Too Much of a Good Thing

[Guest guest]

The Martha's Vineyard Times is a weekly publication.

http://www.mvtimes.com/Calendar/12232004/off_north_road.html

December 16, 2004

By Hoxsie, M.D.

Dorothy and Dick Lennihan were our first Vineyard friends. Their son,

, my classmate at Cornell Medical College, had cajoled us to the

Vineyard for a weekend to consider replacing one of the physicians who was

about to retire from practice. Within three months we had moved into our new

home in Vineyard Haven and I’d hung out my shingle. ’s parents

remained our friends and great supporters until their deaths years later. I

became their physician and confidant and they my senior counselors. Dorothy,

when we met, was in her late sixties, a tireless and humorous woman. She was

severely disabled by a neurological disease called Brown-Sequard syndrome,

combining a peculiar dissociation of her ability to feel pain and

temperature on one side of her legs and body and weakness on the other. The

changed pain perception allowed joint degeneration and deformity to occur in

one knee without the usual cautionary pain perceived by well people and her

opposite knee was weak and tended to buckle. Her doctors predicted to her

husband, Dick, that she would end her years in a wheel chair. With a

four-pronged aluminum cane or elbow crutch she got around wherever she

needed to go. At the beach, she discarded the cane at water’s edge and dove

in for a swim. Somehow she managed to scramble back to her feet when she

came ashore. She painted metal trays in a small studio in the front of her

house and spent hours transforming drab barroom trays into works of art.

Thirty years later Ann keeps our black and gold figured tray polished

as if new. Dorothy’s complaints of insomnia and obesity were frustrating to

me but Dot was a good friend and booster. I suspect she was responsible for

referring many of my early patients.

My first professional call to her was occasioned by a chronically

intermittent fever which had defied her previous Vineyard doctor’s efforts

and those of several others in Boston. She had spent two weeks at the

Massachusetts General Hospital undergoing a considerable body of

investigation without finding a specific diagnosis and continued to have

episodes of her temperature rising to 101 or 102 for days at a time. Despite

this, she felt relatively well and played bridge every Tuesday afternoon,

painted trays and entertained us occasionally for Sunday cocktails.

Nevertheless, as the weeks wore on, her anxiety and fatigue grew. “There

must be some reason for this fever, Russ,” she said.

I began to be concerned a hidden cancer lurked somewhere. Her reports from

Boston came to me in the mail, complete and exhaustive. A week or two after

I had reviewed her tests and examined her in my office, I made a house call

in response to her fever. “Dorothy, I can’t find anything wrong with you

either,” I said after examining her again.” Why don’t we go over some of the

routine things in your life once more? Maybe we’ll see something we missed.”

She heaved a great sigh of impatience but complied.

“You have no pets, no birds in a cage, no ticks on you that attached

themselves, no recent travel out of the country.” And on I went for most of

an hour. “Dorothy, tell me again what medicines you’ve been taking: Diuril

for blood pressure, phenobarbital for sleep, nothing else? Think to be sure

”

“Oh yes, vitamins every day but I’ve taken the same ones for years. And once

in a while some Tums. They wouldn’t hurt, would they?”

“Nothing else?”

“Nothing, only the thyroid I’ve taken for years from my Boston doctor. He

told me to take them for the rest of my life.”

“Nothing there I guess. Keep up the aspirin. As long as you look this well I

don’t think there’s anything else to do right now. We’ll be by Sunday for

drinks. Thanks for asking us.”

Sunday, Dick met the ferry to pick up some guests and wasn’t at home when we

arrived. Out on the deck in the lee Dorothy said, “You know where everything

is, ice in the freezer and liquor in the closet over the sink.”

I idly assembled the cocktails and perused the cluttered kitchen. I saw all

the usual contrivances and pots of growing herbs, a big sack of bird feed,

and a small shelf filled entirely with medicines, many more than Dorothy

indicated in our recent conference over fever. Intrigued, I picked them up

one by one. I’ve forgotten all the names by this time but their datings from

the pharmacies were incredible: two years old, five years old, six years old

Many were so grimy I couldn’t read the names and there were five bottles of

thyroid pills, one from Toledo where Dorothy last lived before the Vineyard,

two from Boston, one from Los Angeles, which made me ponder, and one of mine

from the Vineyard. Each was for one-grain tablets and each said to take

three pills every morning. I mixed the drinks and brought them to the deck.

The moment passed, Dick returned from the ferry with his guests and we had a

pleasant hour before returning home.

The following week Dorothy had an especially bad time with fevers and

remained in bed most of the time. I made a home visit on Friday determined

to contact the specialists in Boston again to begin another round of study,

this time with more extensive tests, maybe even an exploratory operation.

Her medicines sat on her bedside table including all the thyroid bottles,

five of them. Curious, I picked up each one in turn and repeated my

observations of the Sunday before.

“Why have you kept all of these thyroid prescriptions, Dorothy? Why hold

onto all of them?” She looked up at me without expression. “The last one I

gave you ought to be the one you use. Throw out the rest.”

“But I take them all, Russ. I never felt very good when I took two or three

a day. Over the years I found I do better, much better, with more.”

“How many do you take?” I could hardly believe what I was hearing.

“Most days six. When I have those fevers I may take a couple extra. The

doctor always told me they were safe.”

Suddenly her temperature chart and the galaxy of expensive and painful tests

she had gone through were staring me in my mind’s eye. Here was the answer

to her fevers, I thought – too much thyroid hormone driving her metabolic

furnace higher and higher and of course with fever.

Every new young doctor needs a case like this to establish him in his new

practice. Imagine the chagrin of the city specialists when Dorothy, months

later, told them that her fevers ended immediately when she cut back to two

thyroid tablets a day. And imagine my swelling head when Dorothy’s friends

came to my office in increasing numbers.

________________________________________________________________

Thyroid-Adrenal Connection: Information and Resources

http://www.bestweb.net/~om/thyroid

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[Guest guest]

Had THIS doctor been testing her thyroid hormones, he would have caught THIS

much sooner! Though I feel quite angry at her for lying about how much she

was taking, I feel angrier at this doctor for not doing testing for her Free

thyroid hormones. I KNOW that he didn't because nothing was said about it

in this article. SHEESH, all that suffering for nothing, ya know, kind of

like the UNDERtreated, only opposite. This was ridiculous!

Too Much of a Good Thing

>

>

> The Martha's Vineyard Times is a weekly publication.

> http://www.mvtimes.com/Calendar/12232004/off_north_road.html

>

> December 16, 2004

>

> By Hoxsie, M.D.

[Guest guest]

*~ OM ~* wrote:

> Many were so grimy I couldn’t read the names and there were five bottles of

> thyroid pills, one from Toledo where Dorothy last lived before the Vineyard,

> two from Boston, one from Los Angeles, which made me ponder, and one of mine

> from the Vineyard. Each was for one-grain tablets and each said to take

> three pills every morning. I mixed the drinks and brought them to the deck.

> The moment passed, Dick returned from the ferry with his guests and we had a

> pleasant hour before returning home.

i wish i had everlasting Armour bottles - she must have had bottles of a

thousand tablets to be taking a minimum of six a day and sometime 8 to

still have some left.

Heck , i have been deliberately getting Armour prescriptions filled

before its really necessary and i have only been on it for 6 months on a

lowish dose and i've still emptied 3 bottles.

As far as i can see this was an easy get out for the Dr - i hope he

follws up in a few months -though i dounbt it - patient stupidity is an

easy answer