Shooting in the dark: a personal account of managed care

I had a great relationship with the VA for the first 10 years. I had the same doctor for 10 years and there was great continuity of care. She went on to bigger and better things, and they brought in a new doctor who saw me a few times and then retired. Since then (for two years), I have never seen the same person twice.

Now, the lucky thing is, I'm not sick. I have hypertension and am overweight. I also take great care to research my own health solutions and use alternative care as much as possible. So it hasn't been terribly critical for me, but I wonder about the people for whom it is critical.

I think I may have mentioned before that I became concerned about my blood pressure several months ago. It was worrisome when I was daily staying at 145/95, despite my medication, which is said to be the "gateway to dementia." Then it jumped to 155/105 daily for a long stretch, then 165/115. I was getting scared. I went to see my "doctor" (or whoever was there at the time), and they jumped on the bandwagon and ordered a bunch of expensive tests for me -- MRIs (suspecting to find a stenosis of the liver, they said). They sent me to see a cardiologist. They wanted me to have stress tests.

The cardiologist laughed. After an EKG he pronounced that my heart was in exactly the same condition it was 10 years ago, and that I had suffered no heart damage whatsoever despite my longstanding hypertension.

So the Women's clinic upped my meds -- again -- and I went home. (I didn't go for the MRI -- it was ridiculous to cost them all that money when I knew they were shooting in the dark.)

So after my appointment, I went to see my son & family. I was telling the tale to my daughter-in-law who also knew that I was borderline diabetic (as do my doctors, of course). She listened to my story and said, "I just read an article on Dr. Mercola's site. I'm betting that you're insulin resistant, and the article was about the connection between insulin resistance and hypertension.

So, I went home and took Dr. Cassi's (my daughter-in-law who is just a very wise woman and not a doctor at all) advice to take 2 cinnamon capsules every morning and to start walking. My blood pressure came down 30 points the very first day I took the capsules and walked for 20 minutes. Within 3 days, my blood pressure was normal. Some days it stayed at 116/72.

Okay, fast forward. For 3 months, I walked and took the cinnamon caps (which control blood sugar) and started modifying my diet. Four months in, we had moved to Bisbee, and I was tackling those hills daily. I went to the VA for a follow-up appointment and was shocked to find that despite four months of serious diet modification and ramped up exercise, I hadn't lost an ounce. I was mortified. So one of the doctors (again, one I'd never seen before) hearing me exclaim about my weight brought me in to "counsel" me. So I got all the "calories in/calories out" "count your calories, reduce by 15%" lecture.

I asked her how reducing my calories in half and going from completely sedentary to walking up hill and down 20 - 30 minutes a day didn't work. Her response, "Ah, you probably are only burning 100 calories doing that." But clearly, I could tell by the way she looked at me that she didn't believe me that I was exercising and cutting calories. She then reviewed all my hypertension meds and gave me yet another one.

I came home that night, took the new "pill," and by bedtime, my blood pressure was 180/119. I struggled with it for 3 days, then when it just kept going up and up no matter what I did, I went to the ER here in Bisbee.

The doctor sat down with me and listened to my story. "Do you have a local doctor?" he asked. "You need to get some more personal care." I couldn't deny that the way things were going, to never see the same person twice was not good. "Otherwise we're just shooting in the dark," he said. He listened to me talk about my disappointment to find I'd not lost a bit of weight despite all the modification. He looked at my heart rate on the monitors. Resting heart rate: 48. He looked at my meds list again.

"Here's the problem," he said. "They have you on such a huge dose of Atenolol that no matter how much you exercise, your heart rate is not going to go high enough to raise your metabolism." Now everything started making sense. I remembered when they first put me on the Atenolol and it wasn 't working, they just kept raising the dosage. When it still didn't take care of the problem, they just started adding a bunch of other meds to it. Instead of removing or replacing the Atenolol, they just added to it.

"You need to have them get you off the beta blocker." Two EKG's and blood work later, he determined that I likely didn't need the Atenolol at all. I put two and two together. A beta blocker is for the purpose of lowering blood pressure, stopping chest pain, and giving a greater possibility of surviving a heart attack.

Well, with the two new EKG's and the VA cardiologists assurance that my heart was just fine, I decided that my heart was not at risk and that it was even possible that it was overprotected. I wasn't having chest pain (angina). I didn't take the latest med they had added at all (That would have made 4 different meds). First I stopped my evening dose of Atenolol. When my blood pressure stayed normal for several days, but my heart rate was still only in the 50's and only up to 70 after exercise, I cut out a portion of my morning dose, too. I dropped all together from 75 mg a day back to 25.

When I got back from my morning walk this morning, my heart was pounding. What a great feeling! I took my pulse, and it was at 100. My target heart rate for exercise is 114, so I'm getting there. Two hours later my resting heart rate is 65 instead of 48. That's more normal.

So, the moral of this story? Be your own best advocate. Do your own research. If you have to have care of any kind, find a doctor who sits down with you, who listens to you, who makes connections, who can analyze the evidence before him or her and see what the problem is. I think I would rather drive to Willcox to see this ER doctor a couple of times a year, paying for it out of my own pocket, than continue with the VA for anything major. Don't get me wrong, the VA has been good to me. but when "managed" care means "never see the same doc twice," it may be time to take matters into your own hands -- and by that, I mean doing your own research and getting better advice. True, I took myself off the Atenolol, but I had had my heart tested thoroughly by two different doctors who assured me that it was fine, and the recommendation from the ER doc. I don't recommend you taking yourself off of anything, ever. I'm acutely in tune with what is happening in my body, and I monitor my BP and pulse several times a day.

All the fight going on about the health care bill, managed care, "death panels", etc.? The bottom line is that you know yourself and your body better than anyone. Do your own research, make sure they listen. Making connections is what thinking is all about. When your doctor is not making rudimentary connections with what has gone before, they're not thinking -- they're stabbing in the dark. And know when it's possible that causes can be diet related, lack of exercise, stress related, and yes, even psychosomatic. Psychosomatic doesn't mean there isn't something wrong - it simply means that the cause is coming from something other than a disease pathology. And actually, that's good news.