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For the next few weeks I am going to write about being a patient. I have been one for some time having been diagnosed with thyroid problems about 15 years back. This has been, however, an interesting experience...
I was tired. Not a little tired but a lot tired. I had sort of felt this way a few years before when I was diagnosed with thyroid problems. I work hard and I work a lot. I play hard too riding my bicycle 30, 40, sometimes 100 miles. There are times when I feel that maybe I am not getting enough thyroid hormone, but I do go to the doctor fairly regularly to have that checked.
But I hadn't been in awhile, so I set up an appointment. The internist whom I see was trained at Emory and I like him a great deal so I was happy to go. The visits are quite congenial and I like going to the doctor. It's fun to be on the other side of the exam table and have a different perspective on the process. The history and physical was routine and I don't really remember mentioning being tired. I am sure I did but didn't make a big deal of it - not being much different than most patients and tending to diminish symptoms.
And it seemed subtle. The most remarkable thing was that I was getting slower on the bicycle. At the time I was working with a professional bicycle trainer and I am sure that he was frustrated. My times were just plain silly. After a few years of getting steadily faster (mind you, I am not an athlete) I was now riding slower and slower, but I just attributed this to getting older and that I was busy with other things.
It was about a week later when my doctor called. I was in the car coming back from some errands and only about a block from home. He said, "You're anemic," and I almost passed over that, wanting to know how my thyroid hormone levels were. It was only when he said that "Your hematocrit is 25%," that I paid attention (normal is about 40%). I thought, "That puts me about 4 to 5 units of blood down." The rest of it was a bit of a blur, as I heard him and I talking about the workup and sorts of things I say to patients myself: more blood work, how do you feel, we'll need to have you see the gastroenterologist...
I got labs drawn today and heard back from my doctor over the weekend. He gave me the name and number of a GI doc. Tried to call without much success.
Labs back. It's an iron deficiency anemia. This just makes no sense. I have a family history of colon cancer, but I was screened two years ago. That screening wasn't perfect so it's possible that this is colon cancer. I haven't any GI bleeding, I eat healthy, exercise a lot. This just doesn't make sense.
I actually spent time online looking up potential reasons. There's a not a lot. One interesting explanation that I found is that marathon runners will often have occult bleeding. No real explanation but it appears to be related to increased permeability of the wall of the colon.
Jeez, who knows.
OK, it's Friday the 13th. I got in touch with the gastroenterologist today. He was curt but nice. Isn't going to make me come in for an office visit. The issue is that it'll be about 3 weeks before he can do this and we set up for the 6th of March.
After a night of prep I presented myself at the hospital for endoscopy. The prep was not too bothersome and the folks at Touro were really nice.
I was wheeled into the endoscopy suite and then the doc came in to discuss with me and we chatted and signed the consent forms. This being my second time, I knew what to expect: nothing. The drugs are great and I knew that I wouldn't remember much of anything.
I do remember the recovery room, however. The doctor came in and said, pretty matter of fact, "Your colon is clean, but you have no villi." I do remember thinking that there aren't really villi in the colon, then realizing that he had also done an upper endoscopy to look at my stomach and small intestine. No villi. Hmm. That means I have Celiac Disease. Glad I was on drugs.
The gastroenterologist called today. "It looks like you have celiac sprue disease," he said right away. I will admit that all of this seemed so surreal. I have Celiac Disease? While I know a lot about this because of writing for the Dr. Gourmet Web site, living gluten free is different. I have been saying for years that the whole low carb diet thing is silly and that "I would never give up pasta." That's really all I could think about. Not eating bread or any of the other things that contain flour never much crossed my mind.
I came out of my fog a bit to hear him say "I'd like to get some more blood work to confirm this," and we made arrangements to get that set up. I will say that his bedside manner left a lot to be desired, but he's a good technician.
I will also admit to being in denial...
Timothy S. Harlan, M.D.