Have you been on the MEDICAL MERRY-GO-ROUND?

[Mr. ED]

The following is a factual 6 month chronological account of how doctors and the pharmaceutical companies in the U.S. supplement their income with repeated office visits, numerous tests and medication revisions.

April 28, 2009: I went to my Primary Care doctor for a persistent cough, shortness of breath and swollen ankles. She wrote me a referral to see a Pulmonologist and also suggested I visit a Cardiologist.

April 30: I saw the Pulmonologist who determined the cough was due to an Angioedema in the back of my throat which was the result of taking Benazipril 40mg for six years to control my high blood pressure. This medication did an excellent job of controlling my blood pressure all those years with just this one ‘small’ side effect.

May 1: I started taking Amlodipine (Norvasc) 5mg to replace the Benazipril. A week later I called the Pulmonologist’s office to tell him my blood pressure was increasing.

May 13: I went back to his office and he raised the Amlodipine to 10mg. He also gave me a prescription for Hydrochlorothiazide 12.5 mg (diuretic) that I started taking on May 14 for my worsening ankle swelling, which now included my feet and legs up to the knee for which I was wearing compression stockings.

May 21: I had a CT scan of my chest area ordered by the Pulmonologist.

June 5: I was back at the Pulmonologists office because I could hardly fit into my shoes from the increasing swelling. He discontinued the Hydrochlorothiazide and prescribed Furosemide 40 mg (diuretic) for the swelling which I couldn’t start taking until June 17 because I used Walgreens Mail Service to save a few dollars. The results of the CT scan were normal.

June 24: I visited the Cardiologist’s office. He right away ordered several tests and wrote prescriptions for Diltiazem 240 mg to replace the Amlodipine 10mg and Spironolactone 25mg to replace the Furosemide 40 mg. Then he told me to stop taking the Amlodipine immediately because it is KNOWN TO CAUSE SWELLING OF THE FEET AND ANKLES!

June 25: I had an Echo Cardiogram.

July 1 I had a Nuclear Stress Test which lasted 3.5 hours.

July 6: I stopped taking the Furosemide myself because it did nothing at all for my swollen ankles and feet.

July 10: I stopped taking the Amlodipine. I waited the extra nine days because I was afraid my blood pressure would go even higher. (157/103 pulse 113)

July 11: I started taking the Diltiazem 240 mg and Spironolactone 25mg.

July 13: I was back at the Cardiologist’s office to get the test results. After all the tests and examinations mentioned above, I was told “You’re within the parameters for your age group”! Which tells me…? BUT, he did give me 2 weeks worth of Avapro 150mg office samples because my blood pressure was still not coming down, and made my next appointment for October 5. So what do I do after the two weeks? The following is an excerpt from a drug interaction program:

MONITOR CLOSELY: The concomitant use of potassium-sparing diuretics and angiotensin II receptor blockers (ARBs) may increase the risk of severe hyperkalemia. The mechanism is additive potassium-sparing effects. Both agents individually have been associated with hyperkalemia.

Avapro Taken with Spironolactone can cause a potentially dangerous Potassium build up in the body.

July 20: I called his office and told his medical assistant that my blood pressure was still not going down. She said she would fax an order for Avapro 300mg to Walgreens Mail Service.

July 24: I received a letter from Walgreens stating that they have been trying to get in touch with the Cardiologist’s office for missing information on the prescription and could not ship the medication until they could reach him. The mail doesn’t get here until after 4:30 pm, the office was closed so I had to wait until Monday. When I called the office and finally reached the medical assistant she said she didn’t know anything about a call from Walgreens. I asked her to look in my folder and when she came back to the phone she agreed that Walgreens had called. When I asked her why no one returned the call to Walgreens I was told “the folder was in the Medical Records department.” Before I could ask her ‘isn’t that where the folder is supposed to be’ she said she would call them right away and hung up!

August 4: I finally received the Avapro 300mg. Walgreens Mail Order sends a ‘Personal Prescription Information’ sheet with each prescription order. This particular information sheet which came with the Avapro 300 mg clearly stated “ADDITIONAL MONITORING OF YOUR DOSE OR CONDITION may be needed if you are taking diuretics (eg, Spironolactone, triamterene)”. My next appointment with the Cardiologist who prescribed both Avapro and Spironolactone was October 5. So much for monitoring closely.

August 12: I went to the Nephrologists’ office (kidney doctor) to whom I was referred to by the Cardiologist in May. He wrote an order for an ultrasound of my kidneys and bladder and took a urine sample. The reason for the Cardiologist’s referral to a Nephrologist was presumably because of my swollen feet and ankles.

August 21: I met my new Primary Care Physician who immediately ordered a Barium Swallow test and a Thyroid ultrasound because I still had the persistent cough, shortness of breath and swollen ankles for which I originally went to my former Primary Care Physician back in April which started this whole merry-go-round!

August 26: Received an early morning phone call from my Primary Care Physician that she had just talked with the Nephrologist and told me that I was losing 40% of my kidney function BUT they had both decided NOT to alter my medications at this time.

August 27: After doing a computer search on ‘causes of kidney problems’ I called the Cardiologist’s office and told his medical assistant that I was going to stop taking the Spironolactone immediately because my feet and ankles were still swollen and this medication could cause kidney problems which I had just found out about. She said she would consult with the Cardiologist and call me back. When she called back not only did she say it was alright to stop the Spironolactone but that the doctor also suggested to stop taking the Avapro! More money down the toilet!

August 30: Since the Cardiologist’s office failed to tell me what I was supposed to replace the Avapro with, and I watched my blood pressure go up from 128/81 to 156/97 in three days I decided to go back to Benazepril 40 mg again which was diagnosed as the cause of the Angioedema which started the whole thing back in April.

August 31: After fasting since midnight, the Barium Swallow test and a Thyroid ultrasound which were ordered by my new Primary Care Physician were performed.

September 16: I went to my Primary Care’s office to have lab work done for the Cardiologist (since I discontinued the two prescriptions he had prescribed) and for the Nephrologists’ office visit in two weeks. While in her office she prescribed Benicar 40 mg to replace the Benazepril 40 mg for my high blood pressure.

September 18: Stopped Benazepril 40 mg.

September 19: Started Benicar 40 mg.

September 23: The kidney ultrasound was performed. My feet and ankles were completely swollen.

September 25: Stopped Benicar 40 mg. after finding out two of the main side effects of this drug are impairing kidney function and fluid retention in the legs and feet.

September 26: Went back to Benazepril 40 mg again.

September 30: The Nephrologist gave me the results of the kidney ultrasound. He said “ It seems your kidneys seem to be slightly better but that’s not really possible”!!!!!!!!! He did mention that my feet and ankles were swollen but didn’t know why. He also suggested I return to taking Avapro because it would help my kidneys “In the long run”.

October 1: I stopped taking Benazepril 40 mg and Diltiazem 240 mg because the Nephrologist said Diltiazem was “An old drug and didn’t do much anyway. More money down the toilet.

October 2: Started taking Avapro again.

October 5: The visit to the Cardiologist’s office went just as planned. I told him what medication I was taking and that I was not about to change anything anymore. He never mentioned the results of the blood test he requested nor did he ask me why I stopped taking the two prescriptions he gave me. When he asked “Well, how do you want to leave it”, I replied “I’ll call you”!

October 10: Started taking Diltiazem 240 mg again because the Avapro alone was doing nothing to bring down my blood pressure.

October 15: I kept my appointment with my Primary Care Physician. She wanted to change my blood pressure prescription again, to which I said “No thanks.” When I mentioned that I have the same three problems as I did when I walked into this office six months ago on April 28, she asked if I wanted to see an Ear, Nose and Throat specialist. I couldn’t get out of there fast enough.

If you have read this whole article and can identify with a similar situation, please tell somebody. October's issue of TIME magazine had a very long but informative article on Health Care in the U.S. They specifically mentioned that Primary Care Physicians are at the bottom of the medical pay scale and SUPPLIMENT THEIR INCOME BY SCHEDUALING A MULTITUDE OF TESTS AND RETURN OFFICE VISITS!

The people living in the southern and mid western portions of the U.S. might be familiar with a farewell greeting that should be on the inside of every medical office entrance…..”Ya’ll come back now, hear”!

[WildChild]

My goodness, have you considered seeing a naturopath and getting your blood pressure and other issues dealt with naturally? Family members and I have done very well with naturopathic care, my father has gotten his cholesterol where it belongs. They deal with the entire body as an integrated whole.

[ItsASecret]

I can honestly say I am not surprised. The American health care system is one big mess, I know 100% I would never ever move to the states even if I was offered an exceptional job with very nice pay. Why? Because I have a life long medical condition that requires me to be on medications for the rest of my life. I do not want to ever risk the chance of not having medical insurance, so I can without a doubt say that I love Canada for that exact reason lol. I am not sure if the Canadian doctors here can do the hop skip and jump method to more money but it sure is not as visible if they do.

However, I would still listen to what the doctors have to say. No matter how PO'd a person is about the treatment they may be getting or their current state of health the fact is a doctor still has the doctoral degree...and the patient has the 'all-knowing' wikipedia and google at their fingertips. There is no comparison. So honestly if a doctor says they have no idea why something is happening then it is probably safe to say that they are being honest. It stinks but that is why the doctors still make the effort to find something that may fit (as noted by constant new referrals to new specialists).

[OhThereYouAre]

One thing we can do as informed consumers is do our OWN research before visiting a Doctor.

We have to understand....while educated in the field of medicine, Doctors are people just like US. They haven't seen EVERYTHING, or heard every condition out there. Medicine isn't an exact science.

Therefore...read up on your signs and symptoms before you hit the doctor's office. The internet has exposed us to a wealth of knowledge that is very helpful in this regard. Just hearing symptoms from other folks, and giving your thoughts to the Dr. can help in daignosing and resolving your condition.

[Little]

To add to OTYA:
And if your doctor doesn't like that you've looked on the internet (some really don't,) tell him/her to STUFF IT and make do with their self-educated patient that wants to have a say in his own health care!

[WildChild]

It's your body and you live in it. You know better than anyone how you feel and are responding to things. Ultimately it makes sense to educate yourself and resolve the causes rather than treat the symptoms. That usually means lifestyle changes such as diet, exersize, and stress reduction. All those drugs treat symptoms and create more.

[rcoreyus]

I'm sorry to hear about your experience. It is all to common - the medical industry is a 2 TRILLION dollar a year business in the US, and regulation has been completely defeated by regulatory capture. Even the new healthcare bill won't help much - it just makes sure that insurance will pay even more money (to cover the presently uninsured).

I don't have any suggestions.

[ItsASecret]

And if your doctor doesn't like that you've looked on the internet (some really don't,) tell him/her to STUFF IT and make do with their self-educated patient that wants to have a say in his own health care!

Self-education and the fact that each of us know when our body is not feeling right is a good step and can certainly help in the long run. However I think the problem that some doctors have when it comes to people looking for information on google and wikipedia and such is that the public tends to assume the worst based on simple things they read like the word fever or headache. There is nothing wrong with being prepared or concerned over your health or the health of your family but honestly just because a kid coughs more than 10 times a day does not mean he has an automatic respiratory disease, or just because you have a fever it means you have meningitis. People tend to go for the gold in hopes that they got it right and protected themselves, or their family from the worst. I think the best approach is to read things but not to make sweeping generalizations and to keep an open mind when the doctor says something like "In my professional opinion I do not believe that is the case here".

[OhThereYouAre]

Even the new healthcare bill won't help much - it just makes sure that insurance will pay even more money (to cover the presently uninsured).

Insurance? You mean WE will pay more money, in the form of higher taxes, and also in the form of higher premiums to our own Insurance providers.

All because some people say they can't "afford" to buy health insurance. But they're perfectly fine carrying an Iphone with a $150/m plan, and a coach purse on their arm.

What a travesty.

[WildChild]

Well I can't afford insurance. I don't have an iphone, buy most of my clothing in thrifts or make my own, drive a 27 yr old car and just hope for the best. I've been paying taxes for more years than you've been on the planet and I don't expect anyone to hand me anything. I could go off on this but will keep my mouth shut.