My sweet son (Dougie) just brought me my lap top. At the moment, I’m writing from this lovely place. It has been one long misadventure … and I honestly don’t know whether I should be laughing, or crying.

When I saw him on Monday morning, my new doctor refilled my hypertension medication, and gave me something for my UTI. Well, I know that if I stop taking that particular HTN medication for more than a few days, and then restart it, it always hits me really really hard, and I spend most of my time sleeping until I start getting used to it again. Well … that, and the fact that my worry about the dosage on the antibiotic was right on … got me into deep doo when I went for my stress test.

When I got to the hospital, I warned the fellow that was about to do the test that I had just restarted an HTN med, and that I was light headed. Fine. No problem. He tried taking my (usually skyrocketing) blood pressure, and he couldn’t hear it. He said: “I can see it, I think, but I can’t hear it!” … He went out to get another person to come in and try, and she said the same thing. They then brought in the cardiologist on call … and he said: “Hmmm. I can’t hear it. I think I can see it, but I can’t hear it.”

By this time, I wished I’d either stayed home, or not taken the darn pills. The cardiologist scratched the test, and decided that he wanted a nuclear stress test instead, and for me to have it done today. In the meanwhile, he sent me down to the ER (augh!!!) because he wanted them to give me an IV to bring my blood pressure back up. I kept telling everyone that it was fine … it would pass on its own, it was just because I was just starting these particular pills over again. No one seemed to care about that. I’ve been through that scene at home on various occasions over the years since I’ve started with that med … it’s nothing new. I was not happy to end up back in the ER again.

Anyway, once I was down there, they started the IV, and she put it inside of my right elbow. I told her as she did it - “I’m glad I’m not staying, because I would not want it to be in that spot if I were!” That’s when I jinxed myself, methinks.

After she set me up, she said: “The doctor will be in to see you shortly.”

If I could have sat bolt upright, I would have. I squawked: “WHAT? I’m not here to see a doctor. I just SAW a doctor!”

She replied - “Well, everyone who comes into here sees a doctor.”

And that was that.

Anyway, I became a bit of an attraction in there, since I’d been there the morning before, if you recall. The fellow I’d seen then came in and wished me well … so did the nurses.

My heart skipped a beat as I saw Dr. MacCauseland walk in. I’m actually going to name this guy, because he’s got to be one of the nicest people alive. It was the second time I’d ever seen him. The first time was also in March, back in 2004. I had just been diagnosed with HTN and CRF the October before. I had developed a rather nasty kidney infection, and my nephrologist sent me to the ER … where I ran into Dr. MacCauseland. He admitted me that time, too. Lovely man. *cough* ;o)

The long and short of it … my already high creatinine had climbed into the 4’s (which I’m sure was due to the antibiotic,) and no one wanted to take a chance that the hypotension was due to the pills … and so dear Dr. MacCauseland told me:

“I don’t want to let you go home, and I’m conservative about this sort of thing.”

I reminded him that it was the second time he’d done it me … I’m not sure how conservative he really is! *LOL*

Once I realized that I wasn’t going to talk my way out of this one, I looked ruefully at the needle inside of my right elbow … and caught the next nurse who came in, a lovely gentleman, and asked if he would please be kind enough to find someone to move that darn thing into my hand. He gladly accomplished the task himself. I was just about ready to be shipped upstairs.

There was stomach churning moment when they wheeled me into the room which is immediately next to the one I ended up in on that fateful October 2003 day when they admitted me for the 280/160 blood pressure for the very first time. I was there for almost a week. If I were allowed to look out the window, I’m sure I would see Central Ave. in Dover, since that’s what I could see when I spent a lot of long moments staring out of the next door window. However, they’ve given me a cute, special little yellow bracelet which means I’m not allowed to run around without permission.

They plopped me into a bed that moves by itself (ack!) … and put little boots on me that puffed up and gave me foot massages all night. That part, at least, was nice. So were all of the superheated blankets, because I’m awful chilly-willy. Thus began a long, long night. You never get to sleep in places like this.

They’ve done bloodwork every 6 hours, and this morning they did a nuclear stress test, a fifth EKG, and an echocardiogram. My creatinine is back down into in the 3’s, and I’m raring to hit the trail! I’m just waiting on the lovely Russian lady hospitalist to spring me.

This was quickly written … on a WIFI connection which is almost non-existent. I haven’t done my usual reading and re-reading, so please excuse the typos. When I wrote the “Testing the Waters” post, I had no idea that this was going to be a series. *sigh* ;o)

—

Quickie addition …

My lovely doctor came in and told me that she would like me to stay until tomorrow morning to make sure my numbers continue to go in the right direction, but since she’s sure that she wasn’t going to sell me on that one easily, she would let me go under certain conditions. YES! :oD

I’ll do my very best to be a good girl … just let me out of here! *LOL*

Anyway … I called home to ask for a ride, and was told that someone had sent me an edible greeting (bouquet?) of some sort. He told me that he can’t find a name on it. Since I’ve only blogged about what’s happening, and none of my family or local friends know, I suspect it’s one of my very kind, thoughtful readers. I wish you’d let me know who you are! At the very least, I want to say thank you. That’s awfully, awfully sweet of you. Unless I’m going out to eat, fruit is my main fare … so you either already know me pretty well, or you made one heck of a good guess. I assure you that I’m going to go home and demolish the lovely piece! :o)

Next post will be from my nice warm water bed! Now I have to catch up on my school work … I have a really gnarly lab to pass in, and a midterm to take. I’m afraid that I’m at a disadvantage, because I’ve missed both of my live lectures this week. Ah well … I’ll have to do a bit of catching up!

Well, I didn’t chicken out … I actually did go. Had a heck of a time making it happen, though …

I usually start my day very slowly. I might be awake really early, but I’m not running up and down the stairs. This morning, I woke up at 5:30, and tried to go from 0 to 50 right off, and it didn’t work well. That, added to the fact that I was getting ready to do something which made the rest of my hair want to go white … made for an interesting morning.

The stairs to the bathroom always leave me winded, and this morning, it seemed a bit worse than usual. I blamed that part on the hour, and not being able to lounge for the better part of the morning without having to get too active. It was not only a bit worse than usual, I guess … it was a lot worse than usual. I was also nervous. Made for a bad mixture. Worshiped the porcelain god for a while … it was an inauspicious start to my day.

Once I was finally presentable, I sat with my lap top, in my PJs. At 6:30 I thought - “I really should get ready to go.” At 6:40 I thought - “If I don’t get going soon, I won’t be going at all, because I won’t have time to get dressed.” At 6:45, I was still sitting there, with 15 minutes left before I had to go out the door. I wasn’t dressed, didn’t have my contacts in … by this time, I was having a bit of a problem with “fight or flight.” Flight was winning.

An email made a chiming sound as it hit my inbox, and I looked to see who it was from - one of my very kind blog friends, with just enough empathy in it to tip me back over in the other direction. I got up, dressed … and tried to leave. No car keys. I investigated my husband’s pants pockets … nope … I finally had to wake my son … yup. Car keys in hand, I headed out into a crisp, frosty morning, and almost busted my kiester on the ice before getting into the car. When I got in, I realized that I was encased in ice - there was no seeing out of any of the windows. I had to get back out and scrape windows, hanging on to the car as I did, because the entire area was icy and uneven.

Heart pounding, I got back into the car, started it, and saw that the gas was on empty. Folks … I almost went back into the house at that point. When that car says it’s on empty … it’s empty! I’m one of those really anal people who can’t stand the idea of being late, and I always leave myself a lot of time … however, this time I had waited until the last minute to dress, gone on a key hunt, had to scrape the car … there was not going to be enough time to stop in a gas station. I just had to hope I could get to where I was going.

The gas did get me there. It’s a huge building - full of physicians’ offices and labs. I’ve seen two other physicians there in the past, and had an idea of the layout, but knew that it could take me a while to find the right place. I arrived at the desk of the right office without an extra second to spare. Not the way I like to do things!

Of course, I was given the usual forms to fill out, but before I could get a page done, I was interrupted by someone who wanted a specimen, since they knew I had a UTI from my phone call. That done, I was immediately ushered into an exam room, weighed (10 pounds less than I thought I weighed! w00t! ;o) … BP’ed (not bad at all! I think it was about 155, but the diastolic was higher than usual when my BP is that low) … and allowed to continue filling out those awful forms. I got another two words written … when there was a tap at the door.

My moment of truth had arrived! *LOL*

The gentleman who walked in was handsome, well presented, and spoke with a lovely English accent. The first impression: he charmed me off my feet! Good start. Although my first impression was never shattered, things went downhill from there. He asked questions that I wasn’t well prepared to answer, but I did my best. Answers to some of the questions made him want to do an EKG … and he had one of his nurses do just that. Afterward, he showed me some of the places on the EKG which he didn’t like, and much to my horror and dismay, he wanted me to report to the emergency room, and be quick about it, too.

All I could think was: “Oh poop! Here we go again!” My first visit with the last fellow ended up the same way, only I’d refused to go. It took him 2 days to convince me. *cringe*

Today however, I just did what I was told the first time … sort of in a haze … but I did it. The hospital is 1/2 block from the offices … so it was a quick jaunt.

The nurse was kind enough to put in the line in the back of my hand instead of the inside of my elbow. The latter wouldn’t be a problem for a few hours, but it’s an absolutely rotten place to put an IV if you got yourself a conscious patient who’s going to have to hang around for a while.

They did another EKG, hooked me up to a monitor, did chest X-rays, and a renal ultrasound. I have to go back tomorrow for a stress test. I’m also supposed to call the nephrologist’s office … (”Dr. Simper is the one who replaced Dr. ExNephrologist, and we want you to make an appointment with her …” *sigh*) a Cardiologists’ office, and my new Primary care in the next few days.

There was a bit of news that I was surprised to hear, because I didn’t think I had been doing that badly, but apparently my creatinine has gained a bit, more than a full point and a half, since my last labs in November. The ultrasound showed no blockage this time, and that led the ER doc to tell me that he thought my kidney was deteriorating. That wasn’t particularly reassuring.

Anyway, I dragged into the house late in the afternoon, and sweet hubby ran out to get my prescriptions - for the HTN, and for the UTI. My only concern now is that I don’t remember what my old Nephrologist told me about that particular antibiotic. During one visit with him, he had said that he thought my other doctors (PCP, and two urologists from different hospitals) were trying to “do away with” me with their choices and dosages of antibiotics. Beginning with an already elevated creatinine, I hope that’s not the case this time.

And so, there you have it. I’ve been seriously considering changing primary care physician since early 2005 … and now I’ve actually done it. My first impression of him - is positive, but how things work out remains to be seen. I need to be able to overcome my panic at the thought of actually getting nose to nose with someone and admitting what’s wrong … and he needs to be patient with me while I struggle with myself to accomplish that.

Now - I climb aboard the rollercoaster one more time. I’d gotten away from doc’s visits and monthly lab work … periodic extra tests … the referrals to specialists … trying to tell strangers things I don’t tell my closest friends and family. Hope this latest ride isn’t too awfully wild …

Thanks for all of the encouragement. I’m still not entirely happy with myself for putting up these two posts, but the feedback has made it all worthwhile.

Last summer, I wrote a post - A Tale of Two Offices - in which I asked all of my blog friends on both sides of the medical fence for advice on what to do about a PCP that quite literally gave me hypertension. I received a load of great advice from so many of you …

… but when it came time to actually following the advice, I simply didn’t have the courage to follow through.

Well, in the span of time between that post, and this one - there have been some serious changes … and although I’ve been reserving this particular type of topic for my private journal rather than my public blog, I thought I would try to fill all of you in on some of the changes, their consequences, and decisions that I’ve finally been cornered into making.

First of all, my nephrologist - who was the only physician I was seeing anymore - quit. The last time I saw him was in November. He had a lady with him when he came into the exam room, which was a first … and I immediately knew that something was up, but I wasn’t prepared for what. People, I do not like to see extra, or unexpected, “warm bodies” in the exam room. It makes me want to remove my own warm body from the scene post haste.

He introduced the lady as a fellow nephrologist, and proceeded to announce that she was his “replacement.”

Replacement???

He continued: “I’m changing jobs.”

Puzzled, I echoed: “Changing jobs?”

“Yes!”

I imagined him selling cars someplace in Portsmouth, and tried hard to shake the image out of my befuddled brain as I asked: “To what?”

“Hospitalist. I’m going to be a hospitalist.”

This from the fellow who was so down on hospitalists less than a year before … who bemoaned the direction primary care was taking, and mentioned on more than one occasion: “I used to run into Dr. A**** at the hospital, but now none of them ever go anymore.”

Yah … tell me about it. My long time readers know how I feel about ending up with a hospitalist …

Generally, this fellow did all of the talking during visits, and I seldom had anything to say besides quietly trying to answer his questions. I certainly had never raised my voice, or lost my cool … or, well, you get the idea. This time, I nearly bellowed: “You’ve got to be kidding!!!”

He looked a little sheepish, and admitted that he’d never liked the idea of hospitalists before, but … yadda yadda … he had some good reasons for doing it. I couldn’t fault him … but I didn’t have to like it.

At the end of the visit, he shook my hand and said: “Come to the cafeteria at ***** hospital, and we’ll have coffee!”

Without batting an eye, I replied: “I’m going to take you up on that.”

A momentary flash of surprise showed me that he hadn’t expected that response. *snicker* Actually, that visit ended up being the one in which we focused on him, and I think I did more talking than I’d ever done since I met him - mostly in the form of questions about his chosen path.

I haven’t done it yet, but a bit later in the spring, I will call him, and try to meet with him. He’d never heard of blogs, but I’d sure like to do a podcast interview about his trade of a successful nephrology practice for a hospitalist’s job, and post it on this blog. I hope he agrees! You’ll know about it if he does. :o)

Just as my (now ex) nephrologist walked out of the room, the lady doctor who’d been with him came over for a handshake, and as she took my hand she actually simpered … I tried to control my eyebrows as they flew to my hairline, and attempted to glue themselves into place. The hand she proffered was limp and cold, and made me want to take her pulse. The though that crossed my mind: “Uh uh … this is not going to happen.”

I didn’t allow the desk to make an appointment for me until I’d had a chance to think things through. I thought of going to see a different nephrologist in the same practice … the one my mother-in-law was seeing. She had bright shiny things to say about him, and he sounded like a good person. However - within a month of my nephrologist announcing his departure, this fine fellow did too. He’s now in Texas, nearer to his family.

That narrowed the field substantially. That left Dr. Simper, and one other fellow who was rarely in the office which is nearer to me. I would have to be willing to drive to Portsmouth to see him, and if there were an emergency, I would probably end up with pot luck.

I was supposed to have my visit in February. It came - and went, and I still hadn’t decided on what to do. Meanwhile, my meds were running out on me … and so were the prescriptions.

Deep breathing exercises, anyone? Believe me, they’re not as effective as they’re cracked up to be.

Last week, I tried to fill the real “workhorse” of my hypertension pills. It was past the final date, and the pharmacy offered to call the nephrologist for a refill. I got a call from the nephrologist’s office … they wouldn’t fill it. I hadn’t been there in February, and as far as they could tell, I wasn’t seeing anyone there anymore. Did I want an appointment with Dr. Simper?

Um, no.

The long and short of it - by the time I hung up, I was no longer even loosely attached to any doc’s offices.

That meant no pill refills. It also meant that the UTI I’d had for the last month or so was going to be around for a while.

I considered calling my old PCP and begging them to refill the hypertension meds, but I knew that if I did, he would insist that I come in. Maybe someday, I’ll spell out all of my reasons for not wanting to do that, but for now you’ll just have to take my word that I can’t fully trust him, and I can’t communicate with him, although as I’ve mentioned before, I like him as a person. I’m not saying I’ll be able to communicate any better with anyone else, although I’ll certainly want to try, but there have been so many miscommunications, and things are now so complicated, that I think both he and I would agree that I should look elsewhere.

Over the week, I took stock of my situation. I have stage 4 kidney failure and a UTI, really wild hypertension that the meds don’t always control - the systolic’s been in the lower 200’s off and on for the last week, a PTH that tends to bounce way up, and then way down, other secondary problems … I’ve slowly run out of my meds … and finally found myself without a physician. None. Nowhere to turn.

This was it. The moment of truth. I was going to have to find a new place to go.

Now for the rough part … warning: I’m going to be a bit “naked” here …

I do not not not do well with the physician/patient venue. Baby, I can get on here and write my heart out, but when it comes to the nose to nose stuff, I’m a wilting lily. The very idea of sitting in front of someone who is focused on me, and trying to be open and upfront about the things he needs to know … are enough to make want to run and hide - or worse. If I can write things down for him, great … but then if I have to be there, in the silent oppressive room, as he reads what I wrote … I’m likely to go ahead and have a stroke right then and there, and save him the trouble of having to deal with my issues.

There’s a reason that I feel like that, and now finally I know what it is. I’ve had an ever growing realization since January 8th of last year. The first part of the Emanon’s Journey blog touches upon it, but doesn’t delve into it. I have one more chapter to write before I get to that subject … it’s what that blog is really all about.

They say that knowledge is power, and I’m sure it is. However, even knowledge needs a handle in order to be useful. You have to know what to do with the things that you realize.

A few days ago, I grabbed my courage in both fists, and called a new physician’s office. They told me that the doctor is accepting new patients, but that there always needs to be a “getting to know you” visit first. The earliest date, they said, was sometime in June. I imagined myself with a painful UTI and no HTN meds until June. I started to explain that I had a few extra issues, but before I could get into it, I panicked and hung up.

In shock at what I’d just done, I stood there quivering, squeezing the poor telephone as if it were a poisonous snake, wondering what to do next. I’m telling you, this sort of thing does not come easy for me. After about half an hour, I made myself call the number again, and go through my list of issues, asking if there were a way to have that initial visit just a bit sooner. Humiliated to the core because of the ridiculous, but uncontrollable, shaking in my voice, I gratefully thanked her when she found me a spot sooner - much sooner.

And so - tomorrow is going to be an extremely busy, stressful day. I have to be at the new physician’s office at 7:30 in the morning. I honestly don’t have a clue of what I’m going to say to him. I’m hoping that I can actually go through with it. I need to go through with it. I know that we’re going to be checking each other out, and I find that as the years go by, it’s harder for me to keep a light exterior and bluff my way through that sort of thing. I can’t help but wonder what he’ll think.

Tomorrow is also my husband’s birthday … and the day I take care of the bills … and I also have a midterm this week. Honey, I’m going to need those HTN meds! *LOL*

If I don’t write about how things went, you’ll know that one of two things happened:

1) They didn’t go well …

2) I chickened out …

Wish me luck, eh?