Gusto1963

Point taken.

At my GFs appointment yesterday, we asked if her GP was taking on new patients, and the answer was yes, but only family members. I'll be making the switch. I lucked out here. It's not easy to find a good GP.

It's not particularly convenient to get to (downtown Toronto, so I'll be training it in from the 'burbs). The way I figure it, it sit in my current GPs office for 60-90 minutes, or spend the time in transit to Toronto.

I'm always impressed when I see the operation at Toronto Western Hospital. They are almost always on time. The nurse takes several BP readings before you see the doc. Everything is electronic. It's a teaching hospital and her GP heads up the wing. The resident docs always ask questions. They genuinely seem interested.

My GP, on the other hand, is always thumbing through a folder of papers a couple of inches thick to find info.

Thanks for all the comments.

JimL: re the “curiosity/intelligence/desire” thing. Yeah. I get the impression he’s tired—almost lackadaisical. He gets grumpier each time I see him. He’s cut back to 3 days a week, in recent years. I keep hoping he’ll announce he’s handing the practice over to a younger GP. I keep bringing up my low Vitamin D, and he grunts “just keep taking your supplements”. Um. I’ve been taking 5,000 IU a day for years.

brainchild: I haven’t mentioned POTS to him, and so far I’ve kept it strictly about the symptoms. I’ll see how it goes on my next visit, but I’m arming myself with some articles. I would love it if he’d just refer me to someone else.

He’s also very popular with elderly patients, and often chit-chats with them. I regularly wait over an hour for my appointment, sometimes up to 90 minutes. I appreciate that he doesn’t rush his patients, but I think sitting there, waiting, isn’t helping my BP. 

I’m sure most of us would love it if our doctor were eagerly awaiting to hear our roster of symptom, ready to investigate them all with enthusiasm. I remember another Seinfeld episode where Jerry tells George he shouldn’t just have one therapist, but a whole team, having meetings about him all day.

My GF has an appointment with her GP at Toronto General today. I’m tagging along, and may ask a strategic question or two.

Hi everyone,

I’ve been reading over the forum for a few weeks, and wanted to get your input on something. I apologize for the long post, but I wanted you to have some background info.

General health

• 55 year old caucasian male. 6’ 1” and 167 lbs. 
• About 10 years ago I lost about 50 pounds, and I’ve managed to keep it off. I do have some weight around my mid-section, that no amount of exercise or diet seems to make go away.
• 2001: CSR (Central Serous Retinopathy). Often called the “Air Traffic Controllers Disease”. The general consensus is that this is stress related. I had a LOT of stress during this time.
• 2015: In situ melanoma removed.
• 2018: Large lipoma removed from back.
• 2018: Dry AMD diagnosed.
• Labs: All results within range (at least for those tested) except for vitamin D (72 nmol/l or 28.8 ng/ml). Lipids a bit high in the “borderline” zone.
• Resting BP: Morning: 123/71 P: 71. Afternoon: 133/81 P: 87
• Resting HR (according to 2 weeks of FitBit use): 66 
• I have a history of ocular migraines, and would get 2-3 per month. However, I’ve only had one in the past year, perhaps due to diet changes (more on that below).

Anxiety issues

• I’ve always been on edge, right from high school. I suspect I have “high functioning” anxiety. It’s never prevented me from accomplishing stuff, but it does make things more difficult. Being an INTJ doesn’t help, either. I think I have a degree of GAD, but again, not bad enough to keep me from doing stuff.
• Medical tests/procedures freak me out. More on that below.
• I do have a non-refill skrip for Ativan. I only take that occasionally for sleep or a red eye flight.
• I was prescribed Setraline a few years ago, but never took it. This was when my father passed away.

Exercise intolerance

I worked with a trainer for a few years, and I always had trouble recovering. Not because I was out of breath, but many times I would get nauseous and break out in a cold sweat. Absolutely the worst feeling ever (aside from food poisoning). Nowadays, I do my workouts at home, but I can’t push myself too hard.

Adrenal fatigue?

Back in 2012, I trained heavily for a 5k marathon. This was something I had never done. I successfully finished the run, but a few days later I had what I call a “crash”. Physically, it was like I hit a wall. Even after a full night’s sleep I was exhausted. I napped most of the day for almost a week. After I got over this my stamina was never quite the same. It’s slowly improved over the years but was never what it was before the run.

Sleep

I average about 6.5 hours a night. That’s actually a lot better than it was. I don’t get sleepy or feel the need for a nap during the day.

Diet

My partner and I made some significant changes to our diet last year. We eliminated all processed food at home, and reduced the amount of gluten significantly. We still include it in our diet, but save it for dinners out, traveling, etc … We never consumed sugary beverages all that much. I’m not a 8 glasses of water a day guy, but I do try to keep hydrated. I know when I up my water consumption, I’m in the bathroom every 30 minutes.

Supplements

• Vitalux for the AMD
• 5,000 IU Vitamin D3 with a Vitamin K2 daily. I live in Ontario, so for half the year I’m sure I’m getting nothing from the sun.

Recently

I had some labs done back in December, and my Vitamin D levels (which have always been low), were now in the clinically deficient zone. My doc took a BP reading, and it was pretty high, around 165/95, from what I remember. I’ve always had white coat syndrome (even taking readings at home), but this was a shock. My doc asked me to take readings at home for a week and go back. My home readings hovered around 130/80, but in his office were high again.

He said I had “White Coat Hypertension” and prescribed me 4mg of Coversyl daily. When I got home, and told my GF, she asked why he didn’t send me for a 24 hour BP test. So I made another appointment and had the test done. I don’t know the results and won’t until I see my GP again. He also sent me for an EKG, which I was super anxious about, and I’m sure messed up the readings. The lab techs asked why I’m so anxious, and I have no answer for them. BP readings before root canals and other procedures are always higher.

I also picked up a FitBit Charge 3 to track my HR.

So as of now I haven’t started taking the Coversyl. I’m reluctant until we can see the results of the 24 hour BP test.

I asked him what my standing HR should be, and he said about 10-15 above my resting HR. When I told him it’s often around 110, he suspected it may be my thyroid. However, the latest labs show the range as normal. He mentioned my pulse was high, but it’s ALWAYS high when I see a doctor. Despite many years of talking about my anxiety, it never really gets through to him.

I know others here have reported their symptoms as being intermittent. For the 4 days previous to the time I’m writing this, my standing HR was in the 80s, and sometimes in the 70s. I thought this was fantastic. I actually felt “normal”, and that I wasn’t flooded with adrenalin. However, today it’s around 105 as I’m working at my standing desk. I haven’t done anything differently, and it’s somewhat disappointing.

I'll also add that I think this isn't a new thing for me. I've always felt my HR ran higher on standing, but thought that was normal. It was only talking to my GF about it that got me to thinking something was off about me.

The highest I recorded on my FitBit was 132 when standing, but most of the time it’s around 110. The odd thing is, if I walk to another room, it will drop by 5-10 BPM. It seems to go up more if I’m standing still. 

I’ve had times where I got light headed if I stood up from a crouch (build IKEA furniture, anyone?) but not very often, and I haven’t experienced that in a long time.

I don’t think my symptoms are as severe as most, but I do think something is out of whack. Standing, for me, is more tiring than it should be. In general, I almost always feel a bit “off” … more fatigued than I should feel, but also wound up. I don’t have any real stress in my life at this point. I suspect the many years of stress I had working took their toll.

I’ve also found daytime worse than evening.

I also suspect I have Hyper POTS. I’ve done a few BP readings while standing, and the readings are always higher. I understand it’s an informal test, but I feel there’s something there. I often feel like I’m flooded with adrenalin after I’ve been standing for awhile.

Other symptoms …

Over the past few years, I’ve had an on and off weird sensation in my legs. It’s difficult to describe. It’s mostly a stinging, or a feeling of water rushing through my legs. I will get the occasional pin prick and little muscle twitches. I feel these mostly at rest, sitting especially. When I’m moving around I only have a vague sensation of it. This is something I haven’t mentioned to my GP.

I’ve also had the occasional “internal” tremor when waking up. It’s like a cold shiver, except I’m not cold. I’ll get this in my chest and neck.

My main question is:

How do people here present their evidence? I’ll be honest and say I don’t particularly like my GP (even though I’ve been seeing him for many years). He often doesn’t listen (I’m sure I’m not the only one to say this), and at times brushes off my concerns. I’m also not the guy who runs to the doctor with every ache and pain. I’ve thought about switching GPs, but all the good ones around here have their rosters full.

Part of me wants to print off a few POTS research articles and show him, but I’m not hopeful. I don’t like having to use Dr. Google, but it also feels like I’m talking to a brick wall (my GP, that is).

I’ve even considered using an Integrative Doctor (also called a Functional Doctor, I think). It would mean paying for my visits, as it falls outside of OHIP. However, if I can actually get a real look into what’s going on it may be worth it.

Any insights here would be appreciated.

Thanks in advance.