To Your Good Health
Why the long wait for a doctor appointment?
BY KEITH ROACH, M.D.
DEAR DR. ROACH: I was seeing my primary care physician every six months for about five years. We had mutual respect, and I enjoyed seeing him. Then, I got diagnosed with breast cancer and had to see other doctors for a long time. Meanwhile, the spinal stenosis my primary care physician had diagnosed was becoming untenable and ruining my quality of life. Even though I am still seeing cancer doctors, I called my primary care physician to make an appointment to discuss the spinal stenosis situation with him. After a long wait, I finally got someone in my primary care physician’s office and, after another long wait, was informed that he could not see me for six months — there was not one opening until then. I was flabbergasted and asked to be put on a cancellation list. “We don’t keep those,” the lady responded. I reluctantly took the appointment and decided to wait it out.
Meanwhile, I saw one of my cancer doctors today, and after explaining this situation to him, he replied: “Doctors don’t do that. He obviously doesn’t want you as a patient anymore. I would find another primary care physician.” What is your response to this? I am 71 years old, and other than spinal stenosis and breast cancer (which was caught early and treated with surgery and radiation a year ago), I enjoy reasonably good health. — J.E.Y.
ANSWER: I hope there is another side to this story, since I am horrified that a physician would make a longstanding patient with cancer and spinal stenosis wait six months for an appointment. That is not appropriate medical care.
While I fully understand the point of view of your cancer doctor — and would be tempted to find another doctor — it sounds like saving the relationship you had with your PCP might be worth another try. I think speaking directly with your primary care doctor might clear up any misunderstanding.
DEAR DR. ROACH: I always have had small breasts. Suddenly, in my mid-70s, my breasts grew, and now at 80 I have outgrown most of my clothes. My doctor said that it is fat, but I have gained only a few pounds. Could this be hormonal? Have you addressed this issue before? — S.F.
ANSWER: I haven’t addressed this before. Breasts change size during a woman’s life for many reasons. Breast tissue is a mixture of fat and glandular tissue. For young women, there’s proportionally more glandular tissue, the amount of which tends to decrease over time. After menopause, the breasts become less glandular; what is lost is replaced by fat, as there is less estrogen.
About 20 percent of women will notice significantly larger breasts after menopause; however, this usually occurs along with overall weight gain. Significant breast enlargement without much weight gain is not common in my experience.
Hopefully, your doctor did a thorough examination. However, I think it is very unlikely that your breast size changes represent a tumor. Very rarely, there are estrogen-producing tumors, so if there were other reasons to be concerned, your doctor might check blood levels of hormones, including estrogen.