Revenge of the Pre-Meds

As the number of students taking physics who go on to major in physics is vanishingly small– something like 3% of students in introductory physics take even one more class– physics departments end up serving a number of different constituencies. There are students majoring in other sciences, future engineers, and then there are the pre-meds.

For reasons I don’t pretend to understand, the MCAT includes a section on physics. As a result, everybody who wants to go to medical school needs to take physics, so we teach a lot of future doctors (along with a lot of people I devoutly hope never to look up at from a stretcher). This is one of those situations that tends to make everybody involved unhappy: the students don’t understand why they need physics, and so resent being made to take it; the classes for the MCAT’s are generally algebra-based survey course, which are sort of awkward to teach in the best of circumstances; and many pre-meds are so obsessed with their grades that they end up driving the faculty nuts. (I used to proctor the MCAT’s for extra money in grad school, and I swear, those people were so tightly wound, you could hear them vibrating from the stress…) Doctors are just about the worst people in the world for Physics Face.

Of course, some of them have found a diabolical way of getting back at me for their bad experiences with physics… (After the cut, to build suspense and hide whining.)

A little back-story, here: about a year ago, I had some problems with acid reflux, which were taken care of with a little bit of medication, and some minor lifestyle changes. Not long after that, I started having allergy problems that manifested as really bad hives, which led to a referral to an allergist. At the start of this year, I decided to make a concerted effort to lose weight, after which I started having severe heartburn, which has led to a referral to a gastroenterologist, and my present incredibly boring diet.

The allergist was the first to hit on the way to drive me insane. The key word in the diagnosis is “idiopathic,” which is Greek for “fuck if I know.” He calmly and cheerfully said that he has no idea what’s causing the hives (which are too active to do the skin test that might determine the cause), and he wasn’t particularly concerned about that. He wrote me a couple of prescriptions (for Allegra and Zantac, which apparently is chemically similar to antihistamines), and said “We may never know what causes it.”

If you want a sure way to drive a scientist insane, this is it: present them with a phenomenon with no apparent cause. It’ll drive them to superstition every damn time, as they keep looking for a pattern in the random scatter. I’ve come up with half a dozen different theories as to what’s causing the hives, and none of them have panned out. It’s absolutely maddening, but at least the Allegra works.

And then, there’s the gastroenterologists… The heartburn problem was really bad, so they had me in for an endoscopy a couple of weeks ago. I had the follow-up appointment last Friday, and I’ve never come closer to throttling a medical professional.

Following the procedure, my stomach actually started to feel better (this probably had something to do with the fact that they doubled my daily dose of Nexium), so I started phasing some foods with flavor back into my diet. Thursday night, the night before the appointment, it started to act up again, and was bugging me when I went in for the appointment.

“Well, what did you eat for dinner?” he asked. “Chicken breasts,” I said. “How about lunch?” “Leftover stir-fried pork.” “Well, there you go. Stir-fry contains oil, and oil will aggravate your stomach.” I explained that the word “leftover” meant that I had eaten the stir-fry the previous couple of nights, with no ill effects, but he waved that off. “It can be a cumulative thing,” he said.

So, not only am I presented with a huge list of foods that might cause problems, I can’t even rely on the observation that any particular food has failed to cause a problem– I might be able to eat something twice with no trouble, but the third time will fuck up my stomach for three days. Which means I have essentially no information, and no easy way to get useful information.

The capper here is that the endoscopy showed absolutely nothing. They saw nothing wrong in my stomach, and they didn’t even see anything that looked like it might be worth taking a biopsy for further study. There’s no apparent cause for the problem (which, again, has me taking double the normal dose of acid reducing medication), leaving me with speculative babble about how some people are just particularly sensitive to stomach acid (the fact that this started suddenly about two months ago, after thirty-odd years of eating any damn thing I pleased is apparently not significant). The only treatment is to continue taking large doses of medication, and to eat incredibly boring food for at least a month before trying to introduce anything with, you know, flavor.

My opinion of the medical profession has really never been lower. It’s a good thing I’m not teaching any pre-meds this term…

(A little Googling turns up various sites offering “heartburn-free” recipes (another is here). I’m deeply dubious about some of these, but at least it’s something halfway constructive (as in “here’s something you might want to eat” rather than “whatever you do, don’t eat this.”), which is more than I’ve gotten from the doctors. I may try some of them in a week or so, but given that any slip apparently requires several days to recover from, I’m sticking with plain rice and vegetables for the moment.)

Comments

  1. #1 Roman Werpachowski
    March 28, 2006

    Chad, just do what they tell you ;-)

    Doctors have plenty of stories on patients trying to invent their own cure for their illness.

  2. #2 sgent
    March 28, 2006

    For heartburn — remember that Nexium does nothing for the heartburn you are feeling this instant, but rather reduces the heartburn you’ll have in 2-5 days. For PPI’s like nexium, you have to take them daily. I have no idea if you are or are not, but it sounds like this doesn’t apply to you.

    As for solving the “instant” effect of heartburn, I still use an old standby — 1 tsp baking soda disloved in water. Think of the chemestry (NaHCO3 + HCL = NaCL + H20 + CO2).

  3. #3 Jamie Bowden
    March 28, 2006

    One of my friends and fellow TKD students is a doctor. He’ll be the first to point out that getting in to, and through, med school has nothing to do with brains, and everything to do with being dedicated and willing to acquire mind numbing amounts of debt. The people with brains avoid taking twelve years of school to start a job that leaves them in more debt than the cost of an average house.

  4. #4 John
    March 28, 2006

    Doctors are not scientists. They are technical support.

    No, seriously. They can’t always tell you WHY it’s happening, they can’t always tell you exactly WHAT is happening, but if they can find a cure that eliminates the problem, who cares where it came from?

    They troubleshoot, they try solutions, they watch the results of their tests to see what else that tells them about the issue, and, in the end, they’ll cheerfully tell you that they have no clue WHY it was doing that, but at least it’s stopped now, right?

  5. #5 Chad Orzel
    March 28, 2006

    I am, in fact, taking the Nexium regularly– twice a day, an hour before meals, every day for a bit more than two weeks. The heartburn is somewhat better since doing that, and I can get some more immediate relief from commercial antacids. And I’m not about to start seeking out folk remedies or Internet quackery. I’ll keep taking the drugs as instructed, and hoping that the situation improves.

    My gripe is really that I haven’t gotten anything constructive from the gastroenterologists. I got a big list of things that I can’t eat, and things that I can’t do, but basically no advice about things that I should eat or things that I should do, beyond “take these pills, and come back in three months.”

    And I haven’t even gotten any useful information about a cause– I’ve been told (via pamphlet) that I have G.E.R.D. (“Gastroesophageal Reflux Disease”), as if a four-letter acronym is an explanation, but if you look closely at the medical information about GERD, there’s not much there other than a four-letter acronym. It’s just this side of shamanism– we have assigned it an acronym, therefore it is a coherent Thing that we control.

    As a physical scientist, I find this deeply unsatisfying.

  6. #6 Chad Orzel
    March 28, 2006

    (John snuck in while I was typing. I don’t have much to add in response to his comment beyond what I said already.)

  7. #7 Aaron Bergman
    March 28, 2006

    I don’t know how many people you’ve seen, but one thing I’ve learned is that there’s a whole lot of bad doctors in the world. There’s even more who just don’t keep up with the literature and thigns like that. It might be worthwhile seeing more specialists if you’ve only done one person at this point.

  8. #8 David
    March 28, 2006

    I’ve got the same thing. Doctors are very vague about acid reflux because they aren’t good at curing it. In a few rare cases, it just goes away, but usually, they just put people on meds indefinately and hope that they don’t complain about it. A few things I’ve found: the irratating foods vary from person to person so don’t worry too much about something that’s on the list but doesn’t bother you; something might indeed only be a problem after you’ve had it multiple times; not eating about 2 hrs before you go to sleep is extremely helpful; and crewing gum (particularly bicarbonate or orbit or something like that) when you start getting symptoms is suprisingly effective. I would try to find a better specialist though, most gastroenterologists are quick to throw up their hands since a lot of the common conditions are not totally curable–but some specialize in reflux-type stuff.

  9. #9 mk
    March 28, 2006

    Just remember. All doctors practice. When they first pass their medical boards they’re practicing. The day before they retire they’re *still* practicing. The whole time they’re MDs they’re practicing. They never stop practicing. If practice makes perfect, every stinking one of ‘em dies before they get there.

  10. #10 Bill Hooker
    March 28, 2006

    “Doctors are tech support”, that’s perfect. (Not true of all clinicians, but nonetheless a good way to approach one’s own medical care.)

    Chad, just to second (or third, or fourth) the observation that it’s a good idea to comparison-shop for medics. It can take a lot of perserverance to find a consultant you work well with, but it’s worth it.

  11. #11 Mary Kay
    March 28, 2006

    I have GERD too. Bread gives me reflux — everything gives me reflux. And endoscopy showed nothing. Fotunately, one Prilosec every morning prevents it unless I do something really stupid like having a huge meal just before bedtime. I’ll probably be taking it for the rest of my life. At least I have a built-in reminder if I’ve forgotten to take my meds. Reflux immediately after lunch. Good luck finding something that works for you.

    MKK

  12. #12 mn
    March 28, 2006

    Not a doctor, taking my advice will probably kill you, yadda yadda yadda… However, your symptoms (i.e. long history a no problem followed by rapid onset, intense reflux problem) sound exactly like what happened to me. After MANY doctors, I was tested for H. Pylori and the test came back positive. It was not food, or stress, I had an actual infection. 2 weeks of anti-biotics cleared it right the heck up, and I have had very few problems ever since. While I agree with and am quite fond of the doctor as tech support analogy, the Dr.s who discovered H. Pylori are real scientists and my heroes. Good luck to you.

  13. #13 mk
    March 28, 2006

    ‘mn’ makes a really, really good observation. I had assumed that you had been tested for H. Pylori. If you haven’t, maybe you should. However, treating H. Pylori with anitibiotics may have some unintended consequences. Although H. Pylori has been strongly implicated in the development of stomach cancer ( a reason lots of docs treat it with enthusiasm), it could be that killing off all the H. Pylori bugs may open the door for others that attack the esophagus — wish I could recall where I read that. Regardless, it does seem like you could use a second (or, third) opinon for your situation.

  14. #14 Chad Orzel
    March 28, 2006

    On the H. Pylori front, I know my regular doctor did a couple of rounds of blood tests– presumably, that would’ve been one. I asked at the follow-up appointment whether it might be some sort of infection, and he said they didn’t see anything in the endoscopy that looked like a problem spot, so they didn’t take any biopsies to culture.

    At the follow-up appointment, the guy I talked to seemed to regard the fact that Advil gave me dreadful stomach problems for a whole day as complete and sufficient evidence that it’s just an acid issue, and not anything else.

    I do really like the tech support analogy, by the way. I’ll have to remember that one.

  15. #15 sgent
    March 28, 2006

    Try here for a peer reviewed medical textbook discussion of GERD: http://www.emedicine.com/med/topic857.htm

    The banking soda trick I was pointing out because I find it easier on the stomach than Tums or Rolaids — I can’t handle the sugar. It is FDA approved for treatment of acute heartburn, and is the major active ingredient in Alka-Seltzer.

    Good luck with dealing with this!

  16. #16 rebecca
    March 29, 2006

    Diet problems are tricky because, like the doctor said, food problems can be cumulative, and because it takes more than a week for stuff to stop affecting you. Often when diagnosing food allergies, people cut out every possible cause for two weeks, and then slowly add things back, one at a time, each over a 1-2 week period. A pretty classic case of getting the system to a stable base case, and adding variables back in one by one… but so trying on the patience and the appetite. (My reading has been mostly about lactose intolerance and wheat allergies, but perhaps they indicate some general stomach workings.)

  17. #17 Clark
    March 29, 2006

    When faced with annoying pre-med students (they seem to be the same the whole country over) I like to tell them that “Physics saves lives”. They usually don’t see any possible way that physics could save lives, but I make sure they press me hard before I give them the explaination why: It keeps stupid people out of medical school.

  18. #18 Chad Orzel
    March 29, 2006

    rebecca: Diet problems are tricky because, like the doctor said, food problems can be cumulative, and because it takes more than a week for stuff to stop affecting you. Often when diagnosing food allergies, people cut out every possible cause for two weeks, and then slowly add things back, one at a time, each over a 1-2 week period. A pretty classic case of getting the system to a stable base case, and adding variables back in one by one… but so trying on the patience and the appetite.

    See, this is exactly the sort of constructive advice I would’ve liked to get from a medical professional. As it is, I’ve had to work stuff out by trial and error, and get other information through the kindness of strangers on the Internet.

    (Ongoing experiment notes: Steamed chicken breastsdon’t cause immediate problems, but are almost inedible, especially when re-heated. Broiled sea bass tastes a lot better, but has not been entirely successful as an experiment in heartburn-free cookery.)

  19. #19 Joy
    March 29, 2006

    The pre-med students detesting physics is a common theme in all schools. I had to tutor a girl who was a senior in biology, who was taking an introductory level chemistry course. I was amazed by the math proficiency or lack there of, as I had to teach her basic division and logarithms! MCATs do make pre-med students awful cranky..

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