Unintentional weight loss and stress

Patient: Orig weight 110 in jan 2011, lost 10pd unintentionally in 3 mons, fatigue, throbbing pain different parts of my body,mainly in both rib cages, very pale, red blood spots on left hand only-that come and go about every 3 weeks-purpura. very little appetite. all of this started after i had a nuclear dye heart test done in jan of 2011-was told i was fine the chest pains i am having that come and go are just due to stress. in the past 6 mons i have seen 3 new doctors and they all say i am fine-yet i just dont feel good, and have had several people tell me i just dont look right. chest xray done-normal,1 cbc test done-normal,abnormal pap smear done feb,then one in july-normal, i am waiting on the 2 cbc test, my doctors also checking thyroid, i asked for a cat scan, bone marrow test-and i know a bone marrow is an invasive test- but i do not care, she wont even consider these, yet i dont know why she says she can order these unless she finds something yet how is she going to find anything if she does not order these. because i sure dont want this to be something really serious thats diagnosed too late- as in my husband case, he was not diagnosed until he was in stage 4 cancer. what test do you suggest my doctor run. or should i just switch doctors ( again ),until i find a doctor that will run the test i want them to run.

Doctor: I know where you are coming from. What happened to your husband is making you anxious and I’m sure you don’t want it to it to happen to you or to anyone else. I would say that your anxiety issues are within reason and you are still grieving over your husband’s condition. However, I also agree with your doctor not to do bone marrow aspiration and CT scans. As you already know, bone marrow studies are invasive and benefits should outweigh the risks before doing it. Your doctor would not want you to go through an agonizing procedure when it is not indicated, when its result will most likely be normal since the CBC is normal. A CT scan is not an invasive procedure however it involves a high dose of radiation and it has been proven to be linked to certain kinds of cancers. Your doctor might be apprehensive to do this also because again, it is not indicated and it will only heighten your risk of having cancer. I honestly believe your current doctor is only doing her job in upholding your best interest. A peripheral smear study is a superior test compared to CBC; you can request this for now. You can suggest blood glucose and calcium levels, kidney and liver function tests, urinalysis, and CXR, if these were not done yet. I would also suggest for you not to change doctors as frequently. Continuity of care is very important. Everytime you go to another doctor, that doctor will always start assessing you from the very beginning. Yes, the new doctor can gain insight and ask the patient about the opinion of the previous doctors but he must also assess and decide for himself if the previous doctor’s diagnosis is correct. More often than not, the new doctor will start all over again because he also has a credibility and license to protect. I would suggest you stay with this current doctor because I’m sure you will have difficulty finding a doctor who will agree to do a bone marrow test even if the CBC is normal. I would also suggest though you should talk to a psychologist so your anxiety issues can be addressed. What happened to your husband has taken its toll on you. It would also not be healthy for you if you let these anxiety issues stress you too much; eventually, your body will be exhausted because of stress, and it will increase your risk of heart disease, cancer, etc. It is very possible the weight loss is due to stress; if you have had no changes or have an increased appetite but still you are losing weight, that could be alarming. I do hope I have appeased your concern and I wish you well always.