For Sue In El Paso

[Therealbubba]

I was wondering if you could clear something up for me. I can't get a good answer from my doctor.

If your patient has had a thyroidectomy, and you see him yearly for checkups, why would you only check TSH and not the actual thyroid hormone? Back when I was under the care of an endocrinologist, he told me I didn't need him as long as my primary kept my TSH low (0.2 to 0.5).

I'm on what I consider a fairly high dose of levoxyl (0.125mg). My TSH is in the normal range, my primary insists it's OK, and won't order a thyroid level, saying it's unnecessary. Isn't the whole idea of hormone therapy to keep the TSH low so what's left of my thyroid is supressed?

Your thoughts? Thanks.

Therealbubba

Two separate issues here:

1. Why TSH alone, instead of TSH + free T4?

T4 is the predominant form of thyroid hormone, and the active ingredient in most thyroid hormone pills. It can be measured accurately, but this only tells your doctor if your T4 level is within the same range as 95% of "normals", not whether it is the right level for you.

TSH, however, measures whether your pituitary is "happy" with this amount of thyroid hormone.

Nl range free T4 = 0.8-1.8
TSH = 0.5-5.0 (NB: Actual normals vary with testing facility)

Let's take an average person. Their T4 level is 1.3 & their TSH is 1.0 (asymmetric distribution of TSHs). If something goes slightly wrong with their thyroid, the T4 level might fall to 1.0 & still be in the normal range. But their TSH would be likely to increase to 10 & reflect the deficiency. Conversely, if there thyroid started mildly over-producing thyroid hormone, their T4 might go up to 1.6, & again, still appear normal, but their TSH might fall to 0.1, indicating that the pituitary was beginning to respond to the excess...

So if your thyroid hormone levels are not rapidly changing & there's no reaon to suspect pituitary dysfunction, the TSH is lots more sensitive than the T4 value in assessing whether your current dose is right for you.

2. It sounds like there is disagreement between your primary care provider & your previous Endocrinologist as to what the treatment goals should be.

This is tough - deciding where to keep your TSH is trickier than some primary care providers realize, but they are perfectly capable of adjusting your thyroid hormone dose to get you there, once they're really aiming for that range.

Deciding on where your TSH should be kept depends upon a number of factors - what condition prompted the surgery in the first place, how completely the surgeon removed the thyroid (almost always a little tissue is left behind), how old you are & what other medical conditions you might have.
This allows your doc to balance the risks of keeping you slightly hyperthyroid (TSH .2-.5) vs. the risks of someday needing repeat thyroid surgery if your thyroid grows back. (You're right about the goal being to suppress your TSH to decrease the possibility of regrowth necessitating repeat surgery). I can't help you there, except to suggest that you tell your primary care provider that you're not comfortable just keeping the TSH in normal range, could he please talk to your Endocrinologist & find out why he should keep it in the suppressed range?

If you get no satisfaction there, get a different primary care provider, or insist that insurance company/HMO pay for follow-up with the Endocrinologist; tell them it's cheaper than repeat surgery...



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Sue from El Paso
members.aol.com/majormd/index.html (http://members.aol.com/majormd/index.html)

[David B]

Bubba, I'm just wondering: Why not ask your own doctor this question? I mean, why post a message to somebody you don't even know on the web? I'm not trying to impugn Sue's character, and haven't even read her response. For all I know, she has given you a 100% accurate answer. But she's still just a name on a web page.

A note to everybody from me as a user (not acting in any official moderator role, especially since this isn't my area) : Remember that this medium is only as reliable as the people make it. Please check out any medical advice you might get here.

David, did you read Therealbubba's opening paragraph? She said:

I can't get a good answer from my doctor.

This is because most primary care providers get 10-12 minutes max per visit, which translates to 7-10 minutes face-to-face time. Many will not/cannot routinely take time to answer these kinds of questions.

Also, please note that the question here was not should I take .125 mg or .150 mg, but rather, why does my doctor rely on just the TSH.

Message boards & web sites are good sources for that kind of information, as long as the questioner realizes that they cannot review the credentials of the information furnisher.




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Sue from El Paso
members.aol.com/majormd/index.html (http://members.aol.com/majormd/index.html)

[WallyM7]

Er, Sue, Bubba's a guy.

[Therealbubba]

Sue, thanks for your reply.

To answer some of your questions, I had a suspected thyroid carcinoma at age 35 (I'm 40 now, male). A lump was found during a routine checkup. It was found I had a cold nodule. Several attempts at FNA were inconclusive. Surgery followed with removal of the left wing and middle lobe (?). Pathology was done while I was on the table and it was found to be an adenoma. They left the remaining tissue in and told me I was lucky.

My insurance carrier won't pay for the thryoid hormone level (T4?). Is it worthwhile for me just to get it anyway and pay for it out of pocket? It hasn't been checked in 5 years, just the TSH, CBC and fasting blood sugar.

My concern was should I face the possible side effects of going even higher on the levoxyl to be hypothyroid? If I'm euthyroid, isn't that little piece of tissue left in my neck still working? My only other problem is I have to take a betablocker for primary hypertension, which is controlled. Otherwise, I consider myself to be in very good health.

Therealbubba

[Therealbubba]

David....your disclaimer is noted and I release SDMB of all liability.

Therealbubba

[Therealbubba]

Oops, now that I think of it, they check my fasting cholesterol, not sugar.

Therealbubba

First, my apologies for the mistaken gender assignment...

My insurance carrier won't pay for the thryoid hormone level (T4?). Is it worthwhile for me just to get it anyway and pay for it out of pocket?

I really don't see any real need to check the T4; however, if you're unconvinced, then paying out-of-pocket to check it may have fewer side effects than sleeping pills ;)

My concern was should I face the possible side effects of going even higher on the levoxyl to be hypothyroid? If I'm euthyroid, isn't that little piece of tissue left in my neck still working? My only other problem is I have to take a betablocker for primary hypertension, which is controlled. Otherwise, I consider myself to be in very good health.

First, going UP on the Levoxyl would make you more hypERthyroid (too much thyroid hormone), not hypOthyroid (too little thyroid hormone). Second, being euthyroid simply means that the total amount of thyroid hormone in your system is right for you, but doesn't address whether any, some, or most of the thyroid hormone in your system is coming from your own thyroid tissue as opposed to the pill. If the TSH is suppressed, virtually all of the thyroid hormone would be coming from the pill.

Keeping the TSH in the 0.2 - 0.5 is pretty harmless; going below 0.1 clearly puts you at somewhat higher risk for atrial fibrillation (fast irregular heart beat which can cause strokes) and faster than normal bone loss leading to osteoporosis. If you had blocked coronary arteries, it might cause you to get chest pain, or angina, more often, but does not in itself, cause blocked arteries. Based on what you've told me, I would recommend trying to get one more follow-up appointment with your Endocrinologist to discuss the risks & benefits of keeping TSH normal vs. slightly suppressed, and to clarify your treatment goals (in writing) to let you feel more comfortable working with your primary care provider.

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Sue from El Paso
members.aol.com/majormd/index.html (http://members.aol.com/majormd/index.html)

[Therealbubba]

Again, thanks. I guess I got my Os and ERs mixed up. I go next month for followup, and I'll let you know what happened.

Therealbubba

[JillGat]

[[Message boards & web sites are good sources for that kind of information, as long as the questioner realizes that they cannot review the credentials of the information furnisher.]]

And - as informative as Sue's answers are - as long as online doctors realize the limitations of any information, suggestions, or diagnoses (god forbid) given to a patient sight-unseen, and based only on described symptoms and described treatments. The IRL doctor might be inadequate, but he or she is dealing with a more holistic picture of the patient.
Jill

[Nickrz]

I, for one, would be suspicious of a doctor who did not even resort to even the most basic information gathering before rendering a diagnosis/prognosis/second opinion/drug recommendation/etc. I would expect even the most egregious of the cost-cutting HMO doctors might try to determine your gender beforehand.

I've said it before, and I'll say it again: for personal medical problems, the best advice is to see your doctor. If you don't trust your doctor, or he is not forthcoming with the information/reassurance you seek, find another doctor who will examine you and treat you in the manner you deserve.

It's one thing to ask about fuel injectors or brake shoes online, but quite another to entrust your pituitary hormone levels to someone you've never met and is not privy to the most basic of your personal medical history. I wonder what the ethics committee of the American Medical Association has to say about doctors who routinely treat "patients" sight unseen.

If you'd been found to have elevated levels of prostate-specific antigen in your blood, would you trust a cyber digital rectal examiner who called you "ma'am" and told you it was nothing to worry about?

Caveat Emptor and you get what you pay for.

[David B]

Nickrz said:for personal medical problems, the best advice is to see your doctor. If you don't trust your doctor, or he is not forthcoming with the information/reassurance you seek, find another doctor who will examine you and treat you in the manner you deserve.This is essentially what I was going to say. If Bubba's doc won't take the time to answer his questions, Bubba should find a new doc -- or sit there and ask until he gets the answers he needs. Yeah, the doc may be running around, but he still has an obligation to Bubba as a patient. If a doc gives a quick answer and the patient doesn't press the issue, the doc is likely to figure that was all that was necessary. As much as docs run around, I have never had one in such a hurry that s/he was unwilling to answer my questions, even when I went into detail that probably wasn't necessary.I would expect even the most egregious of the cost-cutting HMO doctors might try to determine your gender beforehand.Oh, man, I almost fell out of my chair laughing at this one. :)

I personally appreciate Dr. Sue being willing to take time from her busy Army practice (yes, she is indeed a Major) to share her expertise, which is as an endocrinologist. And I'm surprised at the impled criticism from three moderators, one after the other (well, I'm surprised at the criticism from two of them, anyway), to Sue answering this person's question. She was not diagnosing, she was not attempting to treat, she was providing specific information to answer specific questions, and if you go back and read her posts, at least TWICE she tells this person that he should go back to his own doctor with that specific information, and to follow up his own endocrinologist for further discussion and to determine whether the concerns he has already expressed are valid.

While in certainly true that you don't want to rely on an unknown person posting on a web board for your care and treatment, it's also true that this can be an excellent source of information in a hurry, which can allow one to be better prepared to ask their treating physician questions and understand the answers in the 12.5 minutes the HMO pays for them to be in contact. Not only that, there are millions and millions of people who have absolutely no access to primary care because they have no insurance. To such a person desperately seeking information, the web may be the best source they can find to help them make a decision about what to do. It ain't a great system, but for some people it's all they have.

Oh, and by the way, there are MANNY instances when doctors, specifically certain specialists, can and do render their opinions without ever seeing the patient, based on the medical information provided to them.

Sue, thank you for all that you do, and for being willing to share your expertise with others. Without charge, even! :) (Good thing, or heaven knows what my bill would be at by now!)

-Melin

It's a good thing I've got a flak vest...

What I have consistently tried to do on this and other boards is to answer posters' questions with factual, impersonal type information (e.g. Why do doctors rely on just TSH testing instead of TSH + T4) When personal medical issues have come up, I provide some information & tell the poster to discuss this further with their doctor(s). When needed, sometimes I try to help focus a poster's vague uneasiness on a couple of specific issues that he/she can then discuss with their doctor. I freely admit to not knowing all of the details needed to diagnose or treat someone, and do not do this. I do strive to provide enough information to increase the posters confidence in discussing their issues with their doctors, and sometimes will make specific suggestions about things to ask about (like the risk of osteoporosis, Atrial Fibrillation & angina while maintaining higher than normal thyroid hormone levels) to help them focus their discussion on what they are really worried about. This is not diagnosing or treating a condition; this is helping the poster get the most from the few minutes they do have with the doc.

The particular question that the OP asked about the TSH & T4 is one that a good many competent primary care doctors can't answer quickly & easily because they're seldom asked. As an Endocrinologist, a week doesn't go by that I don't explain this to patients (and doctors-in-training as well.)

This particular question is really not different in nature from many that are fielded routinely by Cecil in his columns or by the SDS in the Mailbag. I do have expertise in this area & enjoy helping people understand what can seem like complex problems. In many ways, what I really do for a living IS teaching patients about their conditions & how to manage them.

AOL pays doctors to do much the same thing in their Ask-A-Doc program, which is highly popular. The ground rules there are that the docs answer questions, explain hows & whys, and direct patients to web sites run by reputable sources (CDC, Mayo, Johns Hopkins, etc). The line between diagnosing & helping patients get the most from their doctor visits, however, does sometimes get fuzzy, as this "spectrum" illustrates:


Your child's fever, headache, & stiff neck should definitely NOT wait until tomorrow. Go to an ER NOW!

You might ask your doctor if (s)he has considered that the numbness & shooting pains in your Left Hand, and your tendency to suddenly drop things, might be due to Carpal Tunnel Syndrome.

The things you're describing do have a lot in common with lupus. But that's a very difficult diagnosis to make, and treatment with the strongest meds is usually only begun for severe complications such as XY or Z. Deciding that your current symptoms are due to lupus wouldn't really change the treatment from what is being done now. If you are this concerned about lupus because your sister had it, by all means make sure your doctor knows why you're so concerned; he'll be better able to address your questions if he understands why you're asking. And since lupus can run in families, knowing that your sister had it may make him more suspicious of it in your case.


I must admit to some puzzlement, then, to find that not one, but three, moderators have chosen to take issue with my answers (which do end with see your doctor). One moderator apparently can't be bothered to read what I wrote before criticizing the OP for even asking the question. Another moderator hides behind "wondering what the ethics committee of the American Medical Association has to say about doctors who routinely treat "patients" sight unseen", when I have done no such thing. He further makes a snide allusion to my not knowing whether the OP was male or female, when the core question about TSH testing is gender-neutral. The third moderator doesn't say anything out-of-line; I'm curious, though, why she felt the need to echo what had largely been said previously.

I sincerely hope that these posts were not due to bad feelings from previous exchanges, or because of who's friends with whom. I also hope that some of what I've posted above demonstrates that I am cognizant of what is, and what is not, appropriate for this forum. I fully intend to continue answering medical posts that interest me when I have time to read this board & provide a reasonably complete answer.



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Sue from El Paso
members.aol.com/majormd/index.html (http://members.aol.com/majormd/index.html)

[David B]

Melin said:I personally appreciate Dr. Sue being willing to take time from her busy Army practice (yes, she is indeed a Major)Ah, I was wondering what the "Major" part was. I just thought it was as opposed to being a "Minor" MD. :)I'm surprised at the impled criticism from three moderators...to Sue answering this person's question.I would like to see where you find any "implied criticism" of Sue in the message I posted. I specifically stated, "I'm not trying to impugn Sue's character, and haven't even read her response. For all I know, she has given you a 100% accurate answer." I also take issue with your acting as though this was done in some official moderating capacity, when I specifically said that I was talking as a user, not a moderator. (If you weren't implying some official capacity, why bother to note that "three moderators" mentioned it?)

Majormd said:I must admit to some puzzlement, then, to find that not one, but three, moderators have chosen to take issue with my answers (which do end with see your doctor).See what I just said to Melin. I was not necessarily taking issue with your answer, nor was I acting in any official moderator role. I would have made the same point if I were a user, or if the same discussion had been going on elsewhere.One moderator apparently can't be bothered to read what I wrote before criticizing the OP for even asking the question.I didn't criticize him for asking, I simply noted that getting medical information on a web message board is not perhaps the best idea in general. I gotta tell you, you seem overly eager to go on the attack here, Sue. I didn't criticize you; I didn't act as a moderator; so what, exactly is your problem with what I said?I sincerely hope that these posts were not due to bad feelings from previous exchanges, or because of who's friends with whom.I know mine wasn't. But your response does, I must say, look like previous exchanges may have played a part. Please reread what I said and take it for what it was. There was no hidden meaning.

David, yours was certainly the lightest of the posts, too, although I notice you weren't above repeating Nickrz' cheap shot about not knowing the gender of the OP and then laughing about how funny it was. Particularly when Nickrz was showing his ignorance in not knowing that there are many things which are gender neutral, and the OP's question was one of them.

And the "moderator" title shows up next to your name whether you disclaim it or not. *I* disclaimed it in a certain post I made a couple of months ago, specifically stating that I was posting as a member and not a moderator, and was told that it didn't make any difference, that moderators were held "to a higher standard." You might recall that.

What I'm really objecting to here is that three moderators felt it necessary to jump in and criticize the OP and, by implication in some posts and directly in others, Dr. Sue, as opposed to simply making the point you originally made about obtaining professional information in a medium such as this. Your first post, and Jill's post, were informative and got the point across; one of them should have been enough but two was overdoing it. Nickrz' post was excessive, obnoxious, insulting, and borders on defamatory. There was no reason for it, and no excuse for it. Dr. Sue was not attempting to diagnose and treat, she was providing information and urging the OP to go back to his own health care provider to discuss what was going on with him.

I think TSD owes Dr. Sue an apology.

-Melin

[Therealbubba]

First off, I want to again thank Major Sue, MD for her expertise. Second, I want to apoligize to her for all of the trouble my OP may have caused.

Although I don't work in the field anymore, I am a Registered Respiratory Therapist. I feel comfortable in asking a question like I did in a forum like this. It was very clear to me that the doctor was not making a diagnosis. I asked her the question because I felt comfortable in doing so based on reading numerous posts she's made. An Endocrinologist pacticing in the army can only be in it for the love of healing the sick, instead of so many docs today who are focused on profit.

I think the moderators may be concerned with this MB turning into a medical advice column, and the liaibility that can go with that. That is certainly a valid concern.

Again, sorry to all for any bad feelings, that was not my intent.

Therealbubba

Melin & Therealbubba - thanks!

Therealbubba - sorry your post & question got tangled up in all this. The question you raised was controversial in the medical community until doctors were gradually won over that the T4 measurement seldom provided any better information than the TSH.

There's an interesting history to this - in 1980, TSH assays were too insensitive to be able to distinguish between normal & low (hyperthyroid-range) values. T4s were quite easy to do, but were a little more confusing because they measured all of the thyroid hormone not just the non-protein bound fraction than can diffuse into cells. People then questioned whether TSHs were all that useful for monitoring patients.

By 1995, there had been almost a complete reversal. Labs were routinely measuring a "free" T4, which made the result more useful, but also made the test more difficult & more expensive to run. TSHs had becaome so sensitive that levels only 1% of "normal" can be distinguished from undetectable levels. With these assays, the TSH alone tells the whole story in about 95% of new patients, and in 99.9% of established patients who are checking if their thyroid hormone pill is the right strength for them. The T4 assays costs 5-10 times what a TSH level costs, and usually adds little information for your provider.

Doctors & patients have taken awhile to convince; most are rightfully suspicious of changes made for cost-efficiency. But some of these changes really do make sense, and omitting the T4 assay for most patients is one of these situations.

Please do continue asking these kind of questions - there's a lot of medical talent on this board :) Most people enjoy talking about what they do & explaining things they understand well. If I didn't enjoy explaining things, I'd sure be in the wrong job!



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Sue from El Paso
members.aol.com/majormd/index.html (http://members.aol.com/majormd/index.html)

[JillGat]

[[What I have consistently tried to do on this and other boards is to
answer posters' questions with factual, impersonal type information
(e.g. Why do doctors rely on just TSH testing instead of TSH + T4) When
personal medical issues have come up, I provide some information & tell
the poster to discuss this further with their doctor(s). When needed,
sometimes I try to help focus a poster's vague uneasiness on a couple of
specific issues that he/she can then discuss with their doctor. I freely
admit to not knowing all of the details needed to diagnose or treat
someone, and do not do this.]]

You're right, Sue, and I really didn't mean to attack you in this thread. I didn't see anything wrong with your specific answer here. It was just a general issue I was bringing up, and I figgered you'd agree with me.
No harm done?
Jill

Fine here.

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Sue from El Paso
members.aol.com/majormd/index.html (http://members.aol.com/majormd/index.html)

I still think Nickrz owes Sue as public an apology as he made a slam.

-Melin

Mostly Dr. X.
Occasionally MAJ X.

My mom is still frustrated not to be able to find in her etiquette guide how to address a letter to my husband & me. (We've been married 21 years & she still worries over this - aren't moms special?)

Interestingly, while traveling in the UK, I quickly learned that Major scored better perks than Doctor, quite the opposite from the US. A trip to Boston was surreal, though. Every person in the hotel from the bellhop to the concierge made sure to use the honorific "Doctor" if they knew it applied. I'm quite used to being Mrs. X when I worked with Girl Scouts & Rick's mom at a middle school band concert.



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Sue from El Paso
members.aol.com/majormd/index.html (http://members.aol.com/majormd/index.html)

[Shirley Ujest]

A little late,but I never knew Sue was a major in the Army. So, do they call you Dr. Major Sue or Major Doctor Sue?

My mom is still frustrated not to be able to find in her etiquette guide how to address a letter to my husband & me.

Mr. & Dr.?

Mr. & Major?

Yikes! Remind me never to send you a formal invitation, that way I can just yell "Hey Dale and Sue!" ;)

Wonder if Nickrz is ever gonna publish that apology . . . .

-Melin

[David B]

Majormd said:My mom is still frustrated not to be able to find in her etiquette guide how to address a letter to my husband & me.If she ever finds out, please let me know. I have a female friend who recently finished med school, and I haven't figured out how to address her and her husband yet. So far, we just use first names. :) But I guess Mr. & Dr. would be the next best thing. (I keep telling her husband he should go back to grad school and get a PhD to make things easier.)

Where's Miss Manners when you need her?

Y'know, I was thinking about my earlier post, and David's follow up, and wondering why it is that we assume that the "Mr." has to go first. Oh, I know, that's the way it's always done, and all that good stuff. Still, if we think that "Mr. & Dr." sounds weird, or "Mr. & Major," then maybe we ought to play with "Dr. & Mr." or "Major & Mr."

I bet Sue's mom wouldn't agree with this! ;)

Still waiting on that public apology from Nickrz -- I think it's long overdue.

-Melin

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Phenomenal woman
Bitch Corporate Lawyer
That's me

So Nickrz, you ever gonna do the right thing and apologize?

Just bringing this thread back up to the top, hoping that eventually Nickrz will see it and do the right thing.

-Melin

::sigh:: Such a little effort, to apologize. Jill did it, and hers was probably the most innocuous of the moderator posts; David at least acknowledged the issue, but no word from Nickrz.

-Melin

[OpalCat]

I have to agree that Nickrz was out of line. I like to go to the doctor (or to any professional) armed with knowledge. I think that if you know a doctor online, asking questions and getting information is a very positive thing! No one is suggesting that the OP *not* deal with their own doctor, or that Majormd try to treat/diagnose etc, it is simply an issue of gathering information and knowledge. Nickrz was highly insulting with his comments.

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&gt;^,,^&lt; <A HREF="http://www.opalcat.com
--"Cluemobile?" TARGET=_blank>www.opalcat.com
--"Cluemobile?</A> You've got a pickup..."
Teem with the Millions: www.fathom.org/teemingmillions (http://www.fathom.org/teemingmillions)

Anybody out there paying attention? When you make an unwarranted attack on a professional person's professional ethics, you cannot expect it to go by without someone noticing it and calling you on it.

Nickrz, prove that you have some sense of decency, fairness, and just plain the balls to do the right thing.

-Melin

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"I'll never argue with a lawyer again." -- The Devil Himself.

[SanibelMan]

I'm certainly paying attention to this topic. I gave Nickrz a taste of his own medicine (no pun intended) in his thread about itching. Majormd was pleased.

Please, Nickrz, do the right thing. Just admit you made a mistake, were overemotional, in a bad mood, whatever. Something.

[RavingMad]

I hope you're not holding your breath, Melin.

Snowballs in hell, and all that...

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~ Complacency is far more dangerous than outrage ~

[lvick]

I to, have been paying attention to this thread, and congradulate Melin for her efforts to keep it going. Nick if you still think your actions were appropriate at least defend them, this is just plain chickenshit,
Larry

[WallyM7]

You were wrong, Nickrz. It wouldn't kill you to say so.

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This space for rent.

[pricciar]

Wally,
You _know_ how Nick feels about taking medical advice over the message board. If Nick's doctor tells him it will kill him, thats life. Or, umm, death.

pat

[gypsy]

Ummm, just my turn to bring it up top.

[Ed Zotti]

The board moderators and I had a discussion about this a while back. The gist of it was that: (1) there was no need for three moderators to pile on with comments when one could have handled the situation perfectly well, and (2) board moderators should express their comments in moderate terms. There had been some concern immediately prior to this that we would be on the hook legally for medical advice posted on the SDMB and this led to a certain overzealousness. I regret that Majormd felt ganged up on and don't expect this sort of thing to happen again.

You're not getting it, Ed. It's not just a question of the board moderators "ganging up" on Sue; that got explained early on, both by Jill and David stating their concerns and by off-board communications.

What's left here is for Bruce himself to admit that he was out of line in what he said and the way that he said it. I know that he is capable of typing the words

Wow, was I spectacularly wrong.

since he did it here: http://www.straightdope.com/ubb/Forum3/HTML/003389.html .

And the words "I'm sorry for what I said" don't really require much in the way of typing skills or keystrokes. They do require something in the way of balls, though. Bruce is hiding behind your apron strings, apparently, and for that matter we don't see much in the way of an apology from you, either. "Certain overzealousness" does not begin to describe the offending post; "slur," "false innuendo," "ignorant," and "bordering on defamatory" do a lot better.

Unca Cecil may have a reputation for the sarcastic, but not for this sort of garbage.

-Melin

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"I'll never argue with a lawyer again." -- The Devil Himself.

[lvick]

Thanks for the clarification Ed, its not that I can't appreciate your position. do you think that maybe you could create a generic disclaimer that could be posted in threads that concern you so everyone could stay cool?
Larry

[matt_mcl]

Re titles: My mom is a physician. We prefer one of the following forms of address:

Dr. Lynn and Mr. David McLauchlin
Dr. Lynn McLauchlin and Mr. David McLauchlin
Lynn and David McLauchlin

So, you could use:

Dr. (or Major) Susan and Mr. Dale Goodguy
Dr. Susan Goodguy and Mr. Dale Goodguy
Susan and Dale Goodguy

I presume that since you say you have no problem with Mrs., that you use your husband's last name. If you didn't, you could make it

Dr. Susan Pancreas and Mr. Dale Goodguy

Most of this information comes from Judith Martin, a.k.a. Miss Manners.

::sigh::

I think the time has come to close this discussion.

I have tried to provide medical information for those just wondering, those concerned, and those frustrated by a breakdown in communication between themselves & their docs in a good many threads in this, and other forums.

I have always meant to attach a disclaimer specifying that the information provided was meant to foster good exchange of information between individuals & their docs, not replace it. My first response on this thread provided the information the OP requested & advised him to use this information to seek satisfaction from his docs. I can't swear that I have, since joing this MB in March, done this each and every time, but since the earlier exchanges on this thread, & off-line communications from EZ, I have always put in a disclaimer. I will continue to put in disclaimers; if I forget to do so, I see nothing wrong with a moderator adding a short non-pejorative message reminding posters that they should also seek an evaluation from their physician.

Nickrz's post in this thread, however, went way beyond a CYA disclaimer. The jabs about misidentifying the OP's gender were funny & not un-earned; the slur about wondering what the AMA ethics committee thinks about "doctors who routinely treat 'patients' sight unseen" was not funny, and went way over the line. I am not holding my breath for an apology. While I appreciate the support expressed by several posters, I now ask that no further posts be made calling for an apology; let's leave the score-keeping buried (I hope) in the "Explain this one, jodih" thread in the BBQ Pit.



------------------
Sue from El Paso
members.aol.com/majormd/index.html (http://members.aol.com/majormd/index.html)

[moriah]

1. Sue's advice was not advice. It was an explanation of the why's of an accepted medical practice. (And 100% correct, from what I've read on the subject.) Since she included the proviso 'see your doctor', the Board didn't need to give any CYA policy statements.

2. Jill's and David's CYA posts, while not necessary, were in no way 'ganging up.' They were polite and moderate in tone. To claim otherwise is irresponsible.

3. Nick was out of line and owes Sue an apology. And Ed, you shouldn't be apologizing for him. Make him suck it up like an adult or find someone with a more civil keyboard.

4. Melin, your self-appointed job as administration watchdog is getting old real fast. You may be totally justified in feeling angry over an injustice you may have actually received at the hands of the Board. I don't know all the details to judge, and I don't want to know. I do know that you take the opportunity to charge in guns blazing to attack the administration every chance you get. You just did here to Jill and David what you criticize Nick for doing to Sue, and you know what that is called. And I won't even go into your championing of Contestant #3's cause -- it's pathetic. You're wearing your vindictiveness on your sleeve.

Peace.

Sorry Moriah, doesn't wash. Go back and read my posts in this thread. Then follow this link http://www.straightdope.com/ubb/Forum5/HTML/000345.html and you'll see where I wrote:

Those that know a little history around here know that there is no love lost between JillGat and myself, yet I can honestly say that her posts were the most professional and reasonable of the three moderators that posted to that thread. She pointed out the issue or concern in a polite manner, and made sure to clarify that her only intent was to emphasize the point made by Dr. Sue to the OP that he should consult with his own doctor. She was neither rude, obnoxious, in search of a cheap joke, nor defamatory. IMHO that's exactly the way a moderator should post. Interestingly, JillGat isn't the moderator in that forum -- Nickrz is.


You state:
You just did here to Jill and David what you criticize Nick for doing to Sue

Really? Where do I defame Jill and David? Where do I cast aspersions on their professional knowledge and ethics? Where do I take cheap potshots for the sake of a cheaper joke?

Read earlier up in this thread and you will note that I did not criticize the fact that a disclaimer was made, simply that it was done by three moderators one after the other, that one moderator did so in most immoderate and inappropriate terms, and that another moderator thereafter chose to repeat a cheap potshot that was taken by another moderator. Oh, and the term "ganging up" was introduced onto this thread by Ed, not by anyone else. Does that make him "irresponsible" in managing his own staff?

My speaking up against the slur against Dr. Sue had nothing to do with any past history with this board; it has to do with the fact that Dr. Sue is my friend, someone I admire and respect for what she has accomplished, and with a strong motivation to speak out against things which I perceive are unfair and/or unjust. That, incidentally, is why I spoke out when C#3 was banned -- and I was hardly the only one to do so. And what, exactly, was the justification for creating a whole thread announcing to the world that an administrative action such as banning C#3 had been done? To gloat? Other names have been banned from the board before, without the need to start a new thread to make a public announcement about it.

Dr. Sue has requested, in her post prior to yours, that discussion end. Perhaps more wisely than I she is willing to concede that an apology from Nickrz -- which even you admit should be forthcoming -- is most unlikely. He turned his tail and left this thread a long time ago. Sue, I apologize for this subsequent post, for I did intend to honor your request, but I felt the need to respond to moriah's comments.

-Melin

[E. Romero]

[[Dr. Sue has requested, in her post prior to yours, that discussion end. Perhaps more wisely than I she is willing to concede that an apology from Nickrz -- which even you admit should be forthcoming -- is most unlikely. He turned his tail and left this thread a long time ago. Sue, I apologize for this subsequent post, for I did intend to honor your request, but I felt the need to respond to moriah's comments.]]

Not to mention get the last word again, Melin, eh?

Why look, it's my pet troll! She's followed me over here, now. How you doin', J- er, I mean, "Elle" ( ::wink, wink:: )? Check your email, BTW.

Moriah, I gave your comments some more thought on my way to work this morning. I can see how, out of context, one could assume that my calling for Nickrz to apologize on this thread was out of a spirit of vindictiveness. I'd like to give you a little context, if you'd indulge me.

I became a reg on the old AOL Straight Dope Board sometime in the Spring of 1998. DISCLAIMER: I HAVE NEVER HAD AN ATTORNEY-CLIENT RELATIONSHIP WITH TSD, OR WITH ANY OF ITS MODERATORS OR MANAGEMENT, OR WITH THE CHICAGO READER. As I got to know people there, and to IM with many of the staff, one of the things I would often do would be to give a little informal legal opinion if I saw a questionable post. Thus, if something was potentially actionable (in my conservative legal opinion), either for reasons of defamation, trade libel, trademark infringement, or copyright infringement, I would send an email or IM with Jenny (TubaDiva) or Lynn or Euty. And without sending them a bill for $300 per hour, either. ;)

When we came over to the new board, this board, I did the same thing. I did it before I was moderator, and I did it, of course, while I was a moderator. Since I stopped being a moderator I do not regularly IM or EM with any of TSD staff anymore, but I am still on reasonable speaking terms with some, and even in the two months or so while I was lurking occasionally and not posting, if I saw something problematic I sent an email, to Dex or to Lynn. I'm going to be immodest here for a moment and say that every time I have suggested to a board moderator or administrator that there is a potential legal problem surrounding a particular post, that person has followed my advice and edited or deleted the offending post.

Until now.

Seeing Nickrz' post put me in a quandary. He and I do not speak. He is the moderator in this forum, and he is the person who made the offending post. I might have simply let it go by, then, but for the fact that it was such a low blow, and it was made against a person I call friend. Accordingly, I sent an email to a board adminstrator, suggesting that he might want to take a look at the post. Exactly as I have done on perhaps a dozen occasions over the last year and a half, includng after no longer being a moderator, except that this time the offending post was made by a staff member.

And that staff member has been totally quiet ever since, and the offending post has not been edited or deleted. It kind of looks like it's not what you know, it's who you know. Y'know?

Now this did indeed present a quandary, because of course I had a concern that if I pushed for an apology as public as the slur, it would be mistaken, as you have mistaken it, for vindictiveness. Had it been directed at someone other than Dr. Sue, at someone I do not consider to be a friend, my one post ending in "I think TSD owes an apology" would have been the last. But I stick up for my friends, and for what I think is the right thing to do, especially when I think I have the moral high ground, and I think I've got it here.

J-, I mean, "Elle," said something to me in an email written before she created this new screen name to follow me around with, to the effect that "You like to win, and you don't give up." Well, yes. And? Thanks for the compliment, it makes me worth the big bucks they pay me for what I do. But I do it honestly, without throwing baseless slurs around, sticking to the facts, and generally without resort to profanity or vulgarity. And without creating new screen names to hide behind, either.

When I'm convinced I'm wrong, I'll apologize, too. I insulted PLDennison on the old board a year or so ago, and when called on it by Tom of Tomndebb I admitted that I was wrong in what I had said, and I published an apology as public as the insult on the old board. It's part of being a grownup, part of maturely accepting responsibility for the things you say and do. I'll be the first to admit that I'm not perfect and I make mistakes, but at least I'm willing to acknowledge it, and to try to correct those mistakes when they are pointed out to me.

That's all I wanted Nickrz to do.

-Melin

[Mazey]

...and, after repeating yourself 11 times, Melin, we all get the idea. You aren't asking Nickrz to apologize for pointing out that people should be cautious for seeking medical advice from a well-meaning doctor they've never met and who does not know their full medical history. You're DEMANDING it.

It's pretty obvious to anyone who's been forced to endure seeing this message pop up to the top of the GQ board yet again (which is why I kept my mouth shut for so long) that you have a major problem with Nickrz moderating this board. Well, that's YOUR problem...no reason to make it the rest of ours.

Personally, in light of the way this thing's going, I think it ought to be moved to the BBQ pit...because that's what this message has turned into...one long, unending flame.

Sheesh.

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A ship in the harbor is safe, but that isn't what a ship is built for.

[Ed Zotti]

Melin, I'm closing this thread. I count 11 posts from you in this thread alone demanding that Nickrz apologize. In my book that constitutes harassment. Any further posts in this vein will be deleted.