A doctor rant!!! Update post #33

[Aidensmom]

I would contact this agency for assistance:

http://www.hmohelp.ca.gov/

Another thing you could try is to write a letter stating your concerns to your doctor, and CC the HMO and the above agency. I had a similar situation when I used to have an HMO, where I could not get a referral I needed (ironically also for a cardiologist), and I got nowhere till I did the above (except I am in FL, and so CC'd the insurance commissioner of my state). Once that letter was received by everyone, they were jumping through hoops for me.

 

[Hannathy]

Have you called the HMO administration there are procedures in place to appeal all decisions by PCP's. Demand to have your case reviewed. Is the HMO thru work have you informed them you are having problems with the plan - they don't want to pay for a plan their employees are getting short changed with.
Is this the DR.you saw first after your MI's after you were discharged from the military because they would have demanded your records of the MI's. if it isn't call that Dr. and as them to call this Dr.(you may have to pay this Dr. to do this) Are you sure the first attack was truly a MI because I can't see another branch of the military signing you up with this history.

If it is your life you may just have to pay out of pocket it is just one of those expenses that you hate but have to do.

If you truly are a risk for passing out I applaud your DR. for telling the DMV it could be my child you run over if you pass out. It is hard for you but she must think of the general public and the risk to us.

Good Luck

 

[Christine]

Not to try to be a doctor here, but with your symptoms I don't believe it is enough to stop at the EKG and echo. They echo is the "gold standard" for showing abnormalities of the heart muscle and blockages, but it is not good at showing "electrical" problems. If your echo came back good, then, more than likely you have some type of arrythmia (and apparently one of the more "dangerous" types). You need to see a cardiologist who specializes in the electrical system of the heart (electrophysicist, I think) to find out where the arrythmia is occurring. Usually these are controlled by medications and/or ablation of the offending node.

As for your other issues, yeah, it sounds like you could have a malabsorption problem. Has your doctor ever suggested celiac's disease? A malaborption/nutrient problem would definitely exacerbate any heart condition.

I'm sure it seems overwhelming but you really, really need to get aggressive with this and take control of these doctors. It's tough to do and most people your age don't have to face it yet. Us oldtimers (I'm 42 and have had cancer before) have had a lot of practice.

 

[icebrat001]

Do you have any documentation supporting that you did indeed have a heart attack, such as copies of EKG, labs that were done, etc. (you should be able to get these old medical records regardless of what the military tells you, even if you have to involve an attorney)? You said that a military cardiologist told you to see a civilian one...did you receive a medical type of discharge (it should be on your DD214)? If you don't agree with what this current doc is telling you, or the direction your care is going....go get a second opinion. And if you absolutely can not find another cardiologist to take you on as a new patient without a referral from a family practice MD, then find a family practice MD...show them your supporting documentation regarding your cardiac history and ask for a referral. Or you can go to a university level care facility like Pea-n-Me suggested and tell them you are having palpitations, that your heart seems to be racing for no apparent reason. They will hook you up to an EKG after verifying through your vital signs that your resting HR is in the 120's and hopefully a cardiology consult is done.

Yes, I recieved a Medical type of discharge. My EKG shows very faint damage, nothing serious enough to see a cardiologist. If my next echo has anything weird, 2 weeks after I have it, I will see my regular doctor and I've been told (Called) that I may or may not be referred to a cardiologist.

I will be at the doctor this afternoon as well, I'll see what they say!

 

[Mishetta]

I eat a lot, a whole lot, I just don't gain weight

Okay.....I have to admit, it took me a good long while to get over that statement you made. THAT'S SO UNFAIR!!!!! I really didn't like you for a few moments there!

Now that I'm back to being a reasonable person or as reasonable as I can be after reading a statement like that , I'd like to also add that you should see a cardiologist. That's very scary that you've had 2 heart attacks already. Can you switch your PCP?

My DH works for an HMO company & I just won't have an HMO insurance. We have our choice of the primary company's insurance (Blue Cross) & that's what we took. My DH works for an HMO company which the mother company is Blue Cross. HMO's are wonderful as long as you're in pretty good health & don't need to see a specialist!

Hope this all works out for you & hopefully one day I won't be mad at you anymore for saying that you eat lots & don't gain weight.

 

[Pea-n-Me]

I am a longtime cardiac nurse in a major cardiac center. The reason I said you should consider paying out of pocket to see the best cardiologist you can find is because we regularly see people who do this. They come from all over the country (and even the world) after going online and referring themselves when they've gotten tired of all the run around and realize they need to get help despite obstacles in front of them. We are often amazed at what we see.

As I see it, if you've in fact had two heart attacks, not only should you be seeing a cardiologist regularly, you also should have been enrolled in a cardiac rehab program. It is vitally important that the cause for these heart attacks is found and steps taken to prevent further attacks. You have a long life to live ahead of you. That's problem #1.

Problem #2 is that a resting heart rate of 120 is too high, particularly after a heart attack (i.e. damaged heart muscle X2 in your case) and here's why: when your heart beats that fast, the chambers in the heart cannot fill all the way. Your heart has to beat faster to get the lesser amount of blood out in order to meet the demand of your organs. It becomes a viscious cycle. This unnecessary strain over time can cause your heart to enlarge to accomodate this extra demand. If it goes on for too long, cardiomyopathy and/or heart failure can result, this is why it is vital to get help now. Chances are you would be started on something like a beta blocker to slow your heart rate and promote better filling, thereby lessening the strain on the heart, and perhaps helping all the other systems in your body when they are better perfused. (Studies have also shown that after an MI beta blockers, ace inhibitors and statins can preserve cardiac function and improve survival so I am surprised you are not on any of these).

An ECG will show lots of things: previous MI (heart attack), heart rate and rythm (whether it is an abnormal rythm or just a tachycardia), strain, conduction disturbances, and a host of other things. It is a very inexpensive test. Based on that and a physical exam a cardiologist will know how to proceed with you. It may cost $500 to see the doc and another $80 for an ECG (figures are just estimates and I could be wrong) but whatever it costs, it would be a small price to pay for getting your health and "preservation of cardiac function" in check, and they will help you "get into the system" from there (even in your own HMO), they may even have care coordinators to help you. Best of luck.

 

[phillybeth]

Resting heart rate of 120, can't gain weight and out-of-whack blood chemistry says to me THYROID. In big red letters. Even if your T3/T4 levels are normal, your body might not be utilizing it correctly.

Another thing to consider is Marfan Disease. It's an inherited disease. Anyone in your family die young of heart problems? Any family members tall and thin with long arms and legs? You might want to consider seeing a genetic counselor.

 

[icebrat001]

I am a longtime cardiac nurse in a major cardiac center. The reason I said you should consider paying out of pocket to see the best cardiologist you can find is because we regularly see people who do this. They come from all over the country (and even the world) after going online and referring themselves when they've gotten tired of all the run around and realize they need to get help despite obstacles in front of them. We are often amazed at what we see.

As I see it, if you've in fact had two heart attacks, not only should you be seeing a cardiologist regularly, you also should have been enrolled in a cardiac rehab program. It is vitally important that the cause for these heart attacks is found and steps taken to prevent further attacks. You have a long life to live ahead of you. That's problem #1.

Problem #2 is that a resting heart rate of 120 is too high, particularly after a heart attack (i.e. damaged heart muscle X2 in your case) and here's why: when your heart beats that fast, the chambers in the heart cannot fill all the way. Your heart has to beat faster to get the lesser amount of blood out in order to meet the demand of your organs. It becomes a viscious cycle. This unnecessary strain over time can cause your heart to enlarge to accomodate this extra demand. If it goes on for too long, cardiomyopathy and/or heart failure can result, this is why it is vital to get help now. Chances are you would be started on something like a beta blocker to slow your heart rate and promote better filling, thereby lessening the strain on the heart, and perhaps helping all the other systems in your body when they are better perfused. (Studies have also shown that after an MI beta blockers, ace inhibitors and statins can preserve cardiac function and improve survival so I am surprised you are not on any of these).

An ECG will show lots of things: previous MI (heart attack), heart rate and rythm (whether it is an abnormal rythm or just a tachycardia), strain, conduction disturbances, and a host of other things. It is a very inexpensive test. Based on that and a physical exam a cardiologist will know how to proceed with you. It may cost $500 to see the doc and another $80 for an ECG (figures are just estimates and I could be wrong) but whatever it costs, it would be a small price to pay for getting your health and "preservation of cardiac function" in check, and they will help you "get into the system" from there (even in your own HMO), they may even have care coordinators to help you. Best of luck.

Thank you for all the information. I will look into it. I do know that my heart does not have an adnormal rythm, just tachycardia.

phillybeth Resting heart rate of 120, can't gain weight and out-of-whack blood chemistry says to me THYROID. In big red letters. Even if your T3/T4 levels are normal, your body might not be utilizing it correctly.
Another thing to consider is Marfan Disease. It's an inherited disease. Anyone in your family die young of heart problems? Any family members tall and thin with long arms and legs? You might want to consider seeing a genetic counselor.

They ran quite a few thyroid panels and they seemed normal. I too have been thinking that maybe I have Marfan's syndrome, a lot of my family has long arms and legs and I have VERY flexible and thin. I don't know if I can talk my insurance into letting me see a genetic counselor though, I'll ask my primary care doctor. I don't think anyone in my family has died of heart problems, but I know my mother has a serious heart problem, don't know anything about it. My family does not communicate with me, and they haven't in over 5 years, so I can't get any family history. All the men die of cancer before age 62 though.

 

[LiteBrite]

Malaysia, do you have any updates for us? Just wanted you to know I've been thinking of you and wondering if you were ok.

 

[DawnCt1]

Resting heart rate of 120, can't gain weight and out-of-whack blood chemistry says to me THYROID. In big red letters. Even if your T3/T4 levels are normal, your body might not be utilizing it correctly.

Another thing to consider is Marfan Disease. It's an inherited disease. Anyone in your family die young of heart problems? Any family members tall and thin with long arms and legs? You might want to consider seeing a genetic counselor.

I agree, it doesn't have to by thyroid or Marfans but it could involve a whole range of endocrine problems that can also affect absorption. I would see an endocrinologist because there are indeed problems that can cause an elevated heart rate that have no cardiac pathology. Clearly there is something in the blood tests that indicate a dietary problem, whether its malabsorption or otherwise. The findings were significant enough for the first doctor to consider an eating disorder. Living in the Bay area really gives the OP an array of outstanding medical facilities to diagnose the problem.

 

[Parkhopper]

Another thing to consider...when is the open enrollment for your HMO? After getting the runaround with my (former) HMO in regard to referrals, I used the open enrollment time to choose a new Primary Care Physician. I chose a Gynocologist for my PCP because he would have to refer me for everything!

Suzi

 

[icebrat001]

Malaysia, do you have any updates for us? Just wanted you to know I've been thinking of you and wondering if you were ok.

Don't really have any updates as of yet. I've been trying to get them to schedule me an appointment for a physical since they reported me to the DMV saying i'm not fit for driving. But the DMV sent me this stuff to give to the doctor to fill out and they want to charge me a ton of money to have them fill out all the DMV paperwork when they are the ones that had them send it to me in the first place.

I am hoping I can an appointment in the next 7 days, because after the 19th my license will be suspended unless of course the doctor says otherwise.

Thanks for thinking about me.

 

[icebrat001]

I saw the doctor Thursday afternoon and he was concerned about my heart, so he said he was going to refer me to a cardiologist and I would wear a heart monitor for 1 day.

Two hours later, he left a message on my answering machine that I would have the echo, wear a heart monitor for a week and have some type of test where they will put some type of dye into me and check my heart, but he cancelled the cardiologist until after I get those test and the results.

We are getting somewhere.

I still don't know if i'll be able to keep my drivers license though.

 

[barkley]

since you live in contra costa county you might try calling social services (try the number for the main office on douglas drive in martinez). they used to have (not sure if they still do) an ombudsman who helped folks with medical insurance issues (coco used to offer kaiser as one of their mediCal choices to clients so the person was familiar with hmo workings) they probably can't get involved since you have private insurance but they might be able to give you some good information.

kaiser used to have a provision wherein if you sought out private (outside their network) medical consultation and the doctor (or specialist) diagnosed something that you had been trying (unsuccessfully) to get kaiser to address-they would end of paying off the med. bills (or reimbursing). i think some other hmo's have this provision too.

one (kind of sneaky/creative but can be effective) way to get the med attention you need is to check your hmo's guidelines on how far from home you have to be before you can go to an out of network hospital/provider. (with ours-healthnet-it's something like 30 miles, and if you are visiting or "shopping" out of town and fall ill you can utilize the closest hospital). if you get ill (not life threatening) you drive to a non participating hospital with a good cardio program and mention your cardio history when you utilize their e/r-they may decide to give you the cardio workup you need. if nothing else they may document that they feel you need certain workups and a cardio referal which you may be able to use as leverage to get your hmo to cover (the administrators only hear what you pcp (gatekeeper to services) tells them, and an outside opinion may sway them to allow you to self refer to a cardio specialist).

 

[Pea-n-Me]

he left a message on my answering machine that I would have the echo, wear a heart monitor for a week and have some type of test where they will put some type of dye into me and check my heart

The test with the dye is probably a cardiac catheterization. That is the one way they can know for sure what your coronary anatomy looks like, and whether coronary artery disease is what contributed to your heart attacks. As I said before,

It is vitally important that the cause for these heart attacks is found and steps taken to prevent further attacks.

you need to know this information, and this is the only way to get it, so this is good news for you.

The monitor is called a holter monitor and will hopefully give them some information about your heart rate and rythm, and how your heart performs with activity. It's a good starting point.

 

[emememem]

Could possibly be a Nuclear stress test too..radioisotope is injected at rest and stress and compared for defects, either fixed or reversible....

 

[FreshTressa]

I'm glad you finally have someone doing something!
Iwas scared fo ryou.

 

[Pea-n-Me]

Could possibly be a Nuclear stress test too..radioisotope is injected at rest and stress and compared for defects, either fixed or reversible....

Possibly, but it would not define coronary anatomy - she's had two previous MIs of unknown etiology.