Treating the symptoms vs treating the cause

[AmericanChai]

This is a question I have had for awhile and I'm not sure where to go with it. I thought I would ask those of you who have been in a medical setting for quite awhile and see what your experience has been. It just seems to me that from my own experience and talking to others that oftentimes the focus is on a patient's symptoms but not on the condition causing them. And as soon as the symptoms are resolved, there is no urgency to treat the underlying condition that caused the symptoms. Also, it seems like a lot of it is guess-work and testing to find out the cause is hampered by limitations of insurance coverage as well as a shortage of doctors and nurses.

I realize this is extremely general, and I realize that you are not doctors and don't always call the shots, depending on which area you work in.

I will give two examples in my life:

My dad has a lot of health issues. He has had severe asthma, allergies, and eczema since childhood. Then he started having some intestinal pain and difficulties. Lots of symptoms. He was given meds to treat the symptoms but they were not able to find the cause. They took out his gallbladder at one point and although he did have some stones, the problems did not go away. He started having more problems. He was given more meds. He was convinced he was dying and they wouldn't find the cause until it was too late. I forgot to mention my dad has a good PPO insurance plan. Finally, two years later it was discovered he has hemachromotosis (sp?). It is an inherited disease of the liver. The main treatment is to have him give blood every month to prevent too much iron in his body. But now his liver is really damaged and I feel if they had been more aggresive about the cause earlier they would have possibly caught it. About a year ago he was dx with diabetes. He had been showing symptoms for several months and he mentioned it to the doctors but they discounted it as being related to his other conditions. We have a family history of diabetes, dad is overweight and has high bp. Why not just test him? It's such a simple test?

My second example is a little different:

My daughter was born with feeding aversion. She sucked by instinct at first but after 3 mos she was crying and screaming and refusing to eat. I brought her to the ped and the CNP kept telling me it was colic. Finally one day she screamed all day and got dehydrated and I took her to ER. She was admitted and put on IV, eventually an NG tube, stayed 6 days. She was found to be malnourished and had a severe case of GERD and eating aversion. She went home on the NG tube, later got a gtube. Still not eating. Total refusal of bottles. She started vomiting many, many times a day. I videotaped some of this to show her GI how bad it was. When she vomited I just fed her again. She ended up on continuous feeds for awhile and still vomited. But she was gaining weight and starting to catch up with development and her GERD pain seemed to be gone. So after they ruled out pyloric stenosis (sp?) basically I was told to just continue with the status quo. Now she is 29 months old, still has feeding aversion. She went through a period of 2 mos where I actually got her off the tube and onto oral puree feeds but then she got an ear infection and the vomiting came back and now she's back on 90% tube feeds. I am starting to realize that whatever her problem is, it's going to last a long time.

I have asked the GI what is causing the vomiting and why is she so gaggy when she eats, and why does she never seem to have any hunger? Even when on all oral feeds and I didn't feed her for a few days, she was never hungry. She eats for social reasons only, and only then a few bites. He always says maybe it's this, maybe it's that. But what's the problem? She's gaining still, she's thriving, and she's not in pain from GERD. So what's the problem?

Her regular ped, who had a child on a gtube for a few years, feels my frustration. He said basically to let go of trying to find the cause for her problems and just focus on the fact that she's thriving and growing and happy. I realize that sometimes you can't ever find out the reasons, but I feel that her case they haven't really tried beyond ruling out the serious things like CF and anatomical abnormalaties. They also don't seem to care *how* she gets her calories, as long as she does. As doctors, they are concerned that she grow. As a parent, I am concerned that she learn to eat, feel hunger, and be as normal as possible.

I know this sounds like a vent session and maybe it is. I just want to know how common it is in a medical setting to focus mainly on treating the symptoms but not finding the underlying cause. It's like the squeaky wheel gets the grease. I wonder how much of this is because of doctor and nursing shortages, and if there were more doctors if they would be spending more time getting to know the patients and looking at the *whole* patient, not just the symptoms presented that day. In my state there are only 8 Pediatric GI doctors. 6 of them in my area, 3 of them at Children's Hospital. They are so, so busy I feel like he doesn't even know us and I can tell when he talks to us that he probably doesn't remember us since it's 4 months between visits.

To end on a personal note: I asked my doctor if I could get tested for my dad's liver condition because it's inherited. She said insurance won't cover testing until (a) I reach menopause, because in women they bleed monthly and don't develop symptoms as soon as men, or (b) I start showing symptoms. Sigh.

Thoughts? Comments?

[psalm, RN]

...maybe your daughter has a psychological aversion to eating?

[traumaRUs, MSN, APRN]

Your frustration is palpable in your post. I really feel for you. That said, I would ask for a second opinion both for yourself and for your daughter. Please take care.

[CIRQL8]

I am so sorry for your experiences. Please know, sometimes only the symptoms can be treated, because there is no treatment for the disease process. Sometimes you must treat the symptoms until the couase is found. Medicine is an inexact science. Many things must be 'ruled out' before one know the real problem. I suspect that your real question is wjat to do about your daughter, and getting to the bottom of her feeding problems. I have some aquaintences (sp?) (I live in Central Illinois) who had preemie twins (they are now 2 1/2 years old). One has an aversion to eating (as you daughter does). They have to literally force him to eat. He's a skinny little thing, but healthy now. They found a specialist in California (I don't know where) - specializes in eating aversion and other nutritional problems. I wish that I spoke with them more often - but I hardly see them (like once or twice a year at a mutual friend's), otherwise I could ask where and who for you. Best I can tell you is NEVER GIVE UP. Look, search, ask until you find the right doctor for you child and her needs. Best of luck.

[AmericanChai]

Thanks for listening! :) I know that sometimes the answers will never be for certain but I feel like they are not that concerned about finding out why.

I did not post here to get answers for her problems because of the rules of this forum. I just wanted to express my frustration and find out how common it is for medical professionals to just be happy with the status quo as long as someone is thriving. I feel that if there was not such a shortage of doctors and nurses that maybe they would spend more time on the patients. I feel like my daughter's doctor is not even trying because he is overworked, and that defines his goals with his patients as "maintain" instead of "cure" in certain cases. I know he has a good heart

I just got her an appt with a feeding therapist through Children's after appealing insurance a few times. They normally don't cover it unless there is a physical inability to eat such as mouth or jaw problem. So this was a huge victory. She has been in therapy in the past but often feels so sick that it's pointless. She will even vomit on slow tube feeds for no reason sometimes. Also, I am limited by insurance with the GI's. If I want a second opinion, some of the GI's are not taking new patients and all of them have a least 4 month wait to get in. Even with my daughter's GI, if there is an urgent matter I can call the nurse but cannot see him in person unless she gets bad enough to be admitted. His appointment book is 3 months out.

I just feel like the medical system is broken.

Thanks for responding to my post. I'm so very thankful that we have the technology to keep her alive and thriving in spite of her feeding problems! She is a happy, healthy 30 pounds at 2.5 years old and meeting all of her milestones. I know that she will be okay.

[Anagray, BSN]

Hi there! I feel your frustration and I am so sorry for everything you are going through. I have no medical info to offer you (do not know much about feeding adversion, unfortunately), but as someone who grew up in another culture (Russia), I can offer you my POV on the subject of symptoms vs cause.

Every day when I come to work I have to "turn off" my personal views on medicine an abide by the rules and regulations I learned in RN school in the States and abide my the standards of my hospital, state and beyhond. It's pretty easy at this point.

Where I come from medicine is terrible, therefore people have gotten really good at preventing problems and treating the cause as soon as possible.

For example - in US (see medical myths thread lol ) it is said that being exposed to cold (ice chips, snow, cold stone, having wet hair in the winter) will not cause you to be ill. It is true to a point - exposure to cold brings down our defences and we are more succeptable to viruses and bacteria because of it. therefore in Russia people practice strict balance between cold and hot and they try to increase threshold of the body by exposing it to cold slowly and in small intervals and only when healthy - that is how some people manage to swim in ice water for fun and still be free of pneumonia and hypothermia.

in the US it is unlikely to happen becuase the whole pharmaceutical industry is amed at treating symptoms, not prevening diseases for the most part. So, this is the sad reality.

I hope your baby feels better soon. Love, NAt

[weetziebat]

I'm so sorry for all you are going through and, yes, your frustration is loud and clear. I don't think the problems with the medical establishment has anything to do with a shortage of doctors/nurses, but the allopathic system itself.

All of the big industries, who try to make us believe they are on our side and searching for ways to better our lives are instead all in 'bed' together, in a scheme for money and power. The AMA, Environmental Protection Agency, the petrochemical companies, pharmaceutical companies, folks who use antibiotics and hormones in raising animals for meat, farmers using toxic chemicals on our foods, genetic engineering, the industrial poisons in our air and water are definately not doing us any good. The capitalistic viewpoint of concern for profits outweighs andy concern for people, health or the state of our planet. And treating only the physical body, while ignoring the mental aspects of illness doesn't make any sense,

The drug industry is perhaps one of the most profitable businesses in the world. So, with pharmaceutical reps pushing docs to prescribe, it only makes sense that symptoms, rather than being looked at as the body/minds way to heal itself, are treated by giving meds. If they don't work, change the meds. It is much more time consuming, and less profitable to try to track down the real cause of the symptoms and treat that. Remember that the U.S.A. boasts the highest medication prices in the industrial world. They claim it is because of the exorbitant costs of drug development but between 1987 and 1991 only 17 new drugs were developed, and 12 of them were paid for by government research subsidies.

Allopathic medicine definately has its place. Its excels at surgery, emergency care, treatment of trauma and certain bacterial infections, while many of its diagnostic tools are without compare. Having an M.I., or pulmonary edema, or an appendix about to bursrt surely call for conventional care.

But, although your insurance company probably will not cover it, IMHO, you might want to look into Naturopathic and other alternative therapies. There you are treated holistically. Although natural treatments take more time to work, they don't add poisons to your system. You might try reading some of Dr.Andrew Weil's books to see what you think of them.

I'll get off my soapbox now, just closing with a quote from Voltaire:

"Physicians pour drugs of which they know little, to cure diseases of which they know less, into humans of which they know nothing".

[AmericanChai]

thanks again for sharing your thoughts, everyone.

weetziebat, as a vegetarian, cloth diapering, earth loving person i can agree with your sentiments. i wish natural medicine was covered by insurance even a little bit. i would have taken my daughter sooner. unfortunately we are still paying off medical debts and as soon as we do and have some free cash i will be trying to help her in other ways. i hope that as she gets older we can gain more insight into her feelings about her own health and eating. we may try to seek out aryuvedic treatment for her when we go to india in a few months. we can probably afford it there.

[weetziebat]

We may try to seek out aryuvedic treatment for her when we go to India in a few months. We can probably afford it there.

Excellent idea. I'm not sure how you go about finding a reputable healthcare provider in India, but I'm thinking if you can, you may discover an entirely different way of looking at life and illness.

I sincerly hope your daughter has her problem diagnoses and successfully treated, and that you and your family find a method of healthcare that works best for you.:icon_hug: