{"id":30791,"date":"2023-05-29T14:14:55","date_gmt":"2023-05-29T19:14:55","guid":{"rendered":"https:\/\/wholehealthchicago.com\/blog\/?p=30791"},"modified":"2023-05-29T14:15:07","modified_gmt":"2023-05-29T19:15:07","slug":"time-crunched-inattentive-physicians-working-in-silos","status":"publish","type":"post","link":"https:\/\/wholehealthchicago.com\/blog\/2023\/05\/29\/time-crunched-inattentive-physicians-working-in-silos","title":{"rendered":"Time-Crunched, Inattentive Physicians Working In Silos"},"content":{"rendered":"\n

Back in 2011, I wrote a Health Tip entitled, \u201cPhysicians as Morons\u201d, whose title over the years I have come to regret, the unpleasantness of name-calling and all. You can read about this case here<\/a>, but it\u2019s just easier if I summarize it.<\/p>\n\n\n\n

A young woman had contacted me for help with the unusual diagnosis of hypertrichosis, a medical term for a skin condition in which she was growing hair all over her body. The extreme condition, which she had seen online, and was appropriately horrified, is called the \u201cWerewolf Syndrome\u201d and was accompanied by the photo of Jo-Jo the Dog Faced Boy<\/a>. Her worried primary care doctor sent her to a dermatologist, who was befuddled, then to another, then to an endocrinologist, and although her hormone levels were normal, she was started on spironolactone to block testosterone production in case she had some sort of weird hypersensitivity to her own hormone.<\/p>\n\n\n\n

When I saw her she did indeed have more hair than normal, but not enough to be mistaken for a young faun and be shot while jogging in the woods by an enthusiastic hunter. She had been spending quite a bit of money on electrolysis.<\/p>\n\n\n\n

I reviewed her case in detail, read over all the lab tests she\u2019d brought, and froze (literally froze) when I read the list of medications she was taking.<\/p>\n\n\n\n

Forcing my voice to remain calm, I asked, \u201cI see you\u2019re taking finasteride, you know Propecia, and your dose is pretty high.\u201d<\/p>\n\n\n\n

\u201cOh, that. Yes, my doctor prescribed it years ago because the hair on the top of my head was thinning. It works well. I take it every day.\u201d<\/p>\n\n\n\n

\u201cBut Propecia grows hair everywhere.\u201d<\/p>\n\n\n\n

\u201cReally? Do you think I should stop taking it?\u201d<\/p>\n\n\n\n

Now, The Problems Of Silo Medicine<\/strong><\/strong><\/h3>\n\n\n\n

Rather than resort to my usual eye-rolling, moaning, or immature name calling, the case I\u2019ll tell you about this morning is simply the problem with Silo Medicine.<\/p>\n\n\n\n

You\u2019ve already experienced Silo Medicine: all your specialists in one field packed in their very own silo, like corncobs, and you\u2019re passed back and forth among them. But challenge them with a problem one inch beyond their specialty, and you\u2019re lateralled like a football to the next silo, then the next, and the next. And, to make matters worse, there\u2019s virtually no communication between silos.<\/p>\n\n\n\n

Every mega medical center is like this most physicians will agree and consider yourself blessed when the specialist you\u2019re scheduled to see, already protected by a phalanx of underlings, makes eye contact with you that\u2019s measurable by stopwatch.<\/p>\n\n\n\n

The Puzzling Rash<\/strong><\/strong><\/h3>\n\n\n\n

Virginia is an intelligent middle-aged woman with a really bad skin rash covering most of her body. It has now been torturing her for over five years. It had started as a few spots on her arms, legs and trunk and spread and spread. But her particular case was complicated by Virginia having an unusual cancer several years before her rash. The cancer fortunately responded well to chemotherapy and her oncologists, checking her regularly, really felt it was now fully cured. Yay!<\/p>\n\n\n\n

But this rash is driving her crazy. Makes her life a complete misery. Itching, burning, leaking fluid, interfering with sleep.<\/p>\n\n\n\n

She\u2019d seen the best dermatologists at the Mega Center. A skin biopsy resulted as \u201cnon-specific\u201d. The rash improves when she was placed on steroids but because these would suppress both inflammation and her immune system, no one wanted to go there on a long-term basis. She\u2019s been variously diagnosed with chronic psoriasis, rosacea, chronic atopic dermatitis (nonspecific allergies), and although the Humera family of meds were suggested, she promptly nixed those because of increased cancer risks.<\/p>\n\n\n\n

Concerning food sensitivities, she \u201cthought\u201d she was a little better when she went off gluten and did notice worsening of her rash when she ate a lot of it, like a plate of pasta. She\u2019d never gone 100% gluten free for any appreciable length of time.<\/p>\n\n\n\n

What really caught my attention (as had the hairy young lady mentioned earlier) was Virginia\u2019s medicine list.<\/p>\n\n\n\n

I asked: \u201cWhy are you taking Bactrim? Do you have a bladder infection? Is this recent?\u201d<\/p>\n\n\n\n

\u201cI don\u2019t know. It just keeps getting refilled.\u201d<\/p>\n\n\n\n

\u201cIf you were to take a wild guess, do you think you\u2019ve been taking Bactrim for what, six months, one year, two, three\u2026\u201d<\/p>\n\n\n\n

\u201cOh, longer than that. Probably at least five years. I don\u2019t remember why they started it.\u201d<\/p>\n\n\n\n

\u201cFive years ago, is a long time. Is it possible that your skin was clear before you started the Bactrim?\u201d<\/p>\n\n\n\n

She was silent.<\/p>\n\n\n\n

I explained that generally antibiotics are used for a short course, ten days or so, although there are exceptions. Bactrim is from the sulfa group of antibiotics, actually the very first group that became available for infections. Doctors don\u2019t prescribe Bactrim too often anymore because of side effects: more than 10% of people are allergic to it.<\/p>\n\n\n\n

Virginia asked, \u201cWhat happens when they take it and they\u2019re allergic to it.\u201d<\/p>\n\n\n\n

\u201cThey get a skin rash.\u201d<\/p>\n\n\n\n

\u201cAnd if they take Bactrim for five years?\u201d<\/p>\n\n\n\n

\u201cThe rash gets worse.\u201d I paused. I was about to go into details of \u201cleaky gut\u201d that can occur with long term antibiotic use, and maybe this links some of her rash with her perceived gluten sensitivity. But this will be for later.<\/p>\n\n\n\n

Once the Bactrim was gone, if this indeed were the cause of her chronic skin rash, her leaky gut would be an easy fix. \u201cYou need to go to every one of your doctors, call them if necessary, and ask them if they were aware that you\u2019ve been taking Bactrim for five years, and can you stop the Bactrim right now.\u201d<\/p>\n\n\n\n

Be well,<\/p>\n\n\n\n

David Edelberg, MD<\/p>\n","protected":false},"excerpt":{"rendered":"

Back in 2011, I wrote a Health Tip entitled, \u201cPhysicians as Morons\u201d, whose title over the years I have come to regret, the unpleasantness of name-calling and all. You can read about this case here, but it\u2019s just easier if I summarize it. A young woman had contacted me for help with the unusual diagnosis […]<\/p>\n","protected":false},"author":4902,"featured_media":30792,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[2316,226,296,130,3,2332],"tags":[2363],"class_list":["post-30791","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-featured","category-immune-system","category-inflammation","category-integrative-medicine","category-knowledge-base","category-preventive-medicine","tag-silo-medicine"],"yoast_head":"\r\nTime-Crunched, Inattentive Physicians Working In Silo Medicine<\/title>\r\n<meta name=\"description\" content=\"How To Take Care Of Your Gut\" \/>\r\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\r\n<link rel=\"canonical\" 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