Thursday, March 28, 2013

Tell Your Doctor About Your Supplements

Anyone who regularly reads this blog knows that I am not a fan of willy nilly use of supplements. One of the primary functions I perform during a Medicare Annual Wellness Visit is to identify which supplements people use, understand their rationalization or reasons for using them, and then discuss the science, or lack of, supporting their use. Despite my best efforts, some people are so emotionally attached, perhaps one dare say addicted, to their supplements, that nothing I say affects their decision to keep taking pills in the absence of reasonable evidence.

A recent episode underlines how confusing the situation can become.

A patient recently came to see me who was taking multiple supplements prescribed by his child, a physician, who lives and works in the northeast. The patient was a slim man, who otherwise appeared in good health, other than having been diagnosed two years earlier with prostate cancer and having a history of hypothyroidism.  His only health concern was that both his legs had swollen up.  During his wellness visit, during which a physical exam is not routinely performed, we discussed his multiple supplement usage, and I tried to persuade him that the supplements were not expected to nor were they doing him any good.  I even went so far to phone his child during the appointment to discuss the rationale for the pills. The child explained that the father had hypothyroidism and that this was responsible for the leg swelling and that the supplements were the best treatment for the disease.

Nevertheless, I convinced the father and child that it would be prudent that the patient visit with an endocrinologist, the specialist that deals with thyroid disease to make sure of the diagnosis. They reluctantly agreed. At the same time, I began to research the connection between hypothyroidism and bilateral leg swelling, medically called pedal edema. At best, the connection seemed tenuous.

The patient scheduled to see me again to discuss the endocrinologist visit and it turns out to inform me that he could only take the advice from one doctor and would be following his child's advice. I expressed concern that the leg swelling might be due to a different cause since hypothyroidism would not cause swelling to the degree he exhibited. Even though he was prepared to leave, I pressed him further about other symptoms and factors that may be contributing to the swelling. At one point he asked if his prostate cancer might be a factor and mentioned some slight difficulty urinating. I immediately implored him to allow me to examine him and he consented.

As he lay on the exam table, and I lifted his shirt, my eyes could not believe what I beheld.  There in front of me was a huge mass protruding from his lower belly. It felt rock hard and was dull to percussion. Without hesitation, I walked him to over to the nearby diagnostic center and ordered an emergency ultrasound. The ultrasound revealed that this rock hard mass was actually his bladder that was hyper-extended and that he had urine backed up on both sides filling his kidneys with water, a condition known as hypernephrosis. I then ordered an emergency CT scan which revealed extensive metastasis, presumably from his prostate cancer, to surrounding lymph nodes and bone.  His cancer had aggressively spread and was presumably blocking the out-flow of urine resulting in distension of the bladder and early shutdown of the kidneys. The patient was then sent to the emergency room where they drained the bladder of 2,400 cc of urine.

The next day, I scheduled him to see a urologist who offered him hormonal therapy for the prostate cancer, but again based on the child's recommendation, the treatment was refused. No comment.

This entire scenario had unfolded because he had relied on a long-distance diagnosis from his child and on supplements that were meant to treat his problem. To me this is akin to self-diagnosing based on what you read off the internet or some health-related magazine, and then self-medicating based on the presumed diagnosis.  In this patient's case, such actions probably cost him a year or two of precious life.

One last comment. Fortunately, this patient had an Annual Wellness Visit and shared his supplement usage with a physician. Many patients do nether. In fact, in 2012, only nine percent of eligible Medicare beneficiaries took advantage of the service. Furthermore, in a recent survey of cardiology patients at one clinic in Scotland, more than half reported they used at least one complementary therapy, according to Jenny Jones, PhD, and colleagues at the University of Stirling in Stirling, Scotland. But records suggested that few patients had told doctors about their use of complementary treatments, Jones and colleagues reported at the EuroHeartCare 2013 meeting in Glasgow, Scotland.

In the study, co-author Stephen Leslie, MBChB, PhD, said that a review of patient notes found little evidence that doctors knew of the use of complementary and alternative medicines. "We found that very few people had volunteered this clinically important information in consultations," he said in a statement, "suggesting that they don't often disclose (complementary and alternative medicine) use to cardiology teams."

A recent study involving children, Canadian researchers found widespread use of complementary and alternative medicines (CAM) among children treated at two hospitals that were widely separated geographically. Again, their doctors were poorly informed of such use.

It's bad enough that people are self-medicating with unproven remedies they've learned of from the media, internet, or well-intentioned friends. But failing to tell their physician is adding insult to injury--to their bodies.

So if you insist on using supplements that may not only be useless, but may also be harmful, at least have the common sense to let your doctor know so he or she can incorporate such information in helping to provide the best care to you. This is not the type of information you may want to keep from your doctor.  It may cost you your health or even life. And if you have Medicare, go get an Annual Wellness Visit. It's covered 100% with no deductible or co-payment and make sure to tell your doctor about your supplement usage even if he or she fails to ask.

If you want to come to MDPrevent and see me, call (561) 807-2561 to schedule an appointment.


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