Bad Doctor/ insufficient testing

[juliemg]

      I'm a 54 yr old female who has been working in a Steel Mill for 2 years (inhaling iron dust particles from constant grinding on pipe, doing the work of 2-3 men).  I've been sick for over a year (nausea, shortness of breath, extreme fatigue, chest pains, etc). My episodes of severe shortness of breath &chest pains for several months are getting progressively worse (& I'm still nauseous, tired & weak).
       I had a treadmill stress test done and lasted 3 1/2 minutes out of the 10 before experiencing shortness of breath and chest pain.  My P.C. doctor wanted to stop the test and I told her I could finish it if I needed to, as I go through much worse all day at work... to which she said "absolutely not?" and stopped the test and referred me to a heart specialist.  
      I saw a one who had an angiogram (catheterization) done Jan 26, 2009.  From the beginning I've been unhappy with this doctor (HS)... he doesn't listen, doesn't allow me to say/ask all I need to before he interrupts. He acts indifferent and seems to just want to do "minimum;" of anything (including "time").
      After the procedure, he merely said  "your arteries are clear" and suggested I'm merely suffering from heartburn.  I said I  have had heartburn maybe 5-6 times in my entire life and this is not it... so why am I still sick & what can I do about it?  He said to have an echocardiogram and a "24 hr monitoring system" done and didn't stick around to explain.  Feb 4 is the day for that.
       I called his office for more details.. turns out he's only doing the 15 minute Echocardiogram (rather than the stress Echo.  Wouldn't the Stress Echo be more effective/thorough?  What would that & 24 hr MS reveal?
      I tried to change doctors, but would have to wait another 2 weeks just to talk to her and then schedule the tests.  My job is putting pressure on me and  I'm afraid to go back to work (and lose my job & health insurance because I can't physically do it anymore) before I find out what's going on.
   I'm in a terrible dilemma and welcome any ideas, suggestions and help,
Thanxz much!  Juliemg

[juliemg]

Thank-you,,, I will persist.  Hopefully the Echocardiogram and 24 hr Monitor System will prove I'm not imagining things or just have "heartburn". I'm researching Healthgrades for a competent Lung Specialist also.
Your email address did not come through... something to do with security on this forum, I guess.
   So, after it all, are you feeling "normal", or rather healthy & fit now?  What types of treatment did you have?
Thanxz much,

[kenkeith]

A good doctor would screen a young patient who has relevant symptoms with a family history of heart disease.  The CT scan 64-slice angiogram would look at the arteries from the inside out and it provides a calcium score.  It is quite accurate in an assessment of the vessel configuration and the degree of calcium buildup that may have unfavorable future consequences to serious occlude the vessels as well as rupturing through the inner lining causing a clot and a heart attack.  

The CT scan also includes and assessment of the respiratory system as well as the thorax looking for an embolism (clot in the lungs...could cause chest pain, breathing problems, etc.) and the descending aorta for aneursym or stenosis.

You should not live with your symptoms without proper treatment and correct diagnosis.

[juliemg]

P.S.  what tests finally determined what was wrong?  Were they ones that had already been done, but misinterpreted?

[juliemg]

Hi,
I live in Portland, OR.  I hear they have great cardiologists here, especially at the University hospital OHSU, but I have to figure out how to go about doing the "2cnd opinion" deal, and find a doctor I can trust. I can trust.  I have trouble with my BCBS insurance not paying all they should on my med bills.
Sounds like you have been thru the ringer as well. I know I should trust in God, but I feel I need to educate myself as much as possible... and am getting overwhelmed with all that's on the internet.
My intuition tells me this is serious.  My Grandpa died of heart attack at 52, my dad had heart attack at about 48, his brother had a heart attack in late 40's.  I tend to take after my Dad.  I just want to know how to take care of myself without becoming homeless with no insurance & healthcare and dying anyway in the process.
    Uhoh, now depression is setting in as well.. how did you deal with that?
  Thanks again,

[emaillmr]

     Completely understand your frustration.  I had not felt good for a few years.  Saw several doctors, admited to several hospitals, different diagnoses, medications. I got worse.  I left the hospital AMA (Against Medical Authorization) they were not happy with me but I know my body and what ever was wrong was getting worse.  

Wednesday 02/20/08 4:00pm, sitting in the car not knowing what to do thinking (money, doctors, co-pays...) I called The Cleveland Clinic Cardiology department.  Gave them a short version of my health issues. Friday 02/22/08 9:00am saw cardiologist, explained in  full detail my history, how I felt, "I know my body better than anyone. Something is wrong"  God must have been watching over me sure enough SOMETHING WAS WRONG, VERY WRONG.

The Cardiologist walked me to admitting and said "get your "things" in order and eliminate all stress". Was admitted Friday 02/22/08.  diag: Hypertrophic Obstructive Cardiomyopathy.  Thursday 02/28/08 open heart surgery-myectomy with valve procedure

When it comes to the heart The Cleveland Clinic is by far "THE BEST IN THE WORLD" they don't mess around or worry about how they're going to get paid.  Doctors are there to save lives, not pick and choose based on who pays or can pay.

Do you have access to Cleveland Clinic?  If not where do you reside?  Can completely understand!!!!    feel free to e-mail me:   ***@****






    

[juliemg]

Thanks for your reply..
      I had rheumatic fever as a baby and a heart murmur (was never diagnosed as serious or to be a problem).  I do have rhythm problems also... palpitations &/or chest pains whether active or lying down, & heart-rate skyrockets upon exertion. I tried to make my doctor understand that, but he just doesn't listen.
      I work at a steel mill standing & grinding with a 30 lb grinder for 9 hrs/day... lifting it from waist to over my head.  It used to tire me out some, but it's been getting progressively worse so that it's all I can do to lift the tool anymore, much less grind . I'm really afraid I'll die doing it if I have to go back to work without my doctor finding out what is wrong and setting restrictions and/or backing me up.
      He scheduled me for the simple 15 min Echocardiogram rather than the intensive stress one.. which I think I need.. but how do I demand he do the the test I want?   I'm the patient, but I can't get him to hear me.  It seems he just wants to do minimum on everything and get the $ and never mind about me.  

[kenkeith]

If you can't last any longer on the stess test than a few minutes, you require treatment for a serious condition.  If it is your heart working through angina episodes can cause serious damage...namely heart cell negrosis (not reversible), and that would lead to heart failure.  

A stess test would be appropriate, and the doctor would be able to dtermine the degree of impairment, if any, and a safe level of exertion for you.

Based on the information that is posted, there doesn't appear a reason (no rhythm problem!) the 24 ms, and echo could determine if there is any heart damage and a possible cause for the shortness of breath.