Grrr. Aggrivated with Doctors.

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I'm_Jane_Doe
Regular Member


Date Joined Mar 2008
Total Posts : 26
   Posted 4/3/2008 5:08 PM (GMT -7)   
I'm aggrivated with the doctors.... Some of you may have read my previous post about my odd, "Borderline Hep B" results that the doctors don't even really understand. Thats been about a month ago and they were going to refer me to a Gastroenterologist. They first mentioned one in a city that I'm just not too familiar with and that Is quite far for me to travel to so I requested a closer doctor. Now about a month later after not hearing anything about my "refferal" appt. I now am told this particular place/doctor is the ONLY place that I can go do about these results and for further testing. I get aggrivated because I sometimes feel that doctors have deals with other doctors and thats why they are so persistant with who we go to. I do realize there is the whole insurance issue about going to someone in my network. Here's where I stand,

I've looked on the local hospital website that I prefer to go to and on thier directory list they only have one doctor under "gastroenterologist". I've also tried going to my insurance website to see a list of covered gastroenterologists and there were several in the city that I prefer to go to. Perhaps they are in they're own private office which is why they're not also on the Hospital website.... I don't know.
I do plan to call some of these doctors, and also my insurance company to get more details and find out if in fact this one doctor/hospital is my only option. I kind of feel like I'm being jerked around a bit. I can't really get to this city they say I have to go to to resolve this, yet I can't just not find out what my results mean and whats really going on. With "borderline" hep B results, I don't feel like its nothing major but I do feel like I need to pursue this enough to at least know.

From all of you that have been there/done that. Would a gastroenterologist be sufficient enough to go to in order to get the resolve of these results, or do you have to go to some Hepatology specialist or something? I told the nurse that insists I have to go to this certain doctor/hosp that I thought I could at least get new blood work done and see if the results are the same. I thought the "borderline" result might be in conclusive or something. She insists that it would do no good that the result would be the same.
Second of all she did tell me that this particular doctor she insists I have to go to would do a liver biopsy. It just seems to me that there would be the biopsy and possible other blood work that could be done first to better understand these results then if need be and I needed specific treatment or something then I could better understand going to this bigger hospital. It just would be a real hardship for me to go this far if I can do otherwise.

Did you guys have to go to a specific specialist or just a gastroenterologist? I'm just a little confused with these doctors. They seem very unorganized as its taken them a month to even get me a refferal and they don't even return my calls most of the time. I'm just very aggrivated and feel like I'm getting the "run around".

Pink Grandma
Veteran Member


Date Joined Nov 2006
Total Posts : 2445
   Posted 4/3/2008 5:34 PM (GMT -7)   
Hello Jane, I feel for you. It gets aggravating sometimes trying to deal with insurance and doctors. Do you have a primary care physician? Is that the one that is telling you that you have to go to a certain doctor in a different city? Most health insurance plans you either have a PCP directing your care or the type where you can go to any doctor you want. But you are hiring that doctor so he should refer you to who you want, that is in your insurance group. If he is your PCP and won't refer to someone closer I would call the insurance company and change your PCP. Something doesn't seem right. I would change doctors.

Good luck........take care.
Pink Grandma
Forum moderator-Hepatitis

When the going gets tough....the tough get going! Don't always know where I going but I get there anyways.


I'm_Jane_Doe
Regular Member


Date Joined Mar 2008
Total Posts : 26
   Posted 4/3/2008 7:53 PM (GMT -7)   
Well, I have a doctor I've been to several times over intestinal issues from my gall badder problems/surgery a year and a half ago. This last person, was actually a nurse practitioner. My "main" family physician is about an hour and 20 min drive away. (we do live in a rural area) and I'm fine with driving to see my family physician, its just this other Hospital/ City, is much much larger of a city and further away and to be quite honest, I've never drove on the interstate which is my main reason for not wanting to go to this Hospital they're trying to send me to. I just currently don't do the interstate... and I never like driving in places I'm not familiar with especially a "Big" city.
But I came down with the flu and had a bad stomach virus that lasted off and on for about three weeks. So, instead of going to my main Family physician I just went to a smaller local clinic, more or less just to get my work excuse and prescription to get over it.... well, the nurse practicioner thought I shouldn't keep getting a stomach virus like that and so she did blood work and found slightly elevated liver enzymes and then she did the Hep test which came back borderline and so now they're trying to send me to this Bigger Hospital. I think this particular doctor specializes or deals with "Hepatology". So, he probably would be a good doctor to see its just a matter of whats " do able" form me. I know once I go to the first consultation, then it will be a whole host of other appointments. Next it will be tests, then to come back for results or more tests, then follow ups etc.... and I would have to rely on people to take me and I don't like to have to rely and bother people.

Maybe they're true in that this is the only Hospital/doctor that deals specially with Hepatitis issues, I just thought that there would be other alternatives that I could do first just to decipher what might results were and if I did have Hep B and needed treatments or special attention then I could see having to go to this doctor in the Big city..
I asked the nurse if I could do another blood test just to see if the results were the same. I thought the "borderline" result could have possibly been in conclusive... I thought that and maybe a liver biopsy could be done more locally first and then if those showed questionable then sure go on to the big doctor...

I should probably schedule an appointment with my actual main family physician doctor and let her know what results this nurse practitioner found... and get her oppinions.

I'm gonna make several phone calls tomorrow, and see what I can find out. I feel like they insist on this facility/doctor because they probably would get a percentage fee for the referral. I've learned lately that when it comes to Doctors, and insurance companies you have to look out for yourself. I think I've found some doctors that are in fact covered by my insurance that are in fact in my preferred location.... I am calling their offices tomorrow and explaining my results and finding out if they can deal with them and if so, I'll also verify with them AND with my insurance company if they're covered by my insurance and if thats confirmed then I will call the doctors office again that referred me and ask them why again it is that I "have" to go to this facility/doctor when I found docs myself? I almost wonder if my insurance will only cover the doctors if I have a direct referral for them and I almost wonder if this facility will not refer me for thier own benefit? If so, I'll just go to another family physician until I find one that does.... But who knows maybe I'm over reacting. I do however think its crazy that its taken me a month just to get a referral appointment. When I 've been to my family physician in the past, I've had my referral appt's before I left thier office. It's never taken me a whole month just to get a referral appt.......

I'm_Jane_Doe
Regular Member


Date Joined Mar 2008
Total Posts : 26
   Posted 4/3/2008 8:27 PM (GMT -7)   
You mentioned the medicine factor, I actually think this has much if not everything to do with my results.
I don't know how I would have gotten Hep B, if I do have it. But nobody seems to know why you would test positive for the Antigen, yet to the side it says "Borderline". I thought I've read that you get Hep B from bodily fluids exchange, needles etc.... for these reasons I think its' highly unlikely that I could have gotten it. Yet, one of the ladies from a doctors office told me that thats Hep C< but not B.... but thats contradictory to most of what I've read...

But back to the Medicine...I had gall bladder surgery about a year and a half ago. I do have a lot of digestive issues I believe because of the gall bladder removal etc... the gall bladder is attached to the liver and I think it could possibly be related to the liver enzymes being elevated and also I do take a Medicine, Cholestyramine that I've heard can affect the liver. So, I actually think this is all going to be related to the Medicine actually. So I'm glad you bring that up. No body seems to know what Borderline Hep B means though. I have read someone gave thier opinion that it could be from getting the vacination some time in the past. Only thing is, I don't recall ever getting a vacine for it. Isn't it a three shot process? I've racked my brain trying to think what could have resulted in this borderline result, if I do have Hep B , how in the world could I have gotten it? I think it will end up being much of nothing, likely medicine and gallbladder related. But, from what I've read, Hepatitis can be a very serious thing so I feel like although its probably nothing I do have to pursue in resolving these results.

But thanks for your help.

hep93
Elite Member


Date Joined Jul 2005
Total Posts : 12014
   Posted 4/3/2008 9:53 PM (GMT -7)   

Just my opinion, but your medication and previous gall bladder problems could very well cause elevated liver enzymes.  Hep C is blood-borne...has nothing to do with "bodily fluids" unless that fluid is blood.  So I think you can rule out Hep C.  You probably don't have B, either, but I can understand that you would want to make sure.

You do not need to see a hepatologist at this point.  When my primary care doc tested me for Hep C and it came back positive, she referred me to a gastroenterologist (GI doc.)  He did the biopsy and we discussed treatment.  about this time, my insurance changed and I had to go with a different GI doc, but I did get the treatment approved.  I only went to a hepatologist when my hep C resulted in liver cancer, 2 years ago.  Of course, she continues to follow me.  A hepatologist deals in diseases of the liver, whereas a gastroenterologist specializes in the digestive system as a whole.  There's no reason you can't go to a GI doc at this point.  Just see if you can get your primary care doc to refer you to one that's close to you.  If you get nowhere with this, I suggest you call your insurance company and ask to speak to your case manager.  You have one, whether you know it or not.  This is their job--to straighten out referrals and disagreements regarding where you should go, the tests/treatment you should have, etc.

Good luck and let us know what happens!
Connie

I'm_Jane_Doe
Regular Member


Date Joined Mar 2008
Total Posts : 26
   Posted 4/4/2008 10:36 AM (GMT -7)   
These are my thoughts exactly "hep93". I've just gotten off the phone, talked to my insurance company to find out what GI doctors were covered. So, I know there are more local GI doctors that I can go to. Grant it, the doc I origionally wanted to go to wasnt exactly a GI, thought he was but I guess I'm wrong in that he was more of a general surgeon. He's the one that done my gallbladder surgery so I'm already familiar with him but I take it he only deals with things that are surgically related. But I did find GI docs in my local area so I see no point to drive to a much larger city and inconvience my self that much at this point. A liver biopsy if need be and further blood work I'm confident I can get done locally. And Then, if there is something of significance I can see the reason to go to a bigger hospital etc....

I've called this local doctors office that is referreing me to again ask them why I "have" to go to this particular Hospital when I've found local GI doctors.... If they still are persistant then I will just simply make my own appointment being that the insurance rep told me that I don't have to have a referral to make an appt with a GI. I'f I'd have known this, I'd have had my appt made weeks ago as its taken a month even to get an appt made through this doctors office. They're not even my main doctor just one I went to because they were close and available for walk ins.

1Shelly1
Veteran Member


Date Joined Oct 2007
Total Posts : 502
   Posted 4/4/2008 11:18 AM (GMT -7)   
I'm_Jane_Doe, I agree with Connie. At this point it is not necessary to see a hepatologist. A GI DR is certainly capable and qualified to do all the testing. I also know that medications can elevate liver enzymes and it is pretty easy to find out. Call your pharmacy or go in there and speak to the pharmacist that filled your Rx's. He/she can tell you within 5 minutes whether or not your meds affected the enzymes. I would still recommend that you see a GI Dr and let them know what meds you are on and what meds you were on at the time the labs were completed. Also make sure to get a copy of your original labs to give to the GI Dr. This will prevent any delays in a diagnosis etc. (He won't have to request them from your other Dr.)
 Shelly
 

“Life is not the way it's supposed to be. It's the way it is. The way you cope with it is what makes the difference."

 


soonersfan1
Regular Member


Date Joined Jan 2008
Total Posts : 29
   Posted 4/4/2008 12:46 PM (GMT -7)   
Hi, I too have to travel over 100 miles to go to my new DR. It is quiet aggravating but to make it worse it seems like no one is in a hurry to do anything very fast.I was diagnosed in Dec. 2007 didn't get in the DR. in OKC until March 4th at that time he told me I will get a biopsy, thats set up for July. Thats 7 months. I guess thats why they are the DR and not me.    I feel fine now, really not even any fatigue. I work full time and my job is alot of lifting and manual labor. I am just wondering if I even need the biopsy because when I was diagnosed I was having alot of fatigue, flu like symptoms, no appitite and lost 15 lbs in short amount of time...... All that seems to have went away ( Thanks the good Lord)
The DR did tell me that he didnt feel like I was in bad shape but only a biopsy could tell for sure.. He told me that he felt sure that I contracted this for a Gamma goublin shot I got when I was about 16 or 17, I am now 43
 I guess I will keep driving the 100 miles because I am told that It is one of the best hospitals
but I did get a bit depressed when I got mail from the hospital, It said Nazhi Zuhdi, Transplant Institute.. Thats scary but in away I guess If it ever comes to that I will be glad that it's only 100 miles away.     Thanks for listening...soonerfan

I'm_Jane_Doe
Regular Member


Date Joined Mar 2008
Total Posts : 26
   Posted 4/4/2008 6:44 PM (GMT -7)   
Hi again.

I think I worked it all out. I called my insurance and confirmed that there were GI doctors closer to home and they were covered. I called the office from the "Big" hospital and canceled my appointments and simply explained that for just further testing I'd rather stay closer to home in that I think the tests will easily clarify the reason for the results I had and then if needed I could see going to this hospital. I guess they made my appt with them because they dealt specially with Hepatitis stuff....But for further diagnosis I can probably do that with the GI. I kind of need to see one anyways for other issues. So I think it will work out well. Havent gotten my appt with the GI yet, they weren't in today but I should be able to next week. I'm sure it will still be a while befor I get to get more tests done but I'll let you guys know the results when I get them if you like.

Pink Grandma
Veteran Member


Date Joined Nov 2006
Total Posts : 2445
   Posted 4/4/2008 6:59 PM (GMT -7)   
Hello Jane that is good news. And yes keep us updated. Good luck with everything.

thoughts and prayers.......
Pink Grandma
Forum moderator-Hepatitis

When the going gets tough....the tough get going! Don't always know where I going but I get there anyways.


hep93
Elite Member


Date Joined Jul 2005
Total Posts : 12014
   Posted 4/5/2008 10:04 PM (GMT -7)   
Jane, I'm glad you seem to have worked out that problem! Do let us know of your appt. and test results.

Soonerfan, I go to Mayo Transplant Clinic, although I didn't have a transplant and am not a candidate for one presently. However, it is where their liver specialists are, including surgeons and hepatologist. By the time I got to Mayo, it had been about 9 mos. since my original liver cancer diagnosis and not much had been done. Mayo questioned this, and I told them that Shands was very slow to make appts. for scans and even slower in making f/u physician appts. This is totally opposite from the way that Mayo works. They try to get all tests and scans done in one day, and physician f/u the next day. This is too tiring for me, and I have to have them break everything up over several days. I'm thankful that they are "on the ball," though. :)

Connie

I'm_Jane_Doe
Regular Member


Date Joined Mar 2008
Total Posts : 26
   Posted 4/14/2008 3:54 PM (GMT -7)   
Hi.

Just a little doctor update. I ended up making an appt with my main family physician. It was a seperate clinic that found the elevated liver enzymes and "Borderline Hep B result" so I went and saw my main doctor to let her know of the results and to see if she could re test the blood work etc... I had about 4 or 5 tubes of blood drawn. I think she tested my liver functions and then did a Hep panel and a Hep DNA or something.... She referred me to another doctor to have an EGD and a colonoscopy done. The doctor scheduled me for a EGD, the upper scope but said he didnt think I needed a colonoscopy. I have alot of digestive issues. My doctor wanted me to have these tests done a year ago but I didnt go to the appt because I really didnt want to have these kinds of tests at the time, but now I've "talked myself into it' and the doctor doesnt "see the need". I had gallbladder surgery about a year and a half ago and all my issues I think he relates back to that....

I still am aggrivated. It seems you take time off work, pay the offices visits and between your co pay and what the insurance pays they get 100 plus dollars for thier office visits only to take a bout 5-10 minutes with you talking and even then they seem to act like you're taking their precious time...

I don't know.... I'm still kind of aggrivated.

As far as this next round of blood work, I expect to hear something in a day or two....

Pink Grandma
Veteran Member


Date Joined Nov 2006
Total Posts : 2445
   Posted 4/14/2008 6:16 PM (GMT -7)   
Hello Jane,
Just remember Jane... you are the boss. You are paying his wages. If your main doctor referred you for the colonoscopy and that's what you want then that what he should do. I would call your main doctor and tell her what he said and that you still want it done.
And if you don't hear back in a day or two I would definitely call your doctor for the blood test results. Sometimes that ball gets dropped by doctors. Mine would not even call. Made all his patients call him for the results. He not my doc any longer. I fired him.

Have a good day.......thoughts and prayers....
Pink Grandma
Forum moderator-Hepatitis

When the going gets tough....the tough get going! Don't always know where I going but I get there anyways.


I'm_Jane_Doe
Regular Member


Date Joined Mar 2008
Total Posts : 26
   Posted 4/22/2008 6:58 PM (GMT -7)   
Well, I had an EGD (upper scope test) yesturday. It's sort of unrelated to the liver enzymes and the borderline Hep B results I guess... (I'm still waiting to hear back on the blood work for that).

I didn't really get to talk to the doc. Never laid eyes on him.... But based on the phone call he maid to my mom in the waiting room..... she said he mentioned that I had a hernia and ulcer....

Anybody have any issues with either of those? I know they're pretty common. I've just been feeling kind of wierd lately and I just wonder if the hernia might be causing other issues..... It doesnt affect my swallowing at all.... I have alot of nausea, no throwing up though. I get severely bloated and have pains in my sides and stomach.....

I do s till get sick at my stomach with D but I don't know............

I just wish I knew what was the problem.. I'm supposed to go back and talk to him about the results on Monday.

But don't you hate it when you have a surgery or procedure even if its "same day" and they don't bother to talk to you? Be fore, or after? It really bugs me......

frustrated_n_wv
Regular Member


Date Joined Aug 2006
Total Posts : 469
   Posted 4/23/2008 3:30 AM (GMT -7)   
Jane

I agree that doctors not talking to you can be totally frustrating, although coming out of the anethesia I am not sure I would be able to understand much of what they are saying anyway, and my doctor normally sets up appointments following procedure to go over all the results. During my last EGD they found that I had ulcers although I have never had any problems with them. My doctor explained that the concern with ulcers is possible bleeding so they would need to be checked on regularly. He prescribed me some additional medication, Previicid, which I hope is helping.

If your doctor has recommended a colonscopy you may want to cosider having it done, Particularly since the symptoms you are describing, nausea, bloating, D could be related. I just wanted to mention this as I have crohns disease also and my GI believes that flares up with that affects my liver negatively. My best suggestion to you is to go into your aopointment on Monday arnmed with all the quetions that you have. Don't be intimidated. Explain to him how confused/worried you are and that you need some answers. Hopeuflly he will spend the time yo uneed and some of your worries will be less.

Good Luck on Monday

Lucy
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