Aa
Yet another loser for a PCP at the VA
I know you all must get tired of all of the complaints I have about my health care at the VA. But I need to vent or I'll lose my mind.
A few weeks ago my PC started me on Dicyclomine at 10mg 3x a day for my IBS. Well it helped some so I tired taking 20mg before my meals. It worked and I was able to eat without any IBS symptoms. I explained this to my latest PCP at the VA and she got all in a huff because I didn't ask before trying this. The normal adult dosage of this medication is 160mg per day so I felt it was safe to try this small increase in the medication. Anyway she is refusing to increase the dosage even though the 20mg works and the 10mg doesn't.
So anyway I have started taking CellCept every day for my MS. It is an immunosuppressant and I need to have my white blood cells checked every 12 weeks to insure my immune system doesn't completely stop working. So I sent my PCP a messages asking her to schedule me to come in every 12 weeks for blood work per my Neuro's instructions. Today I got an email back from my PCP telling me since the medication was prescribed by a Neuro she was forwarding the message to Neurology for them to handle. Now that I call the epitome of laziness. How hard is it really to order a WBC test every 12 weeks and to check the report from the lab to see the values are within range? It's not like she doesn't know how to do this as she did the same test in February the first time I ever saw her.
Dennis
A few weeks ago my PC started me on Dicyclomine at 10mg 3x a day for my IBS. Well it helped some so I tired taking 20mg before my meals. It worked and I was able to eat without any IBS symptoms. I explained this to my latest PCP at the VA and she got all in a huff because I didn't ask before trying this. The normal adult dosage of this medication is 160mg per day so I felt it was safe to try this small increase in the medication. Anyway she is refusing to increase the dosage even though the 20mg works and the 10mg doesn't.
So anyway I have started taking CellCept every day for my MS. It is an immunosuppressant and I need to have my white blood cells checked every 12 weeks to insure my immune system doesn't completely stop working. So I sent my PCP a messages asking her to schedule me to come in every 12 weeks for blood work per my Neuro's instructions. Today I got an email back from my PCP telling me since the medication was prescribed by a Neuro she was forwarding the message to Neurology for them to handle. Now that I call the epitome of laziness. How hard is it really to order a WBC test every 12 weeks and to check the report from the lab to see the values are within range? It's not like she doesn't know how to do this as she did the same test in February the first time I ever saw her.
Dennis
Dicyclomine:
What my PCP RX'ed is 10mg 3 x a day. What I conveyed to my PCP is that I only eat twice a day so I had been alternating which meal I take 20 mg with and which I take 10mg with as I read on-line that it works best just prior to a meal. I also told her I was having no side effects from the drug and that at 10 MG I still had IBS symptoms while at 20MG there were no IBS symptoms.
Oh and the minimum dosage for the drug is 80MG per day.
My PCP is a Family Nurse Practitioner and she pick this medication by looking in a PDR and giving me an RX for the lowest available dosage cap.
Oh and the minimum dosage for the drug is 80MG per day. so she didn't even follow that.
So what other motivation could she have other than being ticked off for not increasing the dosage?
Blood test:
My MS neuro does not have privileges at the VA and can't order tests to be done at the VA. The only time he is allowed to get blood work done at Vanderbilt is when I have an actual appointment. Since the VA doesn't allow appointments with him under six months apart (Which actually end up being 7 or 8 months once the approvals get done) that doesn't cover every 12 week schedule for the tests.
When my Neuro RX'ed me this drug he sent over to the VA a detailed explanation of the what and why of it in order to get it approved by the VA (Non-Formulary) along with what needed to be checked in the way of blood work. This is all listed in my medical records so that when I need a refill of it the information is on hand. It took a little over a month to get it filled the first time as the VA and my Neuro went back and forth on all of this.
Other things:
The above aren't the only gripes I have with this PCP.
1) The first medicines she ever order for me it took over a month to get because she didn't really put in the orders and it took 2 emails from me to get her to finally do it.
2) She told me she was going to put me in for some PT for my arthritis she never did.
3). I wrote to her about shortness of breath in regards to 2 of my 3x bypass grafts failing which I just found out about. She just wrote back to me to contact my cardiologist of which I don't have one that I know of. The definition of a Primary Care is the coordination of health care between all of my doctors. That seems to mean it is her job to contact a cardiologist about this.
Dennis
What my PCP RX'ed is 10mg 3 x a day. What I conveyed to my PCP is that I only eat twice a day so I had been alternating which meal I take 20 mg with and which I take 10mg with as I read on-line that it works best just prior to a meal. I also told her I was having no side effects from the drug and that at 10 MG I still had IBS symptoms while at 20MG there were no IBS symptoms.
Oh and the minimum dosage for the drug is 80MG per day.
My PCP is a Family Nurse Practitioner and she pick this medication by looking in a PDR and giving me an RX for the lowest available dosage cap.
Oh and the minimum dosage for the drug is 80MG per day. so she didn't even follow that.
So what other motivation could she have other than being ticked off for not increasing the dosage?
Blood test:
My MS neuro does not have privileges at the VA and can't order tests to be done at the VA. The only time he is allowed to get blood work done at Vanderbilt is when I have an actual appointment. Since the VA doesn't allow appointments with him under six months apart (Which actually end up being 7 or 8 months once the approvals get done) that doesn't cover every 12 week schedule for the tests.
When my Neuro RX'ed me this drug he sent over to the VA a detailed explanation of the what and why of it in order to get it approved by the VA (Non-Formulary) along with what needed to be checked in the way of blood work. This is all listed in my medical records so that when I need a refill of it the information is on hand. It took a little over a month to get it filled the first time as the VA and my Neuro went back and forth on all of this.
Other things:
The above aren't the only gripes I have with this PCP.
1) The first medicines she ever order for me it took over a month to get because she didn't really put in the orders and it took 2 emails from me to get her to finally do it.
2) She told me she was going to put me in for some PT for my arthritis she never did.
3). I wrote to her about shortness of breath in regards to 2 of my 3x bypass grafts failing which I just found out about. She just wrote back to me to contact my cardiologist of which I don't have one that I know of. The definition of a Primary Care is the coordination of health care between all of my doctors. That seems to mean it is her job to contact a cardiologist about this.
Dennis
I'm sorry you've had so much trouble with health care through the VA Dennis. I actually don't think all of it is distinctive to care received through the VA system. Much of it doesn't sound too different than what others here have described.
Are you quite sure about why this doc is refusing to prescribe the dose you want? We can certainly look up usual dosages but it isn't always as easy to know what a safe dosage is for any individual. I can't say I'd be completely surprised to hear she'd be upset at the thought of a patient doubling up on the dose of a new use prescription medication without asking permission.
I know Dicyclomine has lots of side effects and some specific precautions. You've also shared that you take several medications AND have multiple diagnoses in addition to MS. Could it be she isn't sure the larger dose is safe in your particular case? Maybe she wanted to see what happens with the lower dose first and then consider raising it?
I don't know what's really going on here. All I know is that I'd like you to see you get some relief without making anything else worse!!!
In the other matter......
It seems your Vanderbilt neuro would be permitted to order tests to monitor the Cellcept reduced blood counts himself. How's he supposed to be comfortable prescribing a significant drug like that unless he can be sure the side effects are being monitored?
If he isn't permitted to do the test himself maybe he needs to write an explanation of what test(s) he needs and specific values that need to be maintained (they might be different when taking the drug than at other times). He could give it to you to carry or send it out to your PCP directly - except it sounds like you have someone different every visit?
It seems too important an issue to leave up to chance.....
Are you quite sure about why this doc is refusing to prescribe the dose you want? We can certainly look up usual dosages but it isn't always as easy to know what a safe dosage is for any individual. I can't say I'd be completely surprised to hear she'd be upset at the thought of a patient doubling up on the dose of a new use prescription medication without asking permission.
I know Dicyclomine has lots of side effects and some specific precautions. You've also shared that you take several medications AND have multiple diagnoses in addition to MS. Could it be she isn't sure the larger dose is safe in your particular case? Maybe she wanted to see what happens with the lower dose first and then consider raising it?
I don't know what's really going on here. All I know is that I'd like you to see you get some relief without making anything else worse!!!
In the other matter......
It seems your Vanderbilt neuro would be permitted to order tests to monitor the Cellcept reduced blood counts himself. How's he supposed to be comfortable prescribing a significant drug like that unless he can be sure the side effects are being monitored?
If he isn't permitted to do the test himself maybe he needs to write an explanation of what test(s) he needs and specific values that need to be maintained (they might be different when taking the drug than at other times). He could give it to you to carry or send it out to your PCP directly - except it sounds like you have someone different every visit?
It seems too important an issue to leave up to chance.....
Actually the Neuro that wrote the RX is my MS Neuro at Vanderbilt and my PCP knows that. She forwarded the message to the Neurology Department at the VA.
Dennis
Dennis
It's likely that in the time it takes her to bounce this back to the neuro, she could have the requisition sent to the lab. Seems she's trying to make a point to the neuro. Your irritation about this is completely understandable.
you vent anytime Dennis...........
you are definitely opening our eyes to a portion of VA assistance that we never (and should) see...........
I can see a little of her frustration but she can write the same prescription herself..........duh...............
you are definitely opening our eyes to a portion of VA assistance that we never (and should) see...........
I can see a little of her frustration but she can write the same prescription herself..........duh...............
Have an Answer?
You are reading content posted in the Multiple Sclerosis Community
Top Neurology Answerers
Australia
ON
Queensland, Australia
Queen Creek, AZ
Find out how beta-blocker eye drops show promising results for acute migraine relief.
In this special Missouri Medicine report, doctors examine advances in diagnosis and treatment of this devastating and costly neurodegenerative disease.
Here are 12 simple – and fun! – ways to boost your brainpower.
Discover some of the causes of dizziness and how to treat it.
Discover the common causes of headaches and how to treat headache pain.
Two of the largest studies on Alzheimer’s have yielded new clues about the disease
