You just knew this had to be coming but I never would have believed it had I not seen it with my own two eyes! As many readers of my blog know, I have been diagnosed with Hashimoto's Thyroiditis and subclinical hypothyroidism (elevated TPO and TG antibodies, low normal T4 / T3 and high normal - depending on who you ask - TSH ).
Yesterday, I submitted to an ACTH Stimulation Test to examine if I have adrenal insufficiency as a cofactor in my hypothyroidism. In this test, an initial blood draw is taken to establish a baseline serum cortisol . Then, you are injected with synthetic ACTH , the pituitary hormone that signals your adrenal glands to produce cortisol, and your levels are rechecked every 15-30 minutes for a period of time (usually an hour). I guess I had my first reservations when making an advanced reservation to have the test done. I was actually at the testing hospital for another blood test (free testosterone) but, unbelieveably, they had no method for taking a reservation in person. I called the number they gave me and it was clear the nurses and techs I spoke with were unfamiliar with the test. Finally, I convince someone to meet me in their lobby and after 15-20 minutes of private consultation, paging through 3-ring binders, and calls to other staff I had my appointment.
I show up for my test and they take me to a nice room where they have numerous vials and solutions, IV's, etc. ready for me but they are still not certain about how to do the test. I suggest they simply call the doc who ordered the test for me as he has an office right in the hospital. He faxes some additional info and we are off to the races. About 45 minutes into the process I get bored. So, I saunter outside the testing room with an IV dangling from my left arm to retrieve my chart which I know will invariable be sitting in a chart holder on the wall outside the door. I always love the " how dare you" look I get from the docs and nurses who happen to see me grab my chart but there is really nothing they can do to stop me. As I begin paging through the notes I come upon the "magic" set of faxed instructions that got things moving. My eyes roll and I can barely contain my astonishment - it is a printout of the Wikipedia entry on - you guessed it - the protocol for the ACTH Stim Test. The doc had simply crossed out the optional 45 minute interval draw and accentuated the need to heparinize the blood sample.
So, the moral of the story is, the next time you feel guilty or inadequate about doing battle against an arrogant doctor armed with nothing but web research - DON'T! You may both be practicing Wikipedia medicine!