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Re: Question for Dr. M, Pain & FMS
From: Harvey S. Marchbein, M.D. (anonymous@obgyn.net)
Wed, 29 Dec 1999 20:54:48 -0600 (CST)
At Wed, 29 Dec 1999, Gina wrote:
>
>Hi Dr. M,
>Thanks, love your sense of humor, helps me laugh at myself when things
>get too bad, let's some of the pressure off. I deeply appreciate your
>sense of humor in answering questions.
>In any case, I see I will want to consult with a rheumatologist. LOL I
>can even self-refer for that if need be. I'm going to give it 2 weeks
>since I have an ERCP planned next week.
>My GI doc thinks I will need surgery again, he's thinking it is
>adhesions and they are interfering with my bowels and ligaments and
>tendons, etc. He wanted me to go back to the original surgeon but I'd
>rather not. There are well known great colon rectal surgeons here I'd
>rather see for this.
>My GI doc says I don't have IBS, and he doubts FMS as well.
>(Can you believe my PCP actually called the GI and tried to tell him not
>to do the ERCP next week? My PCP thinks too much is being done & I
>should give it a few months, where is this guy's brain?).
>
>Dr. M, how do I find a good doctor in this world of HMO?
>It seems the good doctors sold out to the HMO's now and are employees of
>them rather than advocates for the patients. I am so fed up with
>looking for doctors who will act on my behalf, and being disappointed
>every time. Any idea how I can get out of this cycle and still get the
>care I desperately need?
>Thanks,
>Gina
If you have a managed care plan with out-of-network options it's easy -
you find the one you want and pay your out of pocket fees and there you
are. If it's a true HMO (no out-of-network capabilities), you have to
go by recommendation. Ask your PCP, if he/she were going to see a
rheumatologist, which one would it be.
If you were here in NY, I'd give you my list.
HSM
>At Tue, 28 Dec 1999, Harvey S. Marchbein, M.D. wrote:
>>
>>At Tue, 28 Dec 1999, Gina wrote:
>>>
>>>Hello Dr. M,
>>>I finally got in to see my PCP about this severe pain that is moving
>>>around. He told me he thinks I have fibromyalgia (FMS) and IBS. He
>>>didn't do any tests to come to this conclusion, and I felt totally
>>>brushed off by him, he even told me I would have to be responsible for
>>>my own solutions to these flare ups/pain. He also said I will have
>>>chronic pain like this and have to learn to deal with it--all this with
>>>no work up to find out what the pain is from and whether it is a problem
>>>that can be treated.
>>
>>I would recommend a consult with a rheumatologist to evaluate you fully.
>>
>>>Also my toes have been turning purple and I showed them to him and he
>>>said it's a sign of GOOD circulation??? I don't believe this, since I
>>>know I have very poor circulation in my legs (have had a vein stripped
>>>that had filled with over 100 blood clots, in 1995). I also had a deep
>>>clot in that leg as well a few years ago. When my toes and feet turn
>>>purple, it is a sign that my blood is pooling up and isn't able to go
>>>back up. Wondering what your opinion is on this?
>>>
>>All I'm saying is - consult with a rheumatologist. :-)
>>
>>>Also want your opinion on my lack of reflexes in feet/ankles and
>>>patella's. My PCP said it's normal and not to worry about it. Is it
>>>normal to not have any reflexes from the knees down??? Couldn't this be
>>>related to the other problems I am having instead?
>>
>>NOt the most common set of symptoms - I'm gonna sound like a broken
>>record but "rheumatologist".
>>
>>>He also said it can't be a nerve compression because I can move my toes
>>>up. Is this true?
>>
>>There's a difference between sensory (feeling) and motor (movement). You
>>can have a pinched nerve in your back and be able to move but be in pain
>>or have reduced sensation.
>>
>>>I'm at a loss as to what to do now about my pain. I feel it is way too
>>>early for my PCP to just give up and call it something without even
>>>doing the diagnostics needed to rule out other problems first. He feels
>>>that by having done a colonoscopy, and EGD and a CT scan, he's done with
>>>diagnostics. He also told me he would not refer me for an MRI because
>>>he didn't think my insurance company would approve it--I don't see why
>>>not at this point, since the other tests were done and din't find
>>>anything, wouldn't an MRI be in order now???
>>
>>Maybe the rheumatologist will order some tests. ;-)
>>
>>>This is my 4rth PCP this year, I like him generally, I am just
>>>disappointed in yesterday's visit with him and the lack of action on his
>>>part. He doesn't even want to see me again for 3 months--talk about
>>>leaving me hanging :(
>>>Gina
>>
>>Let me know how it goes at the rheumatologist.
>>
>>--
>>Harvey S. Marchbein, M.D. FACOG, FACS
>>Great Neck, New York
>>
>>**Note: Opinions expressed here are for educational purposes only
>>and, as such, do not constitute a physician-patient relationship.
>>This information is not intended to supplant the need for you to
>>consult with your physician prior to choosing therapeutic options
>>and/or interventions.
>>
>>**Private emails cannot be entertained due to time constraints,
>>consequently no private emails will receive a response.
>>
>>**Thank you for your understanding ;-)
>>
--
Harvey S. Marchbein, M.D. FACOG, FACS
Great Neck, New York
**Note: Opinions expressed here are for educational purposes only
and, as such, do not constitute a physician-patient relationship.
This information is not intended to supplant the need for you to
consult with your physician prior to choosing therapeutic options
and/or interventions.
**Private emails cannot be entertained due to time constraints,
consequently no private emails will receive a response.
**Thank you for your understanding ;-)
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