the Air Vent

Because the world needs another opinion

Kidney Stones

Posted by Jeff Id on April 22, 2009

I called my doctor cause I have kidney stones pre-diagnosed yet not removed so far. No pain now but it’s coming and I have a few stories for you wusses. Wouldn’t recommend it to anyone except asssmajinidad. The new doc wants me to do an IVP, he’s new cause I didn’t like the last idiot. In the past I’ve had a stone broken up without a IVP. I have to note, IVP’s/cat scans are considered a minor nothing test by the less informed public. I’ve been very lucky with my health, yet I’ve had too many adventures with cat scans for a variety of unrelated reasons. After a dozen trips through the radiator’s you have to start wondering.

Turns out, cat scans involve not too small amount of radiation. Sites I’ve read claim a 1/100 chance of cancer— but according to the web sites which don’t even attempt to specify the possible issues created by not having cat scans, it’s usually worth it. As some of you might have noticed in passing, I make my own damn choices.

So I dialed the doc and got the receptionist Pam. After a few preliminaries, I asked the receptionist/expert in life if I could talk with doc and ask why I needed the test.

Well after she looked up my records in her instantly annoyed office voice she told me – single quote, ‘your doctor recommended it, you just do what the doctor said !! (really that’s what she said and that strong!)

Without pause, she continued in her annoyed voice, ‘ But since you canceled your last appointment for the IVP you need a KUB before you can see the doc again.’

Surprised by this amazing service level, I explained to her, ‘I’ve been irradiated far too many times in my life, I’m not interested in doing more tests unless it’s absolutely required. I’d like to know why I need this test. ‘

The answer came back again surprising and intense, ‘You are a pistol, you just need to do what your doctor says !!

It’s amazing to me that this came 3 sentences into the conversation.

I was an in an abnormally non-confrontational mood for me, so I answered again, ‘No, what I need to do is ask the doctor why?”

‘just a moment’, The receiver went quiet.

After about 1 minute she came back and said – single quote ‘You’ll need to have the KUB, cat scan and the IVP.

I sat quiet for a moment thinking. Now I’ve cleverly negotiated myself into not only into one high radiation test but two high and one minor.

Thinking as quickly as my squeaky hamster wheel would allow, ‘If I need the IVP which shows everything, do I need to go through a cat scan and KUB?”

Deep sigh, “just a minute.” {click} receiver is dead again.

……………2 min

‘Are you there’, came Pam’s voice very clearly hoping for no answer.

“‘Of course”.

Pam said cheerfully and professionally, ‘The doctor said you need an IVP before he can see you but you don’t need the KUB.’

I answered calmly, ‘Thank you that’s good news, but what I need to know is why do I need the IVP. I mean what is the purpose of the test and why is it critical.’ — single quotes because it’s paraphrased.

Pam the wise, ‘The doctor ordered the tests.’

Id the now obvious idiot (you can tell by the name), ‘Yes, I understand the doctor ordered the tests. I need to know why they are necessary….long pause……Ok, fine make an appointment for me and I’ll ask him myself, otherwise let me talk to him for a minute. ” –A clearly unreasonable and frustrated statement from a customer looking for the doc.

‘No, alright,’ hold please — ‘Pam the wise’ went to ask the doc.

………. Two more minutes at least.

‘Are you still there?’ — again obviously hopeful I wasn’t.

‘Yes of course’ – same answer as before.

‘The doctor can see you on May 5th at 1:15. Is that ok?’

‘That sounds good but’ … CLICK!

The receiver went dead. Nothing. My quiet reasonable tone got hung up on. Gotta love the medical field for customer service.

Well now I’ve got a doctor appointment and an Irish temper, what would you do?

I called back, within seconds…..

5 rings 3:30pm and no answer moments after we talked. After a second call, it went to the answering service.

So, I’m wondering. What should I do. As president and co-owner of my own company we’ve decided and implemented a gold standard (incredibly expensive) health care policy long ago. I already know this kidney problem will absorb the maximum out of pocket for the year so money isn’t an issue. So that leaves the question,

1. Should I go to the doctor’s office, tell the private practice doc he’s fired because of the treatment from Pam. (My own preference)

2. Do I phone the doc and explain that I won’t spend my $20,000 kidney stone money there because of Pamie and the idiotic office management? (Easier but less visible to doc)

3. Do I simply request records and move on?

——

Oh yeah, before I forget. In this paraphrased version of my medical adventures in the hideous US medical system. The office proposed a new ‘plain’ cat scan, new KUB and new IVP (cat scan) all non-emergency before the next two weeks.

29 Responses to “Kidney Stones”

  1. Page48 said

    3. Do I simply request records and move on?

    Yep

  2. Page48 said

    You’ll probably have to have all tests re-done at new doc, though. Try to find somebody that isn’t letting the receptionist make medical decisions.

  3. TCO said

    YOu shouldn’t feel bad about moving on, but you might have to get some work redone. If you do move on, they are required to give you your records although they make you fill out a silly privacy form to get them.

    One other option: if the practice has an office manager (clerical, but above the receptionist), might try talking to her.

    I would probably move on.

    Not sure what the big deal is though. Don’t you just need to do the big drink and pass it?

  4. Tom B. said

    Complicated, unfortunately. My wife was in the pharmaceutical sales arena for over 10 years (calling on 10-12 Doctors a day) and has a huge number of anecdotal stories about office staff… The problem may be finding a new doctor. Before you bail on your existing one, you may want to make sure that finding a new one is feasible, many are not taking new patients these days. I asked her, and she said you should likely talk to the Doctor. Most Doctors really want to help their patients, and are willing to listen to them about their staff situation, and if you like the Doctor but not the staff changing may be involve getting a nice receptionist but a less interesting Doctor. The downside is that it will likely make ‘Pam’ even more unhappy with you, and you may end up moving to another office anyway… No good options here, sigh….

  5. BDAABAT said

    Jeff, your doctor is supposed to help take care of you. The doctors office staff are supposed to help the physician help take care of you. So, you need to ask yourself, are you feeling like you’re being cared for right now?

    On a separate note, I wouldn’t worry too much about radiation exposure from medical tests (whether you stick with this doctor or decide to go elsewhere). If you’re going to a imaging place that has new equipment, enormous strides have been made in the technology that have ended up dramatically reducing the dose of radiation. The other thing to realize is that there is good evidence to suggest that the linear no-threshold response model for radiation doesn’t actually match real world data… meaning, it seems from a good deal of biologic and experimental data that low doses of radiation don’t cause the problems that the models would expect (sound familiar?).

    Nice summary here:

    http://radiology.rsnajnls.org/cgi/content/full/251/1/13

    Bruce

  6. BDAABAT said

    Oh, for those film buffs out there, check out the movie, “Repo Man”. It’s from late 1970s-early 1980s, starring Emelio Estevez, Harry Dean Stanton. Terrific, fun, silly movie with a subplot involving radiation. :D

    Bruce

  7. AEGeneral said

    JMO, but if I had lost trust in my own doctor or had to deal with someone like Pam, I’d take my business elsewhere.

    Or there’s option 4, which is cut out your kidney and donate it to global warming research (global warming causes kidney stones). Might be painful, but probably not as painful as your future dealings with Pam are going to be. By now she’s told the whole office about you. Your phone number is on the proverbial bathroom wall.

    Kinda like the nurse at the emergency room near me who asked me how many cigarettes I smoked per day (my kid had a dislocated elbow — so why is this relevant?) I told her it was none of her damn business. You would have thought I had just insulted her mother.

    When we left, everyone in the receptionist area was looking at me funny. No telling what rumor she spread about me in the hour we were there.

  8. andy said

    Go get another Doctor.

  9. Jamie said

    3. Agreed – your doctor should be happy to explain to you why you need a test. Medical/nutritional ‘science’ often suffers from the same problem AGW ‘science’ does – do it, shut up, because we say so (and we’re scared to deviate from the norm).

  10. Kenneth Fritsch said

    Jeff ID, you seem like a person that would charm his way through situations like this one (you put up with a rather consistent nagger on your blog), but I suspect in this case you were a bit anticipatory in your anger perhaps fed by previous experiences. If I were a small business owner paying for health insurance in today’s environment it would probably affect my disposition in a situation like this one.

    I have found that getting into a cordial relationship with your doctor can help in situations like this one. My cardiologist and I discuss the (mis)fortunes of the Cubs and Bears and it makes it easier to ask what might otherwise be awkward questions. I brought my wife along for one visit and she ended up with some free medical advice. Of course, this is the lady who used to make appointments for one of our children, many years ago, with pediatrician and take one of the other children for a two for one — and the doctors thought it was humorous. You probably are not going to change the system or the behavior some bad acting staff so I would work the system to your advantage. Firing your health care provider should always be an option. In fact that is what I am attempting to get my wife to do with her current supplier.

    Complicated, unfortunately. My wife was in the pharmaceutical sales arena for over 10 years (calling on 10-12 Doctors a day) and has a huge number of anecdotal stories about office staff… The problem may be finding a new doctor.

    My visit to my cardiologist have always been made more pleasant by having those young, attractive, pleasant and energetic ladies making their rounds while I was there. Our neighbor’s daughter used to do that work and was source of much good general information about doctors. Those ladies also provide the doctors with samples of those expensive pills to hand out free to deserving/complaining patients.

  11. Keith said

    It is entirely probable that you don’t need the tests, per se, but the doctor needs them for the insurance claim forms. By requesting the tests, he protects against malpractice, gets an additional payday for having requested the tests and then evaluates them, and can then pay off the loan on his Mercedes. Last I heard, kidney stones can be detected and broken up using ultrasound, which doesn’t irradiate the patient.

    If the doctor is so busy he cannot talk to his patient for a few of minutes, and his receptionist is as unprofessional as you say, I would switch in a heart beat. My entire family is in the medical field, and I would expect their office staff to either connect a patient through to them, or if they were unavailable due to business reasons (in surgery, with another patient, etc.), to explain the situation and ask for a number where the doctor can reach you when they are available to explain the situation. And by federal law, they cannot deny you copies of your patient history to take to your new physician.

  12. JAE said

    For Pete’s sake, keep the Dr. if he/she’s any good! It’s neurotic to let Pam run your life. You just need revenge on Pam. Go into the Dr’s office quietly, go to the restroom, and write stuff about Pammie on the wall. Then leave quietly.

  13. page48 said

    RE #10: “I have found that getting into a cordial relationship with your doctor can help in situations like this one.”

    This is “must do” advice under any circumstances; I chat up my doctors in any way I possibly can just so they’ll maybe remember & like me. But it doesn’t always help in a phone situation if you can’t get past the office staff and nurses who sometimes take it upon themselves to “protect” the doctor (keeping calls away from the doc also helps get them out of the office on time.)

    I have a crushed C3 vertebra. Oddly enough, it doesn’t give me much pain most of the time, but if I jerk my head the wrong way and shift or dislodge any of the fragments, inflammation sets in which presses the nerves causing INTENSE pain.

    Last year when this happened, the witch nurse at my neurosurgeon’s office absolutely would not relay messages to the doc for anti-inflammatory meds (I was not asking for pain meds). She kept insisting that I have an MRI first.

    I had had an MRI the year before ordered by the same doc. I only carry hospitalization insurance because I am self employed. I get to pay for MRI’s unless I’m an inpatient. They are very expensive.

    Did I mention that I had had an MRI the year before.

    Oh, guess what – the doctor’s office couldn’t find it.

    Fortunately, my neurosurgeon is married to my cousin so I had no problem getting him at home and procuring the much needed meds. God forbid that I will ever go through the regular channels again.

    Unfortunately, I don’t have the above advantage with all my docs so, if I can’t get through to the doc to at least find out what’s going on and why I go elsewhere. Offices really do differ in access.

  14. Kenneth Fritsch said

    This is “must do” advice under any circumstances; I chat up my doctors in any way I possibly can just so they’ll maybe remember & like me. But it doesn’t always help in a phone situation if you can’t get past the office staff and nurses who sometimes take it upon themselves to “protect” the doctor (keeping calls away from the doc also helps get them out of the office on time.)

    On a visit to see my doctor a year or so ago, I was waiting to see him for what seemed like a long time, but an interesting magazine article prevented me from inquiring. Suddenly out of the corner of my eye I see my doctoc entering the waiting area. He said the receptionist had said I was not there (I had checked in with them) but that he knew I would not blow him off without a call. Get the doctor involved and let her deal with the Pams of the world.

    I must admit though that instinctively my reaction would be to do something not unlike JAE’e – perhaps a little less direct.

  15. TCO said

    Just have sex with some hottie and then wake up in a hotel bathtub filled with ice with a kidney missing. Got an email about this happening a lot.

  16. Having had kidney stones when I was 19, 39 and 69, I would either 1) wait and until I felt the ‘pain’ again (I’m 77 now) or 2) find another doctor.

    As Bill used to say, “I feel your pain…”

  17. Fluffy Clouds (Tim L) said

    I don’t know what to say.
    the office help deal is not unusual though.
    take care.

  18. Ron H said

    Jeff, how you proceed depends on how you feel about the doctor. My preference is for option #1, except if you are pleased with this doctor, you might add another step between seeing doctor & firing doctor. You could tell him of your problems with Pam, & see how he handles it. He should also answer all your questions about the tests to your satisfaction.

    I think many times doctors are busy doctoring, (as it should be) and are unaware of problems in the front office. he deserves to know about Pam’s unacceptable behavior so he can correct the problem. I doubt that he wants his patients treated as you were treated. If he isn’t responsive, then I believe I would request my records & move on.

  19. Fluffy Clouds (Tim L) said

    Jeff, a little humor.

  20. Page48 said

    Hi Jeff – this post is totally off-topic, but I couldn’t find anywhere else to put it. I’ve noticed that some of the commentators have pictures by their names. I’ve looked all over the site and can’t figure out how to add mine. Could you take the time to give me instructions (or tell me where to find the instructions)? Thanks in advance.

    Page

  21. Phillip Bratby said

    I agree with BDAABAT. The LNT model is non-physical and does not validate against data. It is an expedient model which results in billions wasted on unnecessary radiation control, but which nobody will change because it would upset the greens (and would be seen as giving in to the nuclear industry).

  22. Rathtyen said

    For a number of years I had deteriorating health, including chronic fatigue, to the extent that I couldn’t see how I could continue working. The cause was a mystery (I’d seen doctors and specialists) and in the end a friend suggested I see a Traditional Chinese Doctor (“TCD”).

    He diagnosed my problem as loose Gall Stones, with a less-than-optimal liver and kidneys. I had an ultra-sound two day later, and it turned out he was right. My life made a real change at that point, and now, several years later, I’m in the best shape I have been in decades.

    There was an oddity to my condition which deflected the attention of “traditional” doctors from what I would have thought (once I checked out the symptoms) should have been a fairly obvious diagnosis. Yet the specialist who gave me the referral for the ultrasound (I had to have quite an argument with him to get it) assured me at the time the problem couldn’t be gallstones because of its inconsistent symptoms.

    Jeff, your condition is different, but caused by very similar things. What I did to treat my condition (guided by my TCD) was very easy, safe, cheap and effective. It was also slow, so its not for the impatient, but then, it addressed the causes of the problem as well as the symptoms (the stones).

    My doctor and specialist told me the only treatment was to have my Gall Bladder removed (and this is the automatic and standard treatment for loose gall stones, more so than getting kidney stones blasted is normal). I told them I’ll go with what the TCD said, since he was the one who diagnosed it (and without painful examinations….there is a Family Guy episode….), and I’ve never been back to see them.

    The TCD gave me a few weeks of brew to fix up my kidneys and liver, and a type of Green Tea-like drink to dissolve the stones. AND he told me to avoid eating fat, which is what triggers attacks when you have loose gall stones. The loose stones were gone in a few months (I can now eat fat without difficulty). I still have Gallstones, and will have for years, but I get ultrasounds every second year, and they are reducing (and it would be faster if I drank the stuff more often). All I have to do is drink a cup of this green-tea-like stuff a day.

    I mentioned this to a friend who had both gallstones and kidney stones. He was originally from Columbia, and had bought a herbal cure in Mexico which he wasn’t game to try. After hearing my story, he gave it ago, and both sets of stones are shrinking (he gets his checked every year by Ultra-sound). Its slow but steady.

    What I suggest you do is:

    1) Since Kidney Stones, while potentially painful, won’t kill you, treat trying an alternative approach as a nearly-free option to try out (give it a month or two, and if it doesn’t make a difference, rebook a time with the Doc).
    2) Drink more water. Kidney and Gall Stones are made from salts and cholesterol. Improve your diet and exercise, and drink water to flush it out.
    3) Have a cup of green tea (normal, not the stuff I’m talking about above) after every meal. Seriously, give it a try for a week or two and you’ll be amazed.
    4) Try to do an exercise where you stand still, feet close together, and swivel at the hips from side to side with your hands held in front. Its simple and easy, takes only a few minutes, but you’ll be amazed at the results.
    5) Go and see a Traditional Chinese Doctor. The catch here is getting a good one. The TCD I see is really gifted, but like anything else, you might need to shop or ask around. You should be able to get a cheap easy treatment to jig up your kidneys and liver (the liver is central to all these types of problems), and to tackle the gallstones you most likely have (most people do. Its only when they are loose they are a noticeable problem).
    I kept an open mind about what I was doing, and I’ve never looked back. I still find it amazing just how easy it was. Its worth a go!

    All the best

  23. Rathtyen said

    “You should be able to get a cheap easy treatment to jig up your kidneys and liver ”

    I forgot to add this is a brew, and it always tastes vile. Usually really, really bad. But is does work.

  24. AEGeneral said

    Page48 said
    April 23, 2009 at 2:27 am

    Hi Jeff – this post is totally off-topic, but I couldn’t find anywhere else to put it. I’ve noticed that some of the commentators have pictures by their names. I’ve looked all over the site and can’t figure out how to add mine. Could you take the time to give me instructions (or tell me where to find the instructions)? Thanks in advance.

    I think you do it at gravatar.com.

  25. Beware Chinese medicine, it may well work well, but it has been known to kill people due to some of the plants being highly poisonous. Also, would you have much faith in a medical system that suggest an extract of dried tiger penis to treat impotency?
    Ah, the delights of the “Pam”. I was for many years a Medical Rep and had to get past these modern manifestations of Cerberus, jealously guardian “Their” doctor from such inconveniencies as reps & patients. Makes him miss valuable golf-course time!
    Have a read round Medline http://www.ncbi.nlm.nih.gov/sites/entrez for clinical papers on lithotrypsy and such.
    Likely to provide better info on risks.

  26. alan jones said

    You need not concern yourself about radiation dosage from modern diagnostic medical techniques: they are a very tiny fraction of the background radiation your receive continually throughout your life.

    Fifty years ago when they could be as much as a thousand times greater than today there was legitimate cause for concern in some circumstances; for example you did not X ray pregnant mothers if you could possibly avoid it: for Baby’s sake not Mums’.

    The permitted limits for exposure are not intended to protect the individual merely to prevent genetic drift in the population which is why they increase with age: there is of course no permitted limit for medical purposes.

    Given the huge variation in background radiation up until the 1970’s it was thought there was a safe limit which might vary from individual to individual but below which no long term hazard would occur because the body could repair any minor damage itself. After all according to where you live background radiation can vary by twenty times or more without any evidence of ill effects: and the results of the atomic bombs suggested this was correct.

    However in the 1970’s the data from atomic bombs and test was ‘reinterpreted’ to suggest that there was no safe limit. Despite the fact that this idea was somewhat dubious and depended on the use of relatively new computer aided mathematical techniques to re-analyse the data en masse, so it was not at all clear whether the result was statistically valid, it has become orthodoxy.

    The problem is that the data from Chernobyl, the first opportunity to see and evaluate over many years the effect of mass high level exposure using modern techniques, shows the exact opposite. It demonstrates very clearly that there is indeed a safe limit for radiation below which no long term hazard exists: and we can calculate from it an average value for humans which, surprise, surprise, turns out to be a bit above the high end of average background radiation.

    But don’t tell anybody, it might spoil a good scare story.

    Amazing what you can by re-interpreting data with arcane statistical techniques and then projecting them thirty years ahead to create some newsworthy disaster scenario ain’t it?

    Kindest Regards

  27. Fluffy Clouds (Tim L) said

    Green tea is one thing I do here and it helps some, I get it at sam’s club for 11$ for 24(Lipton). I forget what I did for my stones, I am sorry I just don’t remember (20+years ago).
    I do know I drank a bit of cranberry juice, but it may have been just an increase in volume drank that helped. the stones past without any other medical help.
    take care.

  28. Jeff Id said

    Thanks to everyone for the advice. I’m interested in some of the alternative meds this 10mm puppy ain’t passin’ no matter how many whatevers I do happen. In the meantime the radiation thing, I’m rreacting to it mostly because this doc is too free with it. I mean consider that the last time I had stones broken up I needed none of this, I just want to know why. Less risk or not.

    I’m also willing to try any home remedies which make sense. China’s been around for a while, if a KS remedy exists, it wouldnt be surprising that it came from China.

    I’m curious about the Chernoyl data. I have been privy to some behind the scenes info on that story so it’s interesting.

  29. Kenneth Fritsch said

    Jeff, you have not disclosed much of the history of your kidney stones, but I suspect the actions you take will be accordance with that experience. The internet, I think can be a great source of general information in helping you make the necessary decisions in a case like this one, but can also be a great impediment. I always try to find a source that thoughtfully presents the background information and try not to let my preconceived notions get in the way. I have known people to use the internet as source for this kind of information and let it rather single mindedly steer the person down a path driven their prejudices. I think in that latter case, we see some of the worst aspects of the internet – because it will take you where you want to go and then some.

    I thought the link below was a thoughtful piece for me and that does not necessarily mean it will be for you.

    http://www.cigna.com/healthinfo/hw204795.html

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