live with the pain...as I always have."
He then asked me if I take supplements. I said that yes, I take many supplements. Now if this guy was asking if I take steroids, he should have asked that. But he didn't. He could easily see my miserable hormone profile and saw that I wasn't taking them so I figured that he must really mean supplements. He was clearly against them as he said that his sister is a bodybuilder and doesn't take any supplements. I desperately wanted to scream "BULLSHIT!" but kept my cool, although at this point it was getting pretty hard to not start raising the bullshit flag. I informed him that I had not taken any supplements for two weeks in anticipation of my colonoscopy. He said that he sees 4 or 5 people a month that come in with liver or kidney failure due to supplements'
I told him once again that I mitigate my cholesterol using supplements and that my experience might be considered anecdotal but the number change is significant when I am on a regimented use of these supplements. He asked which ones and I told him.
On discussion of my hormones, he defers any discussion to my endocrinologist appointment in November.
I left the appointment sort of stunned and at a loss for words, which anyone that knows me is quite an anomaly. I am not sure why I didn't ask "Which studies?" every time he said that. I am not sure why I didn't ask for justification of most of his comments.
I later logged on to to the health portal and saw his notes:
"Hyperlipidemia and hepatic (something or the other) and hypogonadism due to bodybuilding" He makes several notes about "bodybuilding supplements" and a "mild tachycardia likely due to bodybuilding supplements". Never once was "bodybuilding supplements" discussed and he obviously made that assumption based on my use of supplements and my "hobby".
I also became aware that he had NOT ordered a blood panel even though he KNEW I was going in for a blood draw. He also KNEW that he was NOT going to prescribe an opiate yet he ordered the urine tox screen test (the only thing he ordered) anyway. For me, a 27+ year veteran who has NEVER had a positive piss test, this is incredibly insulting and the relevance escapes me if he did not intend to prescribe Norco. He certainly tried to prescribe just about everything else though. Statins, NSAIDs, etc.
So his assessment of hyperlipidemia was based on an 11 month old blood test! Incredible!
What is the take away from this? I don't know? Maybe to be vocal at your appointments? Maybe that you don't have to settle for whoever they assign you? I don't know.
I do know that I am going to request a different physician.
I made it to my 1130 appointment and waited, of course, and finally the nurse came out. I have had a good relationship with this nurse for years and he seems to be a good guy. He took my vitals and then asked if I wanted the COVID vaccine. I declined and he asked if I ever intended to get one. I said "No". He then asked if I wanted the Flu vaccine and again I stated "No". Then he said I was due for a tetanus booster. I found this sort of odd so I said that I would wait until my next visit. The vibe changed significantly from there on.
A bit of back story first:
My previous physician was incredibly knowledgeable about nutrition and supplements. We frequently discussed mitigation of some of my blood test numbers using things like Red Yeast Rice, CoQ10, Omega/EFAs and resveratrol, etc. He understood I prefer to take no medication and prefer to manipulate my health through more natural ways. He never spoke down to me or in an authoritative manner and seemed to enjoy discussing these sort of things as most of his patients were not exactly health conscious.
Unfortunately he became ill two years ago and I have had to deal with several stand ins who were very distant and detached, as one might expect with a physician who has no investment in their patients. Dr. Le became healthy again and to my disappointment, retired.
I finally see my new PCP who appears to be a healthy, fit guy in his late 30s to early 40s.
The start of our conversation is my mentioning to him that I saw a skin cancer specialist in Cabo who spent nearly an hour inspecting every inch of my body (pretty much) and that he burned several AKs off but prescribed Efudix cream, which is a chemotherapy drug, for the persistent ones. The nurse brought in the liquid nitrogen dispenser but the doctor seemed totally disinterested in it. I mentioned that when I last saw a dermatologist at the VA in Houston, she only looked at my torso, unlike the head-to-toe the Mexican doctor did.
This guy starts to tell me that studies have shown that burning off AKs was not proven to be necessary and only mildly prevents skin cancer. His suggested course of action was to use this chemical cream vs. burning off the spots right then and there.
Next to my blood work. He states that I have hyperlipidemia and asks why I refuse statins. I tell him why and he makes a scoffing sound and face. He also says my liver function is off based on my blood work. My previous physician KNEW that people who engage in weight resistance training have muscle damage which skews the numbers and it is perfectly normal (to an extent).
He asked if I exercise. Probably the stupidest question I have heard a professional ask. But, I take it in stride and tell him that I do 30 minutes fasted cardio every morning or at least 6 days a week and spend 4 days a week, for one hour lifting weights. He immediately blurts out "That's too much!" He continues with studies have shown that anything over 6 hours per week is counterproductive...repetitive motion, etc. I explain to him that I use the acute pain of training and muscle soreness to mitigate my chronic pain. He says a few things more about too much exercise and the like.
He uses the pain conversation to segue into my ongoing Norco Rx. He states that studies have shown that chronic pain treatment is not effective using opiods and that they do little to ease the pain. He then says that this new approach has nothing to do with abuse of these drugs and that the VA is no longer prescribing opiods for chronic pain. This part made me a bit emotional, not because I could see where he was headed to, to NOT renew my Rx, but because I immediately thought of all of my brothers and sisters who are dealing with incredible pain from horrific injuries and how they might fare in the future. I immediately think of the "22 per day" suicide rate. I got a bit choked up and told him it had EVERYTHING to do with abuse on the street. In the decades I have been dealing with chronic pain, I have seen the entire spectrum of "Free willy" prescribing to total "gate keeper" shut off, all depending on the politics of "medicine".
I made it clear that I didn't use Norco for chronic pain but for days that I just couldn't get "over the hump" of dealing with my pain in other ways. I told him "Fine, I will just learn to live with the pain...as I always have."
He then asked me if I take supplements. I said that yes, I take many supplements. Now if this guy was asking if I take steroids, he should have asked that. But he didn't. He could easily see my miserable hormone profile and saw that I wasn't taking them so I figured that he must really mean supplements. He was clearly against them as he said that his sister is a bodybuilder and doesn't take any supplements. I desperately wanted to scream "BULLSHIT!" but kept my cool, although at this point it was getting pretty hard to not start raising the bullshit flag. I informed him that I had not taken any supplements for two weeks in anticipation of my colonoscopy. He said that he sees 4 or 5 people a month that come in with liver or kidney failure due to supplements'
I told him once again that I mitigate my cholesterol using supplements and that my experience might be considered anecdotal but the number change is significant when I am on a regimented use of these supplements. He asked which ones and I told him.
On discussion of my hormones, he defers any discussion to my endocrinologist appointment in November.
I left the appointment sort of stunned and at a loss for words, which anyone that knows me is quite an anomaly. I am not sure why I didn't ask "Which studies?" every time he said that. I am not sure why I didn't ask for justification of most of his comments.
I later logged on to to the health portal and saw his notes:
"Hyperlipidemia and hepatic (something or the other) and hypogonadism due to bodybuilding" He makes several notes about "bodybuilding supplements" and a "mild tachycardia likely due to bodybuilding supplements". Never once was "bodybuilding supplements" discussed and he obviously made that assumption based on my use of supplements and my "hobby".
I also became aware that he had NOT ordered a blood panel even though he KNEW I was going in for a blood draw. He also KNEW that he was NOT going to prescribe an opiate yet he ordered the urine tox screen test (the only thing he ordered) anyway. For me, a 27+ year veteran who has NEVER had a positive piss test, this is incredibly insulting and the relevance escapes me if he did not intend to prescribe Norco. He certainly tried to prescribe just about everything else though. Statins, NSAIDs, etc.
So his assessment of hyperlipidemia was based on an 11 month old blood test! Incredible!
What is the take away from this? I don't know? Maybe to be vocal at your appointments? Maybe that you don't have to settle for whoever they assign you? I don't know.
I do know that I am going to request a different physician.