Furious with primary care doc! HELP!!

Hi everybody! My primary care, Carol Mimless, has decided she wants a new 90 day diet surveilance. I don't think that's fair because I am already into 55 days on this one! I just think she knows she will eventually lose a patient as I won't need her. My cardiologist is on board with this bariatric surgery and all my records are together. Do I have to have my primary care doc say yes to be able to go any further? I have Medicare and AP/IPA Can a doctor besides primary care give the go ahead to start going through the procedure should I dump this woman? The worst thing is that if I go ahead and start the 90 day one from scratch all my other tests will have time to expire. I can't afford to have them done all over again. Insurance rules could even change during that time. I'm so upset right now. Thanks for listening! Hugs! Sheryl

Sheryl, I would change PCP and fast. Any doc who knows your history and is not on board with you is not the right doctor for you. You deserve to have your doc on your side. Best of luck, Tanya

The first thing I would do is make an appointment and have a serious heart-to-heart talk with her. Make notes ahead of time about what you wish to cover and take a note from your cardiologist if possible to help reinforce your position. You have 55 days invested in her current diet and it makes no sense whatsoever to have you stop and begin again on yet another diet. You have a number of excellent reasons why starting over is NOT an option. Has this already gone to your insurance for approval? I am not sure of the process for Medicare and AP/IPA. I had documentation from a cardiologist that I was fit for surgery and had I needed it he would have stated it much more succinctly that surgery was the best option for me. I also had a letter from my endocrinologist stating that I needed the surgery as well as my PCP. I really hate it when a PCP plays around with your life like this. Good luck. Remember you can be your best advocate in this. Speak up firmly, concisely, and be prepared with the facts when you talk to her. Sandra

Why is she making you do this? Is it required by your insurance company? I would get a new doctor if it is just to appease her. My PCP was great. I made the personal choice to try other avenues first. When it came time to make the decision about the surgery he was behind me 100%. His name is Clark Ruttinger - Sun City. Good luck - keep us posted. Diane

hi everybody! My next appointment with her was scheduled for March 11. I made them move it up by going into the office every day and calling everyday asking about cancellations. I was doing this twice a day. Needless to say, I was probably the talk of their breaks and lunch rooms! haha! SOoooo now I am scheduled for Monday -- THIS one after the weekend. I will have a list of things to discuss and a chart of a scale with a cookie on it on one side and a list of my diabetes, GERD, fibromyalgia, and heart disease and the conditions they are causing me on the other side of the scale. Of course this side of the scale will be waaaay heavier. Because that's the way it really is. What is more important -- that I eat an extra Oreo or that I get out of all these heart problems and things before they get me? This was HER -- I haven't even gone through insurance yet. She is saying she won't write the letter until we do it all over again. I can't keep doing this. Thanks for all input! Sheryl

Hi! APIPA may be interested in you fulfilling diet requirements but medicare is more concerned with your comorbities.Since medicare is your primary and APIPA is your secondary you only need to be concerned with medicares requirements as APIPA has to follow their lead regardless. You do or did at the time of my surgery need a PCP's support however so tell your Doc to get on board or just find another one ASAP who is pro weightloss surgery.

I did have one thought if she is totally uncooperative after your next appointment and that is to find a new PCP and have the records of your dietary efforts thus far transferred to the new PCP. This way you should not lose any time as far as the diet goes. Good luck. Sandra

This is the letter I'm taking into my primary care doc on Monday. I hope I was explicit enough about the urgency of this surgery. Sheryl Sheryl Tilley 1924 Rocky Dells Drive Prescott, AZ 86303 Phone: (928) 445-1335 Email: [email protected] Carol Mimless 726 Gail Gardner Way Suite B Prescott, AZ 86301 Friday, February 27, 2004 Dear Dr. Mimless; The other day I received a phone call from your nurse saying you would not write a letter for me for bariatric surgery without a new diet plan written down for 90 days and that this was to be considered Day 1. I am writing to you to say that this is totally unacceptable. I am already on about Day 56 - which is written down and I refuse to start over as a Day One. My reasons are these: · I started keeping a food diary and exercise log on January 2nd as a New Year's resolution and so far I have kept the record going; · My cardiologist, Stephen Cantor, M.D., F.A.C.C., and his certified nurse practitioner, Patti Cox, are totally on board with me as this is probably the only thing that is going to save my life. I have a weak left heart wall and a thickening of the heart wall because of excess weight carried so long. · My diabetes 2 is getting worse as witnessed by the last lab sheet in your office and raising my meds hasn't helped; · Even though I am walking 3-5 times per week - inside or outside - walking is getting harder and harder due to my fibromyalgia; · My weight keeps climbing even though I'm not eating anything out of the ordinary because diabetes 2 makes it harder to lose weight; · Edema: My left leg has a lump on the shin above the ankle and my right leg has a large hump just below the knee. These look like deformities and aren't getting any smaller; · My BMI is currently 51.7 - morbid obesity, much more than the BMI of 40 considered as candidacy for bariatric surgery; · I am past 55 years of age and the clock is ticking; · I have been diagnosed as having sleep apnea by the Medical Grand Sleep Clinic; · My insurance may change. The way it is now the surgery will be taken care of. My co-morbidities: sleep apnea, heart disease, diabetes 2, & morbid obesity. The disorders they cause are what I have been having to put up with for years: · Breathing problems; · shortness of breath; · stopping breathing at night; · Lack of sleep and abundance of night sweats; · Back, leg and neck aches; · Circulation problems picked up on Doppler during an angiogram; · Hygiene - how well do you think somebody my size wipes their butt?; · Rashes and sores (due to skin touching skin) in pubic/groin area; · Knees hurt badly - can't climb stairs (which put me out of a job in real estate in 1999). · Horrible and frequent diabetic stomach aches; · Not being able to keep up with activities with others; · Frequent feeling of choking due to necessary heart meds. What's the rush? The rush is this: the tests I have already taken such as a mammogram, etc., will be out of date and I can't afford to pay for them and Medicare won't pay for them twice. Yes, it's a $$$ money $$$ issue. The tests are paid for at this time. The process needs to begin now. The insurance policies can change - right now they are in my favor. Regular diets don't work for me as witnessed by the attempts I've made. I was losing weight well before the hysterectomy and the finding of my diabetes 2. After that, it has been a disastrously quick uphill climb. I lose five pounds here - put back on fifteen pounds there and it's an endless cycle that keeps the weight climbing. I've tried to be cheerful and positive but depression from obesity matters is the worst thing to deal with. It has to do with looking at yourself in the mirror daily and wondering why and who you are. Everything has a reason - so what purpose is THIS **** serving? I have the chance to change and I need to reach out and take it as soon as possible. I've started going to the group support for weight loss surgery patients and have learned a lot about the process. I want the diabetes gone, the heart problems to slow down if not stop. I want to be healthy. The times you have changed my diabetes meds to something higher hasn't helped the diabetes numbers go down. In fact, it has risen. My family history is one of amputations and death with diabetes. I am going to avoid this with this surgery. Heart problems have also taken family members to the grave. Now that I am taking Diovan 80 mg for my heart, I can no longer take potassium that was needed for my Lasix as it slows down my heartbeats making them weak. I broached the subject to the support group about 'what if your Primary Care Physician doesn't seem to be able to see it your way about the surgery and they want you to start a new 90 day diet cycle? What do you do?" The answer was unanimous - 'dump 'em.' And along with that answer came plenty of recommendations for other doctors. I don't want a new PCP - I like the one I have but I don't like the feeling of being held hostage. I made a resolution on New Year's - the first one I've finally kept - to get healthy and strong. I will not see it sabotaged. I am focused on this goal. The diet program I have written down should stand and not be started over as a Day 1 to a new 90 day plan which will not prove anything different and can only be regarded as an unnecessary delay. I'm proceeding with Dr. F. Darwin Zahn's seminar on March 12 at St. Luke's Hospital. I expect your complete support. Sincerely, Sheryl Tilley

Good letter and it definitely gets to the point. Two comments: the Fibro pain is much worse because of the weight (skinny people have it too, but with those of us with Fibro and morbid obesity the pain is significantly worse) - your quote: "· Even though I am walking 3-5 times per week - inside or outside - walking is getting harder and harder due to my fibromyalgia;" AND I would take the word "****" out of the letter and find something that reflects positively on you. Your quote "Everything has a reason - so what purpose is THIS **** serving?" perhaps just using the word DELAY would suffice. Given what you have been told you have nothing to lose and everything to gain. I wish you luck with this. Sandra

Thanks Sandra! I needed the input. I wrote the letter in the heat of the moment so I went a little over the top -- ok -- a lot over the top! LOL!! I am taking the sh** part out and adding that when my feet feel really bad due to swelling with my socks on, I reach down to take off the socks and I'm not wearing any. I can't tell you how many times this has happened. Thanks! Sheryl