Regarding Mom's test results postings:
    I decided not to seek out any test results from the PCP she visited before we switched her to her current clinic because I realized that any test results would tell more about her former PCP and his doctoring habits that they would about her.
    I have a good recollection of her relationship with her previous PCP and an excellent recollection of my relationship with him that began when I realized it was becoming necessary for me to become involved in this aspect of her life and be present to record and remember what he told her and what medications and actions he prescribed. I don't think he was a "bad" doctor but he was clearly overbooked, overworked, and intimidated by the relatives of patients who acted on the necessity of becoming involved in their loved ones' medical care. I also remember that he took and required few tests. Some of this may have been because up to the late 1990's her health was in excellent order. Beyond that point though, especially when he began prescribing metformin for her, he did not monitor her adequately, did not inform her that self-monitoring was necessary, gave her some printed information about diabetes but dismissed it as he was giving it to her and the only statement my mother remembered of his management of this particular dis-ease, from the day he put her on the metformin, was that he said, "...you can eat all the popcorn and peanut butter you want." Because he did not monitor her from the beginning she stopped taking the medication soon after she'd started. It made her "feel bad"; which is to say lethargic and foggy, and despite the fact that I'm sure her blood sugar was on its way to thoroughly saturating her blood at that time, she felt much better off the medication for awhile.
    I will be continuing my collection of test results from now on and poring over them as has become my habit, learning as much as I can about how to interpret them for clues about handling her day-to-day health.
    Oh! I almost forgot. The very last test I input this morning for which blood was drawn on 7/27/00, much to my surprise, seems to indicate in the context of all her other tests that she was beginning to develop waves of suspiciously anemic conditions back then but which were not addressed at that time. As I look over the tests I can see why. Sometimes her blood was in perfect order, sometimes it wasn't, but there was no consistency to these indices except for their inconsistency. I'm pleased that they became consistent enough within the last year for this to finally be addressed although I also, now, see why it is so hard to determine the cause for her anemia and why, although it appears to be somewhat likely that she intermittently bleeds internally, this also may not be the case. It's important, I think, for me to keep in mind that she was at her most severely anemic during the period when the colonoscopy was performed on her and yet, without discovering any indication of internal bleeding, her anemia cleared up more quickly than is usually the case after the procedure. Despite my insistent questioning of all that her doctors have been doing for her, I am now grateful that they have been paying close attention to her for the last year, am more sympathetic with their dilemma in regards to her anemia and am going to write her PCP a letter today expressing both my further understanding of this issue and my thanks for his care and his endurance of my involvement in her care. I am thinking, too, that both he and I (and, perhaps, the entire institution of medicine) had and have a lot to learn about managing intermittent, resistant anemia in the elderly and I want to express to him that the more information he can give me and the more he can help me consider all the personal-to-my-mother and general information about this problem, the more likely I am to go along with his recommendations, even though I may initially question them.
    It is fascinating to me to consider her health in light of the series of tests from this PCP but it is also interesting to consider the dynamic state of medical laboratory technology, which is clearly indicated as I peruse the history. Not only do reference ranges change depending on the vendor of the test and demographics regarding test results as they are recorded and processed throughout the nation (and, I'm wondering, possibly the world), but groups of testings one can order and the ability to get usable results regardless of the state of the testee's health and ability to maximize themselves for usable results continues to upgrade. I read yesterday, in a book I have just begun (published in 1999), that computers are beginning to edge out doctors in the ability to sensitively diagnose individuals. I'm not surprised. I know this is going to usher in (already has, in fact) a difficult period in medical treatment for both doctors and patients, in large part because past expectations and what was once legitimate ego gratification for both doctors and patients due to the "doctor as God" syndrome will have to change. But I find the possibilities exciting and am pleased that my mother continues to live to take advantage of these pregnant possibilities.
    I should mention that there were two urinalyses which I did not post. Both were done to diagnose and treat a severe bladder infection (which turned out to be caused by Strains 1 & 2 of Escherichia coli) that precipitated a change in PCPs. The tests merely confirmed the diagnoses and that she was on appropriate treatment.
    Lastly on this subject, as I recorded tests I also became aware of mistakes I made when posting previous tests, mostly in names; i.e., I was, for awhile, recording "Alkaline Phosphatase" as "Alkaline Phosphate". I noticed as well that I have been occasionally misspelling "Albumin", which I have yet to correct. As I come across these I will correct them. If any of my readers discover or question the veracity or correctness of any particular postings, please feel free to let me know. As well, it is interesting to me to note how the labs become clearer in recording the names of tests as time goes on and the changes in names, etc., of groupings of tests. I've been noticing, too, that tests for certain values of particular chemicals or conditions in the blood become redundant as time goes on or, I suppose, unnecessary and not cost effective, so these are dropped and, as they are dropped, the names for particular groupings change. Very interesting field! Gives me lots to think about!
- posted by gail rae @ 15:05   email...this post