Trying to see a “specialist” doctor in this country is a true nightmare. I’ve had to wait four months just for an initial appointment with an endocrinologist. To coin a phrase, it is cruel and utterly usual to tell someone suffering from lack of thyroid hormone that he must wait a third of a year before he can see an endocrinologist to discuss his problem, after which he might have to wait interminably long for the medication and for it to start working (just imagine the wait for a followup appointment…). Even seeing a “family doctor” (ie, a general practitioner) to get the most basic prescription (for Lanton, which is supposed to treat acid reflux) can be downright Kafkaesque if it needs to be done on that same day.

I’ve struggled and struggled and struggled and struggled with this system for the five years I’ve lived in this country. The doctors here can be personally nice, but as physicians the service they provide is atrocious. They’re really more like accountants, gazing into their computer screens and looking for ways to minimize everything (nothing against accountants – my father is one and so was my grandfather).

I could go on and on about the insane delays, the abusive nurses, the uncaring doctors and everything, but I want to highlight one aspect of the system here that sucks beyond belief. Our country has a Health Ministry that publishes a list of approved medications. Obviously, they’re not going to approve a medication that is more expensive and less effective than alternatives. But what about a medication that is more expensive and more effective? Or a medication that is less expensive but less effective? Or a medication that’s priced similarly but is differently effective?

Or what about an inexpensive natural medication that’s approved by the American FDA but is no longer commonly used anywhere in the world because a synthetic alternative has been developed? Such is the case with Armour Thyroid, which I take for my Hashimoto’s. Armour Thyroid is not approved by my country’s Health Ministry because they have already approved one medication for hypothyroidism – Eltroxin, a generic version of Synthroid – and why in the world would Armour be necessary if there’s already a perfectly good option available?

Well, Eltroxin is a perfectly good option, as is the branded version Synthroid – for those helped by it. For people whose symptoms didn’t improve on Eltroxin/Synthroid, the medical system here offers no solution. I can convince a doctor to prescribe it. But once he’s written the prescription, I can’t take it to a pharmacy to get it filled. I am shit out of luck.

By comparison: in America, as in my country, it is highly uncommon to prescribe Armour Thyroid for hypothyroidism. But if a doctor does prescribe it, the patient can acquire it with hardly any difficulty. The point is, it exists in America (legally, too). If the corner pharmacy doesn’t have it, they can order it. If they can’t order it, another one can. If another one can’t, the patient can order it by himself online – and probably save money, too.

Maybe the patient will spend more so he can see a doctor known to prescribe Armour. Maybe he’ll spend more ordering the Armour and ultimately getting reimbursed by his insurance for less than if he’d taken Synthroid. He has options – some better and more costly, some not as good and less so. Here, we have no options. And we slap each other on the back out of excitement for our wonderful health system.

Though I carry American citizenship, I’m not insured in America and don’t live there, don’t vote there and try not to tell Americans how to run their country. But I will say that it will be a sad day for me and for many other people all around the world who rely on America’s options when Americans accept their president’s proposal to socialize their medical system.

I get the Armour Thyroid I need from my uncle, a dentist in Philadelphia, via my mother. It costs a hell of a lot more than it would if I were insured, but at least I can get it. If an American bureaucrat some day decides that no one needs Armour because Synthroid is already available, I will again be shit out of luck.

I went to his office the other day to tell him that I’d finished the Clonidine and that I didn’t like it. Since I’m unemployed, I offered to sit in his reception area and wait until he had a spare minute to talk to me. But his receptionist sent me away and said that the doctor would call me later. When he called, he agreed that I should stop the Clonidine. He said that he could prescribe some beta blockers, but that the effect would likely be the same. He also said that there were some pretty hardcore surgical options to address the sweating, but he wouldn’t recommend them.

Then he divested again, telling me that I should go to my family doctor and get him to submit a request to the HMO for a second opinion with a specialist at Mass General. Apparently, this is something the HMO offers for people on their supplementary plans. Perhaps I’ll do this. Perhaps I won’t.

In the mean time, I’m starting a gluten-free diet. I’ve done the gluten free diet several times, but usually combined with something else. Once it was no grains, once gluten-free and dairy-free, a couple times paleolithic. I have long believed that I might have Celiac disease, especially after I failed to rule it out with genetic testing about five and a half years ago (HLA DQ2 was not detected; HLA DQ8 was detected). Still, the blood tests usually come back in the normal range toward the high end, and I’ve had two upper endoscopies that were clean, as well as a colonoscopy.

Both hypothyroidism and Celiac can affect pretty much every part of the body, so excessive sweating could be caused by Celiac, as well as the fact that I had diarrhea every day for the past 17 days.

I’m two days into the gluten-free diet and feeling ok. I’m a little bloated because of all the fruit, but I’m having an easier time than I did in the past because I’m eating rice and dairy and processed foods. I plan to keep it up for two weeks and then evaluate how I feel and whether the sweating has diminished at all.

I intentionally didn’t get my thyroid blood tests done this time, because I don’t give a damn what the results would say. No matter what, I’ll continue taking whatever medications, in whatever amounts, I find to treat my symptoms.

I desperately want, and have wanted for the past two years, this endocrinologist to address the fact that many of my hypothyroid symptoms have not gone away with treatment for hypothyroidism, whether using synthetic T4, synthetic T3, or natural T4+T3. The main three are weight gain, sleep disturbance and sweating. Right now I’m managing the sleep problem with melatonin, though I prefer not to; the weight gain isn’t such a big deal because I don’t really care about my weight; but the sweating, however, is really awful.

He seemed surprised that I hadn’t tried anything for the sweating yet. He gave me a prescription for Clonidine, which is a medication for high blood pressure that is also used to treat some other things. I am kind of worried to take it because I have already fainted a half dozen times and strongly prefer not to do so again. But I’m going to take it at night when I take my melatonin, so I’ll be in my bed or close to it anyway.

The doctor asked me to call him in two weeks and tell him how it’s going with the Clonidine. His receptionists do a terrible job and he never gets messages, so I guess I’ll have to go back over there to deliver the message in person.

I have another endocrinologist appointment in a month, and I’ll bring it up again with him, but he has again and again done nothing to help me, so I know he’ll do nothing this time. In the past, he’s always said he’ll think about it, but I know he doesn’t think about it at all, because it surprises him whenever I mention it the next time. I’m sure he’s overworked and doesn’t get the time, but in that event he should just tell me up front that he will not think about it.

I am thinking I’ll tell him: that he needs to send me to someone who can do something about my sweating, and that I know he must know of someone in this country who can – and if he doesn’t, he must know someone who knows someone who can – and if he doesn’t, he must know someone who knows someone who knows someone who can (that’s all that will be necessary, because it’s a small country).

By this point, I’ve gotten everything from him that I expect to get, so I don’t really give a damn if I ruin the relationship.

This sounds awfully familiar to me. Growing up it was always “stress” that was causing me severe indigestion and discomfort. Whether it was constipation or diarrhea, bloating, gas, cramps, aches or anything else, my mother and the pediatrician always said “stress.” How many times when I was 10 fucking years old could I explain to them that I was not “stressed” and I had nothing to be stressed about?

Years later an actual doctor gave me an actual diagnosis of an actual disease – Hashimoto’s Thyroiditis. She might have been the only doctor who ever believed me that “stress” was not my problem. Now whenever I go to the endocrinologist or the family physician on my HMO and try to tell them that I am treating my Hashimoto’s and still experiencing crappy quality of life symptoms (fatigue, tiredness in the evening, sweating, weight gain), I’m back to hearing about “stress.”