Dear Frannie,
Q. I am only 20 years and having to deal with the fact that I could be seriously ill or disfigured for the rest of my life. I could endure pain better than this. How can I have hope for the future when I feel like I will always be alone? How am I supposed to find someone to share my life with when what I see is repulsive? Please help.

A. I understand what you are feeling, and your thoughts about it. I can see you are working through much of it, even though you may be unaware of that fact. It appears to me you are beginning to work through an acceptance of what you feel you know to be true. This is good, though quite uncomfortable for you. What you have been dealing with all alone has been very brave.

Although I am at a different point in my life than you are, I have two children who are your age and in college as well. I understand the importance of someone your age to feel attractive to both the opposite sex and also in the crowd of your peers. I know this is somewhat of a difficult time for every person your age.

When I was in college though it was many years ago, I remember that my scoliosis was overtly visible, as I walked crooked. Even though people told me my face was pretty, I couldn't bear to be looked at in a bathingsuit. And I was extremely underweight. Friends told me I was anorexic telling me I looked like a skeleton. I never would let anyone see my body. I would not wear a bathingsuit, and I would not wear shorts or short sleeves because I was afraid they would see my weight and my scoliosis. I spent much of my young life that way, until maybe about 15 years ago when I got sick. Then all of a sudden, my life changed and I saw that there were things in life that were worse than being self conscious about the way I looked. In fact, not being able to function at all, having to do things from my bed, was the worst thing I had ever dealt with.

Now, I am not saying that my physical appearance challenges were at all the same as what you are dealing with. But I am saying that every person your age feels self conscious about the way they look. Every single one. This is a time in your life when it seems what's on the outside is more important than whets on the inside. This changes with time. This actually changes.

My years of being bedridden and so sick taught me that priorities change with illness and adversity. Sometimes we are shocked back into the reality of who we really are. And we are not who we appear to be on the outside, we are who we are inside. We realize this, as we age and change in the way we look. This may not make sense to you so young but perhaps in time you can reevaluate your life. You must grow up earlier than most and become inside who you always wanted to be.

What makes us attractive to others isn't the way we look, (although it appears that way to us). It is our essence. Its the energy that comes from within us, its the ease we have with ourselves, and the passion we have about life and the things we are doing. When I became better and they found the medicines to help me, I realized that I had to build a new me. That the old me who was superficial had to let go of the things that were important before. I was 15 years older and I had lost 15 years of my life. I had to be something that was more than a "sick person". And so I made a conscious effort to rebuild myself into someone I was proud to be: someone who had all the qualities that I always admired in others.

All I am saying to you now my dear is that you will have to let go of the outside. You want to find a good doctor, one that specializes in your disease or one who can help you find out what is wrong for sure. Then, if its what you think it is, you must concentrate on your essence and who you are inside. You want energy to emit from you so that people miss the imperfections and see only the brightness in your eyes, your big white smile, the light of your soul and feel your presence as something of comfort and life. Did you ever watch a movie where the main character in the beginning was very plain, and then by the end of the movie, you thought they were attractive? And if you didn't see the movie, and you saw a picture of them from the last frame of the movie, you would think they were very plain or blah? But because you saw the movie, they were beautiful to you by the end? This is the essence, the passion, the energy and the light that can emit from someone. And believe it or not, this is what we see first when we meet someone exciting. I know you don't believe it, but the attractiveness of the individual in terms of facial features etc., you don't see first. You see and feel their essence, their very special essence.

My advice to you now after you find out what it is that is causing your problem, and after you have medical support, is to find this essence. Find what is special about your laughter, and what is special about your smile, your laugh, your presence. And if you don't know what it is, then its time to build yourself from the inside out. You will see that your beauty will be deeper and more everlasting than that you used to have in terms of your skin. I can tell you this because I had to do it myself. I have seen others do it. It CAN happen....this I am SURE of.

I know this is hard. And I know you feel that you shouldn't have to do this, that none of your friends have to and its so unfair. You just want to be normal. I understand this feeling, I really do. But you know what? Nobody is "normal".

What I can tell you is that in our lives EVERYONE has a challenge they have to face. Some face their challenges when they are children, others while teens, others while young adults and others not until they are old and gray. But we all have a story that we must live regarding adversity in our lives sometime. This is going to be yours. And so, given the knowledge that you will have to accept these changes, what you do with them will be what defines you as a very special person.

No one talks about what Helen Keller looked like, or Eleanor Roosevelt, Mother Theresa, or Anne Frank. But they do talk about the things they did to change the world. I am sure that you will strive to make your mark on the world. Remember that once we all mature, its not what you look like on the outside, its your inner glow and essence that creates the energy for you to do the wonderful things I know you can do.

Dear Frannie,
Q. My doctor is part of a group practice. He has not been very kind to me, in fact I was looking to find someone kinder. I met another doctor in his practice that I think I would gel better with. The front desk wont let me switch. But I want to see this doctor. How can I go about seeing the doctor I want to see without hurting anyone's feelings? Would Dr Levine have any suggestions?

A. Along with the dilemmas involving insurance companies and doctors, and patients getting sandwiched in the middle, are the dilemmas that the business of medicine creates. Doctors have joint practices in order to cover their patient loads. If a doctor was on call every single night, he could not provide quality care. In fact, he probably would not be able to function at all.

Still, as patients finding the best doctor for us is crucial in our healing, isn't it? Sometimes this involves terminating care with one doctor to begin working with another we get on with better.

Keeping in mind, you may not get your way in this situation, I would try contacting the doctor that you want to see. Email is best, if he or she has an email address. If not, I would tell the nurse or front office person that you want to speak with this doctor regarding a personal matter, giving the hours when you will be home to answer your phone.

If this doctor does not call you back, try again. Sometimes messages get lost. Sometimes the office staff has a busy day. Give the doctor a few days to get back to you before trying again. But try again. And if you should speak with him, tell him your situation and ask him how this would be best handled.

Some might say to talk with your current doctor and tell him that you are sorry having found someone you gel with better. Well, sometimes this works providing ego doesn't get in the way. But doctors are people too, and their feelings get hurt. So this may not work. Perhaps telling your doctor that you want a fresh approach, someone who has not worked with you, and make the suggestion of who. However, you may have to deal with the fact that you may have to go elsewhere for medical care.

It is a shame that in the day and age of insurance companies, and the mechanics of medicine that one has to worry about egos but this is a reality as medicine is a human to human service. And therefore with human beings, many times emotions can affect the service they provide as with the science of medicine.

It is worth a try to get the doctor that you really wish to work with. But you are taking risk either way you deal with it. You have to decide if working with the other doctor is worth the risk of losing both. Quite a dilemma indeed. I too am quite eager to hear Dr Levine's answer.

Dr Levine's response: I suppose every group has their own internal policies. We allow people to switch doctors within the group whereas others do not. Also some doctors' practices become too large and they stop taking new patients, that might be another reason for not allowing the switch. All you can do is ask. Joel S. Levine, MD, FACPProfessor of Medicine and Interim HeadDivision of Gastroenterology-HepatologySenior Associate Dean for Clinical AffairsUniversity of Colorado School of Medicine

We thank you, Dr Levine for your monthly contribution.