Episode 56: Latest Health Care From Doctors of All Stripes: "Just Go to the Emergency Room"

Thanks, ClipArt101.com, for this
very pink physician! Not that
color has anything to do with
how good or bad a doc is--
just appreciate the free graphic.

Remember when the stereotypical advice from a doctor was "Take two aspirin and call me in the morning"?

Well, guess what it is now?

"Just go to the emergency room."

This is yet another example of today's health care system's passing the buck at the expense of each and every patient, AND the system itself.

I've worked in health care for many years, and I know for a fact that the emergency department is the most expensive place for a person to seek care.

So why are doctors increasing health care costs by sending patients there instead of seeing them in their offices?

In today's case, I have to admit it is my dear, eminent Dr. A who has resorted to this non-answer. He is my neurologist, and I admire him greatly, but when I called today and told the office about my nearly non-stop headache for the past week and my new sleep behavior problems, I was called back and told, you guessed it, to go to the emergency room.

Why aren't doctors taking care of their patients anymore?

About a year ago, I was having a myriad of problems, and my regular doctor, or PCP (Primary Care Provider) in medspeak, told me I just needed to be admitted and a bunch of tests run to figure out what was going on.

Stupid me, I told her I didn't want to go to our local hospital, since it nearly killed me a few years ago, and said I wanted to go to one in the next town over where a number of my specialists are.

The next day I changed my mind, called her office, and received a call back that said, you guessed it, "Go to the emergency room."

When I did that, I told the attending physician that my PCP had said I should be admitted.

He gave me a scornful look and said, "What are we?  A McDonalds?"

And the visit went downhill from there.

Sports fans, I've been to the emergency department, and it is an utter waste of time unless you have a gunshot wound or have broken an ankle. For the problems I have, I'm given the same battery of tests, and none of them pinpoint the problem. I learned this after I was told numerous times when I couldn't breathe properly--NOT when I actually could not catch my breath to the point that I was about to die of suffocation, but chronically, and seriously--to go to the ED.

And each time I went I was given the same tests that showed nothing at all. And yet, calling specialists about the problem, I was still given that same old non-answer. And despite all the signs and symptoms of being deoxygenated on a regular basis, no one has cared enough to really get to the bottom of it.

Send patients to the emergency room to doctors they've never met, racking up costs that are higher than if we are seen in a doctor's office, without the benefit of our own doctor's history with us and knowledge of our case.

Does that make sense? Yet, that's what doctors are doing today.

My headaches are bad, and I told the person on the phone that, but I said they weren't quite as bad as migraines, which I've had before.  It's true they are affecting my ability to eat anything--everything looks nauseating to me--and I know migraines cause nausea. But I also know what a migraine is--you can't stand being alive; light hurts; sound hurts; and vomiting adds to the misery without giving any relief.

No, my headaches right now aren't that bad. But they're pretty darned close. I just lie in front of the TV, with the sound low, and pretty much stare into space. I feel nauseated if I think of food, and all I can think about is the pain in my frickin' head. I mean, they're miserable.

Is that enough for me to go to the ED?

I don't think so. I really don't.

But maybe my doctor could see me; maybe he could talk to me and try to get to the bottom of the problem. He is a neurologist, after all--and the emergency room doctors are NOT.  Moreover, I'll be lucky to see a doctor if I go there; most likely I'll see a physician's assistant or a nurse practitioner, which are fine with colds or flu or that sort of thing, but they don't have the training to deal with my myriad of health problems, including serious neurological issues.

If my neurologist had agreed to see me, maybe he could have ordered the appropriate tests to see whether, perhaps, the mass found in my sphenoid sinus in 2012 has spread. Maybe he could tell, by the way I describe my headache, what type it is. Maybe he could prescribe something to help.

I am so confused. Supposedly, doctors are on board with reducing health care costs. So why are they now, as a matter of course, sending their patients to the Emergency Department, the most expensive place to receive care?

Not only that, why are they forsaking their patients this way?

I don't know.  I guess I'll go to the damned ED if my head feels like it did last night--and the headaches get worse as the evening wears on after I wake up. (Being hypersomnolent, I sleep all day and usually emerge sometime between 6 pm and 9 pm, and that's when the headaches have begun.)

I'm not happy about it, though. Why go for substandard care at increased cost for something that could be handled through my own doctor's office?

Well, sports fans, I guess I don't have any damned choice. I feel like crap, but I have to pull myself off the couch, go out in zero degree weather here in the mountains, and drive to a place where I"ll have to sit among a bunch of people coughing and hacking, only to be seen by a person without the neurological training to truly get to the bottom of what's going on.

Does that make any sense?

Oh, and I forgot.  My car won't start.  The cold has killed its battery.

True, I'd need a car to get to the doctor's office, but I could perhaps borrow one for such a trip--but when going to the ED, who knows how long it will take, and it's hard to borrow a car when you have no idea when you can return it.

Yes, it's just so easy when you're sick.

"Just go to the emergency room."

Hey, U.S. health care system, you are one sick patient.  YOU'd better go to the emergency room! Not, as I already know, that you'll get the diagnosis or care you need there unless, indeed, you have a traumatic injury of some kind.

The ED is NOT for problems such as the ones I'm dealing with right now. But that's what I'm told.

"Just go to the emergency room."

Maybe it is a McDonald's after all.  God help us all.



  

Episode 55: Headache, Nasty, Nasty Headache

Thanks, ClipartPanda!
She looks like my mom!

This headache has lasted about four days now, though it briefly disappeared today before reasserting itself most obnoxiously.

Despite medicating myself with Tramadol, which my kidney doctor told me I should be taking rather than NSAIDS--your typical, over-the-counter pain killers--as well as Aleve Sinus and Cold (containing an NSAID--but desperation leads to recklessness), and 3 tabs of Ibuprofen (another NSAID) and back to yet another Tramadol, well, sports fans, the headache remains.

And it's a bitch. Honey gave me a heating pad to put behind my head, along the skull base, where it and my neck were hurting.  But no sooner did the heat help that area that the headache moved to across the top of my head.  Meanwhile, a constant low-grade pain and pressure resides right behind my eyes.

I've had headaches over the years, including bona fide migraines, complete with vomiting.  These are not migraines, but they're fairly debilitating nonetheless. I know I don't feel like doing much of anything. It's Valentine's Day, and Honey had mercy on me and didn't even pressure me to make love.

He could see I was in pain.

That's one of the reasons I love that guy. Though making love to him is another reason I love him, and it would be nice to actually feel like doing that once in a while--but it's as if my sex drive switch has been turned off, literally. And not because Honey isn't the sexist, sweetest man alive.

But I digress.

This sudden onset of intractable headaches, combined with my also sudden and recent onset of REM Sleep Behavior Disorder, can't help but make me think something more acute than mere neurodegenerative disease (with which I've been diagnosed) is going on.  Something becoming acute. What might it be?

Then I remembered:  Two years ago, when my episodes of weakness and breathlessness upon slight exertion began, an MRI showed that I have a mass in my sphenoid sinus.

According to the literature, any mass in that sinus--the one closest to the skull base--should be investigated. I was told by my Ear, Nose, and Throat specialist (ENT) that mine was most likely a benign polyp or cyst, and that was the end of it.  Unless it wasn't.

Tonight I did some more research and, in fact, even benign processes such as those suggested by my ENT, or mere inflammation, can cause symptoms such as headache--in the very areas mine has been hurting--and other neurological symptoms.  For instance, problems with the trigeminal (5th cranial) nerve may originate with sphenoid sinus problems.

I've had about five instances of trigeminal nerve neuropathy, in which a light touch beside my nose led to an electrical shock down the side of my nose and across the bone above my top teeth.  This is, in fact, the trigeminal nerve and one of its branches.

So now, sports fans, I can't help but wonder--is, in fact, problems in that sinus the root of my problems?  I've already said numerous times that my medical problems frequently originate in the hypothalamus, a little bitty part of the brain just behind the sphenoid sinus, that is responsible for regulating the hormones that control our autonomic functions--sleep, breathing, hunger, sweat, sex drive, etc.--all of which have been problem areas for me for several years.

Oh, well.

One can only speculate.

And one can call the eminent, wonderful Dr. A, her neurologist, Monday morning.

It sure can't hurt to take another look at that mass in that ol' sphenoid sinus.

Wouldn't it be wonderful if what is happening to me turns out to be curable, albeit with a rather nasty and risky surgery?  I'll take those odds over slowly degenerating neurological function, so here I am, almost hoping there is such a problem.

All I know is, I want this frickin' headache to go away.