Nice Catch, Dr. Google!

A couple weeks ago, I went in for my not-quite annual wellness exam. I told my doc I was feeling pretty good, aside from the usual intermittent stuff--migraines, fatigue, etc. I went in to the appointment with a list of things to talk about, and we finally got to the last item: my thumbnails.  I'm not sure when I first noticed it, but both of my thumbnails have been bumpy for awhile. I told her that it wasn't anything I was particularly worried about, but wondered what was happening in my body to make both thumbnails bumpy.  She noted that I pick at my cuticles and said that that can lead to infection and irregular nail growth. I said that I'd been picking at my cuticles for several decades and had never seen bilateral weirdness with my nails.

At that point she turned to her computer and said, "As a patient, I don't know how you feel about Google, but let's see if we can find anything."  I laughed and said, "Well, as a librarian, it's my starting point for a lot of research, so let's give it a go."  I think her initial search was something like ridges thumbnails which pretty quickly brought up the term "washboard thumbnails," also known as "transverse ridging of the thumbnails."  I gave her some search tips, like taking away quotations marks, and pretty soon, we kept seeing results that had the words thyroid and hypothyroid in them.  Ah ha! I have a diagnosis of chronic fatigue/fibrymyalgia, so wouldn't ever think to overly complain about brain fog, fatigue, headache, etc, since it's stuff that comes and goes. But, there's a huge amount of overlap between hypothroidism, chronic fatigue and perimenopause (another thing we've assumed was going on).  Given the addition of the bumpy thumbnails, the doc decided to test my thyroid levels.

Last week, while sitting in the hotel lobby at Computers in Libraries, wondering why I was feeling so absolutely crappy when I hadn't been up til 3 am doing karaoke, I got a call from my doctor's nurse. She was telling me all the stuff that came back okay, and I kept thinking, "something didn't come back okay or she wouldn't have called me to say that stuff was okay." Finally, she said that my thyroid test had indicated that I have clinical hypothryoidism and that the doctor wanted to start me on Synthroid.

Jeeze, that sucks, I thought. But after a few minutes, I was pretty happy about it because it explained so much. Admittedly, I am older than most of my CiL peers, and past my partying prime.  Excited as I was to be at CiL and as much as I was enjoying it, I felt really out of sorts. I really pushed myself to participate, socially, as much as I did, and was wiped out for much of the conference. It seemed out of proportion the other factors--age, amount of sleep, etc. I was also getting bummed out by my lack of motivation to be more professionally active, compared to my peer group.  Intellecually, I want to be in the game. I want to be writing, presenting, creating.  My friend Matt always asks me "what are you working on," when we haven't talked for awhile. For the past several months my response has been, "uh....nothing."  Inevitably, we talk about projects we could work on together, but  the conversations have never gone past that.   

Everything makes sense now, or at least I hope it does, as I'm feeling pretty relieved to know that there's a reason behind my lack of energy and engagement. There was a prescription for levoxothyrine waiting for me when I got home, and I fired up Doctors. Google and Ebscohost to learn what I could.  The downside is that it could take several months for me to start feeling better, depending on how long it takes for the medicine to get my thyroid levels back to normal. The upside is that I can stop beating up on myself for not doing more more more. I'm going to cut myself some slack, say "no" without feeling guilty, and give myself time to heal and feel better. And, yes, I already have a follow-up appt scheduled with my doctor, the real one, to supplement what I've learned about online. I'm most grateful for Dr. Google, though, as I'm not sure I would even know that I had a problem if it weren't for such immediate availability of information. 

Comments

[Jodi Schneider]

Glad this worked for you, Rochelle! There've been studies about doctors' use of Google, which might interest you.

Here's one that comes to mind:
Googling for a diagnosis—use of Google as a diagnostic aid: internet based study.
BMJ 2006;333:1143-1145 (2 December), http://dx.doi.org/10.1136/bmj.39003.640567.AE

The authors conclude: "Google searches revealed the correct diagnosis in 15 (58%, 95% confidence interval 38% to 77%) cases." and "suspect that using Google to search for a diagnosis is likely to be more effective for conditions with unique symptoms and signs that can easily be used as search terms".

[mdoneil]

Geez, it would worry me if my physician did not know what possible causes of nail plate abmormalities might be of concern.

Google with help from a librarian is not the answer.

That would scare me off and make me find a new physician. Also not having had a complete lab analysis (not just a sma6 and cbc every other year) would concern me too.

You might want to print out "Nail Abnormalities: Clues to Systemic Disease" From the March 15 2004 issue of American Family Physician, and from the same journal "Treatment of Hypothyroidism" from November 15, 2001.

That story just amazes me. I remember some of the nail problems like Beau's lines in Reynauds, and the clubbing characteristic of COPD patients and that was from nursing school ~15 years ago.

Even if she has to look it up I would hope google would not be her authoratative source. Any hospital at which she practices has a library ... use their librarians don't run off to google.

Wow, just wow.

[Rochelle Mazar]

I'm glad your doctor worked out what the problem was! I had my thyroid removed about 3 months ago, and went on synthroid about a month and a half ago; while it takes about 3 months for it to totally kick in, you should start to feel a bit better much sooner than that. I had severe hypothyroidism when I started it, but I felt the effects within 3 days, no joke. I still have some way to go, but improvement is improvement! I hope it kicks in soon for you!

[Courtney S]

I have "washboard thumbnails" too (and a history of hypothyroid in women in my family)....sounds like I need to mention it to my doc and push harder for a more thorough thyroid test next time. Thanks!

[lislemck]

Good catch, Patient Rochelle. It's those little things that many people wouldn't want to bother a doctor about that can disrupt quality of life for years. I've been on levothyroxine for years, with no ill effects.

I have to add my thanks to Doctor Google--I've found plenty that way. But I also love MedlinePlus . I was really shocked when I mentioned it to a doctor recently and they were unaware of it.

[Mikhail R.]

My Mom was on "natural" thyroid hormone for many years and the strength varied quite a bit (ranging from sluggish to hyper). Synthroid was a God-send for her. She takes half a pill a day and she's OK. The only side effect is that she thinks Fox News is fair and balanced.

[Jenna]

Pretty much what Michelle said. I just wanted to say it, too and wish you well.

[Michelle McLean]

Glad to hear that the end is in sight for you. Its horrible to feel like that and not know why. I hope the medication kicks in for you in record time.