January 2009

Q. I read your article about Opra.Can you please give me advice. I’m 53 / live in Canada, we do have very poor medical system- for a specialist we have to wait 6 months and he is very busy give only 2 minutes to talk. I’m taking Tapazole for a 1 year and 2 months and now for the 3 months I’m on 15 mg. I was for a long time on 5 mg then 4 months on 20 mg and my thyroid overactive condition is very slowly getting better but my endocrinologist is telling me that is taking too long, that taking tapazole for that long is not good for me so he wants to give me a pill to kill my thyroid permanently and put me on hormones for a life. I do not like the idea and I do not want to do it, do you think is this necessary? I’m very scarred of the 131 pill that is going to give me more trouble to my health & taking artificial hormones it will be not that good too me also I would give more time for the tapazaole but not in 15mg but 10 the most and see if that will help . What could possibly happen if i will take them for another year? I’m also taking Propananol 10 mg but only half does what the doctor told me/ 40 mg/ other then this i’m fine . I was loosing weight and now for the last 3 months I gain 10 Ib.

A. It sounds like you have Grave's Disease? Is that correct? Rarely an overactive thyroid is from a "hot" nodule of the thyroid that is working overtime. Most patients with Grave's disease end up needing to take radioactive iodine as the gland takes too long to burn itself out. If however you are having no problems with the medications and your pulse and heart is good (your pulse should be in the 60's to 70's if you are getting enough medication). You are right that the iodine will almost certainly cause your gland to no longer function and that most patients then have to take a simple thyroid hormone pill daily for life. This sounds like a big deal but for almost everyone it is much preferred over worrying about the risks of an overactive thyroid which can affect the heart, bones, etc. What does your family doctor say? They too should be able to guide you and reassure you. Have you ad your eyes checked? Do you have the prominent eyes of Grave's disease?

Q. Good article as are some of the others of yours I have read, but I do have a question. My wife and I are both medical professionals ( Medical and Radiology techs) Recently I was scheduled for a routine colonoscopy, the date was set, the prep was provided, then I requested my wife accompany me to observe at which the Doctors response surprised me, he said absolutely not, I asked again but received the same response. My wife and I attend each others intimate as well as routine exams, we find we get better care that way and it helps to retain the large volume of date received in the exam room. But enough about that, I researched the presence of 3rd parties in the exam room and found no legal or medical reason for the Dr's refusal. I assume some states have regulations regarding the presence of 3rd parties in certain medical settings but can find nothing referring to the 3rd party in the exam room during a colonoscopy, perhaps you could help.

A. I more than understand your desire to accompany your wife to all medical exams/procedures etc. as so much information transpires and often the patient is not in the best position to comprehend it at the time. In the case of colonoscopy - many doctors perform then in a surgical/ambulatory care center suite and in that case hospitals rarely if ever allow a family member to accompany patient beyond the waiting room. However you should be able to be in attendance when the results of the procedure are discussed with your wife. My GI physician in Philadelphia does exactly that - since the anesthesia requires an adult accompany the patient home after the procedure - they invite both the patient and significant other to talk to the doctor about the findings. I suspect however that many doctors don't take the time to do this and simply expect that the results will be relayed back to the referring physician. In smaller practices/offices where the procedure is not in a hospital suite, perhaps they would on occasion allow a family member to observe. Yet since it is a surgical procedure I suspect this happens infrequently. Bottom line - you should request that you accompany your wife when the findings are discusses (as she will be sedate from anesthesia and may not be in best position to remember/relay the information.