Went to first appointment with my GYN doc to go over my DEXA results (scores range from -1.672 to -1.892). I am premenopausal, age 41. I was in the office for no more than three minutes and she said she wanted to put me on Fosamax. She said my osteopenia was mild, that I was in the lower limits of being abnormal (??), and when I asked then why she wanted to treat with Fosamax for "mild" osteopenia, she said it was to give me a boost before I hit menopause (??) When I suggested concentrating on good weight-bearing exercises and adequate calcium and then rechecking in a year, she said that I cannot build bone without medicines, and she is afraid that in the 2-year period of time, until a recheck DEXA, things could be worse. When I asked her about the bad side effects of the Fosamax, she said I'm only hearing the bad cases, and that there are many women out there taking it with no side effects at all that I just don't here about. That still was not enough to convince me, and I asked for a second opinion. She gladly offered me an opinion with an endocrinologist. I asked her about hormone testing, progesterone cream, spine x-rays (as I have chronic thoracic back pain and have lost 1.5 inches of height in 15 years), and she was not interested in any testing at all. She said she can't test my progesterone level because it changes and fluctuates daily, and did not want me to use progesterone cream (although she did agree that this does build bone), because if it is too much than it puts me at risk for breast cancer. As long as I was not having menopausal symptoms, hot flashes, vaginal dryness, etc., she did not feel it necessary to test any hormones. This is the same doc who told me on my yearly exam in June, when I questioned her about the need for a DEXA scan due to my height loss, and we were discussing my calcium intake, that I cannot possibly drink enough milk to get enough calcium. As she put it, I could drink a gallon a day and still not get the calcium that I need, and that milk has very little calcium!!! She did not want to answer my questions nor entertain any other treatment. It was easier for her to just refer me off to another doctor to answer the questions, while charging me 70 dollars for her 10 minutes time. Also, she told me not to focus on the issue too much or to over-analyze! I'm wondering if it is time for a new doc?!
Well the one thing she is probably right about is that milk is not a good source of calcium.
It is so frustrating to encounter docs like this and I've certainly had many! I really think that the onus is on all of us to be proactive and speak up and say what we want, what we don't like, etc. but do it in a way that it will be heard. If it isn't heard, at least we are speaking up and that in itself is very healing.
I have no hesitation about changing docs if I feel that my insights are not being respected, I'm rushed in and out, or feel generally dissatisfied. I now have a great doctor and she only refers me to great specialists. She knows, from our conversations, that I am pretty savvy about medical conditions, especially those I have have directly experienced. She knows I will not start any protocal until I myself have thoroughly researched it. When she sends me to someone she always asks afterward how it went. And I tell her the truth. I praise the good docs and tell her exactly what I don't like about the others.
How will doctors ever change if no one gives them feedback? I think too often we set them up as the "authority" which then makes it difficult to speak up when we don't like what the "authority" has to say. I feel that my medical care is a team effort and that I am not only a part of that team, but also get the final say.
Just my 2 cents.
Peregrine
[This message has been edited by peregrine (edited 08-05-2003).]
I hear you about the being proactive part. This is what I tell my family too. You must be in charge of your own healthcare and not rely solely on the docs, or something will be missed or will fall through the cracks of the system. I'm also pretty savvy about medical conditions as I've worked in the health field for 20 years, but I find this does not help me on my office visits as it almost seems like docs don't like to deal with someone with a little knowledge, enough at least to show a little opposition when needed. I'm always careful to be respectful, not come off like a know it all, and to respect their position, but at the same time ask the why's and what's that are needed to be asked. Sometimes I think I try too hard to be the perfect patient. I know the types that would totally aggravate the docs, I've seen their reactions to these patients, and I try hard to be totally compliant and responsive to the doc, a good patient. But admittedly this gets in the way sometimes of getting the answers and the satisfaction I want from my visits, as many times I will drop issues for time sake, not be as persistent as I should about things, not ask for explanations about issues, etc. etc. Sounds like I need to be more like you, Peregrine! By the way, why isn't milk a good source of calcium? My sources say an 8-ounce glass of skim milk has 302 mg of calcium. This seems pretty good to me. Also, I can count on it being absorbed better than supplements. Two to three glasses of milk a day for me is very easy to do. I figure I get a good 900 to 1000 mg of calcium a day just from milk alone. Is there info out there I don't know about? Thanks for the input!
"Harvard's large studies of male health professionals and female nurses, have found that individuals who drank one glass of milk (or less) per week were at no greater risk of breaking a hip or forearm than were those who drank two or more glasses per week. (1) Other studies have found similar results."
You say you drink 3 glasses a day, so possibly that would make a difference.
"In addition milk can produce lactose intolerance, an increase in saturated fat, thus greater risk for heart disease and possibly and increase in ovarian and prostrate cancer because of the higher levels of galactose."
But if drinking that much milk is working for you and keeping your bones strong, I wouldn't worry about it. I try to maintain a low carb way of eating, so I haven't used milk for many years. I also have heard that there are better sources of calcium (if getting it through food is the way you prefer to go), such as broccoli, spinach and legumes. Because I have trouble absorbing calcium, which is probably why I have osteo, plus I am thin and thin women have thin bones, I don't think that I could eat or drink enough calcium rich foods to really make a difference. I take a liquid calcium which is highly absorbable and that way I know pretty much what I am getting each day.
Hey, I use milk as a calcium source too. An 8 ounce glass has about 300 mg of calcium. I count my 1500 mg a day including my milk intake. I think it is a good source of calcium and if you drink fat-free or 1% you aren't getting too much fat. I would be needing to take a lot more calcium supplements if the calcium in milk isn't absorbed. What gives?
Time for a new doc?? 
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