Am I expecting too much from my oncologist

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CallMeTenacious
CallMeTenacious Member Posts: 39
edited December 2021 in Hormonal Therapy - Before, During, and After

Shouldn't your oncologist tell you when your labs show you are seriously hypothyroid and your lipids have escalated to the danger zone? I'm not expecting her to treat them but please note them and recommend followup.

I have been on Tamoxifen for almost 18 months and am not impressed with my oncologist's interest in seeing me. I went for a blood draw immediately before my appointment (standard). She normally requests a CBC and metabolic panel. I requested that thyroid and lipids be drawn as well and they were.

She is always pleasant to me. She felt my neck and checked my breasts. Despite knowing that I am also an ovarian cancer survivor (treated at another hospital), she never does any abdominal palpation (seems like she should do a quick one). She asked if I'm tolerating the Tamoxifen and I gave her the laundry list of annoying side effects but affirmed that none are bad enough that I want to switch.

I asked about the bloodwork and she told me everything was fine. Then she said to come back in 6 months & left. When I picked up the printout and saw the issues, I was livid. I immediately contacted my PCP and received a new thyroid med prescription and have made myself a cardiologist appointment (was on my list for next year).

The reason that I am taking Tamoxifen at 67 instead of AI is that I have osteopenia and am hoping to slow the progress to osteoporosis. I am due for a dexa scan in February and she did not order it. I think this is her job to order and not mine to have to request.

I hesitate to change oncologists because another would likely insist on the switch to AI. Am I expecting too much from my oncologist?

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  • ctmbsikia
    ctmbsikia Member Posts: 1,095
    edited December 2021

    Hi, No I think exactly the same. If something is off on your blood panels, they should alert you to follow up. What's the point of doing them if they don't look at the results? UGH I don't know why some don't. I am on my second MO (not by choice a change in the doctors location and I didn't feel like following my 1st one to a further away location) I really liked her, she was on top of all of it. New guy is not but I do enjoy challenging him a little bit, especially by requesting putting in the orders that he should already do, but I have to remind him. Once I gave him the code to type in his trusty computer. Looking forward to graduating to just once a year visits someday.

    I trust you have a good general practitioner and can pose concerns to them, or your upcoming cardio. Best wishes.

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  • Rah2464
    Rah2464 Member Posts: 1,647
    edited December 2021

    In my opinion your oncologist is driving your health bus because they are prescribing medications that can have serious side effects. My Onc very thorough in evaluating all facets of my health. She works very well in conjunction with my PCP. I think you should perhaps find a new one.

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  • gb2115
    gb2115 Member Posts: 1,894
    edited December 2021

    I can see this both ways. She should have noted the off labs and sent you off for evaluation. BUT, I work in a different specialty with doctors. They generally don't like drawing labs or doing testing for things they either don't want to treat or feel ill equipped to treat. One explained it to me this way, if you test for it, you're obligated to treat it. So you asked her to draw certain labs. If she didn't want to treat them, she should have refused and sent you to your primary care provider to have that done.

    I had to ask for bone density testing too, I have my dexa scan today. I don't think she was going to do it because I'm premenopausal, but I thought a baseline sounded good. She agreed after I asked, but I think it wouldn't have happened if I didn't ask.

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  • ThreeTree
    ThreeTree Member Posts: 709
    edited December 2021

    gb2115 - Interesting what you say about if a doctor draws a lab and there's an off result, they are obliged to treat it. My PCP wanted a cholesterol reading and to save me a needle stick, asked me to just have the oncologist add the cholesterol on to the next blood draw that they did at the cancer center. Well his office faxed over an order to them for the cholesterol to be added two different times. When I got to the office and asked to make sure they added the cholesterol onto the testing request, the nurse freaked out, went out to the front desk, and came back saying they could not find either of the orders that were sent over and so then she went to talk to the oncologist. The oncologist came in to see me and told me that not only did they never receive an order (not true, as I double confirmed with my PCP's office), but that a cholesterol reading should be done after fasting and I hadn't fasted. The request completely discombobulated them and they did not add the cholesterol test onto that blood draw.

    I told the PCP what happened and he thought his request had put them "way out of their comfort zone" for some reason, and he added that only in a narrow range of cases do you need the fasting cholesterol number. He said if you just want to know if someone has high cholesterol or not, and generally what the range is, the number you get from a normal non fasting draw is just fine. He questioned just how much this oncologist knew outside of oncology.

    A couple of months later, I went to an urgent care for an unrelated problem and they said they wanted to do a blood draw. I asked them if they could add the cholesterol on for my PCP, and they said no problem whatsoever, and they not only had the test done, but gave me the results by that afternoon and sent a comment from the urgent care doctor as to the nature of the results (no high cholesterol). I sent all that on to the PCP, so the job got done, but the oncologist was way more of a problem than a help.

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  • Katyblu
    Katyblu Member Posts: 171
    edited December 2021

    My MO has been very accommodating in sending out referrals to other specialists for issues that I have. When speaking with my palliative care doctor, she said that I should only expect my MO to take care of the cancer issues and to use my PCP for other issues. I tried that and my PCP flipped out over tachycardia without an irregular EKG. He sent me to the ER to get some scans. In contrast, my MO looked at my tachycardia and EKG and put in a referral for an echocardiogram and a cardiology appointment. I feel like if my referrals come from my MO they are taken a little more seriously. And it was actually my Ro that discovered I had Graves disease during an annual thyroid panel because of the location of my radiation. He called me to talk about it and put in the endocrinology referral.

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  • bcincolorado
    bcincolorado Member Posts: 5,758
    edited December 2021

    Mine put me on meds for my thyroid after lab tests and did not send me to my primary doc for it. She is the second one I have had since the first one retired. She also also questioned some of the treatment the first one who retired and had been in the same practice. Why did he not do xxxxxxx....... She would have been more aggressive in her treatment of the cancer it sounds like. He was more reassuring and she is not. So you never can tell.

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  • AliceBastable
    AliceBastable Member Posts: 3,461
    edited December 2021

    My MO deals with cancer-related things, and that's what I expect. On a few occasions, I've asked her about something probably unrelated, and she's told me to ask a (specific) different doctor. It makes sense to me, because I wouldn't, for instance, ask an orthopedic doctor about breast cancer. It would never occur to me to ask the MO's lab people to test for anything she hadn't ordered. At my PCP visit yesterday, I did ask if she includes a specific thing on the blood draw, but 1) I explained why I asked (it was approaching a number that would require immediate intervention when it was run at the MO's a month before), 2) it was a condition I'd had to deal with before, and 3) I asked the doctor before she wrote up the lab work rather than asking a technician to deviate from what a doctor had ordered.

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  • MinusTwo
    MinusTwo Member Posts: 16,634
    edited December 2021

    My PCP has agreed to put in blood test orders for everything all my other docs want to see. That way I only have to have blood drawn twice a year and results are reviewed by the various experts.

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  • HersheyKiss
    HersheyKiss Member Posts: 550
    edited December 2021

    Ditto, MinusTwo.

    My PCP also orders the DEXA scan, serum CTX, 25-OH vitamin D test, mammogram, colonoscopy, etc. Results are shared with all my other medical providers.

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  • gb2115
    gb2115 Member Posts: 1,894
    edited December 2021

    Which makes sense, because primaries can be used as a gatekeeper of sorts to all the different specialties.

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  • AliceBastable
    AliceBastable Member Posts: 3,461
    edited December 2021

    My PCP checks to make sure my other doctors have access to all tests she runs, since they're on different systems. If she can't tell, she emails them. She's great at ordering initial tests of any kind but then referring me to a specialist if needed. She's not just a gatekeeper, but an air traffic controller.

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