Re: saw

From: Christine M. Smith (
Fri Jun 18 21:03:45 1999

At Fri, 18 Jun 1999, Peggy wrote: >
>Hello everyone,
>I saw my gyn today and he told me that he is very frustrated with the
>pain being back so severe so soon after my last surgery{6 weeks ago}He
>now wants me to see the G I Dr. again to rule out anything with the
>bowel and intestines,And is sending me to a urologist and chronic pain
>specialist.The problem now is getting the referrals from my primary care
>physician.I called them today to ask for the referrals and told them
>that if there was a problem I would like to talk to my P C .THe triage
>nurse called me back a short time later and ask me who was sending me to
>these specialist and why? I told her what is going on and she told me
>that my gyn needs to send them a note telling them Why he wants me to
>see these Drs.,THen they would decide if I needed to see all of them.I
>have to wonder what gives them the right to question what a Dr. wants
>done? The last time I needed a referral they gave me a big run a
>round.You would think I was asking for something personnal of thiers.I
>did get the report from the last surgery which showed thin filmy
>adhesions tenting the bowel and dragging it downward the descending
>colon.There were multiple adhesions of the epiploic appendages and of
>the sigmoid colon tenting this up and fixing it anteriorly and then
>these adhesions went down the pelvic brim around posterior to the area
>of the symphysis and up to the area of the right ovary .No wonder I was
>in such pain.My gyn was very sympathic.He told me he wished he had a
>magic pill that would take away all the pain.Any advice on going to any
>of these Drs. would be appreciatted.

Hi Peggy: This is the way it is with managed care. I don't have an HMO but have what is called Point of Service. I can go out of network (needs no referral) but they don't pay as much, so naturally it's good to get a referral. I've had the same insurance company since 1977 and in July 1997 they started to require a primary care physician and referrals to specialists. I hadn't seen my pcp in 4 years so I called them up and they told me they didn't even consider me a patient any more and I had to reestablish myself! Then I asked if I would still be allowed to see my gyn that I have seen for TWENTY years and they said "maybe", it would depend on what the doctor thought. And I had to ask each and every time. Well, I didn't like this at all! I decided it was best to be cooperative but firm. Establish a good relationship with the pcp and I think he will be more likely to make referrals and if he seems unreasonable, then change pcps. My pcp gave me a referral to my gyn without any problems. I didn't really ask, I just said nicely, Oh, I'll need a referral for my annual gyn exam. I even needed a new doctor because my old one retired because of illness. Some states have a law that says an insurance company can not deny access to an ob-gyn. I'm waiting for maine to pass this law! As far as your adhesions and the problems they have caused, would you believe that some people have all of this with no symptoms? I've had my adhesions (the ones I had at the last lap, I'm hoping they're not there again) for at least 12 years and maybe as long as 20 and they didn't give me any problems at all until 2 years ago.(this is one reason why I question if my current problems are really adhesion problems) I had a lot of what you described. The left colon was adhered to the omentum which was adhered to the side wall, the sigmoid colon was pulled over to the right pelvic wall and stuck there, and folded back on itself at one point, plus stuck to the anterior abdominal wall. The colo-rectal specialist I saw said that some peoples' colons look like they are tied in knots and they have no pain from it. The surgeon said you wouldn't believe the messes we find when we go in and the patient never complained. I'm not saying that I believe adhesions don't cause pain, but it appears that in some people they do not, even those who have a lot.

Chris S.

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