New PCM

Yesterday was my first visit with my new PCM (primary care manager).  The doctor was rude.

He came into the exam room and told me to give him my life history in two minutes because that was all the time he had for me.  Sheesh.

He asked how old my son is.  Mind you SHE was dressed in a camouflage dress and bib but she also had a pink headband on her head with a pink flower on it.  I corrected him.  He said, "well you never know with today's army".  Really?

He then says I don't have spinal stenosis according to the MRI he looked at.   Well it would be nice if he looked at the newest one taken a few years ago and read the report from the neurologist I went to at JBLM.  He didn't even know that I had been to see a neurologist.

So after explaining to him in the little time I had why I was there and asking for the lab results, of which, he said were normal, he put in the referrals that I requested.

I will be going to see a pulmonary specialist and getting the sleep study done.  He listened to my lungs and asked me how long I've had asthma.  Since 1997 and the hospital there noted that my O2 stats dropped into the 80's when I was sleeping.

I will be going to see the neurologist but will be needing a referral off post to get the MRI and EMG done.  Yes they could in theory do them at Winn but they don't allow the dependents to use the MRI and EMG testing facility now.  Why? I wondered.  It costs the government more to send us off post for testing.

I will be getting an ultrasound done on my thyroid to see if the cysts are shrinking.  It has been a good three years since the last one was done.

None of my questions were answered as to the blood work.  I wanted to know about the Large and Giant Platelets they had found and why it is so rare.  I wanted to know if the iron issue is back to normal. All he said about the iron was that it wasn't tested on the 2nd of September.  Really?  The internal med doctor specifically requested that test.  Oh I've booked an appointment with my internal med doctor for next week as the PCM told me I should follow up with that doctor instead even though my PCM had no idea why I was seeing him to begin with.  UGH!

The PCM did agree to prescribe me the lasix and the statin.  My cholesterol was high he said but he didn't tell me the numbers.  Hopefully I'll remember to ask next week.

As for the GYN visit I was supposed to have on this past Monday; GYN called late Friday last week to cancel it.  My doctor had to go on emergency leave.  He won't be back until early October.  I'm now rescheduled with another GYN, one I've seen before and liked, for next week to address the urinary incontinence issue that suddenly started after the pelvic exam in late August.

Little E is doing well.  My days are running together and I can't remember if I mentioned her weight and height from last visit.  She is 10 weeks old now and weighs 11 lbs 2 oz.  Length is 22.4 inches.

Here is a new photo of her from yesterday

Tomorrow is the oncology appointment in Savannah.  It is a two hour appointment.  Not sure what they are going to do but I can guess it won't be all medical history.  Hopefully this Savannah doctor will be on time because I have a dental appointment in Hinesville in the afternoon to have my new crown put in place.

Military Medical Insurance

Also known as Tricare.

Oxymoron there since I really doubt they do "try (to) care".

I'm venting again.

Every two years I need to see my ENT at Madigan for the follow up on my Meniere's Disease, audiology to make sure I'm not losing more hearing, and a thyroid scan to hope that the scan shows that the cysts are shrinking or gone.  This means that I need a new referral each time since they are good for only 6 months.  A waste of a doctor visit is required now to get that referral even though my PCM has told me many times I don't need to see him just call his nurse and tell her what I need since I have chronic illnesses.

Guess what?  I have to now go see the man, PCM, that has a god complex.  This is the PCM mentioned above that said to call his nurse.  He is also the same PCM that denied me pulmonary specialist ( I have asthma), dermatology (I've had a skin lesion removed) , cardiologist (I've had a heart attack), rheumatologist (I have arthritis) , neurologist ( I have narrowing of the spinal canal in the neck and have had several TBIs plus fibromyalgia) and now he is trying play God again and determine if I need to see the ENT or not.  The above mentioned specialists are listed on my EFM (exceptional family member) paperwork as being necessary to see.

Oh and because I am slowly losing my vision I also need to see (lol rather ironic) the optometrist and sometimes ophthalmologist too.  I tried to schedule an appointment to see the optometrist for October but they are booked solid and only accepting appointment for active duty soldiers right now.  If one should cancel their appointment and I'm lucky enough to call that day to see if they have openings I might get in.  Other wise I'll be referred out to someone that doesn't know my case, probably billed the excess amount for it too, and have to find transportation to get to the appointment off the installation.

As it is we have a perfectly good ultrasound department here at Madigan. But I get referred out to the economy for my appointments because they need to make sure the machine is available at all times for the soldiers which means many time slots go unused.  Those time slots are listed with $$ signs in the computers as that stands for soldiers only.

I live right behind Madigan.  I purposely picked this village in the installation so that I could walk to my appointments at the hospital and not be a burden on my spouse.  We cannot afford two vehicles.  He cannot afford to be taking time off of work to share the vehicle with me either.  Even though he does primarily office work he still needs the vehicle when they are doing field operations because not all of the field exercise is in the field...figure that one out!

Tomorrow I have an appointment with another doctor, a co-worker of my PCM for a second opinion.  I do not remember ever seeing this doctor before and I can only hope he doesn't have the same god complex that my PCM seems to have.  Though my PCM is a nice person with a good bedside personality he isn't competent to be making health care decisions for a specialist in my opinion.  I remember back to when I had the ovarian cyst pain really bad before surgery and my RE office was booked solid.  They referred me to my PCM for pain medicine.  My PCM said he won't prescribe pain medicine as he is not of the school to provide narcotics for pain relief.  Sure doc what ever you say as he pokes my pelvic region with his hands not believing how much pain I was in  just days before I went in for my surgery.

With any luck tomorrow's doctor appointment, a waste in my opinion of a time slot someone ill could be using since all I need is a renewal of my referral, I'll have my new referral in the system.  But I've been warned by Steve on the phone that they are doing away with referrals because the specialists are overwhelmed with the realignment of the bases and the fact that Madigan now serves not just the Army but the Air force, Navy and Marines with it now being a regional medical facility.  Oh and let us not forget the retired military community.  I can only imagine that if I'm having difficulty getting an appointment as a spouse of the active duty service member that it must be nigh impossible for them to get care here too.  For those of you from my hometown Madigan is about half the size of CVPH and serves at least twice as many people.

Maybe I'll have them take a look at my foot while I'm there since it is getting blacker by the day at the injury site.

Military medical insurance isn't what the public sector seems to thinks.  We don't get appointment easily; medicine and treatment is often denied to family members who really need it.  Medicaid seems to be better and I would know since while I was going through my divorce, working and in college I did use it for a year.

Oh and side note: Steve on the phone said he was playing phone tag with me today.  No he wasn't.  I was home all day and the only two calls I missed were Equity and my friend Kim of which I returned their calls shortly after they left messages.  Even  my incoming call log denies that Steve called.  I don't deal well with LIARS.  I called my PCM's office on Monday.  I called my PCM's office on Wednesday.  I called my PCM's office today before they decided to call me back.  So much for leave a message and we'll get back to you within 24 hours.  Is that 24 working hours or normal 24 hours in a day?

Diagnosis: Sick

Ah, well that makes sense.

Yes, my doctor finally agreed with me on something.  I do indeed have a sinus infection. 

Treatment:
Continue with Neti pot
Rest
Augmentin
Flonase

Knock on wood I won't get a yeast infection from the antibiotics.  I never have as of yet though, they have treated me for one suspecting I had it but the lab results proved it to negative.  My doctor told me that I'm lucky.

Funny I don't feel lucky.

Looks like I'll be sitting this cycle out.  Usually antibiotics mess up my cycles.
This is just like the Neti pot that I use.  It really does help me breathe easier.

Still on the Bench

J and I are still waiting for an answer.  No news is good news right?  Well not for stress it isn't.

We are hoping to have an answer by the end of today or at the latest early next week.  Half days will be starting at most offices on the installation soon.  If J is going to be able to re-enlist they'll need to get this approval from the colonel soon.

In sad news, a friend of J's family died recently.  J's mom emailed him about the death.  I haven't seen him so sad in a long time.  May Col. Q. rest in peace.

My labs came back from the draw yesterday.  All is fine.  No numbers were given to me.  I really didn't think I was deficient to need support since I do take vitamins daily.  Now to figure out why I'm still sick.

J told me that maybe I need to file an ICE complaint about my doctor.  Honestly I had forgotten about that option.  I'd rather not have to report my doctor for anything but his general knowledge is lacking.  He is the same doctor that won't prescribe narcotics and refused me any before my laproscopic surgery back in June.  Many of you will remember how much pain I was in back then.  This is the same doctor that has misdiagnosed me on a few visits too and refused to put in referrals to specialists too.  If we didn't have such a shortage of available doctors for dependents at my clinic I would actively seek out switching in a heart beat.  It could take months for me to get a new doctor, not a PA or NP either since with my medical issues I need an MD, D.O. or what have you.

I hope that everyone has a good weekend.

More of the Same

I'm exhausted. 

I went to the doctor's office today.  My PCM looked down my throat and said it was fine.  Is he going blind or am I stupid?

My glands are swollen, my throat is red and my tonsil are sticking out.

He offered to do a culture if I thought I needed it.  I don't have a fever so I said no since I know I'm not infectious.  He offered me the Isolep solution again.  Gag No Thanks!

So I guess it isn't just my RE office that is suffering the budget cuts but my PCM office that is being tortured with budget cuts too.  I say this because I told the doctor that I've had this problem since September and he thinks I'm fine.  Okay, sure.

He did order blood work for the fatigue.  Vit B 12 and follate.  I'm thinking that yes I might be a bit low on the B 12 but still in the normal range.

My PCM also didn't like the long list of problems I have.  By problems I mean diagnoses by other doctors and started eliminating them on the computer from my records.  I had to stop him.  He heard in my voice that I was getting angry, especially when he tried to take out my infertility diagnoses.  I mean I wish I didn't have it but taking it off my records won't change that fact considering I am still actively trying to conceive!

Why are they instituting such budget cuts that I end up with crack pot doctors?

Oh Things Get Better

Insert lots of sarcasm with the title please.

I'm in pain.  The tramadol is not working.  Well okay it works for a few hours to knock the pain down to a 5 but there after its back to knife stabbing pain that then leads to throbbing radiating pain.  Fun times!

I called my RE office today.  All doctors are off site.  Nurse S tells me that since I have an appt. with my PCM today for  a dermatology consult to ask him about my issue.  Yeah sure.  Okay.  Like I want my PCM coming near my pelvis.  They office has no ultrasound but it does have an exam table with stirrups.  What can he see with just a light and a speculum?  Not the ovaries for sure.

So Nurse S tells me then I need to go to the ER.  Really?  Only if I'm dying lady.  Last year I took their advice and went to Madigan's ER for a ruptured cyst.  Not only was the medical treatment crappy the time was absurb.  They left me in the room for an hour before coming to check me out.  The problem was that they forgot me.  Lovely.  Then one of the medics knows that I'm in bad pain and she gets someone to give me a script for a shot of Diluadid. Finally a little relief.

The doctor then decides to ignore my ovaries and look at the uterus with a speculum.  Really doc?  I said that I need an ultrasound. He listened after I yelped when he pressed on my ovaries with his hand.  Sure enough the ultrasound had shown I had one rupture.  He didn't prescribe pain meds.  He didn't prescribe antibiotics.  He just printed out a medical flyer telling me my endometrioma, the 9 cm one, had ruptured.

So do you really think I want to go back to the same ER?  NO WAY!

I will if I have to I said to Nurse S after telling her the above story.

She calls back while I'm on the phone with my spouse.  She said that even though they are double booked with all the IVF for Thursday that Dr. B (not the Lt. Col. but the Major) would be willing to see me tomorrow if my PCM can't do anything for me today.

I then told her what Lt.Col B. said about having to do surgery if they reach 8 cm.  I explained that the cysts are large enough that they are touching and Lt.Col. B. couldn't be sure which ovary they were on.  She said, "EWWW".   As in that's not good, not the yucky eww tone.  Basically the same.

So there is where I stand as of today.  I'm waiting.  I'll still need to be seen tomorrow.  That is a given.  Whether or not my PCM gives me pain pill is irrelevant I know I'll still need to see the RE because of the possibility of the cysts growing since last week.

*****UPDATE*****
Just got back from seeing my PCM. 

He said, "I am not of the school to prescribe narcotics.  I will not prescribe you pain medicine.".

So I called my RE office and talked to Nurse S again.  She said she will make a note to herself to talk to Dr. B. about getting me in tomorrow or at least to see what they can do for me if they can't get me in.

Nurse S was aghast  at what my PCM said.  She said, "...your medical conditions are well documented.  Its not like you have a drug seeking behaviour.".

So with any luck something will be done for me tomorrow. 

Again though, Nurse S said, "If the pain gets worse please go to the ER.  I don't like the ER either.".

Pretty bad when the nurse doesn't like our ER!

PCM Appointment and Ponderings

Sedimentary deposits on the access road to Pacific Beach.  Photo by me.

First off the PCM appointment went well.  Dr. G. listened well to me and decided to do the blood work though he too thinks that without a doubt I at least have an allergy to gluten.  He isn't sure that the blood work will show much as the test has to be done, according to his computer, after I've been eating gluten for a month straight.  He didn't want me sick for that long so he had the blood drawn yesterday.

Funny thing was that even though I've ditched my asthma medicines completely the wheezing has cleared up on its own.  Dr.G. said, "I don't know what you've been using to clear it up but its gone and whatever you've been doing keep it up.".  Interesting.  Maybe it was the vacation to the ocean?  Since then my breathing has gotten better.  I also have a new referral to Gastroenterology in the computer and will be able to call and book my appointment some time next week after its been approved for an available opening.

Now for my ponderings.

I can't figure out why they are deploying J.  He was told he wasn't going to be on the list.  He's on the list.  I wonder if its because I miscarried again.  I mean how is that nice to take away my spouse when we are both still grieving?

This third loss is tearing us both up.  I urged J to make sure he tries to get an appointment to talk to a counselor about the grief.  Seriously I have my own psychologist and we see a marriage counselor but J has no outlet and I've seen just how much this is tearing him up inside.  He is so angry and yet within seconds he is almost in tears.  If I didn't know better I'd say he was injecting himself with my IVF meds.

I know quite well that he is afraid that I might again be pregnant and that we might very well lose this one too if I am.  Really when a soldier deploys he has to get into the zone.  Yes, they get their tunnel vision before they deploy and become real bears to live with.  Its not that they don't love us its just that they have to build up that protective wall again.  The worst part is that we had just broken through that wall and now he is defenseless due to the repeat pregnancy loss.

I'm worried about him.  He is going to a hostile country.  Of late there have been more killings.  I don't want to be a widow.  I have to tell you its a big fear among us military spouses because it can very well happen.  Just the other day there was a training accident in the news.  More dead.  I guess I'll be breathing easier when he gets back home again.  I'd breath a lot easier if they just sent him off on some field exercise.  Well no I doubt I'd be happy with that either.

I know I can handle being apart from him.  I've done it before and I can do it again.  I'm not one of those fall apart spouses that can't handle being left alone.  I'm far from friendless and defenseless.  I know how to take care of myself and shoot an intruder.  Yes, my father, a former soldier himself, taught me well.

I know J will come home again.  But I don't know how well he'll be when he gets back.   He ended up being medivac'd to Balad last time.

I can't worry about the unknown because I can't control it.  I can only live the time I'm in right now and plan for a future with many different options.  I can dream of long vacations together.  I can dream that some how they'll still decide to leave him behind.  But in the end I have to face reality.

Due to OPSEC I won't be posting where he is or when he leaves.  I can only post that he will be leaving and how things are going well after he gets to his destination.

A New Bread Attempt

Today I'm going to attempt to make a bread I've never made before.  I will make the Jewish braid bread called Challah.  J loved the one we bought last year from our commissary and I figured while he is on CQ today I might as well put my excess free time to good use.

Who needs to do laundry?  Me, probably, but it can wait while I try to make this particular bread.

Oh I lost 0.8 lbs yesterday only to gain back 1.2 lbs overnight.  What the heck is going on with my body?  I now need to lose 5.2 pounds to get back to my pre IVF weight.

I now have an appointment to see my PCM for the very same day as my WTF appointment.  So if my RE doctor doesn't cooperate then my PCM surely will.  Well I hope he will.  Tricare, when I called them to schedule a referral appointment, had on hand the information that I was supposed to undergo a surgical procedure and they had no problem in getting me in to see my PCM for next week to get it back on its way.  Something barium endoscopy was the thing I was supposed to do according to their records.  All I know as that I will be under anesthesia of sorts and they might have to put in a balloon.  But that isn't now and I don't know when it will get done.

Our weekend plans have changed.  Good news is that its extended.  Yay!  I knew that J had a four day weekend coming up but that because he has CQ today he would be too tired to drive on Friday for the start of our vacation.  Also the place we had reservations at had only one night available and I asked to be put on the cancellation list.  So they called back and told me they now had an opening.  Now I get two nights away from this hell hole house.  I'm so thinking that beer and a hot tub are just what J needs.  He's been avoiding all alcohol and hot tubs because it can affect his swimmers.  Time to relax a bit.

Yesterday J ran 2 miles in the morning for his PT and another 11.5 miles for the "Walk To Afghanistan".  They required them to run, though the family members could walk.  I didn't go as my hip yesterday, just taking the trash cans out to the road decided to slip out again.  This time it was the left one.  Back to J again.  So J has finally decided to admit he is a bit of an athlete.  Running half a marathon in one day is enough I'd say to make that observation.  Wish I could walk half of what he runs without the pain I get. 

Okay so if I want to get that bread made, remember I'm experimenting with the gluten issues though I think we all know I have some sort of sensitivity by now, I'd best end this post and get the dough rising at least.

Fertility Break and Tricare Rant

Tuesday I was to call Tricare to schedule a fertility consult.  Scratches head as to why I needed one yet again as the last one wasn't that long ago.  I mean just give me an appointment already.  After the nurse called me yesterday with the results, of which were negative, the fertility clinic calls me.

The fertility clinic informs me I can't get in to see them until January and that they don't have a schedule up for January yet.  So I tell them that I'll use my clomid until I see them.  They tell me I can't do that and that I have to be monitored with ultrasound and blood work.

In all the times I've used fertility drugs and been under the care of fertility doctors I've yet to have an ultrasound except to prove that I was indeed pregnant.  When I was on fertility shots I never had an ultrasound.

I explain to the clinic nurse that called that I'm fine taking this medicine on my own and that I'll just go in for the blood work when I'm supposed to.  I've been on it before and have been instructed that I'll be fine to take it, by their doctor no less, when my husband got home from his deployment of which I'm doing now.  She argues we me about their policy and that fertility is not a benefit its a privilege that they can grant.  So they are now the guardians of my reproduction rights? I'm not allowed to reproduce without their permission?

Just before the deployment I had my last fertility work up at this installation.  I'm not a new patient.

 Me: So if I take the clomid are the fertility police going to arrest me?

Her: No.  But we don't want you taking it without our supervision.  Please hold.

She comes back on the line and all of a sudden has an appointment for me on the 3rd of December.  During that hold she looked over my chart and realized I had already gone through the HSG, blood work, ultrasound, and for the spouse the semen analysis. 

I had explained to  her before the above that the only reason we stopped trying was that my husband had deployed and we couldn't bank his semen.  The military does not pay for banking of semen.  They do not pay for IVF or IUI.

Me: I thought my insurance allowed me to have the clomid.

Her:  Its a privilege not a benefit.

So two years ago at West Point it was a benefit.  Talk about budget cuts.  Two years ago I was informed that they would pay for banking my spouses semen.  Not anymore.  I'm starting to wonder what Tricare does cover because the quality of care that I receive is not at the highest it could or should be.  I haven't seen my PCM, who is a real doctor, since before my husband deployed.  I keep getting pawned off to the nurse or PA.  I was informed yesterday that my PCM is now back at my clinic and has been for sometime.  So why did the have a PA fill out my EFMP paperwork?  The PA that messed up the paperwork!

I think I had better medical coverage when I was using Family Health Plus in college.  At least I got to see a doctor, a real doctor at that, and had tests preformed in a timely manner.  I've yet to get that referral to see the neurologist from the auto accident of  2 year years ago.  My doctor in NY told me I had to see one.  Its in my records that I was to be referred to one as soon as I got to this duty station.  Here, the majority of health care providers on post just don't care.   I can think of only one, KK, and she was my physical therapist.  She is the exception to the rule.  I think if Tricare found out she had a heart they'd fire her.

After my little dialogue with the nurse she gives me an appointment for December.  I'm in finally.  I'll let them monitor me.  Until then I had to promise to not use the fertility drugs.  The nurse was quite upset to find that that last doctor gave me a four months supply of the drug.  Well I'm guessing he thought I was smart enough to know how to take it on my own with the home tests being just dandy.  She figures not.  Oh well.  I have the appointment now and will keep it.  They have two doctors on staff now that deal just with fertility.  I was lucky to even get an appointment.