Health Care American Style: How to Avoid Being Stented

My latest health crisis started three weeks ago when I went to my primary care physician for a check-up.

The check-up consisted of a review of a basic blood test and a few questions. My doctor listened to my heart and told me to go see my cardiologist.

I went to the cardiologist. He did an EKG and ordered a CAT scan. I went for the CAT scan. I went back to the cardiologist. He told me that my pericardial effusion had grown from mild to moderate and that he wanted to install a “pericardial window.”

Pericardial effusion is a build-up of fluid between the inner and outer layers of the pericardium, an envelope which envelopes the heart. The fluid between the two layers of the pericardium reduces friction between the heart muscle and the surrounding tissue.

When excess pericardial fluid builds up, it makes it more difficult for the heart to function and results in a fatal heart attack if it is not treated.

The preferred treatment is to open up a pericardial window by cutting a hole in the outer layer of the pericardium, which allows excess fluid to drain into the chest cavity where it is reabsorbed by the body. This does not sound like fun to me.

The cardiologist also told me to go see my oncologist because carcinoid tumors are known to produce secretions that cause pericardial effusion.

I went to my oncologist, who took a blood sample to look for carcinoid markers, something that my primary care physician should have done.

My oncologist also told me that he examined my CAT scan and noticed a 3mm kidney stone in my ureter, which is a tube that drains urine from the kidney into the bladder.

The oncologist said that I would need a stent or risk kidney failure.

A stent is an artificial tube that is inserted into the kidney and the bladder to allow the kidney to drain into the bladder despite a blocked ureter.

Still with me?

I went to my urologist today. The nurse looked at the radiologist’s findings from my last CAT scan and said, “I don’t see any mention of a kidney stone.”

I said, “Funny you should mention that, because I don’t either.”

The urologist looked at the scan himself and told me that the scan doesn’t even show the ureter, so there was no way that the oncologist could have seen a kidney stone in a ureter if there was no ureter to look at.

Still with me?

Here’s what happened: I DID have a kidney stone in August of 2019. The CAT scan that the oncologist was looking at was from 2019, not 2020. The oncologist didn’t check the date on the CAT scan, sending me to the urologist for a completely unnecessary visit.

The urologist suggested doing a nuclear medicine study to make sure that there were no kidney stones in the ureter that the oncologist couldn’t have seen because the CAT scan from 2020 didn’t focus on that area.

I asked about doing an ultrasound instead, which would be free of charge in the doctor’s office instead of $150 co-pay at Diagnostic Centers of America.

The urologist told me to come back that afternoon for the free ultrasound but he warned me that the ultrasound wouldn’t show anything if there was nothing there to be found.

No. He really said that.

I spoke with a friend of mine who is a retired physician, and she told me not to go back for the ultrasound because all of these investigatory processes are picking up anomalies that don’t really mean anything but must be investigated once they are noticed.

I’m used to this kind of thing by now.

In 2003, my doctors didn’t diagnose my carcinoid tumor.

I did. I could feel the tumor growing. I didn’t know what it was but I knew that something was wrong.

They took an X-ray. The X-ray was inclusive. They did a CAT scan. The CAT scan was inconclusive. They finally did a flexible bronchoscopy and found the carcinoid. This saved my life, but it cost me two-thirds of my right lung. If I had accepted the first answer or the second answer, I wouldn’t be here right now.

Health Care, American style. I call it Do-It-Yourself Medicine.

Hive Mind: Do I keep the cardiologist? Do I stay with the oncologist? What are the odds that the next doctor will be better than the last one? Not good, because it is the system itself that is completely broken. Information overload.

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