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oh no here he comes, the difficult patient

Posted by alan k on 1/25/00 at 00:00 (015072)

I had my PCP appointment yesterday but somehow he mangaged to shuffle me right out of the office without discussing anything. I did get permission for a referral to a neurologist, but I have to find one now on my own because they aren't going to help there in the office.

They are as sick of me as I am of them.

I can't get anyone-- 3 doctors, 2 podiatrists, 1 pt, to get interested in figuring out what is causing this, or take a strong course of action to discover it. I have, I am sure, a bio-mechanical problem like a nerve impingement. Maybe surguery will help some. But that does not explain why I have it, which in my feeble layman's mind seems like a good thing to know. There is no reason why I should have tts and cts symetrically now, with no increase in activity. There is no reason why my wife should have pain in hands and feet (and she doesn't use a computer or type). There is no reason why we should get this both exactly at the same time.

AHHHGGG!!!!!! AM I CRAZY?

This seems so significant to me. I can't understand why no one takes any interest in this, and to the whole office I am being 'difficult' if I try to insist (and gently, too) that something be done about this. I have a hard time believing that even if they find something that helps it's going to address the underlying cause of this. Don't these people like puzzles? You would think they get bored on the job, seeing the same old things day in day out. You would think they would be curious. I don't understand, I really don't.


alan k



Re: oh no here he comes, the difficult patient

Marti C on 1/25/00 at 00:00 (015074)

I, dont understand either alan, one of the drs.I went to told me I was confrontational! He said because I asked sooo many questions and cried quite often, that I just like to argue and didnt want to get better! Hence, the reason I gave up (as far as the drs. are concerned) after one too many visits like that one. I wish I could help you more! Thanks for sharing.
Marti

Re: oh no here he comes, the difficult patient

wendyn on 1/25/00 at 00:00 (015075)

Alan that's terrible. What did your doctor say? Did he order any tests at all? Did you have the pod give you the cortisone shot?

I don't know how your health system works - can you just go see a neurosurgeon on your own?

About the B12 and problem in the toes...no, my problem started in my right foot and it started as pain and swelling. I have little doubt that I have TTS, but perhaps the B12 has a theraputic effect. (?) I will be sure to ask my doctor more about this next time I see him, and also about why this may have happened in the first place. From everything I'm reading it doesn't sound too easy to get low on B12 since it's found in animal products. Perhaps I have an underlying problem absorbing the vitamin, in which case I need to have that addressed whether it helps my feet or not.

Although the acupuncture person I am seeing is a medical PT - she is using the traditional (Chinese) acupuncture on me. I didn't have any needles in my stomach (I was laying on my stomach for part of it). Had them in my shoulders, behind my knees and then a whole series on my innner legs and a few on the outside of my knee (right along the pain path).


Re: oh no here he comes, the difficult patient

VLJ on 1/25/00 at 00:00 (015076)

Alan, have you thought of trying to see doctors at a med school situation? I don't know if it is even possible...but my nephew who is finishing up his training to become a podiatrist was very enthusiastic to talk with me about all the possibilities behind PF, tts, etc and drew me diagrams etc... and says that probably the reason for most doctor's eyes glazing over when a patient comes in with pf is because it is so difficult to pin point exact causes, specific damage done, which treatment is best for which patient,no one protocal works 'in general' etc etc etc...however, he was very eager to talk with me, explain the workings of the foot, all the associated injuries that fall under the heading of pf, etc... which makes me wonder if talking with a dr right out of school or going to a clinic at a med school would give you access to someone better able to listen and discuss...don't know...maybe they would be too eager to 'cut' also...but it is just a thought. My nephew heard my anger and frustration regarding the drs I had seen who were no help and responded appropriately...which I chalk up to his youth, the family relationship and yes,that his commitment to heal has not yet been bashed and battered by the 'real world' of managed health care, insurance companies, and feeling completely dumbfounded in the face of a patient's suffering....etc, etc etc.

Re: oh no here he comes, the difficult patient

alan k on 1/25/00 at 00:00 (015077)

I think that's a good theory. Someone else I was complaining to said she'ld ask her friend in school about me, because she finds him to be eager and inquisitive. You are probably right.

alan k


Re: oh no here he comes, the difficult patient

alan k on 1/25/00 at 00:00 (015078)

My doctor didn't order any tests, but he did let me see a neurologist. There is a teaching hospital an hour a way. I think I'll go there.

There are many things from congenital to bacterial infestation to cadidiasis that can cause B-12 malabsorption, which as you know then renders diet less relevant. Remember that your borderline B-12 could be low if that's how your body reacts to it.

I too believe I have tts, but why not that and something else as well? We could have multiple factors effecting us simultaneously, us and the chronic sufferers of pf. Even just two simultaneous conditions seems to be too complex an idea for the minds of my doctors to handle. I wish we could get to the bottom of this.

I only get needles on my lower leg, base of middle toe, and in tt area. One of my docs adds electrical current too. I'll ask for more needles.

Also, my chinese doc gives me chinese herbal concoctions which are supposed to enhance the acupuncture. I've seen them in my health store too. Off the shelf, one cannot make heads or tails of them, because no claims are made on them. The brand is Health Concerns and say something about chinese herbal remedy on them, they are black with red trim, and the formula she gave me is 'Acu-C tabs.' I suppose the acu is for acupuncture.

alan k


Re: oh no here he comes, the difficult patient

john h on 1/25/00 at 00:00 (015080)

alan: i developed pf in both feet at the same time. i was also told that (emg studies) that i had mild tts in both feet at the same time and i think i have some carpel tunnel in my left writst. i also had back surgery 20 years ago and have some degeneratie disc. i think degenerative disc, carpel tunnel, and tarsal tunnel sort of go hand in hand in many cases.

Re: oh no here he comes, the difficult patient

alan k on 1/25/00 at 00:00 (015081)

I did hurt my back in yoga a few months before all this started, but my wife didn't. I'll try and get the neurologist to look into the back thing.

Aside from the obvious nerve pinching causing extremities pain, I wonder why or what condition would associate tts cts and degenerative disc together. Do you have any idea?

alan k


Re: oh no here he comes, the difficult patient To Alan

Laurie R on 1/25/00 at 00:00 (015083)

Hi Alan,I am so so so sorry to hear what happen at your doctors....I have a app with my podiatrist today I will let you know what he says.Right now I just want to know if I have TTS.My right foot has been real bad for the last two weeks.Hang in there buddy.Laurie R

Re: oh no here he comes, the difficult patient

Elise M. on 1/25/00 at 00:00 (015084)

Hello,
It disgusts me to hear of such mismanagement in medicine, but this is what happened when medicine went from being a profession to being just another business. I hope that anyone who goes to a Dr. and is less than satisfied with their care would consider not paying the co-pay or in many cases, the entire bill and would follow it up with a letter of dissatisfaction. I remember sending a Dr. a bill for my time when I spent an unusually lengthy amount of time in his waiting room.I charged him with what I normally got paid an hour as a nurse. I did so professionally, without condemnation but with a full explanation. My next visit there I was handled PROMPTLY. Did I ever get any money, NO, but I did get professional courtesy and a more
understanding relationship with the Dr. Don't be afraid to speak up, ask questions, get a second, third or fourth opinion if needed. And when it's absolutely necessary, serve them up a piece of humble pie.
Feel better...............Elise

Re: oh no here he comes, the difficult patient

Nancy S. on 1/25/00 at 00:00 (015091)

No Alan, you're NOT crazy. You just have hopes and expectations that it seems the medical system in general, as it is now (and it is sick), is not prepared to meet. There seems to be an awful lot of laziness in the profession now, and, as you've noticed, a lack of curiosity and unwillingness to take on challenges. They seem to be assembly line types, and if you don't fit the mould they are uncomfortable. I think their treatment of you yesterday was despicable.
I would have higher hopes for more interest on the part of a neurologist -- so do have hope. A neurologist should not be as baffled and so apt to put you off. I also picture them as more willing to tackle challenges, since much of neurology is not so cut-and-dried as other doctors and podiatrists seem to prefer to see their work (I hope I'm not imagining this). In looking around for a neurologist, I wonder if you could approach them with a one-page synopsis of your condition and simply ask 'Do you think you can help me?' The medical school / teaching hospital idea sounds like a good one to me. I'm sorry you were treated so badly yesterday and shuffled out of the office. How disappointing for you. But you are not crazy! They are the difficult ones, due to what sounds like laziness, soullessness, and a lack of heart. Don't give up -- there have to be exceptions out there, and it's too bad we have to work so hard to find them, but if that's the reality, then so be it -- we will work hard to find them.
--Nancy

Re: oh no here he comes, the difficult patient

john h on 1/25/00 at 00:00 (015093)

in august i had a pf release, tarsal tunnel release, and chelictomy all on the same foot. the doctor, hospital, anethesia,folloup etc was billed out at about $8000.00. Meicare paid about $1700 and my copay was about $300.00. I can sort of sympathize with doctors on some points. medicare refused to pay for an item listed as 'decompress nerve'. the doctor barely got 25% of what he billed.

Re: oh no here he comes, the difficult patient

Janet on 1/25/00 at 00:00 (015097)

Hi Alan,

I'm so sorry about your disappointing visit to your doc. Its so maddening and hurtful when a doctor, of all people, won't empathise with your pain. I've been to more docs than I care to count and most have treated me similarly, which does little to boost the morale. I don't know where you live but if you have a few days and your insurance will cover it you might want to investigate the Mayo clinic. I hear they won't let you go until they have exhausted every allopathic test known. Even if the tests come out negative its good information to have. It's an option. Hang in there and know you have the support of us all.


Re: oh no here he comes, the difficult patient

psydac on 1/25/00 at 00:00 (015099)

Alan, you are a very lucky one.
After 9 months of PF, orthotics, developing pain in feet, muscles,lower back and hands, and without ANY (!) examination,
my doctor told me to look for a good psychiatric therapy.

Re: oh no here he comes, the difficult patient

dang dave on 1/25/00 at 00:00 (015103)

Hey, didn't they give you an X-ray? As much as I hate paying for it, the x-ray is standard examination procedure. If they did a least that then they did exam the feet.

From what I experienced the orthopeadic surgeon office is probably the better healing route to go... but but be wary of 'surgical' solutions if only in the first year of PF symptoms...


Re: oh no here he comes, the difficult patient

Marti C on 1/25/00 at 00:00 (015074)

I, dont understand either alan, one of the drs.I went to told me I was confrontational! He said because I asked sooo many questions and cried quite often, that I just like to argue and didnt want to get better! Hence, the reason I gave up (as far as the drs. are concerned) after one too many visits like that one. I wish I could help you more! Thanks for sharing.
Marti

Re: oh no here he comes, the difficult patient

wendyn on 1/25/00 at 00:00 (015075)

Alan that's terrible. What did your doctor say? Did he order any tests at all? Did you have the pod give you the cortisone shot?

I don't know how your health system works - can you just go see a neurosurgeon on your own?

About the B12 and problem in the toes...no, my problem started in my right foot and it started as pain and swelling. I have little doubt that I have TTS, but perhaps the B12 has a theraputic effect. (?) I will be sure to ask my doctor more about this next time I see him, and also about why this may have happened in the first place. From everything I'm reading it doesn't sound too easy to get low on B12 since it's found in animal products. Perhaps I have an underlying problem absorbing the vitamin, in which case I need to have that addressed whether it helps my feet or not.

Although the acupuncture person I am seeing is a medical PT - she is using the traditional (Chinese) acupuncture on me. I didn't have any needles in my stomach (I was laying on my stomach for part of it). Had them in my shoulders, behind my knees and then a whole series on my innner legs and a few on the outside of my knee (right along the pain path).


Re: oh no here he comes, the difficult patient

VLJ on 1/25/00 at 00:00 (015076)

Alan, have you thought of trying to see doctors at a med school situation? I don't know if it is even possible...but my nephew who is finishing up his training to become a podiatrist was very enthusiastic to talk with me about all the possibilities behind PF, tts, etc and drew me diagrams etc... and says that probably the reason for most doctor's eyes glazing over when a patient comes in with pf is because it is so difficult to pin point exact causes, specific damage done, which treatment is best for which patient,no one protocal works 'in general' etc etc etc...however, he was very eager to talk with me, explain the workings of the foot, all the associated injuries that fall under the heading of pf, etc... which makes me wonder if talking with a dr right out of school or going to a clinic at a med school would give you access to someone better able to listen and discuss...don't know...maybe they would be too eager to 'cut' also...but it is just a thought. My nephew heard my anger and frustration regarding the drs I had seen who were no help and responded appropriately...which I chalk up to his youth, the family relationship and yes,that his commitment to heal has not yet been bashed and battered by the 'real world' of managed health care, insurance companies, and feeling completely dumbfounded in the face of a patient's suffering....etc, etc etc.

Re: oh no here he comes, the difficult patient

alan k on 1/25/00 at 00:00 (015077)

I think that's a good theory. Someone else I was complaining to said she'ld ask her friend in school about me, because she finds him to be eager and inquisitive. You are probably right.

alan k


Re: oh no here he comes, the difficult patient

alan k on 1/25/00 at 00:00 (015078)

My doctor didn't order any tests, but he did let me see a neurologist. There is a teaching hospital an hour a way. I think I'll go there.

There are many things from congenital to bacterial infestation to cadidiasis that can cause B-12 malabsorption, which as you know then renders diet less relevant. Remember that your borderline B-12 could be low if that's how your body reacts to it.

I too believe I have tts, but why not that and something else as well? We could have multiple factors effecting us simultaneously, us and the chronic sufferers of pf. Even just two simultaneous conditions seems to be too complex an idea for the minds of my doctors to handle. I wish we could get to the bottom of this.

I only get needles on my lower leg, base of middle toe, and in tt area. One of my docs adds electrical current too. I'll ask for more needles.

Also, my chinese doc gives me chinese herbal concoctions which are supposed to enhance the acupuncture. I've seen them in my health store too. Off the shelf, one cannot make heads or tails of them, because no claims are made on them. The brand is Health Concerns and say something about chinese herbal remedy on them, they are black with red trim, and the formula she gave me is 'Acu-C tabs.' I suppose the acu is for acupuncture.

alan k


Re: oh no here he comes, the difficult patient

john h on 1/25/00 at 00:00 (015080)

alan: i developed pf in both feet at the same time. i was also told that (emg studies) that i had mild tts in both feet at the same time and i think i have some carpel tunnel in my left writst. i also had back surgery 20 years ago and have some degeneratie disc. i think degenerative disc, carpel tunnel, and tarsal tunnel sort of go hand in hand in many cases.

Re: oh no here he comes, the difficult patient

alan k on 1/25/00 at 00:00 (015081)

I did hurt my back in yoga a few months before all this started, but my wife didn't. I'll try and get the neurologist to look into the back thing.

Aside from the obvious nerve pinching causing extremities pain, I wonder why or what condition would associate tts cts and degenerative disc together. Do you have any idea?

alan k


Re: oh no here he comes, the difficult patient To Alan

Laurie R on 1/25/00 at 00:00 (015083)

Hi Alan,I am so so so sorry to hear what happen at your doctors....I have a app with my podiatrist today I will let you know what he says.Right now I just want to know if I have TTS.My right foot has been real bad for the last two weeks.Hang in there buddy.Laurie R

Re: oh no here he comes, the difficult patient

Elise M. on 1/25/00 at 00:00 (015084)

Hello,
It disgusts me to hear of such mismanagement in medicine, but this is what happened when medicine went from being a profession to being just another business. I hope that anyone who goes to a Dr. and is less than satisfied with their care would consider not paying the co-pay or in many cases, the entire bill and would follow it up with a letter of dissatisfaction. I remember sending a Dr. a bill for my time when I spent an unusually lengthy amount of time in his waiting room.I charged him with what I normally got paid an hour as a nurse. I did so professionally, without condemnation but with a full explanation. My next visit there I was handled PROMPTLY. Did I ever get any money, NO, but I did get professional courtesy and a more
understanding relationship with the Dr. Don't be afraid to speak up, ask questions, get a second, third or fourth opinion if needed. And when it's absolutely necessary, serve them up a piece of humble pie.
Feel better...............Elise

Re: oh no here he comes, the difficult patient

Nancy S. on 1/25/00 at 00:00 (015091)

No Alan, you're NOT crazy. You just have hopes and expectations that it seems the medical system in general, as it is now (and it is sick), is not prepared to meet. There seems to be an awful lot of laziness in the profession now, and, as you've noticed, a lack of curiosity and unwillingness to take on challenges. They seem to be assembly line types, and if you don't fit the mould they are uncomfortable. I think their treatment of you yesterday was despicable.
I would have higher hopes for more interest on the part of a neurologist -- so do have hope. A neurologist should not be as baffled and so apt to put you off. I also picture them as more willing to tackle challenges, since much of neurology is not so cut-and-dried as other doctors and podiatrists seem to prefer to see their work (I hope I'm not imagining this). In looking around for a neurologist, I wonder if you could approach them with a one-page synopsis of your condition and simply ask 'Do you think you can help me?' The medical school / teaching hospital idea sounds like a good one to me. I'm sorry you were treated so badly yesterday and shuffled out of the office. How disappointing for you. But you are not crazy! They are the difficult ones, due to what sounds like laziness, soullessness, and a lack of heart. Don't give up -- there have to be exceptions out there, and it's too bad we have to work so hard to find them, but if that's the reality, then so be it -- we will work hard to find them.
--Nancy

Re: oh no here he comes, the difficult patient

john h on 1/25/00 at 00:00 (015093)

in august i had a pf release, tarsal tunnel release, and chelictomy all on the same foot. the doctor, hospital, anethesia,folloup etc was billed out at about $8000.00. Meicare paid about $1700 and my copay was about $300.00. I can sort of sympathize with doctors on some points. medicare refused to pay for an item listed as 'decompress nerve'. the doctor barely got 25% of what he billed.

Re: oh no here he comes, the difficult patient

Janet on 1/25/00 at 00:00 (015097)

Hi Alan,

I'm so sorry about your disappointing visit to your doc. Its so maddening and hurtful when a doctor, of all people, won't empathise with your pain. I've been to more docs than I care to count and most have treated me similarly, which does little to boost the morale. I don't know where you live but if you have a few days and your insurance will cover it you might want to investigate the Mayo clinic. I hear they won't let you go until they have exhausted every allopathic test known. Even if the tests come out negative its good information to have. It's an option. Hang in there and know you have the support of us all.


Re: oh no here he comes, the difficult patient

psydac on 1/25/00 at 00:00 (015099)

Alan, you are a very lucky one.
After 9 months of PF, orthotics, developing pain in feet, muscles,lower back and hands, and without ANY (!) examination,
my doctor told me to look for a good psychiatric therapy.

Re: oh no here he comes, the difficult patient

dang dave on 1/25/00 at 00:00 (015103)

Hey, didn't they give you an X-ray? As much as I hate paying for it, the x-ray is standard examination procedure. If they did a least that then they did exam the feet.

From what I experienced the orthopeadic surgeon office is probably the better healing route to go... but but be wary of 'surgical' solutions if only in the first year of PF symptoms...