A Sad Case of Mistaken Diagnosis? – 2nd February, 2014

A Sad Case of Mistaken Diagnosis?

Last Wednesday Noo and I arose at the ungodly hour of 4.30 a.m. and drove to Thon Buri, (just over the river from Bangkok), for my appointment with the professor/doctor at Siriraj government hospital.

The traffic wasn’t too bad and we were there at around 8 a.m –  still a 3 hour journey.

As I was being prepped for the procedure, the good doctor arrived and ordered an ECG, ‘just to make sure my heart was functioning normally, bearing in mind your aortic heart valve replacement.’

The room was full of patients being prepped for various procedures (endoscopies and the like) but I seemed to be the only one with a EUS sticker on my hospital gown. EUS is also known as ERCP, (endoscopic ultrasound).

ERCP is considered the gold standard in the diagnosis and assessment in severity of pancreatitis and requires a high level of operator experience. The EUS instrument is inserted through the oesophagus into the stomach and duodenum and manipulated to obtain high-quality images of the head, body, and tail of the pancreas.

After a student nurse had made right balls-up of trying to set up an intravenous ‘inlet port’ in the back of my right hand and eventually had to have it re-done by a proper nurse, I was wheeled into the OR and told to lie on my side. They put a large ‘plug’ between my teeth and before I had a chance to ask anyone if I was going to be sedated, I was out like a light.

The next thing I remember is being shouted at to wake up; and when I opened my eyes, I found I was in the recovery room, surrounded by similarly sleeping souls. More than two hours had passed.

I was still feeling a bit groggy when the doc appeared at my bedside to give me the results.

He told me that his  suspicions he had expressed at our previous consultation had now been confirmed. He was now 100% sure that there was nothing wrong with my pancreas and that I did not have pancreatitis.

In view of all the other tests I had undertaken over the past few months, which showed nothing abnormal, and also in view of my specific diarrhoeal symptoms, (very watery which are atypical for pancreatitis), he was now convinced that I had a severe case of IBS, (irritable bowel syndrome). I had no idea that IBS could cause such intense abdominal pains, but he assured me that it can, and I have since done some research and found that he is correct on this – of course!

He also told me that IBS is aggravated by stress and the more I worry about my illness, the worse it will get. As I have been suffering from enormous stress over the last few months, due to the collapse of my investment portfolio, it all fits.

So I have stopped taking the very expensive pancreatic medicine and I am now being treated for IBS, which involves completely different medication, including some anti-depressants, so I’ll see how it goes. I will see the doc again on 13th Feb to review progress.

It does beg the question – what’s with all these Thai quacks with their differing, (or lack of a correct) diagnosis? In particular, why on earth did the specialist at the  hospital in Sri Racha tell me I had pancreatitis after she reviewed my MRCP scan, whereas the latest doctor reviewed the very same report and thought it very unlikely that there was anything wrong with my pancreas.

The ERCP test has now proved him correct.

Doctors really are a lottery in this country. For anything serious, patients would be well advised to seek out the very best doctors, which pretty much can only be found in the top private and teaching hospitals in Bangkok. I now realise that it is a false economy to try and get serious medical problems sorted in the provinces. The doctors are simply not up to it.

There is also the little matter of the inability to sue doctors in this country for mis-diagnosis or incorrect treatment  (malpractice), so that may lead to many of them being  less than fastidious in their work practices.

Now that I know there is nothing seriously wrong with my major organs, I should be over the moon, but strangely, I feel somewhat deflated. I don’t know why – maybe it is the anti-depressants the doc has prescribed; but they are supposed to make me feel happy – not depressed.

Frankly, I feel somewhat underwhelmed by the whole experience, but I probably need to take it easy for a while, and let the realisation sink in that I do not have a life threatening disease and let the anti-depressants do their work.

I recall once reading about a man who had been diagnosed with terminal cancer and had been making all the necessary arrangements for his imminent demise when he was suddenly told that his doctor had made a mistake and he was not going to die after all.

Far from feeling elated, the man became very depressed and unhappy – not because someone had made a terrible mistake, but apparently because he had set his mind to his impending death and he was finding it very difficult to re-adjust to the idea that he now had a long life ahead of him.

Maybe I am getting a bit of what that man had……

 

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