Tag Archives: Primary Care

My Visit With My New Doctor & Compliments to Lake City, FL VA Hematology Clinic

I had an appointment at the Veterans Clinic in Lake City, Florida today. I was a bit apprehensive about this appointment because I have a new Primary Care doctor. Those who know me know that this is my 5th Primary Care Doctor in the past two years. I have never had so many doctors, in such a short time. What happened was the doctor assigned me when my old doctor got promoted quit because she did not like all the computer BS the VA makes the doctors do, and they had a hard time replacing her. Of all these doctors, I only saw one, back last year, for a whole 5 minutes. Needless to say, I felt like I was being put on the back burner, all the while my health kept declining from an already diminished state. I was in and out of a local private hospital because the pain of the pancreatitis, which they now say is chronic, was too much for me, and the medications I had would not touch the pain. The last time I was hospitalised, June of last year, on top of all the medications I take routinely, they were having to give me 1.5 mg of Diladud every 2 hours. I was very miserable until it cleared up. I could have taken care of things at home had I had something for the intense pain, other than what I already take for the myriad of problems I have. Moreover, I were in the middle of a dose adjustment when the doctor who was supposed to be my new doctor quit. I did okay, for a while, then I needed another adjustment, yet had no doctor who knew me to call on.

The Primary Care Doctor is very important in the VA system. They are the proverbial Quarterback of the team. When you have a severe health problem you do not want second string replacements, you want a real Doctor who is going to stay, get to know you, and you them, so as to develop that special relationship a severely ill patient needs with their doctor.

I am glad to report my new Primary Care Doctor seems to be a good one. It is going to take time for her to get to know me, and understand fully my problems, but we had a great start today. She did not pull any punches with me, and gave it to me straight. I respect that. Moreover, she discovered some medications I had been taking for a long time that are not exactly good for a man’s prostate, and discontinued them, lest I develop prostate problems. I appreciate that. I go back in 3 months. I will see how it goes, but thus far, all is good.

My blood has been tired for over six years now. I had a significant GI bleed back in 07 that created many problems for me. I want to take this time to tell whoever reads this how nice, compassionate, professional, and efficient the Hematology Clinic at Lake City has been to me. I truly appreciate them. Of note, is a nurse named Amy, and an NP named Ruth. They have bent over backwards to accommodate me, and I am truly grateful. Stacy deserves an honorable mention as she is another one who has helped me. Kudos to these front line troopers. The VA needs more like them, especially Amy, and Ruth.

As I have mentioned, my health has been giving me fits. I now have chronic pancreatitis, and it hurts like hell. Most of the time, about 70 percent of the time, my regular meds work, but the rest of the time I am in sheer agony. I had to go to the ER last month for a pain shot. I also am dealing with the crohns (from Accutane given me for my service connected disability), the effects of 11 abdominal surgeries, 5 surgeries to repair a broken bone in my face (Army injury), sacroilietis, fused disks in my neck, myofacial syndrome, osteoporosis, joint pain (severe in my hips), and neuropathy. I am dealing with more than this, but to list it all would take more space than I wish to use. Suffice it to say, I need your prayers, if you pray. Anyone wishing to send cash, that will help too, although it will not take the pain away. I have been in constant pain now for 25 years, 15 of those being severe up to now. I hope that together my new doctor, and the pain team can come up with a workable, practical, and EFFECTIVE treatment. I am grateful for what I have now, but I know they can do better.

Thanks for stopping by!

mark

ENJOY YOUR FREEDOM? THANK A VETERAN!

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Filed under Crohns Disease, Life as a Disabled Veteran, Personal

Cymbalta – What Your Doctor May Not Know – Withdrawals

The anti-depressant Cymbalta is being prescribed in ever increasing numbers, by a wide spectrum of physicians who are ignorant of this powerful drugs side effects. Cymbalta is a serotonin-norepinephrine reuptake inhibitor (SNRI) approved by the Food & Drug Administration (FDA), and marketed for the treatment of major depression, anxiety, and some forms of chronic pain, due to nerve damage, fybromyalgia, etc. In the United States a patient can go to a primary care physician complaining of depression, and walk out with a prescription for an anti-depressant. Patients suffering from certain types of chronic pain can also be prescribed an anti-depressant, including Cymbalta, by a primary care, or a pain management doctor.  Anti-depressants can also be prescribed as the result of a consult, from a primary care physician, to a psychiatrist, based on the psychiatrists findings. As the FDA approves more of these type drugs, for the treatment of major depression, anxiety, and chronic pain, new guidelines may need to be formulated, for prescribing, monitoring, and patient education.

Cymbalta has helped many people suffering from major depression,  anxiety, and others suffering from certain types of chronic pain caused by nerve damage, as well as people suffering from the pain of fybromyalgia. It is very important the diagnoses of depression is one that is certain. If Cymbalta is given to someone suffering from level 2 bi-polar disorder Cymbalta can make their symptoms much worse, hence the need for a proper diagnoses. Does a primary care doctor have the time, training, and resources to differentiate between depression, major depression, and the intricacies of bi-polar disorder, including level 2 bi-polar disorder? As the drugs marketed to treat depression become more, and more powerful, as Cymbalta is, it may be dangerous for a primary care doctor to prescribe it to anyone, including people suffering the types of chronic pain Cymbalta has been approved to treat. A primary care doctor is working outside his scope of medicine when it comes to matters of the mind, and should refer depressed patients to a psychiatrist. Any patient failing to respond to normal protocols for pain management, suffering from fybromyalgia, or nerve pain unresponsive to other treatments should not be given Cymbalta without a consult with a pain management specialist. It is important for physicians to stay within their scope of medicine. Cymbalta is not a panacea, and despite the advertisements hailing it as a non narcotic alternative, it can be a very dangerous drug.

Anyone seeing an advertisement for Cymbalta will be led to believe that it is a great drug for treating depression, as well as a wonderful, non-narcotic treatment for chronic pain. Anyone talking to a person who has had to stop taking Cymbalta will hear the dirty little secret the manufacturer does not want you to know. The withdrawals from Cymbalta are as bad as, or worse than withdrawals from narcotics. To name a few, the withdrawal symptoms from Cymbalta are brain “zaps” (feeling of electrical shocks in the brain), crying, anger, shaking, diarrhea, feelings of doom, and increasing anxiety. Here is part of one story I pulled randomly from the internet:

 “Hi-   I too am taking Cymbalta- 60 mg. a day for about 2 years( and would love to get off of it-) as I suffer from Fibromyalgia  and severe depression. I HAD terrible daily pain before Cybalta, and found that the Cymbalta has helped me incredibly with the pain- but not NEAR enough for my depression and anxiety. I find that if I even miss my dose by 4 hours- I start getting the “Brain ZAPS” . It’s very scary to me, I don’t want to be on this drug- I am actually having suicidal thoughts (alot of teenager stress going on here), and I didn’t ever get THAT bad with my depression before Cymbalta.”

The really bad part about all of this is the physicians prescribing this powerful drug are often unaware the problems patients have coming off of it. Any drug that causes brain “zaps” does not sound like it would be good for anything. This is why it is very important for doctors to stay within their scope of medicine, and for patients to insist on a referral. Physicians have gotten used to prescribing ant–depressants when a patient comes in with the blues. With the newer class of anti-depressants, such as Cymbalta, doctors need to be extra careful, and get a consult before they run the risk of causing someone brain “zaps”.

I have someone close to me who went two days without Cymbalta, due to an insurance mix up. I honestly thought we were going to have to commit her. That is why I am writing about this powerful drug. Do not let your doctor start you on it unless you really need it, and if that is the case make sure a psychiatrist is the one doing the prescribing.

Take Care!

mark

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VA Adding 1,900 New Mental Health Workers – Is This Enough?

The Department of Veterans Affairs has recently announced they will be adding 1,900 new Mental Health personnel. Of the 1,900, 1,600 will be doctors, nurses, and PAs. The additional 300 slots will be for administrative support. Which VISN gets what has not been announced, but the announcement indicated these workers will be disbursed throughout the entire Veterans healthcare system. I salute Congress, and President Barack Obama for seeing the urgent need for these workers, and allocating resources to meet the need.

It appears the VA is trying to get ahead of the wave of new Veterans returning from Iraq, and Afghanistan. Many of these men, and women have been sent on multiple tours, and have seen things they will never talk about. Studies show the decade after a war ends is the costliest part of waging war. The physical, and mental wounds these men, and women have will take time, and money to begin the healing process.

It appears the lessons the VA learned from Vietnam were not forgotten; however, this increase may be insufficient, or the needs may be greater elsewhere, during any given time, in the decade beyond these wars. Currently the Department of Veterans Affairs is struggling to meet the Primary Healthcare needs of millions of Veterans. In my humble opinion, the VA should have concurrently allocated additional funding to recruit, and retain quality Primary Care Doctors. I know there is a shortage. I see it in my own VA, and read stories of other veterans struggling to access Primary Care.

Let us not forget how crucial the role of a Primary Care giver is to overall good healthcare. Ideally the Primary Care doctor is the main player in a person’s healthcare. If a person has a problem outside the scope of the Primary Care doctor, a referral, and consultation should follow; however, if the Primary Care doctors are overwhelmed with their current workload, we cannot expect them to be effective.

I am hoping to hear the VA will allocate funding for more Primary Care doctors. Not just a body, but good quality doctors. Incentives should be maximized. One incentive to lure quality physicians is to pay off their student loans, and I am sure those who know more than me can come up with even better ways to recruit, and retain top Quality Physicians. It is my hope that the 1,900 additional VA workers will be recruited based on quality, not quantity.

Thanks for stopping by!

mark 

 

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Heroes At The Veterans Hospitals – How They Helped Me When I Had No Primary Care Doctor

I have made no secret I have health problems related to my service in the United States Army, and health problems related to the treatments I have  received for my service connected disabilities. I have a myriad of physical ailments, most of which are painful. Most of the time the pain is tolerable, or what I have learned to call tolerable, but the past two weeks have been very difficult for me. I have been in terrible pain. I am hesitant to go to the hospital due to all of the hospitalizations I have had over the course of my adult life; hospital stays that went into months, with recoveries taking years, at a time. I hate the hospitals, so please understand why I try so hard to stay out of them.

When my pain kicked into high gear a couple of weeks ago, I had no Primary Care doctor at the VA Clinic to call, and explain what was happening. My new Primary Care Doctor, who had just taken my case 7 months ago, and had just started to understand the impact of all of my health problems on my body, up and quit, with no notice. Had I called the VA Clinic, I would have been passed of to Lord knows who; furthermore, they would have been totally ignorant of what is being done for me, and would have made a cursory judgement, based on one visit, and possibly jeopardized my health. I have been down this road before, with another doctor trying to do what my regular Primary Care Doctor does, and had everything get off track, leaving me in a worse state than when I went in.

I held on because I knew I had a speciality clinic appointment coming up, and I would at least have access to professionals familiar with my case. I also held on hoping I would get better. I made it to my appointment, it was last Friday. The nurse knew right away I was not feeling well, and when I got a bit ticked over something an NP said to me, something that normally I would have corrected her over, and moved on, they all knew I was not feeling well. I asked the nurse where I was receiving my treatment to contact my other specialist, over their intranet, tell him I was having a flare up, and need a certain medicine to calm things down. She tried to get in touch with him, but he is very busy, and sometimes cannot get back to anyone until the next day. An end run was made for me, and the NP, who I had just got ticked off with, told me if the other specialist had not called back, in time, she would write the prescription for me because it was obvious I was having a flare up.

The prescription was written, and while I was waiting for it, my other specialist called. This was fast for him, because we had messaged him only a few hours prior. I briefly explained I was having a flare up, and needed the meds to calm it down. I told him the strength required (I know about the treatments this), he replied “no problem”, went down the list of things to watch for, and said he would add a note to my chart reflecting our conversation.

Everything worked out fine, but I should not have had to circumvent Primary Care, because they cannot keep a decent doctor on staff. The entire Primary Care system is built around the Primary Care Doctor. The Primary Care Doctor is the Quaterback of the team. They get the ball, and pass, or hand it off to the appropriate speciality. Sometimes, if they are familiar with your case they will make the call on the spot to prescribe the usual course of treatment, and send a note to the specialists reflecting their decision. Seeing how I had no Primary Care Doctor who knew me, I had to be the Quaterback of my healthcare team. For me, this usually turns out okay because I am so familiar with my case, and have been dealing with all of the problems I am diagnosed with for decades; however, I am not the average Veteran.

Most of the guys would have suffered silently, or went to the ER. Suffering silently, while heroic, is dangerous, and going to the ER for something Primary Care should be able to handle is a waste of resources, and the Veteran winds up being admitted needlessly, or labeled a malingering drug seeker. Do not let me get started on that. Suffice it to say that Veterans Administration‘s Emergency Room Doctors, and Nurses need to get it  into their brains that every Veteran walking through the door, stating they are in pain, are not there with the sole intent of getting pain medications. We are there because our bodies are telling us something is wrong, and we are unable to handle it at home, nor are we able to wait for the Clinic to open.

Well, I have been on the meds for the flare since Friday, and am having very small results. I truly believe if I am no better tomorrow, I will wind up going to the Emergency Room, and running the gauntlet. However, I may dial-up my specialists, if I think I can wait another day for a call. All I know is this is very painful, I have been through it before, and the hospital course for it is so difficult, and hazardous, it  should enable me to be eligible for combat pay.

Much of this could have already been handled had I been able to see my Primary Care Doctor. One who knows me, and has worked with me, and on me. Taking the luck of the draw, on a walk in Clinic appointment is dangerous at ALL Veterans Administration Clinics. You could wind up having your entire treatment plan screwed up, sent for needless tests, and/or even worse things, life threatening things, could happen that I will not write in this blog entry.

My thanks to Amy, Ruth, and Tom, at the Veterans Administration Hospitals for helping me in this time of health crisis. I am very thankful to have such highly competent people looking out for me. Now, if I can just get another good Primary Care Doctor, who will learn my case, and work with me, as a partner in my healthcare, things will be great!

Take Care,

old soldier

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Filed under Health, Life as a Disabled Veteran, Personal, Veterans Issues