Well, I think it is official: My primary is an overly aggressive worry-wart. The good: I can always (and I mean always) get him to prescribe me medication I need (or think I need). The bad: He's forever scaring the living daylights out of me.
So, I got the blood test results back. My white blood cell count is well within normal, so I do not have to worry about being overly immunosuppressed with the new, increased dosage of my immunisuppressant meds (Azathioprine, in case any one is curious). Levels of glucose, cholesterol and most everything else he described as "beautiful!" However, my Lipase reading came back too high -- about 2.5 times normal ... for this particular lab (144 U/L whereas the reference range is 7-60 U/L). Immediately, he suggests that I have further testing done - that I go to a specialist and see about getting a CT scan to see if there are any abnormalities in my pancreas. Apparently, he suspects that I have pancreatic cancer (!!!) (Yes, he actually said that.)
Um, really?!? First of all, the whole reason I had the blood test done in the first place was to see how my body was handling the new, increased dosage of Azathioprine which can interfere with liver and pancreatic functioning, or at least show up in higher than average liver and pancreatic enzyme readings. So, I asked him, wouldn't the increased dosage be a more reasonable explanation for the high readings? Like I just said, that is precisely what we were testing for! Besides, my Lipase and other enzymes became slightly elevated after I started taking the medication at a lower dose, so it makes sense that they would be even more elevated at a higher dose. When you hear the sound of galloping think horses, not zebras and all that.
Besides, I told him:
1) I am still young (52) and have absolutely none of the risk factors for pancreatic cancer. I am not and have never been overweight; I have never smoked; I am not African-American (a risk factor); I have a large extended family in which not a single person has ever died of cancer (and, besides non-melanoma skin cancer, only 2 family members have ever had any cancer at all -- very early and easily treatable breast and prostate cancer.)
2) Pancreatic cancer is a rare disease and even rarer for someone with no risk factors.
3) There are no truly effective treatments for pancreatic cancer and the 5-year survival rate is abysmal, so really why bother myself with it?
So, I suggested that instead of rushing off to a specialist to get a CT-scan (which of course would pump more radiation into my body), I'm just going to either wait until I see my rheumatologist later in the month and see what he has to say or make an executive decision and move myself temporarily back to the lower dose of Azathioprine, which was just as effective than the higher dose and what I was going to try to get the rheumatologist on board with anyway. Then, I'll go back for another blood test in another month and see how the Lipase is doing.
Oh, but wait, there are indeed other abnormalities on my blood test. My red blood cell count, hemoglobin, hematocrit were all very slightly below the normal range. He suggests that I see a gastroenterologist to see whether or not I have bleeding in my intestinal tract. He says they can do an endoscopy. But, wait, I've never noticed any bleeding. I have no other symptoms (and I don't even feel particularly tired). He says, well there can be microscopic bleeding, that's why it's good to have an endoscopy.
But, wait! Once again, like increased liver and pancreatic enzymes, anemia is also a potential side effect of Azathioprine. In fact, that is one of the reasons why I had the test in the first place, to see whether the increased dosage of the meds were making me anemic. My primary hemmed and hawed for a while, but finally admitted that it was indeed more likely that these abnormalities were due to the increased dosage of the medication than a combination of pancreatic cancer and intestinal bleeding.
His attitude is well, best to be on the safe side. What can it hurt to have every thing checked out? I told him that there was indeed a cost. Well, obviously it costs me co-pays, but also all these appointments and testing take time. And, they very well might lead to more worrying instead of less. Let's say I have a scan of my pancreas and it's not totally perfect. Let's say they see a tiny spot. Well, it's not like there are going to stop there. They are going to have to do a biopsy and probably more testing. And, all the while I'll be worrying about my pancreas instead of enjoying life, when I am pretty goddamn sure I don't have this cancer.
Anyway, I don't want to go on about this any more than I already have. The fact is that all this testing and medical worrying is so incredibly wasteful (non-Mustachian) it really pisses me off. Sure, most people only think of the co-pay. But why on earth are our health care insurance premiums so incredibly high? Well, it is just this kind of overtesting that is one culprit.
OK, I will descend from the soapbox now.