Medical DIscharge?

[keez1979]

I am currently in my 4th year of active duty and I have 3 years left until it is finally over. I have a number of health conditions including endometriosis, fibroids, recurrent ovarian cysts (large ones), pelvic adhesions, depression, and fibromyalgia and I am usually in a significant amount of pain. The gynecologic conditions have all be diagnosed surgically. I feel that I am generally mistreated by physicians practicing in the military setting and sent on my way with ibuprofen or printed advice on good sleep hygiene. I am not a malingerer but I wonder if doctors see cases like me and automatically label them as malingerers. Are doctors in the military so stressed out and incapable of caring that they feel that conditions like these warrant a 'get over it' attitude? The options I have been given so far include getting a total hysterectomy (I am still in my 20s, so I refused) and taking Motrin. What gives? I can barely run and anymore (by the way, I used to max my PT test) so this is not a cry to get a no PT profile. They won't even refer me off post. I have never asked for a medical discharge (or even hinted at one), but I am at the point that I think that I have no other choice. I am under so much stress in the military that I think that it is making everything even worse (my blood pressure is high, I've gained weight, and I am losing hair in spots). Any suggestions?

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[Mirror Form]

I am currently in my 4th year of active duty and I have 3 years left until it is finally over. I have a number of health conditions including endometriosis, fibroids, recurrent ovarian cysts (large ones), pelvic adhesions, depression, and fibromyalgia and I am usually in a significant amount of pain. The gynecologic conditions have all be diagnosed surgically. I feel that I am generally mistreated by physicians practicing in the military setting and sent on my way with ibuprofen or printed advice on good sleep hygiene. I am not a malingerer but I wonder if doctors see cases like me and automatically label them as malingerers. Are doctors in the military so stressed out and incapable of caring that they feel that conditions like these warrant a 'get over it' attitude? The options I have been given so far include getting a total hysterectomy (I am still in my 20s, so I refused) and taking Motrin. What gives? I can barely run and anymore (by the way, I used to max my PT test) so this is not a cry to get a no PT profile. They won't even refer me off post. I have never asked for a medical discharge (or even hinted at one), but I am at the point that I think that I have no other choice. I am under so much stress in the military that I think that it is making everything even worse (my blood pressure is high, I've gained weight, and I am losing hair in spots). Any suggestions?

So have you asked for a second opinion and been denied? In my experience, if somebody wants a second opinion from a civilian doctor, we usually have no problem allowing it unless they really have nothing wrong with them.

BTW, having fibromyalgia on your record will likely cause many doctors to immediately be suspicious of you. Although it does sometimes truly exist, it's turned into the new "chronic pain syndrome."

 

[BigNavyPedsGuy]

I am currently in my 4th year of active duty and I have 3 years left until it is finally over. I have a number of health conditions including endometriosis, fibroids, recurrent ovarian cysts (large ones), pelvic adhesions, depression, and fibromyalgia and I am usually in a significant amount of pain. The gynecologic conditions have all be diagnosed surgically. I feel that I am generally mistreated by physicians practicing in the military setting and sent on my way with ibuprofen or printed advice on good sleep hygiene. I am not a malingerer but I wonder if doctors see cases like me and automatically label them as malingerers. Are doctors in the military so stressed out and incapable of caring that they feel that conditions like these warrant a 'get over it' attitude? The options I have been given so far include getting a total hysterectomy (I am still in my 20s, so I refused) and taking Motrin. What gives? I can barely run and anymore (by the way, I used to max my PT test) so this is not a cry to get a no PT profile. They won't even refer me off post. I have never asked for a medical discharge (or even hinted at one), but I am at the point that I think that I have no other choice. I am under so much stress in the military that I think that it is making everything even worse (my blood pressure is high, I've gained weight, and I am losing hair in spots). Any suggestions?

You're problems have nothing to do with the military health care system. If you were a civilian and listed off your problem list you would get the exact same response. There are no good treatment options other than what you listed. I know that sucks, but it's true. If you are too unhealthy to serve, then look into a LIMDU board.

 

[BigNavyPedsGuy]

Again I'll argue: if her physicians are so unimpressed by her "condition" that they won't even give her a chit to get out of the PRT, what are the odds they will put her on LIMDU?

I don't know. I'm just trying to throw her a friggin bone.

 

[The White Coat Investor]

I am currently in my 4th year of active duty and I have 3 years left until it is finally over. I have a number of health conditions including endometriosis, fibroids, recurrent ovarian cysts (large ones), pelvic adhesions, depression, and fibromyalgia and I am usually in a significant amount of pain. The gynecologic conditions have all be diagnosed surgically. I feel that I am generally mistreated by physicians practicing in the military setting and sent on my way with ibuprofen or printed advice on good sleep hygiene. I am not a malingerer but I wonder if doctors see cases like me and automatically label them as malingerers. Are doctors in the military so stressed out and incapable of caring that they feel that conditions like these warrant a 'get over it' attitude? The options I have been given so far include getting a total hysterectomy (I am still in my 20s, so I refused) and taking Motrin. What gives? I can barely run and anymore (by the way, I used to max my PT test) so this is not a cry to get a no PT profile. They won't even refer me off post. I have never asked for a medical discharge (or even hinted at one), but I am at the point that I think that I have no other choice. I am under so much stress in the military that I think that it is making everything even worse (my blood pressure is high, I've gained weight, and I am losing hair in spots). Any suggestions?

But these cysts are "BIG ONES," doc, and besides, I've got fibromyalgia too! If you knew how that sounded, you might change how you said it.

There are four options for managing "chronic pelvic pain syndrome," which, BTW, I see at least once a day both within and outside the military and which your description fits perfectly:

1) Take motrin and suck it up until you're ready for #2
2) Get all your pelvic organs removed. Alternatively, you can
3) Get addicted to narcotics and visit doctor after doctor trying to get some or
4) Get pregnant. Most of these symptoms improve with pregnancy.

If there were great treatments for this we'd give them to you, but there aren't, so pick from the list above and do the best you can. In the meantime, stop collecting diagnoses. The more of these you carry around the less seriously you'll be taken when you complain of pelvic pain.

Doctors hate chronic pain almost as much as chronic pain patients. It makes both doctors and patients feel powerless because there is nothing we can do about it. If there were we'd have stopped it when it was still acute pain. It isn't that we think you're malingering, we just don't have any good answers for you. Depression makes it all worse. Treat that and you might find your pain is only half as bad as it was before.

Seriously, there are a few other options (a few meds that calm down the endometrium, decrease the formation of cysts) and a few minor surgical options (burn off some endometriosis, cut out a cyst or two, lysis of adhesions etc) but these are all temporizing measures and just lead to more adhesions. It's really just about getting along with your pelvic organs for a few years until you're done with them, then getting them hacked out by a gynobutcher.

And I agree with BigNavyPedsGuy. Your problems have nothing to do with the military.

 

[Two-Bit]

I am currently in my 4th year of active duty and I have 3 years left until it is finally over. I have a number of health conditions including endometriosis, fibroids, recurrent ovarian cysts (large ones), pelvic adhesions, depression, and fibromyalgia and I am usually in a significant amount of pain.
I am under so much stress in the military that I think that it is making everything even worse (my blood pressure is high, I've gained weight, and I am losing hair in spots).

I took the liberty of editing your original post, removing the some of the words, but keeping your 'Smiles'.

Your statement regarding your hair loss is interesting. Not trying to be Dr. House via the internet, but if my wife or sister or mom, etc. had all your medical issues AND began to have bald spots, I'd think a trip to a doctor would be warranted.

Thread readers, any comments?

 

[Two-Bit]

Yeah: Less editing, more reading.

She goes to the doctor. That's who she doesn't like.

No need to be a smart aleck.

I'm just saying if the lady is losing her hair, it might be worth looking into, that's all.

One thing's for sure... If she's looking for any love on this thread, she ain't gonna find it!

 

[Gastrapathy]

No need to be a smart aleck.

I'm just saying if the lady is losing her hair, it might be worth looking into, that's all.

One thing's for sure... If she's looking for any love on this thread, she ain't gonna find it!

Really...what's your differential? This patients thyroid has been checked...7 times and its normal every time. She is a health care professional at the same command as these doctors which makes this all the more challenging. When she comes to me with IBS sx, she'll get scoped both ways, even though the guidelines say not to. Why? Sadly, its because it treats me. That gets her out of my office and since she works at the hospital, achieves the important goal of being perceived to have tried everything and avoiding a waste of time chat with patient relations. Even worse if I perforate her, no one will object to the fact that it wasn't indicated. I'll just be the one who has to live with it.

Patients like this are very very tough. Ask yourself, if she told you about IBS sx as her PCM, would you manage them in the context of her fibromyalgia and chronic pain with a low-dose TCA, etc, or refer to GI? Because if you'd refer her, you validate her belief that we are missing a mystery illness.

30% of my clinic is patients exactly like this. I spend hours each week explaining what functional symptoms are and how to be manage them. It is critically important that patients with functional sx like the ones she details not be given the "well a doctor on SDN said that this "might be worth looking in to" tease. Her sx have been looked into, they are not easily solved, and they won't shorten her life. Encouraging her to persist in believing that 1)something is being missed or 2)there are other options that are being withheld by cruel doctors is harmful.

rant (almost) over.

Here's some free advice for the OP (worth what you paid for it). My advice is to point out that diagnoses "made surgically" of the presence of cysts and endometriosis represents exactly the kind of risk that repeatedly presenting to doctors with frustrating complaints gets you. Just like if you came to me, I'd shove a camera somewhere, you went to a gyn surgeon and he/she grabbed a trochar. What did that gain you? If you do get your second opinion and are offered more procedures, I hope no harm comes to you from that. What would be ideal is for you to find a new primary care physician. It needs to be a doctor, not a nurse. You go there and explain your history. You tell the doctor up front that you don't expect the sx to disappear but want help managing them. Together, you try TCA's, SSRI's, Lupron, and more and gradually get your sx under control. If you start off a visit angry and defensive, you can be the doctor will practice defensive medicine, refer you all over and you'll be back where you started. I'd try to find an FP since your issues are primarily of a gyn variety.

 

[Gastrapathy]

Again I'll argue: if her physicians are so unimpressed by her "condition" that they won't even give her a chit to get out of the PRT, what are the odds they will put her on LIMDU?

Those are really separate decisions. The PRT waiver process in some ways is harder than a quick limdu (although she's an officer so it isn't quite true). I've had to LIMDU the occasional patient with IBS (the GI version of chronic pain, fibromyalgia, etc). j

 

[NavyFP]

Patients like this are very very tough. Ask yourself, if she told you about IBS sx as her PCM, would you manage them in the context of her fibromyalgia and chronic pain with a low-dose TCA, etc, or refer to GI? Because if you'd refer her, you validate her belief that we are missing a mystery illness.

As a primary care guy I share your pain. I've lost count of the number of times I have tried to take the conservative (and appropriate) approach but all the patient wanted was a referral to a specialist.

 

[Gastrapathy]

As a primary care guy I share your pain. I've lost count of the number of times I have tried to take the conservative (and appropriate) approach but all the patient wanted was a referral to a specialist.

I think, in that situation, you probably have to refer the patient, if after a conversation they still want to go (particularly in a case like this where the pt works at the MTF). Its part of my specialty to see these folks. What I appreciate is a referral like "Pt with IBS, desires opinion from specialist" and the primary having spent a couple of minutes lowering expectations. The killer consults are "pt with severe diarrhea, normal labs, please consider endoscopy." Then you take a hx and instead of chronic diarrhea, they have IBS.

 

[AF_PedsBoy]

I'm pretty easy about giving a month off PT for a sprain or strain, but when it comes to longer than that I tend to be more stringent - for instance I just had a CMsgt who told me he had two back surgeries and his civilian neurosurgeon told him he wasn't supposed to run ...ever. So I told him, "That's fine, I'll give you two months off running, you get your doc to send me the medical records and if that's his recommendation I'll be happy to get the MEB going and we can have this all wrapped up pretty quickly." He didn't seem real happy with me when he left...

As far as the OP goes, with that many problems going on and the inability to meet the physical criteria, just doesn't seem to have very much retainability. And as far as the civilian consult goes, someone made the mistake of letting one guy doctor shop, so after three separate military ID docs and two civilian ID docs kept getting negative studies and told him he didn't have Lyme, he finally found one doc who "specializes" in it who told him he did have it. The result is even though he's gotten three complete courses of treatment in spite of the negative tests, he's convinced he has Lyme. I have a similar one except for Lupus. And my techs wonder why I bang my head against the wall at odd moments...

Er, Tired, they don't make you do a MEB if a patient has been on a DR for 365 total days? I was told after that the person needs one...

 

[BigNavyPedsGuy]

I think our nomenclature is different.

After 90 days on light duty (or sooner or later depending on my mood) Marines are referred for an MEB (ie - LIMDU board, not a PEB/medical separation).

Once on the LIMDU board, they have the 6mo to recover. If warranted, they can get a 2nd LIMDU board. After that, if their specialist feels they still can't return to full duty, they are written up for a PEB board, which can result in Medical Discharge.

Lately I've been tired of bull****, so for the dudes who are clearly injured and not going to get better, I've pushed to do Med Seps right away, or after a single LIMDU board.

I have also made it a habit to threaten Marines with Med Sep when I think they are trying to pull a fast one (usually PFS patients). Ironically, while a lot of the young guys like to whine and try to get out of work, most of them really don't want to be discharged from the service.

At the same time though, you can always move paper in such a way as to keep guys off boards. I have 1-2 guys with legit injuries who, for a variety of reasons, don't want to do LIMDU. I've kept them off going on 7-8 months (starting, obviously, with the last medical officer). One more thing I like about this place: basically I can do whatever I want.

Doesn't it have to be a subspecialist that initiates the LIMDU board? We (as GMOs) can't intitiate it. I have to write consults and request that the guy on Pamalor sp?), Imitrex, and Indocin with migraines that bring him sick call 3 times/week be evaluated for fitness for operational duty. It's annoying.

 

[J-Rad]

And as far as the civilian consult goes, someone made the mistake of letting one guy doctor shop, so after three separate military ID docs and two civilian ID docs kept getting negative studies and told him he didn't have Lyme, he finally found one doc who "specializes" in it who told him he did have it. The result is even though he's gotten three complete courses of treatment in spite of the negative tests, he's convinced he has Lyme.

Strictly out of unrelated curiosity, was the Lyme "specialist" an FP in Springfield, MO by the name of Crist (http://www.drcharlescrist.com/)? I saw a 9 year old in Peds Cards clinic who had seen this guy. He, at one time, was on an impressive boatload of meds.

 

[AF_PedsBoy]

I think this "Lyme Specialist" was working out of Mississippi...


Hm I'm probably not all that conversant with the process yet but for the initial problems I put them on a AF469 which let's you specify duty restriction, mobility restriction, or both. Usually I just leave them on this until they're recovered (i.e. 1 month for the sprains or strains) or the work up of the condition is complete (i.e. OSA, chronic back pain, etc.). Apparently this form also conveys what they can do on their job too - like my seizure work up guy drove fuel trucks and so I thought it'd probably be a good idea to put a hold on that for a while...

Theres a AF422 that seems to specify the restrictions with the PULHES format which I never use except when I'm clearing someone for a PCS or unless someone tells me I have to...

And then the MEB which is essentially a big ol' summary of the problem, what was tried, and if they can still do their job or not. So I think about 70% get returned to duty with a limitation code which really just specifies where you can get sent, or you get medically separated. Getting an MEB isn't the kiss of doom it seems to be in the Navy, but it's such a pain in the butt to do that some patients coast along from profile to profile for years... I haven't had to start one yet but I've had to sign off on a few of them... the signing off doesn't seem that hard...
Unfortunately apparently not being board eligible yet doesn't seem to be any protection against having to write MEBs - I get out of inpatient stuff though, because I don't have admitting privileges! Woohoo!

 

[AF_PedsBoy]

Wow.... just... wow.... I looked at Crist's website and the utter lack of science in it... "I treat the patient not the lab" so even if it's negative he treats - what's the use of even running the lab And $2000 for injections of dextrose... amazing... I need to go back and look at my note on that patient now - Crist sounds kind of familiar and that would be hysterical if it was the same doctor...

...by the way how are your munchkins? Say hi to your wife for me!

 

[DermpathMD]

deleted

 

[AF_PedsBoy]

Yeah the records thing is seriously annoying - I've had two sets of patients whose records got lost or "destroyed" because they were handcarrying them, and then they get PO'd when I don't give them what they want and tell them to go get their civilian PCM to fax us their records...

 

[J-Rad]

Wow.... just... wow.... I looked at Crist's website and the utter lack of science in it... "I treat the patient not the lab" so even if it's negative he treats - what's the use of even running the lab And $2000 for injections of dextrose... amazing... I need to go back and look at my note on that patient now - Crist sounds kind of familiar and that would be hysterical if it was the same doctor...

...by the way how are your munchkins? Say hi to your wife for me!

Evil monkeys, as usual . You're only ~10hrs away by car, feel free to drop by some time.

 

[AF_PedsBoy]

Holy %$^& Dr. Crist WAS the guy who "finally diagnosed my Lyme after all the other doctors missed it"! He sent my guy back to the military on 6 different antibiotics for an 18 month course! They were... Zithromax, Flagyl, Plaquenil , Biaxin, quinine, clindamycin. Fascinating... I have to say, though, I was wrong, after he got sent to the specialists at Wilford Hall he paid for Crist out of pocket and then somehow got the military to pay for the special regimen and follow up visits... I wonder if he got any of those dextrose shots too... Is MO the abbreviation for Missouri? I thought that was Montana...

 

[TheGoose]

^^ MT is montana

 

[J-Rad]

Holy %$^& Dr. Crist WAS the guy who "finally diagnosed my Lyme after all the other doctors missed it"! He sent my guy back to the military on 6 different antibiotics for an 18 month course! They were... Zithromax, Flagyl, Plaquenil , Biaxin, quinine, clindamycin. Fascinating... I have to say, though, I was wrong, after he got sent to the specialists at Wilford Hall he paid for Crist out of pocket and then somehow got the military to pay for the special regimen and follow up visits... I wonder if he got any of those dextrose shots too... Is MO the abbreviation for Missouri? I thought that was Montana...

Small world. So what's the deal? I thought you were up in the hinterlands of N.Dak., not Japan (that's why I guessed on the Missouri guy).
And that looked like the drug list my kid had been on...

 

[AF_PedsBoy]

I bow to your superior counsel - of course you know me and common sense have only had the most tenuous of relationships!