RLR
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"Here are the choices in my mind: Do I believe that I have IST and try to increase the beta blocker dosage to see if it helps?
Do I treat anxiety with my psychologist and stop searching for an underlying medical condition?
Do I try to treat both at the same time?
Do I get a second opinion from a different Cardiologist?
Do I follow through with my scheduled electrophysiologist appointment in March recommended by my pulmonologist? (An EP study scares me)
Do I get a new GP who will review all my tests and make a recommendation? as my current GP doesn't want to see me for 3 months as he believes this is all anxiety."
Let's see if we can invoke some reduction of the possible choices you've highlighted. First of all, family members are great for emotional support and their advice is often mixed. With respect to the dilemma at hand, however, they are unable to provide you with objectivity from a clinical standpoint.
The second point before we look at your concerns is that most of the choices do not have to be made with any sacrifice of the others. The manner in which they are being presented appears to suggest that you must choose the best course to proceed as though any other decision sends you in the wrong direction. This is not necessarily true.
Do I believe that I have IST and try to increase the beta blocker dosage to see if it helps?
There is no harm whatsoever in increasing the strength of your prescription in this regard to determine whether it provides a reduction in symptoms. A trial of 8 weeks or so should be sufficient to make a reasonable conclusion. This option is available to you regardless of any other decisions made. Beta blocker therapy in the dose range being contemplated by your doctor is quite mild indeed and is safe for you to take in determining in your own mind the source of the problem.
Do I treat anxiety with my psychologist and stop searching for an underlying medical condition?
This is sort of a trick question if you don't mind me illustrating the fact that your scheduled appointments with your psychologist are designed to provide the insight necessary to answer to such a question. If you believe that the underlying cause for your difficulty is organic in nature, then you should persist in searching out the cause until it is either found or you no longer believe it to be the case. Where you choose to intervene along such a path is entirely your choice and necessary for you to feel both competent in your decision and more importantly, comfortable with the choice.
Do I try to treat both at the same time?
Again, this is not the sort of problem that dictates a single course of action and it's important to try and let matters steer the course for you and temper them with what makes you comfortable. You may be establishing a condition of ultimatum out of both frustration at the circumstances and the compelling need to find the answer. The bottom line is that none of this would be relevant if the symptoms would abate, regardless of whether they constitute an underlying organic disorder or represent the somatic features of significant anxiety.
Do I get a second opinion from a different Cardiologist?
If you have questions regarding the diagnosis by your present cardiologist, then it's always a good idea to seek out another professional opinion. The only caveat is making certain to draw the line where you intend to stand if the second opinion supports the first. In other words, seeking opinions can become a sojourn of sorts and patients rarely recognize that they are sometimes driven by what they wish to obtain rather than what is available, if you see my point.
Do I follow through with my scheduled electrophysiologist appointment in March recommended by my pulmonologist? (An EP study scares me)
This is actually a very common obstacle put in place by patients when seeking help. There is a concerted effort to find a cause for their symptoms and the avenue for doing so is an increase in the number and type of diagnostic studies relative to the concern. Once testing is established, the patient becomes highly reluctant to follow through and is based either on a fear of the invasiveness of the test itself or the results which might be produced. You can see the irony of persistently seeking a cause for which the increased potential for discovery becomes a matter to be avoided. In other words, I need more testing but I'm scared of what the tests might reveal, a testimonial to the moving target features of anxiety.
Do I get a new GP who will review all my tests and make a recommendation? as my current GP doesn't want to see me for 3 months as he believes this is all anxiety.
This is again, a common difficulty for patients who feel frustration with their circumstances and the medical community. What you're stating here is that you want a doctor who will treat you for the cause you believe to exist rather than what the doctor professionally contends based upon their training and experience. The essence of your statement is "do I get myself a doctor who responds to my needs or stick with the one that's ignoring me?"
Perspective will probably help with this one. A patient is basically driven by the need to be well. They have symptoms which they wish to have abated by their doctor, a very basic and customary exchange. The doctor is interfaced between medical science and the patient and their task is more driven by a passion for science than one of compassion, the nature of which is quite variable among clinicians. Their primary view of the patient is in the context of a study of human health and disease and they apply their training and experience to the presented case in order to make decisions in accordance with best standards of practice. It is rarely, if ever, observed that a physician begins experimenting with various techniques or medications in the hopes that it will somehow increase diagnostic accuracy over and above the strict regimen of clinical medicine.
Your difficulty here is that you feel alone in your quest for answers and your patience tested by the medical community which is supposed to constitute the resource capable of accurately defining and resolving your health problems in a timely manner. Whether they meet this responsibility with any degree of success is, for the patient, based upon whether their symptoms remain and the cause singularly defined.
Your confidence in the healthcare system is under challenge by virtue of the fact that you are being left to make clinical decisions on your own and based upon a diverse and even conflicting set of viewpoints.
What matters at this particular point is that you find relief. All of the options described by you are available and each is reasonable. If you fear having tests performed, take a close friend with you and plan a little reward once everything is completed. It's normal to be apprehensive about tests. It is impractical to your needs, however, to avoid it altogether.
Set your course and proceed. The indecision that many people experience is in most cases nothing more than the avoidance of doing what you know to be logically necessary but emotionally troublesome.
You'll be just fine. Let your doctor adjust your medication, take a friend and go have the EP study performed and share your thoughts with your psychologist about it all. Sometimes a careful blend of choices is the right path to proceed. Exercise them as it suits you. None are harmful.
Hold me fast from purgatory, for the indecision which lures me there would bind my fate.
Best regards,
Rutheford Rane, MD (ret.)
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