Jun 23 2010

How I Ended Up Without A Primary Care Physician And The Worst Hospital I’ve Ever Been In

I haven’t yet posted why my original 3-4 week Arizona vacation turned into a 6 week plus adventure.

There’s some backstory here that needs ‘splaining. First of all, let’s get the planned itinerary out of the way. I left on Mar 28th and arrived on Mar 29th. On Mar 25th, I got notice from my insurance (Tricare Prime) that I needed to find a new primary care doctor by April 1. The letter was dated several weeks earlier. 

This pissed me off because on March 22, I’d seen my primary care doc and got a bunch of blood tests done pertaining to a chronic problem. Had I known I was about to be “dumped” from treatment at the MTF (which I’d been coerced into 4 years before) I would not have bothered.

Anyway… with little more than five days notice, I have to find another primary care physician. First, I contact the physician my husband has used for years. That’s a no go. Then I find the largest group practicing near my home and affiliated with the hospital nearest my home. I contact them and am told that each physician decides whether to accept new patients and their insurance. After a few denials from specific physicians in that group, I’m finally informed that none of the 13 will take me on.

By this time, I’m in Arizona. So, I search again and this time find a physician who will take me. I fill out the paperwork and am informed by Tricare that if the paperwork is received before the 2oth of April, the assignment to the new PCP will be valid on May 1.

That’s wonderful and I make an appointment with the new doc for May 6. I plan to be home on April 28th… exactly a month after I left. Except for the perhaps wasteful blood tests, everything is good.

Except… on April 25th, I am running a fever and have stomach pain. Monday, April 26th, the pain is worse, the fever a bit higher. Since I don’t think I have a primary care physician to call for a referral to an urgent care clinic, I call Tricare directly. I am informed that since April 17th when I submitted my request (that I was told would be effective May 1) I do have a PCP and that I must get any referrals from her.

Unfortunately, she hasn’t seen me before and ethically can’t make any referrals. (This is another topic…) and therefore I can’t get a referral from anyone. I am advised that since this is the case I should go to the ER since that doesn’t require a referral. However, it’s been pounded into me that using the ER for routine care is a bad, bad, wasteful thing and that Tricare might not cover it. Since I don’t think my problem is an emergency, I’m not that thrilled with that advice. But I’m also worried that I won’t feel like driving 1200 miles unless I get feeling better.

So I go to the nearest ER which is less than a mile from my daughter’s house. Why I should have chosen an ER much further away may be the subject of another post. Let’s just say that the close hospital didn’t have a great reputation. But… I was only going to probably get a prescription for an antibiotic and a suggestion I follow up with my PCP when I get home, right?

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Feb 05 2010

Emergency Room Fun

Tag: bariatric surgery,healthDonna B. @ 2:40 am

There’s not much that’s more exciting than spending six or more hours in an ER when you’re pretty sure you don’t need to be there. This is especially true when the ER staff discerns that you don’t need to be there either, but they can’t let you go until they get permission/instructions from a doctor.

Thanks to the internet and my knowledge of my past medical history*, I was 94% sure the radiating chest pain I’d been experiencing was not due to any cardiac problem.

Six percent lingering doubt is enough for a primary care physician to send one to the ER to rule out an emergent condition.

Blood tests, EKG, and chest x-ray ruled out the heart as the cause of my pain as I was almost sure it would do. I knew the pain was more than ordinary acid reflux and, after much reading, decided esophageal spasm was the best fit to my symptoms.

Yet… the chest pain I was experiencing didn’t involve difficulty swallowing, correlate to eating, position, or exercise, or involve regurgitation or a “sour taste” in my mouth. Then again, I didn’t have any nausea, vomiting, or shortness of breath that might be associated with a cardiac problem. 

Thus the doubt and the need to rule out a problem requiring some action more proactive than taking a pill.

All I had was a recurring, intermittent, and sometimes severe chest pain that radiated to both arms and almost into my jaw.  Yep, that’s “all”. It is scary to hurt that bad in that part of your body and I don’t blame my PCP for sending me to the ER. As she stated on the phone, “We can’t do an EKG and our lab can’t do cardiac enzymes.”

What annoyed me the most about my ER visit is that a cardiac problem was ruled out within an hour of my arrival. The tests had been run and all returned normal. The next five hours was waiting for someone with the title and authority to tell the ER to dismiss me.

When that guy finally showed up (and I realize I was not high on his priority list because he also knew I wasn’t in danger of having a heart attack) he assured me that my heart was almost positively A-OK. 

I’d had a cardiac cath in mid 2006 which showed zero blockage and he told me that a blockage developing in 3 1/2 years severe enough to cause symptoms was highly unlikely.

(I am overweight and have high blood pressure, so was required to take a stress test to join a fitness center… and I failed. The docs said that it was probably boob size that caused the failing reading, but the only way to make sure was cardiac cath.)

He was more than happy to write me a 3 month prescription for Nexium — which is what I intended to ask my PCP for when I was lucky enough to get an appointment with her.  So…

Is all well that ends well? This time, for me, certainly.  

*my past medical history includes banded gastroplasty, which always creates gastro problems while not even close to always resulting in weight loss… but that’s an entire blog’s worth of rants that I don’t really feel like going into right now, especially on this blog.

Aug 05 2009

What To Think, What To Do

Tag: bariatric surgery,brains,healthDonna B. @ 3:10 am

My symptoms.

I’m not even sure the site linked above is a reliable one. The design sucks, but that’s not an infallible indicator of bad information. Nor is bad spelling and grammar, but it makes one wonder.

However… dammit, except for PTSD, every one of those things is happening or has happened to me. I had VBG – vertical banded gastroplasty about 16 years ago. Oh yeah, I lost weight at first, but now I weigh about 5 lbs less than when I had the surgery.

Until recently, I didn’t even consider that any of my health problems were related to that surgery. I was diagnosed with fibromyalgia before the surgery, but tended not to say anything about that to anyone because it was not really accepted as a “real” problem at the time.

Several years after the surgery, I found I had a small meningioma which finally grew much larger. It was treated with radiation when it got larger. Many of the symptoms listed in that link, I attributed to the tumor.

I’ve seen neurologists, neurosurgeons, gastroenterologists, psychiatrists, rheumatologists, and… of course, my primary care docs. I recently had a hernia repaired which was due to the incision made by the VBG surgery. Ever since then, the diarrhea is much worse.

Honestly, I don’t know what to do. None of these symptoms alone are serious enough to worry about or cause much trouble, but taken together, they do cause problems. And they’ve become much worse over the past 3-4 years. But how am I — or a doctor — to know what causes what?

I also had a bad fall about 3 years ago. Both knees were injured, but my right knee has never been “right” since then. It was x-rayed and nothing is broken, but it is still very tender and painful at times. My left knee is “unreliable”. Sometimes it just doesn’t work, but it was that way before I fell. It’s just worse now.

Though I’ve joked about losing 25 IQ points, it’s really not funny. I am blessed that even with that loss, I’ve still got at least an “average” IQ and supposedly can express myself well.

Well, not as well I once did and not as well as I want to. I hate the inability to concentrate. Once upon a time, I read two books a week, now it’s a book a month, at best. This is a serious blow to my sense of well-being.

One of the main reasons I have this blog is to try to keep my mind as sharp as I can. It’s also why I read certain blogs daily. But frankly, sometimes I’m a little bit frightened that I can’t communicate the way I want to, whether in a post here or a comment elsewhere.