I haven't been well the last month or so, and I am not 100% certain how much of what is happening with my health is directly related to tapering down my duloxetine. I recently had a visit to the ER, for peripheral edema, chest pain, shortness of breath, and lots of other symptoms like joint pain, muscle weakness, nosebleeds and so on, but the ER was really only concerned about the symptoms that could possibly be congestive heart failure or a pulmonary embolism. They didn't find anything life threatening, so pretty much got discharged with no answers, no treatment, just that I need to follow up with my primary doctor. So I did, which the doctor doesn't schedule until at least 5-7 days after the ER visit (I do not understand this policy at all), and since my primary physician was out of town that week, they schedule me with the nurse practitioner, who recently joined the practice. So, I muddled through this week of pain and swelling and everything only to have the most incompetent, short-sighted, rude and uneducated individual in healthcare that I have ever encountered in my 37 years. If there was any way to have my insurance company deny payment for this encounter, I would pursue it. I have already submitted a complaint through the health system that the healthcare provider did not listen to my description of the issues I was having and gave me medical advice that was not backed by any scientific research and also contradictory information that if I did follow her advice, I would be endangering my health. I was asking questions that she was obviously not able to answer about my bloodwork, and instead of writing a referral to a specialist, she told me that it is basically a result of me being obese. I specifically asked about my red blood cell count, because it was actually abnormally high during my last physical, and in looking into what symptoms may result with abnormal RBC levels, shortness of breath is a possibility. The more RBCs there are, the less oxygen is actually able to be transported. She told me my RBCs were high because of my "excess body habitus" which I know is complete and utter nonsense. By that logic, anyone that is overweight or obese would not be anemic ever. Obviously she is clueless, and given that she is making inaccurate assessments about even the simplest blood level issues, I would question her competency in being able to diagnose anyone accurately, let alone have the authority as a medication prescriber.
This is what I submitted:
I had an ER visit on April 10th for symptoms of congestive heart failure or pulmonary embolism. No life-threatening condition was diagnosed and was discharged to follow up with my physician and made the appointment to follow up with my primary care doctor immediately. My primary doctor was not available, so I was scheduled with Lucille Zappitelli-Sason CNP. I was extremely dissatisfied with my encounter with the CNP and do not feel my medical complaints were taken seriously or addressed. I am also disturbed by some of the medical advice I received and believe it was unnecessary and potentially dangerous. My dissatisfaction/concerns are as follows:
1) Multiple times during the encounter it was stated that my weight is the reason I am experiencing the symptoms I have been having. Understanding that I am overweight, and I do discuss it with my primary physician during my exams, I stated that my weight has been increasing significantly for my age and there is no reason why, dependent on the lab tests I am able to obtain given my current age and medical history, that I should be gaining weight at this rate because my diet is not controlling the gain, and I have been trying since my physical in 2017. My diet is not the only factor involved and does not explain why my blood-pressure has risen significantly and I am having peripheral edema (arms and legs). No effort was made by the provider to investigate other factors that may be causing my recent health concerns and I was given a referral to a dietician.
2) Most disturbing is that I was instructed to eliminate dairy from my diet because it causes inflammation. I have no medical justification or circumstance that would be applicable to an exclusion of dairy in my diet, and no registered dietician worth their salt is going to suggest a patient eliminate dairy without medical reason. There is no research to substantiate the claim for this medical advice. I asked about how calcium intake would be altered if I eliminated dairy, and was informed that there is sufficient calcium in leafy green vegetables. There is research to support that the top 5 nutrient deficiencies (B12, iron, calcium, Omega-3 and vitamin D) may occur in people that follow a plant-based or vegan diet. Again, I feel that my concerns regarding dietary changes were dismissed suggesting the provider does not believe I am actively involved in maintaining a healthy diet to the best of my ability.
3) I asked about the levels of magnesium in my blood as this test was performed during my ER visit. I do not have a baseline level for magnesium as it is not a routine test. My levels were within range and on the higher end. I told the provider that I discussed taking a magnesium supplement at my visit with my primary physician about 1 month prior, and have been taking high doses of magnesium (above the recommended daily allowance), and took 500mg approximately 3 hours before my blood test in the ER. I asked if my levels would be in range as a result of taking the supplement or the timing relative to the bloodwork and if it is possible I have an undiagnosed deficiency. I was told it takes time for magnesium levels to build up in the blood, and taking a high dose just prior to the bloodwork would not effect the levels and I am not deficient. I was told to keep taking the magnesium, but to alternate to every other day. My concern is, if my magnesium levels are fine and already on the high end of the normal range, then there is no need to continue supplementation, and that to continue taking a high dose with the blood level I am at, the magnesium will accumulate in my system and reach a toxic level and be a dangerous situation. The medical advice was not only contradictory, but potentially dangerous to my health.
Truly, if there were any way to notify my insurance provider to deny payment for this encounter, I would pursue that option. I will be seeking a referral to a specialist in endocrinology or hematology. but this provider should be monitored because her medical advice was not sound and potentially dangerous to my health if I followed it.
I am still pretty livid about the whole thing. All this time that is passing before I can get into an appointment with a competent medical professional is putting a lot of strain on my body and if I end up in the hospital because of this, I am seriously considering filing a malpractice suit, and I am not a letigious person, I never even filed a formal complaint when I got a hospital acquired infection from a surgical procedure. Honestly, the infection rates for the hospital are actually low nationwide, it is a good hospital. I just drew the short-straw and was the patient that year that managed to get a surgical site infection.
My blood pressure, which was usually normal to the high side of normal basically jumped to stage 2 hypertension (I am getting readings near 144/95 often through-out the day) without passing go or collecting $200. Not a slow creep, but a rapid jump. Apparently there IS a reason I started having nosebleeds in the shower recently and I am pretty sure it has nothing to do with me being overweight. Not really sure if the swelling is causing the hypertension, or the hypertension causing the swelling, seems to be like a chicken or egg situation from what I have read so far. They are interrelated, but not always present together. When they are present together, that is pretty much when things are reaching critical mass and need to be treated. So, here I am, just a few points from hypertensive urgency and possibly having a stroke or aneurysm, literally close to blowing a gasket, and I was told to eliminate dairy from my diet and eat more leafy greens.
However, having had 37 actual years of experience in this body and how it functions, I believe I am a good authority on my health needs, and am keeping up with monitoring everything I can and am ready to head to the ER on a moments notice if my diastolic pressure hits 100 or higher, or my blood sugar increases to danger levels (even though I am not diabetic). So I have been carrying around a blood-pressure cuff and glucose test kit in my bag all day and keeping tabs on myself. I know I am on the border of having metabolic acidosis, but I have no way to test my electrolyte balance and am basically praying the diuretic that nurse know-it-all prescribed doesn't kill me. Under different circumstances, I wouldn't take it until I was able to see a different doctor, but I am kinda in a pickle since I am swelling and on the brink of rupture. The ER can't help unless I am actually having a hypertensive crisis, so it's not like I can just walk in and say "hey, I think my electrolytes are a bit wonky, can I get a CMP please?" I might just grab my daughter's tent and camp-out at the ER door, so I will at least be there in the event I lose consciousness or go into a metabolic shock, it will save on the ambulance bill. I am sure my disability attorney is going to drool after they get the medical records from this encounter for my SSDI case. Medical negligence seems to excite attorneys. But I'd rather not die or have a medical emergency if I have any say in the matter.
