Supporting DH at doctor's appointment

[BecauseMumSaysSo]

Can you help me to make the most of the doctor's appointment for my DH on Thursday, by suggesting what to do / not to do during the appointment, which questions to ask etc.

The most recent events leading up to this appointment is an incident where my DH nearly fainted and experienced unexplained extreme weakness. GP suggested a blood test, followed by another two blood tests, which revealed high lymphocyte count and high serum TSH (potential underactive thyroid). The appointment is to talk about blood test results.

DH doesn't feel well for a while now (years rather than months) - persistent tiredness, headaches, depression. I found the knock-on effect of his depression particularly hard last year, and I'm not sure I have it in me to cope with this level of moodiness, blame and anger again, should it return in the future.

DH is highly skeptical of doctors and refuses medication. If not me insisting on him seeing the doctor, he wouldn't go at all. He believes in alternative medicine, practically to the exclusion of traditional medicine. He is highly intelligent but can't always communicate clearly and can be very impatient when people disagree with him. Last year he was offered anti-depressants which he refused, and CBT counselling which he started to attend but dropped out after 2 sessions. We did some private counselling together (my initiative) which he was very negative about, and so that hasn't worked either. Generally speaking he is not planning to take medication this time either, and believes that me being present at the appointment will create further tension between us, as I will be in support of doctor's recommendations, and he won't. Still he says it's ok for me to go, if I want, so I have his (reluctant) green light.

The reasons I would like to attend are: 1) To have first-hand information about the results, next steps, and diagnosis (when it's possible to establish one). When I previously asked DH to tell me what the doctor said, he huffs and puffs, makes sarcastic comments mixed with criticism about GPs and general negativity, and I find it difficult to understand what the doctor actually said; 2) To understand the prognosis (again, maybe too early at this point, we'll see); 3) Highlight symptoms, family history and other important information to the doctor that was potentially missed out. For example, DH is vegeterian, previously vegan, so diet might have played a role; he feels lack of fresh air far earlier than most people do and gets headaches as a result. His dad died in his forties from cancer. I'm really not sure any of this was ever mentioned to the doctor.

So, what's my best bet at this stage? A friend of mine suggested to push for diagnosis, further tests (scan and biopsy), and maybe a referral to a specialist. Makes sense. What else? Any tips? I want to be supportive to the best of my ability.

(I'm in my 30s, DH in his 40s, two primary school age DCs).

Thanks for reading.

Because - It's a positive move that you are able to attend the appt on Thursday. I wonder if he is actually fearful rather than 'blase' about his health. Anxiety can manifest in many different ways and this could be his way of coping with his current condition.

See how the appt goes. The GP will do further investigations if he/she thinks it is necessary. Write down questions you might have. At least you are able to be receive the information first hand and the GP will be aware that you are concerned & being very supportive.

If the consultation doesn't go to plan, perhaps write a letter to the GP voicing your concerns. Obviously, your husbands medical history is confidential but the letter might give the GP some background info that will help them in the future management of your husband's health.

Thank you jalopy for your kind words and support.

It is true that DH is fearful, I think.

A friend of mine suggested to push for diagnosis, further tests (scan and biopsy), and maybe a referral to a specialist.

Let the GP do their job. But nothing is going to work if your other half just sticks his head in the sand. As s grown up that's a decision he's free to make but will have to live with the consequences.

But nothing is going to work if your other half just sticks his head in the sand.
That's exactly right. I have mixed emotions about this. Most of the time I respect it's his choice and decision, but other times I can't help but feel angry - not only at his decision but mostly at his disrespect towards people who are trying to help him.

Let the GP do their job.

Well, getting diagnosis is important. But if you listen to DH then you might think he's just, well, not bothered. Whatever. Because, what do these doctors know?... In which case should the doctor be bothered? Do you see what I mean? I want to counteract this 'not bothered' attitude, not make GP's job difficult.

I think as the carer rather than the patient, particularly when the patient is very ambivalent about you being in the room at all, you need to focus on information sharing rather than pushing for particular actions. If DH flat out says he doesn't want referring it doesn't really matter what you or the GP say.

So your first list was very good, I thought - and definitely take a pen and paper.

1. Get the results and discuss their implications for his health.
2. Understand the prognosis (may be too early to know).
3. Ensure a full history has been given.

You might then want to ask the GP what they would do if they were the patient, make it a bit less confrontational. If your DH is anti traditional medicine the GP should at least try to work with that - stress the benefits of exercise on mood, for example.

Thank you tribpot, that's helpful.

Thanks again to all who responded. The results/diagnosis is subclinical hypothyroidism. Doctor's recommendation is to replace the missing hormones, which at this time DH refused.

Gosh that's hard :(

He will feel so much better if he did but the 'alternative' thyroid community are quite strong.

It is literally a missing hormone (pro hormone technically speaking) without which cells and organs etc do struggle. I've no thyroid left as antibodies have slowly killed it off and without the hormones I'd be dead. It's a bit like diabetes in slow motion.

I'm sorry he's refusing for your sake. Many would jump at the chance! The British thyroid foundation are a very good source of information for yourself x

Out of interest do you know the results and were antibodies tested?

I might add; even the majority of the alternative thyroid community seek treatment via natural dessicated thyroid extract or the 'golden' t3. For many t4 works well, often other things can hinder it working well eg low vit d, ferritin (iron) b12 etc.

I've met a woman who had a struggling thyroid following viral illness (denuegue fever - sp) who is determined she can manage it via diet etc. She is a chiropractor. I'm not 100 sure she copes well though. But thyroid are complicated things.

Sorry though for a few t3 is prescribed via endos or even GPs so not really in the non- traditional medicine bracket. It's a possible future treatment for all if they could make it slow release.

Thank you Clarella. Results - TSH level 6.81. Not sure about antibodies, it's not something that was mentioned. Would this be in the blood test do you think?

Thyroid antibodies is usually a separate blood test, so maybe it wasn't done. The diagnosis perfectly explains his tiredness and depression, and if he were to take thyroid medication, whether natural dessicated thyroid or levothyroxine as likely prescribed by the GP he ought to start feeling better. So from your point of view, it is a shame he's refused medication as it might have made your home life happier with his depression lifting when the medication took effect.

Yep, my sentiment exactly. I despair.

Would he not consider the natural dessicated stuff? Is there any kind of extreme diet that might work, I wonder? (I don't think so but just looking for options at treatment that he might consider).

I'm glad you went, I doubt you would have such a clear picture of the situation if you hadn't.

Would he consider taking the result to a nutritionist and seeing if they would recommend either accepting the GP's advice or trying for a limited time to affect the hormonal levels through diet, though I suspect the vegetarian diet might cause a problem from a dietary perspective? I would say that most alternative practitioners would adviseonitoring hormone levels and some would suggest medication if it cannot be controlled.

There is nothing diet related that can help thyroid, sorry. It can be dangerous to try eg iodine etc.

I don't know the ins and outs of testing for antibodies - in some ways it doesn't really matter as it's usually assumed there are, the only 'cure' or rather treatment is replacement thyroxine.

Antibodies could indicate further deterioration as they attack the thyroid. At the same time, I think non western medicine people think they can control this through diet.

He is actually lucky as the nice guidelines would generally treat Tsh over 10. Some gps keep monitoring till it gets to 10. So it's a grey area. It's just very unusual for a patient not to want treatment as it's pretty hellish living like that. I seriously struggle with Tsh near 3.

Type 2 diabetes may sometimes be controlled with diet but not type 1 - it's a bit like that in my very non medical view.

I'll try to post the nice link but in the meantime the British thyroid foundation are very helpful.

I suspect his resistance is more the issue.

The issue with natural dessicated stuff is it's not supposed to be as easily measured and has the wrong ratio of t4 abd t3. This is why people seek it though as a more complete treatment would be t4 and t3, except some studies have shown no difference and t3 has a short half life making it tricky to administer/ control effectively.

Some patients end up on combo as their particular body type doesn't respond as well to just t4.

cks.nice.org.uk/hypothyroidism#!scenario:1

Your husband has the symptoms - I find it really affects muscle strength eveb above Tsh 3, although this may have been ferritin issues for me too in the past.

So gp has been v good to suggest treatment.

Technically he should be tested in a few months and antibodies checked. This is because presence of antibodies "influences decisions on monitoring frequency"

I really feel for you. I felt suicidal the first time I was ill and another time when I didn't realise I wasn't correctly treated. I was horrid to live with

There is no evidence that diet has an impact on the thyroid function.

DH was on a strict diet before (this is before he knew about thyroid issues). No alcohol, no coffee, no meat, no fish, no eggs, no milk, no cheese, no sugar. He believes that he felt a lot better then, but I would report differently from the sidelines. He might have had more energy, but he was very difficult, pre-occupied with conspiracy theories, end of the world, his previous life, telling children that fish is poison and eating pigs is the worst thing they can do, ever, in their lives. So, based on that experience, I'd rather not go there again.

I don't know what my role should be in this. I don't want to press my point of view too hard, and I accept that there is more than one way of living a fulfilling life, but at the same time I cannot pretend that I support self-medicating or status quo, because I don't. Like most people in this kind of situation I go in circles through confusion, self-doubt, demoralization, anger, and finally, the desire to escape. (Described wonderfully in a book 'How to Survive when they are Depressed').

:(

As you know the thyroid is only a part of the issue.

The only diet related stuff that's ever to be considered with thyroid is to take the thyroxine a little while before food and 2-4 hours before calcium containing foods due to absorption but it's only a slight difference.

Iron b12 and folate are important plus vit d. I eat a diet rich in these but following a medication issue have had to take extra iron to help recover, diet alone didn't work.

To be honest if he wants a super way to recover from his depression and fatigue without antidepressants, he should to take the thyroxine. It's simply a pro hormone his body already makes but isn't doing a great job of.

I'm just so sorry for your situation. Is he working?

To clarify, the diet he followed would have reduced b12 and iron.