A Miss Diagnosis

You know how I can’t resist a “good” pun.

Invasive Procedures

This is going to be one of those blog posts that is either really interesting to you or the most banal experience of your life. So, take it or leave it, but here comes a classic Justin rant and not surprisingly, it covers healthcare and customer service.

I don’t really expect anyone to read this post, I just have to get all this off my chest. For those who aren’t going to read, bottom line, I had a doctor who ignored her patient’s medical history and symptoms, berated me and treated me with such passive aggressive nonsense that I felt it necessary to write a 2,700 word blog post about it.

In the end, I got the prescription I came for.

If you are still up for reading the full story…

Here is a “quick” backgrounder.

Starting my sophomore year of high school I started getting sinus infections that turned into bronchitis. It would happen about once a year, around the fall/winter months and got so bad a few times that I broke multiple ribs from coughing, and then other times, I came down with pneumonia.

This has been my life for the last decade or so. In college, while in Missouri, these sinus infections came more and more often; we’re talking four times a year or more. Nine times out of ten these cases would turn into full on bronchitis and a few times, pneumonia.

After six months of a lovely cocktail of bronchitis and walking pneumonia I moved to California. Almost immediately I was healthier and for the entire time I lived in California I didn’t have a sinus infection or bronchitis. It was an awesome change.

My Pulmonary Function Test machine

My Pulmonary Function Test torture box machine

Moved back to Missouri a little over a year later and they came back. The first one came back so hard that the infection spread into my eyes, digestive system and ears. I had to take a handful of eye medications and some nasty broad-spectrum antibiotics, a few invasive non-surgeries and more blood work than I can count before finally I was cured of the problem.

At that time I also was going to an allergist who prescribed me some allergy medication and for a while I was doing great, but by this time it was summer already. The problem started in the fall semester and didn’t end until summer!

So these problems came up four to six times a year, every year, almost like clockwork. My doctor sent me to see two specialists at the University Hospital to find out why I kept getting bronchitis and what to do about it. I did more blood work, a pulmonary function test (PFT) and CT scans.

Two pulmonology specialists worked together on my test results and explained to me what the tests found, what they didn’t find and ultimately the final diagnosis.

It sounded so weird that I asked the doctor to write it down so I could look it up later.

 

I was then prescribed two inhalers, one pretty expensive, one not so bad. With insurance it wasn’t a problem.  The more expensive one required four times the normal maximum dosage for an adult. It is a COPD medication that comes in a sort of bizarre disk-inhaler thing.

One of these disks has 60 doses and a retail price around $300. For most people this would last two months but for me it would last 15 days. So without insurance, for just one of my medications, it was costing $600 every month.

We all remember why I don’t have insurance right?

So I stopped taking the medication and when I moved to San Francisco I was fine and didn’t really need them anymore. Yay!

So the “quick” backgrounder is done. Now for what happened today.

I flew into Missouri last week. After only two days here I got a sinus infection. Oiy. I tried to wait it out but after a few more days I decided I really needed to get to the doctor, get my standard Z-Pak and be more or less cured of it, before getting bronchitis.

Tried making an appointment with area doctors. None were taking new patients or had no openings this week. So I went to the health clinics in the area. Unfortunately you have to have proof of income to go to these clinics.

Ok, I sort of get why you would need that but aren’t these clinics for people who don’t have insurance, are poor or otherwise unable to get a regular doctor appointment? I’m self-employed. I don’t have a pay-stub from an employer and I’m traveling from California via Florida. Who travels with a 1099?

A regular doctor appointment was out of the picture. The health clinic was now out of the picture. My only other options were urgent care or the emergency room, which is obviously a last resort.

I decide to hit up the urgent care center. I wait around two hours to get into an examination room, have a wonderful talk with the nurse about my situation, she is very understanding, shares my annoyance with the health insurance thing. Etc.

One Sexy Sphygmomanometer

Vitals look good; blood pressure is a little high (which is unusual). Would have love to see my blood pressure by the time the appointment was over! My nurse leaves and saying the doctor would be in soon.

This is where I get pissed.

Thirty minutes the doctor comes in.

“So, why are you here today?”

I tell her I think I have another sinus infection, normally I get a Z-Pak and all is well, unless it has already turned into bronchitis. I also share a short medical history.

“You don’t have a sinus infection, at least not one that antibiotics will help.”

I respond again with the history, I get a sinus infection and I get a Z-Pak and then I’m fine. If I don’t get the Z-Pak in time or at all, I get bronchitis and am sick for weeks, months even.

“Well, if you really are having all of these sinus infections, and they keep coming back, you don’t need antibiotics. Besides, I can tell you don’t have a bacterial infection. The dark circles under your eyes show you have a chronic fungal respiratory infection.”

“Well, all I can say is that every time this happens, I get a Z-Pak and all is better. And I have dark circles under my eyes because I hardly get any sleep because of the coughing, sneezing and just feeling sick. I’m just really tired.”

“And I would give you an antibiotic if it would work. You have a fungal infection and there is nothing you can do but wait it out.”

I remind her about my history of respiratory problems and that waiting out an infection isn’t safe for me. If I don’t get this in check, I will get bronchitis and I will end up racking up hundreds or thousands of dollars of medical fees (since I don’t have insurance).

“What you need is an allergy medication. If you took that you wouldn’t get the ‘sinus infections’ and this wouldn’t happen.”

“I used to take allergy medication. I did for around four years. I started with a nasal spray, it caused me to have a bloody nose and horrendous throat pain, and I can’t remember what it is called though. My allergist switched me to another spray, Flonase, and I was much better. Eventually I switched to Zyrtec, which I stopped taking when I moved to California since I no longer needed it.”

“You were taking (some RX I have never heard of) which does give bloody noses for some.”

“No, that isn’t the one. I can’t remember but I would recognize the name if I saw or heard it. What is the brand name of that drug?”

“That is the brand name…” (Insert super snarky look)

“Well all I can say is that isn’t the one I took and besides, it was really the sore throats that made me switch. I could hardly swallow it hurt so bad, like strep throat.”

“That wasn’t because of the nasal spray. They don’t do that.”

“Yes it was. And yeah, it was Nasonex.”

“No. You had a sore throat from it working, drying you out and draining your sinuses. That would have ended after a few weeks if you had just stuck it out.”

“I was on it for a few months. It didn’t get better, it only got worse. My allergist said she would switch me to Flonase and I was great after that. Besides, the allergy medicine didn’t help my sinus infections or bronchitis. I stopped sneezing but I didn’t stop getting the infections.”

“So did you get tested for allergies?”

“Yes, I’m allergic to ragweed.”

“So, basically you are allergic to everything.”

“No, I am allergic to what just about everyone is allergic to. I also have an oral allergy to some fruits and nuts but that is unrelated.”

“Well, if you were on an allergy medication, you wouldn’t have sinus infections.”

“Like I said, I had the infections on and off the allergy medication. It didn’t do anything to help that condition.”

“Probably because you weren’t using a nasal spray, pills don’t work as well.”

“I took Nasonex and Flonase for around a year. It didn’t prevent the infections.”

“Yeah, that’s because you aren’t having a bacterial sinus infection, it’s fungal.”

My head spins. She just said that if I took allergy medication, I wouldn’t have sinus infections. Now she says that allergy medication won’t work because it is fungal. Which is it?

“I will write whatever prescription you want, what do you want? I don’t think you should take anything but if you insist, I will write whatever you want.”

That sounds really professional doesn’t it? How about some antibiotics and… oh I don’t know, oxy…?

“All I need is a Z-Pak. I already have the inhaler I am normally prescribed so I don’t need another one of those. I don’t have insurance so I don’t want to get a bunch of prescriptions, just a Z-Pak.”

“Why do you have an inhaler? What are you taking?”

Face meets palm.

“As I said earlier, I have an existing respiratory condition that I take medication for.”

I then repeat to her my medical history, even more annoyed.

“These two conditions aren’t related. Your respiratory problem doesn’t cause sinus infections and sinus infections aren’t causing your respiratory problems.”

This is when I had an “OH REALLY” moment.

“You can look at my medical history, most of it regarding this issue was treated right here at this hospital. You have everything right there (pointing to the computer and medical records). Dozens of appointments for sinus infections and bronchitis, pulmonologist appointments, blood tests, respiratory tests, x-rays, CT scans, various specialists and a conclusion with prescription. Every single doctor has treated me the same and all agree that these two problems are directly linked. I don’t mean to get aggressive but at this point I am getting upset. This should be a pretty straight forward diagnosis and treatment.”

“Like I said, I will write whatever you want but antibiotics won’t work. You have a recurring fungal infection that if you just let it run its course, will get better.”

“It has been ten years. If ten years of waiting it out isn’t enough—”

“What do you want me to do? Just tell me.”

“I want a Z-Pak.”

“I will write you the prescription. It won’t work. Besides, it takes seven days for a virus to finish doing what it does before you start to get better. So if this even is something an antibiotic will fix, you only have to wait seven days to know for sure.”

What is this, a Salem witch trial?

“That seems inconclusive. If I get better with no medicine it is a virus. If I don’t get better, it is either a virus that is continuing to wreak havoc on my body or… it is a bacterial infection that I could have taken an antibiotic for and would be feeling much better in 24 hours, not another week. Besides, I am traveling and I don’t live here. I can’t continue to be sick.”

“Are you flying or driving?”

“Driving to Texas.”

Nothing else…

“Wait. So what are you here for? A respiratory problem or a sinus infection?”

“I’m here because I want a sinus infection treated before it aggravates my existing respiratory disease.”

“Let me hear you breath… Your lungs sound fine to me. I don’t think there is anything wrong with your lungs.”

Insert WTF moment.

I remind her I’m taking four times the normal dose of one inhaler and a regular dose of another. My lungs sure as hell better sound at least decent. Plus, my particular problem cannot be diagnosed by anything but a CT scan, most often done after a PFT.

“I will be right back.”

Fifteen minutes at most pass with me sitting in the room, fuming over what has just happened. This doctor who has known me for some fifteen minutes apparently thinks she is smarter than the crazy number of doctors who have run so many tests, have specialized in my particular condition and have all come to the same conclusion. She thinks she is Doctor House!

You have dark circles under your eyes so obviously you have a chronic fungal infection that will cure itself over time.

She comes back in.

“Here is your prescription for a Z-Pak. Like I said, it won’t do anything for you. “

Attached to the prescription are two documents.  One about why you shouldn’t take antibiotics and an article from the Mayo Clinic, “Acute sinusitis.

Let me highlight a few gems from the very article she gave me, as her passive aggressive way to tell me I don’t know what a sinus infection is (I presume).

“…triggers include bacteria, allergies and fungal infections.”

“…persistent sinusitis can lead to serious infections and other complications.”

Contact your doctor if you have any of the following:

  • Symptoms that don’t improve within a few days or symptoms that get worse
  • A persistent fever
  • A history of recurrent or chronic sinusitis

(Bolded items represent my situation as described to the doctor.)

See a doctor immediately if you have signs or symptoms that may indicate a serious infection:

  • Pain or swelling around your eyes
  • Swollen forehead
  • Severe headache
  • Confusion
  • Double vision or other vision changes
  • Stiff neck
  • Shortness of breath

(Bolded items are the symptoms I described to the doctor.)

Acute sinusitis complications include:

  • Asthma flare-ups. Acute sinusitis can trigger an asthma attack.
  • Chronic sinusitis. Acute sinusitis may be a flare-up of a long-term problem known as chronic sinusitis. Chronic sinusitis is sinusitis that lasts longer than 12 weeks.
  • Meningitis. This occurs when infection spreads to the lining of the brain.
  • Vision problems. If infection spreads to your eye socket, it can cause reduced vision or even blindness. This is a medical emergency that requires immediate treatment to prevent potentially permanent damage.
  • Ear infection. Acute sinusitis may occur along with an ear infection.

(Bold items are the complications I have experienced and informed her of when explaining my medical history.)

You might have noticed that my appointment had hardly any actual examination besides her listening to my lungs (two breaths) and a classic “say ahhhhhh”. No feeling of my lymph nodes, no checking my ears or nose for inflation, no cultures, etc. She spent her time berating me and by extension, all of my previous doctors and their treatments.

Let’s go to the “Treatment” section of the article.

“Antibiotic treatment is generally needed only if you have a bacterial infection, especially if the infection is severe, recurrent or persistent.”

Rarely, acute sinusitis is caused by a fungal infection, which can be treated with antifungal medication. The dose of medication — as well as how long you’ll need to take it — depends on the severity of your infection and how quickly your symptoms improve.”

She insists I have a fungal infection but doesn’t suggest any medications and refuses to believe I need an antibiotic even though it is needed for “recurrent or persistent” infections.”

I pay for the appointment, go to Walgreens to get my prescription filled and now here I am.  Obviously still crazy-mad about the situation.

A passive aggressive, doctor who didn’t even halfway examine me or my symptoms before passing a judgment on me. She disregarded my medical history, previous diagnoses, treated me like an idiot and exhibited no sympathy or bedside manner.

Did you make it this far? What do you think, am I wrong on this or is this a ridiculous situation? Would love to read your thoughts one way or the other.

14 thoughts on “A Miss Diagnosis

  1. I’m so sorry! I’ve been through the same thing, but I’m fortunate enough to have insurance.

    I had major sinus surgery October 27, 2010. I *still* have sinusitis! The only way I was able to prove that to my ENT doc was because I had an MRI ordered by my primary care doc. I’m still not well, and will be going back tomorrow to see the PA, who actually listens to me. I need another antibiotic because Levaquin isn’t doing the job.

    I have found that Neil-Med Sinus Rinse helps to flush the allergens from the sinuses along with any grossness that’s in the sinus cavities. I use it twice a day with distilled water only. Tap-water contains too many chemicals and is quite irritating.

    Again, I’m sorry that this woman was such a rude bitch to you. Perhaps that’s why she’s working in an urgent care facility?

    I hope the Z-Pack does the trick and you’re feeling better soon.

  2. I’m so sorry! I’ve been through the same thing, but I’m fortunate enough to have insurance.

    I had major sinus surgery October 27, 2010. I *still* have sinusitis! The only way I was able to prove that to my ENT doc was because I had an MRI ordered by my primary care doc. I’m still not well, and will be going back tomorrow to see the PA, who actually listens to me. I need another antibiotic because Levaquin isn’t doing the job.

    I have found that Neil-Med Sinus Rinse helps to flush the allergens from the sinuses along with any grossness that’s in the sinus cavities. I use it twice a day with distilled water only. Tap-water contains too many chemicals and is quite irritating.

    Again, I’m sorry that this woman was such a rude bitch to you. Perhaps that’s why she’s working in an urgent care facility?

    I hope the Z-Pack does the trick and you’re feeling better soon.

  3. obviously you’re crazy and haven’t lived your very own life for the past ten years. and what a z-pac…. oh my, what a tough prescription to write, you’re obviously hooked.

    funny thing in my thought process is, WHAT DOCTOR asks you what you want, and then just writes it!? wtf.

    well boo i hope you get to feeling better.

  4. obviously you’re crazy and haven’t lived your very own life for the past ten years. and what a z-pac…. oh my, what a tough prescription to write, you’re obviously hooked.

    funny thing in my thought process is, WHAT DOCTOR asks you what you want, and then just writes it!? wtf.

    well boo i hope you get to feeling better.

  5. @thejustins86 I know right?! LoL If I ever go back to her, and dear GOD I hope I never have to, I’m just gonna ask for some Vicodin haha.

  6. @thejustins86 I know right?! LoL If I ever go back to her, and dear GOD I hope I never have to, I’m just gonna ask for some Vicodin haha.

  7. @diana.brooks Sounds like you are in the same boat, if not a rockier boat. I’m so sorry!

    I have been using the Nasopure sinus rinse and it does work wonders. Can’t believe something so simple can be so effective. Sounds like we have the same regimen.

    Levaquin was one of the other antibiotics they put me on. It tore my stomach chemistry to pieces.

    Thanks and I hope you too get to feeling better!

  8. @diana.brooks Sounds like you are in the same boat, if not a rockier boat. I’m so sorry!

    I have been using the Nasopure sinus rinse and it does work wonders. Can’t believe something so simple can be so effective. Sounds like we have the same regimen.

    Levaquin was one of the other antibiotics they put me on. It tore my stomach chemistry to pieces.

    Thanks and I hope you too get to feeling better!

  9. No you’re not wrong. Doctors don’t listen!!!!!! It’s horrible!!! They’re not trained to, and if anything their training seems to be inimical to that.

    The condescending attitudes, the refusal to explain their thought processes (I’m an engineer so I have a “show me your work” attitude towards doctors: “how did you arrive at this diagnosis?” — bad doctors hate that; the good ones will actually explain). And, frankly, despite having gone through medical school, a lot of them .. just aren’t that bright. Or at least don’t seem to be able to think logically. This woman is clearly a case in point.

    So yeah, I can totally sympathize.

    (That being said, antibiotics *ARE* prescribed way too often, and not all are benign and without side-effects, especially the most recent generations of antibiotics, some of which can cause horrific, even permanent side-effects, neurological damage, spontaneous tendon rupture. So this doctor has the right idea IN GENERAL, but it’s ridiculous that she couldn’t listen to you.)

  10. No you’re not wrong. Doctors don’t listen!!!!!! It’s horrible!!! They’re not trained to, and if anything their training seems to be inimical to that.

    The condescending attitudes, the refusal to explain their thought processes (I’m an engineer so I have a “show me your work” attitude towards doctors: “how did you arrive at this diagnosis?” — bad doctors hate that; the good ones will actually explain). And, frankly, despite having gone through medical school, a lot of them .. just aren’t that bright. Or at least don’t seem to be able to think logically. This woman is clearly a case in point.

    So yeah, I can totally sympathize.

    (That being said, antibiotics *ARE* prescribed way too often, and not all are benign and without side-effects, especially the most recent generations of antibiotics, some of which can cause horrific, even permanent side-effects, neurological damage, spontaneous tendon rupture. So this doctor has the right idea IN GENERAL, but it’s ridiculous that she couldn’t listen to you.)

  11. @JJMG Thanks for the comment. I thought blogging about the situation and getting it off my chest would feel good. Turns out the comments are what really made me feel better.

    And yeah, anti-biotics are overused but sometimes they are necessary. 24 hours after taking my first dose I was almost to 100%. It is ridiculous how much better I felt by the second day.

  12. @JJMG Thanks for the comment. I thought blogging about the situation and getting it off my chest would feel good. Turns out the comments are what really made me feel better.

    And yeah, anti-biotics are overused but sometimes they are necessary. 24 hours after taking my first dose I was almost to 100%. It is ridiculous how much better I felt by the second day.

  13. I spoke to a father who clearly did NOT have a son with autism and he bodily told me “I know my son isn’t autistic, but if it gets him behavioral services at school, then so be? it…” That really disgusts me, as I have a son with severe autism. The word autism is being used for so many of the wrong reasons. I see kids with ADHD, celiac disease, and just simple speech delay being given the autism label. Very disturbing.Thanks!

    @LINDSEY

  14. I spoke to a father who clearly did NOT have a son with autism and he bodily told me “I know my son isn’t autistic, but if it gets him behavioral services at school, then so be? it…” That really disgusts me, as I have a son with severe autism. The word autism is being used for so many of the wrong reasons. I see kids with ADHD, celiac disease, and just simple speech delay being given the autism label. Very disturbing.Thanks!

    @LINDSEY

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