Advice on Doctors?

Discussion in 'Community Discussion' started by temiller, Jan 11, 2011.

  1. temiller, Jan 11, 2011
    Last edited: Jan 11, 2011

    temiller macrumors member

    Joined:
    Aug 30, 2010
    #1
    Hey all,

    I really don't feel like asking my parents about this, because I will just get a life lesson and a half about wasting money and what not.

    But, I messed up my ankle/foot a few years ago. Its never really healed right, still swollen to this day, In constant pain (more or less discomfort, major discomfort). I was suppose to get a MRI or whatever they do to check out ankles after the incident, but I lost my job, and my insurance. With the Health Care Reform, I got put back onto my parents insurance policy, and they believe if its not broken, don't fix it. I moved a few hours away, so I can't go to my family physician. I moved to a city, with family physicians, multiple hospitals, specialists and everything.

    I honestly have no clue on what kind of doctor I need to see. Can I call a hospital and tell them my issue and ask them who I would see? Do I go strait for a specialist? I called a family physician, but they want me to send my medical records to them, and the physician will evaluate me to see if he'll accept me for a patient. I'm only going to be living here for a year so I dont' want to waste their time on just one visit or one issue.

    Any help on what to do would be great.
     
  2. 184550, Jan 11, 2011
    Last edited: Jan 11, 2011

    184550 Guest

    Joined:
    May 8, 2008
    #2
    In my experience, you usually go to a general family physician first and then s/he refers you to a specialist if need be.

    Which major metro area are you located near? Assuming you're in the US.
     
  3. Hmac macrumors 68020

    Joined:
    May 30, 2007
    Location:
    Midwest USA
    #3
    Make an appointment to see and family physician as a starting point.
     
  4. B.winkle macrumors member

    Joined:
    Aug 3, 2010
    #4
    You can see a Family doc, but you need an Orthopedist with your ankle injury.
     
  5. Don't panic macrumors 603

    Don't panic

    Joined:
    Jan 30, 2004
    Location:
    having a drink at Milliways
    #5
    try to go to a specialist. possibly a sports doctor
    just make sure your insurance is good for it.
    did you get x-rays at the time of the injury? are they accessible? do you know what was the problem then?

    if the 'city' happens to be NY, go to the HSS (hospital for special surgery) explain your problem, tell them that you neglected it (don't tell them it was for insurance reasons) and now it hurts and hear what your options are.
     
  6. shinji macrumors 65816

    shinji

    Joined:
    Mar 18, 2007
    #6
    Your parents' insurance policy should have a listing of all doctors on the plan, probably searchable and online. Look through that listing for a general practice doctor or internist, and pick them as your primary care physician (if this is an HMO/PPO/etc.).

    Any doctor will want your medical records or at least the records pertaining to this injury. But that doesn't mean you can't get treated until these are sent to the new doctor...you can get a checkup and have them sent later. At that doctor's office, you'll sign a form consenting to the request for medical records and they'll be sent over to the new doctor.

    Don't worry about wasting anyone's time. Everyone involved is getting compensated for this by your insurance company, and that's their job anyway.

    I would mention on the phone that it's still swollen even years later and you're still in pain. Something is definitely wrong here and you need treatment ASAP. Not going to take a year either way.
     
  7. NickZac macrumors 68000

    NickZac

    Joined:
    Dec 11, 2010
    #7
    If you have an 'Open Access HMO' you can go straight to the specialist provided they are in your network. Call the number on your insurance card, tell them you need to see someone for your foot, and have them give you information on people to make it happen who accept your insurance. Then research them and pick one.

    While this isn't definite, you are probably never going to get your ankle perfectly fixed because it has had an issue for a few years which has not been treated and has likely aggravated it. It may have even done more damage. Many parts of the body also become more prone to issues later in life if they have already had a major injury. The ankle/foot is a very complex area with about 30 unique bones and plenty of nerves. It will take time to see improvement as it will take time to get the correct diagnosis.

    A good chance also exists that it is at least partially nerve related. If it is, you are talking a complex treatment plan. The best outcome will be obtained by seeing a:
    -Pain management specialist
    -Orthopedic specialist
    -Orthopedic physical therapist (or similar)
    -Lifestyle manager to make changes to aid healing (ex: improved diet, lower risk factors, physical exercise, etc. This aspect makes a major difference)

    More than likely, your biggest gains will be through PT as long term injuries tend to respond best to physical therapy and some problems respond better to PT than the standard operations. I can't say anything for sure as I have never met you, but all of the above are at least possibilities.

    If the pain reaches points in which you need to reduce the pain to function or be comfortable, you can use a variety of medicines and mechanisms. Just a few are:
    1) Opioids: very vague terminology but the initial narcotic pain relievers are usually hydrocodone (Vicodin, Lortab, Lorcet, Norco, etc) and oxycodone (Percocet, Percodan, OXY IR, etc) mixed with the medication you know as Tylenol. If a doctor tries to give you Demerol or Codeine based drugs, I would ask for something different and not use them.
    2) Oddball medications: Tramadol (Ultram) is an opioid but not a narcotic, and does not have the severity of side effects that stronger opioids do. Tapentadol may be another option as it gains popularity.
    3) NSAIDS-be careful with NSAIDS as they cause a LOT of issues. Advil (IB) is probably the easiest on the body but Naproxen is pretty rough. Torridol (ketorolac) is the best NSAID for the level of pain relief but also the most dangerous. Read up on all NSAIDS before using them as they can cause more harm than good.
    4) Antidepressants and anticonvulsants-older and never gens are being used. For nerve pain, Lyrica (pregabalin) seems to be the new gold standard of its class. The success of this category is either hit or miss though.
    5) Natural anti inflammatory foods/supplements-certain foods really help decrease inflammation where as others create terrible inflammation. Soy is one of the strongest inflammatory foods and is a nightmare for anyone with muscular skeletal autoimmune diseases. Many foods with chemical additives can make pain worse as well. The stronger foods that decrease inflammation would be high quality green tea, Silver Needle white tea (possibly the strongest of all AIs and by far the most beneficial tea IMO-massive research is being conducted on it) and broccoli are a few.
    6) Supplements-most pain relief supplements are bogus, but one supplement called Kratom appears to have pain relieving ability in a manner similar to opiates and it has been used for pain control for at least a few thousand years. The issue is getting pure Kratom extract is hard to find and hard to verify. Aloe vera juice may help pain as well.

    There are other ways too but you want to use as little medication as possible as all medication has side effects, and the addiction potential of opioids is real (although exaggerated greatly by the media). Start with Tylenol, then if you want to go with NSAIDS, try Advil. You can take up to 800mg of Advil every 4-6 hours, but only for a few days consecutively and it will likely cause stomach issues and I would not personally advise using more than 600 every 6-8 hours. Tramadol (Ultram) is a great drug and has a very low side effect profile and it can be used for years. If doctors think Lyrica may help you, by all means try it despite the high cost as it has a very mild and small side effect profile (compared to other pain mgmt meds) and it has really changed the quality of life for a lot of people.

    I wish you luck! I know how much chronic pain sucks and I really hope you decrease the level of discomfort dramatically.
     
  8. temiller thread starter macrumors member

    Joined:
    Aug 30, 2010
    #8

    When I injured my foot, I went the following morning because I didn't think it was much more then a sprain. When I woke up in the morning, I saw that my foot/ankle was severely swollen (no space between toes), black and blue around the base and ankle, I couldn't move it, blah blah. They didn't do xrays because of the severity of the swelling.

    This was about 2.5 years ago. I went to a check up a week later to get released back to work, and that was with my family doctor. He told me I did a Lateral sprain. It was still swollen at that point, but he cleared me to work, and said the swelling will take some time to go down.

    So fast forward a year, the inside of my foot is still swollen, and I'm still in discomfort (I would say 2 out of 10 pain wise, nothing I couldn't live with. It was mainly on the inside and outside of my ankle, around the joint.) Another 6 months later I realized I needed to get back into shape so I started to run again. After a half mile of a jog/walk, It would really start to hurt. I'd feel it in my calf, knee, and foot. It was just that leg. Playing football throughout HS I was always taught to work through the pain. So I continued to go a little bit longer every day. Which I was able to do, but I would still get the same pain. After a while I decided I best stop before I mess something up again.

    Fast forward to the past few months, I'm noticing pain in my knee now. Its starting to hurt while I'm just sitting or laying in bed. It feels like my foot is tensing up and feels like it needs to be stretched, but can't get rid of it. I was taking Motrin 800s when it did hurt more then usual, but after a while the motrins didn't have an effect on me unless I took upwards of 3 of them (2400 mgs of motrin by the way) and I realized that wasn't to healthy for me so I stopped all together.


    I just have BCBS PPO, and what I think I'll do is this;

    Go to the campus doctor. All students are charged $10 for an exam, insurance or not. Then they will refer you to a doctor if x-rays, a specialist, or something along those lines are needed, and hopefully they can refer me to someplace that my insurance will cover. I'm trying to keep my parents out of this as much as possible, mainly because of their beliefs with doctors (When i was in 8th grade I had to wait a few days to go to a doctor because they didn't think my arm was broke. Well, it was. And those few days were the longest I tell you). I'm thinking that I'll just get told I'm SOL with the whole thing, but I would more or less like to find out that there is nothing that can be done instead of waiting until its to late (which I might have already done.). Thanks guys, I appreciate the help so far. I'll keep you updated as things progress.
     
  9. temiller thread starter macrumors member

    Joined:
    Aug 30, 2010
    #9
    And a visual aid so show the level of swelling (or the level of pansy I have reached).

    Shortly after the incident. It was wrapped for a few days so the swelling and bruising went down substantially.

    [​IMG]

    And present. You can see the swelling on the inside of the left foot.

    [​IMG]
     
  10. mscriv macrumors 601

    mscriv

    Joined:
    Aug 14, 2008
    Location:
    Dallas, Texas
    #10
    Sorry friend, but I don't think this is the best plan.

    A PPO (Preferred Provider Organization) means that your insurance company (Blue Cross Blue Shield) has a network of preferred providers that you can go see at any time you like without having to get a referral from your "primary care physician". Based on the details of your plan you should only be charged a "copay" for this visit. I'd suggest you use the Blue Cross Website or customer support number on your insurance card to locate specialist in your area (most likely an Orthopedist or Podiatrist) and schedule a visit.

    From what you have said I understand you want to keep this from your parents, but if you are on their insurance and you use it then they will know you are seeking medical treatment. Insurance companies send out documentation, typically an EOB (explanation of benefits), whenever the insurance is used. If you are willing to pay the out of pocket expenses that are incurred (copays etc.) then just be honest and tell them your foot still bothers you and you're going to have it checked out. Insurance is there for a reason, to be used. Do you really think your family will be upset if they aren't out anything?

    Last, I'd suggest calling the insurance customer service line and talking with a representative about your issue and see what your parent's policy covers in detail. For example, if the doc orders x-rays will that be covered? What about lab work? Is everything done during the office visit covered by the copay or could there be additional charges based on services rendered? Insurance plans vary and I'd suggest you know going in what the plan will cover so that you can work with the doctor to avoid surprise charges.

    For example, I have BCBS and here's something that happened to us. According to our policy all preventative care including annual well child check ups are reportedly covered. Last year my son had his 5 year old annual check up. As a part of this check up they do a vision and hearing screening. Even though these screenings are a routine part of the "annual well child check" they are billed under separate procedural billing codes. Well, BCBS does not cover vision care as it is a "carved out" separate service that is to be covered by your private vision insurance. What this means is that they won't pay for that part of the visit even though it's part of the general check up. I was able to appeal it with my doctor and they wrote off the cost, but next year I need to tell them in advance that we don't want the vision screening. So, it's important that you know exactly what is covered and what isn't.
     
  11. temiller thread starter macrumors member

    Joined:
    Aug 30, 2010
    #11
    Went to the doctor. Got some x-rays and an exam. It looks like its just Tendinitis, but once the Doctor can review the x-rays he'll know whether or not if there is anything else, or how severe the tendon damage is. So hopefully its nothing..
     

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