Elizabeth Lee Vliet, M.D.
|Elizabeth Lee Vliet, M.D.|
You may wonder why my website shows me – as a physician – in a fighter jet! The day I took those flights and experienced the intensity of aerobatic simulated combat flying was one of the most exhilarating days of my life. The photo of that day is a reminder of my desire to live life to the fullest, and to face the fear of the unknown.
The fighter jet experience, and my desire to use this photo for my new website, is also an apt metaphor for my career in medicine “fighting” for what I believe is right for my patients…one person at a time. I have had to be creative and “fight” for what makes sense biologically. I have adapted the medical information and research to the needs of each individual patient, even though it has meant taking approaches different from the fragmented specialty “boxes” in medicine that focus on one body part or one organ system.
I understand what it is like to be a patient, as I describe below. So join me in “taking off” for optimal health and vitality! Let me help you on your personal health journey!
My Experiences as a Patient
From: Introduction to Screaming to Be Heard: Hormone Connections Women Suspect and Doctors Still Ignore, Revised Edition, 2001.
I have had my own adversities. I was a patient who was not listened to until I lost the function of my left leg, bladder and bowel and had reached a point requiring emergency back surgery for a fully ruptured disk compressing my spinal cord. I know firsthand the pain, suffering, fear, self-doubt (“Imustbecrazy. NO. I’mNOT!”), the helplessness of not being listened to or believed, the frustrations of wanting to be well and not being able to make progress. I was a physician; I was also the patient. And when the patient is female, the old stereotypes and patterns of relating to a patient seem to take priority over her professional status as physician.
As the patient, I knew something crucial had happened. I had followed directions and stayed in bed for a month; yet, I wasn’t getting better. In fact, my ability to stand up for more than three or four minutes was getting progressively worse. I had problems with bladder control that were really worrisome. My brain felt like it was in a fog; I couldn’t even think clearly enough to focus on my medical reading. I began to berate myself, lying there telling myself that I must be lazy or something; that I really should be using this time to catch up on reading my medical journals. I would start to read, and I couldn’t focus on the pages. Several years later, while at Johns Hopkins, I found out that I had not been imagining this “foggy brain” feeling. It was real, and a side effect of the Valium that had been prescribed four times a day for muscle relaxation. There was something terribly wrong with my body, but my doctors were telling me there was nothing wrong. I thought I was going crazy!
“Nothing wrong? Nothing? What do you mean? I collapse when I try to stand. I can't go to the bathroom. What is this? How could it be something in my mind? I just don’t understand.” I went back for a checkup. The neurologist thought I “might” have a worsening herniation of the disk and sent me to his partner, a neurosurgeon. This doctor did not even recheck neurological function. He just patted me on the shoulder saying, “Now, you’re just fine. You’re just too anxious. All you have is a back strain, and it will be fine if you just get out of bed and go on about your business. It’s time for you to get back to work.” I felt chastised for avoiding my work responsibilities. So, having been raised in the southern tradition of responding like a dutiful little girl to an older male authority figure, (even though at the time this happened, I was an adult woman, a physician through medical school and internship), I went back to work at the hospital.
I lasted half a day before my legs collapsed once again and I couldn’t stand. I was getting really frightened by this time, although I tried not to show it. “Remember, Lee, physicians don’t cry. If you cry, they’ll just think you’re anxious and neurotic,” I said to myself. My internal medicine doctor said he thought I should be admitted to the hospital for a week of traction to see if that would help. So I did that.
As the week went on, I could barely walk well enough to go to the bathroom; once I got there, I had trouble urinating, and I became unable to have a bowel movement. Thinking I was constipated from inactivity, my physician ordered regular daily doses of Metamucil as a stool softener. But the problem wasn’t constipation; it was nerve damage to the bowel from spinal cord compression. My abdomen was blowing up like a balloon from the Metamucil because I couldn’t have a bowel movement on my own. It was awful. I must have looked like a snake that had swallowed a pig.
When I first wrote this in 1994, I could see the humor in the mental image that flitted across my mind. In 1979, when I was going through it, I was terrified, and it was not at all funny. But I still did what I was told, like the proverbial “good girl”. I didn’t know what else to do, and no one seemed to be listening. My confusion and fear were compounded by the fact that I was reminded I was the patient, not the doctor, and to follow directions.
Finally, after lying there a week in the hospital and getting worse, I called my medical school and asked one of my former professors for a psychiatric consultation. He was concerned and sympathetic but astutely said, “Lee, I'll be happy to see you professionally, but I don't really think you have a psychiatric disorder. I think you should get a second opinion from a back surgeon.”
Two days later, Dr. Henry Wilde, from Houston, Texas, came to Williamsburg for a business meeting with my husband, who mentioned that I was in the hospital with unexplained back problems that weren’t getting better. When Henry, an orthopedic surgeon who specialized in back surgery, came to my hospital room, I felt a sense of relief. I just knew he would take me seriously. He listened to my description of what had happened, did a thorough neurological examination, and said, “Lee, you don’t have a muscle strain, you have a centrally herniated lumbar disk with compression of the end of the spinal cord. You have lost function in your leg, bladder, and bowel because of the nerve compression over such a long time. You need surgery, and you need it now in order for to have any chance of the neurological function coming back.”
Needless to say, I felt an overwhelming sense of relief at finally having confirmation that something was wrong, what it was, and what needed to be done. Dr. Wilde listened, did a thorough examination, and gave me a diagnosis that explained all that I had been experiencing. It made sense. What I was experiencing was real. I wasn’t imagining this.
I certainly wasn’t at all eager to go through major surgery, but I felt a tremendous weight lifted from my shoulders because I now knew what was wrong. I can deal with known problems a lot better than with all the uncertainty that only intensifies my fear. Understandably, I did not want to go back to the neurosurgeon who had failed to properly diagnose my problem. Two days later, I was in Houston having the surgery I had needed all along.
Thanks to Dr. Wilde’s visit and, I believe, God’s hand in all this, I had surgery in time. In addition to the technical skill of his surgery, Henry also gave me a vitamin and exercise regimen that helped the healing process, and helped me regain my strength. The nerve function returned, the pain gradually lessened as I diligently swam my mile a day and did my walking program. Several months, later I was able to go on with my specialty training.
Dr. Henry Wilde has now retired from his very successful career, but his legacy of listening and using integrated approaches lives on every single day of my life in my own health management. I also continue his legacy to hundreds of others because of what I know to do with individual patients, and in my writing and in my teaching.
Dr. Wilde used many modalities to help me get well: surgery, muscle relaxants, vitamins, early mobilization and pool exercise, massage therapy. His innovation and interventions were one of those life-transforming moments, and I am profoundly grateful to him for listening when I was in such pain.
I want to continue to share that gift with others. But for many of my patients over the years, the outcomes have not been as positive. They have told me of lost years of productive careers due to hormonally-triggered health problems that weren’t addressed. Some have had their families broken apart when their spouse didn’t realize that hormonal problems were the trigger of behaviors that just seemed “difficult and witchy”. Some women had even experienced irreversible damage – heart failure, spinal deformity from incapacitating bone loss, dementia – because they did not have proper attention to the hormone issues they had been describing. I hope the next millennium will bring changes in how we approach women’s health to help prevent such tragic consequences for so many women and their families.
Richard Bach said “Every problem has a gift for you in its hands.”1 For me the problems were certainly clear at the time. The gifts have emerged in many ways since 1979. One of the most meaningful gifts from my herniated disk problems has been the gift of hearing patients more clearly and trusting that if I listen carefully, they will tell me what I need to know to help them.
Another gift from my own surgical experience was that I learned very early in my medical career just how crucial exercise, vitamins, healthy food, and a positive mindset are to enhancing the healing process.
My Experiences as A Physician…Listening to Patients
What led me to branch out from internal medicine and psychiatry to begin working with the hormonal aspects of women’s health that are usually addressed by gynecologists? During my residency days, and early days of practice, physicians would refer women to me for “psychogenic” problems such as PMS, anxiety, stress-related illness, sexual concerns or depression. I would see the person, expecting to help with those issues. But patient after patient, a pattern emerged and I often found myself saying to the woman and her physician, “The problems you are describing have a clear pattern related to your menstrual cycle, and I don’t think you have a major depression [or whatever happened to be in question]. I do not find a psychiatric disorder; I think you are experiencing hormonal changes that are affecting your moods.” I thought the referring physician would be glad to have the information. The woman typically was relieved that she now had some answers that made sense to her.
What I discovered, however, was that most commonly their physician didn’t listen to me either. I struggled for many years to get other physicians to understand and accept that hormonal shifts can effect brain chemistry and trigger changes in mood, anxiety, pain, headaches...you name it.
Finally, I decided I had had enough of this battle. I knew the women were right, and I could relate what they told me directly to the normal physiology of a woman’s body rhythms and hormone shifts.
I undertook a more systematic study of endocrinology and reproductive hormones, searched the international medical literature and read hundreds of articles, attended many Continuing Medical Education programs on menopause and gynecology, joined the Menopause and Climacteric Medicine societies, subscribed to journals I couldn’t find in my own medical library and began to integrate whatever I could find with the knowledge I had already gained from Internal Medicine and Psychiatry. Much of the scientific work I could locate came from the international menopause journals and research done in Europe, Australia, and Canada over many years, in addition to the pioneering work in this country by Dr. Robert Greenblatt, Dr. Edward Klaiber and Dr. Phillip Sarrel, Professors Campbell, Whitehead, and Studd from England, and many others.
I learned more and more about the differences in the various types of hormones and saw how well these differences fit with what women were describing to me. I was finding the pieces of the puzzle that had been overlooked and these pieces were fitting beautifully with other pieces of the puzzle that were discovered at Johns Hopkins, where extraordinary neuroscience research was happening during my residency. It was exciting and rewarding for me at both the personal and the professional levels. The improvement women described as a result of fine-tuning of their hormonal balance further validated my belief that I was heading in the right direction. Obviously, not every woman needed hormones, but those who did clearly benefited from the changes we made together to address these issues.
I began speaking around the country, doing what I could to educate women and groups of physicians. Women still had so many questions and they kept asking me, “Is there a book on this anywhere? Is there something I can read about what you are saying? It makes so much sense.” I gave the usual references, but the bottom line was that there was no book that addressed the integration of all these hormonal issues with other traditional women’s health concerns. So, I had to write this book. I could not ignore the “screams” any longer.
My first book, Screaming To Be Heard: Hormone Connections Women Suspect and Doctors Ignore, is an outgrowth of more than twenty years of clinical work and outcomes research that measured ovarian and other hormones at specific times in women’s menstrual cycles using reliable and standardized methods. I also carefully tracked women’s menstrual symptom calendars, their own descriptions of how they ate and exercised, what medications they took and how they felt emotionally from day to day. I used objective rating scales for mood, pain, headache and anxiety problems so that we could together see the “before and after” changes. I included reliable tests of bone density as early as 1985, and measures of cholesterol and cortisol and thyroid and glucose so that I could see what other factors were affected by the changes in the ovary hormones.
As my patients and I worked to figure out their individual puzzle pieces for a whole picture, I also began to see ways that we as physicians could take a more integrated approach to the multiplicity of factors affecting women’s health: from the biological to the spiritual.
The medical practice model I have developed over the years has been useful, practical, results-oriented, as well as cost-effective, since we often eliminated many other medications women had been taking. Another important aspect is that the approaches I use could be taught to others in the programs I gave for physicians, nurses, psychologists, physical therapists, and as well as women themselves. Best of all, the women themselves described feeling better overall, often could stop other medications, and their improvements with the hormone interventions validated their own insights.
Screaming to be Heard has become a tapestry woven of women’s experiences. The voices of women’s wisdom as patients, family members, friends, colleagues have taught me much. The voice of my own experiences through several ordeals as a patient has been a great teacher, even if a painful one. The voices of women who have not been heard yet, as well as the voices of our ancestors whose writings gave us the legacy of their wisdom, pain, joys, struggles and achievements in the face of adversity...all have contributed to this complex and beautiful tapestry. I hope you will add your own voice to the tapestry as you read these pages.
1 Illusions: The Adventures of a Reluctant Messiah