Update: Sinuses, ENT, CT and me....

Update to Is it AI or just electrolytes? Or thyroid? Or an infection? :

My ENT scoped my sinuses last week, at least those front ones everyone can see. Since I've recently had way too many antibiotics and still am having major headaches with facial pain with bouts of AI, he decided to send me for a CT scan instead of more antibiotics.

Normally, that would be no big deal, but with Cushing's I've developed a slight phobia about enclosed machines with a "bore". (Yeah, especially those loud ones with the initials MRI stuck on them.) Not to mention I'm a "hard stick". Thankfully, I knew the CT wouldn't be the torture of an MRI.

In order to get the CT done, my ENT's office had to call my insurance to get a pre-authorization code. Supposedly they were going to pass it on to the facility (in the same network of practices) who did my CT scan. Yeah...you are getting ahead of the story, but I bet you know what happened there....

My appointment was at 7:45 this morning. With early morning traffic, it takes me about 30" to get there, so I left at 6:45 anticipating the sign-in procedure, etc. The traffic was actually a lot less than I anticipated, which means I managed to arrive by 7:10. With my trusty jacket and book in tow, and making sure my insurance card was in my wallet, I headed into the building. NOT! It was locked!

Ok, is there another door? (No signs, no nothing.)

Do I have the wrong place? (It's what my appointment card says.)

Hmmmm....ah...I see someone!

"Excuse me, sir, but where is the entrance to imaging?"

The nice gentleman, who turned out to be a security guard, said, "You are standing at it."

I'm sure my look said it all. He sheepishly and quickly said, "I'm not allowed to let you in before 7:30."

I'm sure my look said it all, again. I learned them well from my mother and had practiced them for years on my own daughters. (Love you, Mother!)

He assured me he would be back, and sure 'nuff, left me there standing outside that door! Pretty soon there was a line of folks, which really made me feel a bit more secure. They seemed to already know the doors didn't open 'til 7:30. Why didn't I know that?

The nice man magically appeared at 7:30 on-the-dot to let us in, and I headed to the registration desk as fast as my short, round legs would take me. Hey, I learned that from my mother, too! Plop! I was in that chair waiting her with my insurance card, appointment card, and information sheet all ready for the lady behind the glass. She was courteous, moving right along when everything came to a standstill.

"We don't have your pre-auth."

Yeah, she got one of those looks. "My doctor's office was supposed to make sure you had it." They use the same gosh-darn computer system. How hard could it be? (Rhetorical, ok? I know...I know...)

"Well, I have to go all the way out and get it and go all the way back in again..."

Another look. (What's taking you so long....do it already)

"...or we will have to reschedule."

WHAT?? No way. There is more going on in my life than CT scans.

"Please look it up for me. I'd appreciate it." Why did I have to ask? Ok...I asked. She did it. Uh, let me rephrase that. We waited while the computer "searched" and did it. Eventually. After we looked at each other, the walls, the floor, the ceiling, each other again, she the front of the monitor, me the back of it, and I was too sleepy to make small talk. Finally! She got it. I was done. I got my forms, paid my co-pay, and turned to leave.

"Do you know where to..."

I was gone. Off. Out-the-gate. I knew.

At the "finish line" I handed the nice lady in "imaging" my forms I'd parlayed so hard for and she asked me to have a seat after asking me my birthdate a few times. Ok, so it was early. She was just on her first cup of coffee and she was interrupted by about 5 people in the midst of all that. I'd have done worse, myself. I think she must be the one who keeps everyone where they are supposed to be, because I heard her voice everytime anything got done.

I didn't have to sit very long, actually, before I was escorted to "the room". I measure time by the number of pages in a book I've read, and I'd read about ten pages. Not long.

The tech asked me if I'd ever had any sinus procedures. I asked her if transsphenoidal surgery to remove a pituitary tumor counted.

"That counts." Scribble, scribble, scribble..... "Have a seat on the table until I finish warming up the scanner and write all this down. When did you have your surgery?"

"December 2006."

I can't remember everything that was said, but I do know she was curious and asked some questions. She wanted to know if sinus infections were a concern due to the surgery. The short answer is "yes". I hope there is not going to be a long answer. She winced when I described the surgery (at her request).

She asked me to lie on the table on my stomach and put my head in a cradle of sorts. No problem. I was just starting to get a bit nervous when she said, "This will be over quickly." That's what they all say.

What, no contrast? Yippee!!!!

Whirrrrrrrrrrrrrrrrr....click, click, click....

"You are done."

What, done? Already? I didn't have time to get nervous. All that for a 5" procedure?
"What time is it?"

"8:10"

I almost felt like I'd not gotten my money's worth. ;)

(Note: The CT scanner was a newer one which took multiple slices during one rotation. It really was quiet and quick.)

A neverending story....

.....

I really am not a doctor basher. Oh dangit...I don't want to be, anyhow. But I know I'm not the only one who seldom finds a doctor who sees the whole picture. Yes, it's "just" a sinus infection. But it's more than that to me. Here is the letter I wrote today about my experience, with names hidden to protect the not-so-innocent:

I am a patient of Dr. M. This is not about her. However, I did see her on June 13 for a sinus infection which included a very bad headache and sore, painful areas below and above my eyes which worsened when I chewed, plus pain all the way to the back of my head. She did concur and prescribed 5 days of levaquin. Since I had transsphenoidal endoscopic surgery to remove a pituitary adenoma several months ago, a sinus infection is doubly concerning. I have fought sinus infections for years, and use preventative measures. However, I feel I need to be seen by a professional when I can’t get rid of it or control it with no antibiotics.

The levaquin did work for me, but it took about 4 days before my sinuses loosened up enough for a little of the “crud” to start coming out. I went out of town for several days, and returned late yesterday (Friday). My sinuses have closed back up, are very painful, and my terrible headache is back. I thought it would be better to see someone today rather than wait until Monday to try to catch this before it got worse. I felt like, and still feel I did not have a long enough course of antibiotics. I am not trying to play doctor, but I do know how my body acts and am not stupid.

I saw Dr. X at the urgent care on ***** Avenue. I went there because it is also where Dr. M works during the week and thought it would be a continuance of care rather than starting all over. Dr. X said my right sinus was very congested and my left was fairly congested. However, since the levaquin didn't work, he said it had to be viral and I needed to use Flonase. I refused the Flonase and told him I knew I could not use it but could not remember why. He then wanted to put me on sudafed and steriods. I politely refused both telling him I could not take the sudafed due to blood pressure issues and I was already on steroids due to adrenal insufficiency from my pituitary surgery. I am trying to wean off of those, but adrenal insufficiency, especially when magnified by an infection, makes it tough. Well, he was very unfriendly/antagonistic, did not want to listen to my explanation, and told me I could just wait and see Dr. M. I was in tears. I told him the levaquin was starting to work, but I just needed a longer dose, I thought. He said I didn't need to "just be taking antibiotics to see if they might work". I was furious but courteous. I told him that I never "just took antibiotics" and took very few of them compared to most folks. He was not interested in any of my history. He walked out on me! He said, "You can get dressed and leave." I was never discourteous and I did not deserve that type of management.

As for the Flonase, GlaxoSmithCline, Inc. include the following in their studies:

Like any other nasally administered corticosteroid, acute overdosing is unlikely
in view of the total amount of active ingredient present. However, when used
chronically in excessive doses or in conjunction with other corticosteroid
formulations, systemic corticosteroid effects such as hypercorticism and
adrenal suppression may appear. If such changes occur, the dosage of
fluticasone propionate should be discontinued slowly, consistent with accepted
procedures for discontinuation of chronic steroid therapy (see DOSAGE AND
ADMINISTRATION).

(As a sidenote: All the studies of the effects of Flonase on the HPA-axis have been done with “normal” patients, not those with a compromised HPA-axis and/or Cushing’s Disease.)

I do not want to mess with my HPA-axis more than I have to. The repercussions are enormous and obviously not understood by Dr. X. I am already dealing with a tenuous balancing act trying to replace all the hormones lost due to a pituitary adenoma that was not caught for over 20 years. (Thank you, Dr. M for saying “endocrine” to me when I first saw you.) Each of these affects the other, and adrenal insufficiency is just one price I pay if these aren’t balanced properly. I realize this is a lot to understand in one office visit, but he should have treated me with more dignity and understanding. And he could have listened.

GlaxoSmithCline also says that Flonase is contraindicated with viral infections (which Dr. X said I probably had), yet he wanted to put me on it. I am at a loss to explain this, but perhaps would understand if he had taken the time to explain.

To summarize, I am in pain, will have no treatment until Monday when I can reach Dr. M, and I feel Dr. X was out of line.