Grrr. Aggrivated with Doctors.

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".

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.......

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, 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.)

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.

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

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....

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