Ischemia

[john999]

The stress test I had at the VA indicated ischemia. My C&P exam skipped the stress test and made a diagnosis of no heart disease. I told my PCP and she got a stress test for me. Now I have a bad feeling about the care I have been getting from all my doctors. My private doctor said no need for a stress test unless I had symptoms and I don't have symptoms. I have not gotten my rating for heart disease secondary to DMII yet, but I know from the C&P exam it will be 0% or denied due to an inadequate exam. This really pisses me off, and I want to know what to do about it. The VA did not respond to my request for a new C&P exam. They are going to wait until I get the rating and force me to NOD it. Now I have evidence of active heart disease. I had artery disease in my legs and that is why I wanted an exam for my heart because the two often go together. I am currently 0% for arteriscelorotic heart disease. I am not really happy about this, but it shows how poor and inadequate our C&P exams are and how they skip steps to save a buck. I don't want to wait until I get a rating to head off a denial. I only got a echocardiogram and the C&P PA ignored it and just asked me if I ever had chest pains. The exam worksheet requires a stress test, but I did not get one before the exam. This is malpractice I think, but I know that the c&p PA was just doing the VA's dirty work. I wonder if I should just go to the VA and get the records and go to a private cardiologist. The VA will let me die while they discuss what cheap medication they can give me. You cannot trust a c&p exam to diagnose your problems. I got the results from the stress test in the mail today from my PCP at the VA. She is concerned but she is the only one. Any suggestions?

[hotcoffee2]

dear heart>>>>get thee to the ER with chest pain. not ethical, but it will get you where ya need to get.

I had a VA Stress test April 2006 and another one at a read Doctor's and had a stent put in cause one artery had a blockage of 90% and to think that I had been trying to find out for over 4 years at VA why I had such a problem walking more than a few hundred feet.

I also asked for a cardio consult 4 months ago and have not even gotten an appointment yet. I think that the VA gives Veterans the false impression that they are treating them when in fact they are shelving us and waiting for us to die.

[hotcoffee2]

ischemia? ischemia of what? inschemia refers to the lack of blood supply to tissue cells whether it be heart, kidney, intestine etc. cutting off blood flow cuts off oxygen and other nutrients and causes an 'infarct' or hypoxia (loss of oxidation and critical metabolites for atp generation. there is ischemia/reperfusion, irreversible injuries and others. ischemia in the heart muscle sufficient to cause cell death is referred to an infarct and is in essence signs of an old tissue injury associated with a heart attack. Ischemia should be understood in the context it was observed clinically. there should be ekgs and O2 sats for treadmill test and you get an echocardiogram yes? maybe next time, do the chemical test and correlate the results. you should be able to request that. but there are contraindications and a code cart in the room if the chemical doesnt agree with you. i have to have chemical tests, because i would kill myself on treadmill.

The stress test I had at the VA indicated ischemia. My C&P exam skipped the stress test and made a diagnosis of no heart disease. I told my PCP and she got a stress test for me. Now I have a bad feeling about the care I have been getting from all my doctors. My private doctor said no need for a stress test unless I had symptoms and I don't have symptoms. I have not gotten my rating for heart disease secondary to DMII yet, but I know from the C&P exam it will be 0% or denied due to an inadequate exam. This really pisses me off, and I want to know what to do about it. The VA did not respond to my request for a new C&P exam. They are going to wait until I get the rating and force me to NOD it. Now I have evidence of active heart disease. I had artery disease in my legs and that is why I wanted an exam for my heart because the two often go together. I am currently 0% for arteriscelorotic heart disease. I am not really happy about this, but it shows how poor and inadequate our C&P exams are and how they skip steps to save a buck. I don't want to wait until I get a rating to head off a denial. I only got a echocardiogram and the C&P PA ignored it and just asked me if I ever had chest pains. The exam worksheet requires a stress test, but I did not get one before the exam. This is malpractice I think, but I know that the c&p PA was just doing the VA's dirty work. I wonder if I should just go to the VA and get the records and go to a private cardiologist. The VA will let me die while they discuss what cheap medication they can give me. You cannot trust a c&p exam to diagnose your problems. I got the results from the stress test in the mail today from my PCP at the VA. She is concerned but she is the only one. Any suggestions?

[Pete53]

My Dallas Cardiologist who used to be a weekly guest on one of the local morning TV shows and a very positive man told me that the Dallas VA has wonderful equipment and facilities but it does not help Veterans cause they don't use people who know how to use the equipment.

[hotcoffee2]

if you have diabetes ll then yes, you have a predisposition (significant) for HBP, cataracts and PN. emgs are should be low velocity, amplitute (shoot there's another criteria for major sensory nerves. for the most part the neuro docs test major motor nerves. all of this is connected. you are lucky not to have diabetes l. however, you must take good care of yourself not to exacerbate the disease and its symptomatology. you have a hands down claim. provided i am understanding your diagnoses.

as for non english speaking docs. i would politely say sir or madam doctor "I am having trouble understanding you and i would like reference to this in my chart". then ask to speak to the department chair or attending, and make them explain/document the findings in your chart. tell them that you do not want "also seen by doctor blah blah as an antedotal note.

at your cardiology visit, you would like a documented discussion of the present status and potential consequences of the disease. look at the history in the file and ask the doc to summarize this in writing while documenting new evidence.

it is true unfortunately, that they can write anything they want. At a minimum, take notes while you are there. make people repeat themselves. OR get a recorder and advise them you are going to record. tell them you need the device because of your PN, which causes difficulty writing. ((this is going to be like giving them an emg (that's the needle part of the test)) make sure they understand that you will slap them with (to me this is equivalent to a skeeta bite) an employee misconduct and patient abuse complaint with the "IG". unfortunately, this is the VAOIG hotline. I did this recording thing while on the phone with FOIA. I caused the guy to stampede and hang up. then i called the directors office and told them to get him back on the phone or i would file . He was at his phone ten minutes later.

**Go to PAdvocate office and ok the recording document the need for a recording device with them. You want the device to take your own notes, you can't keep up handwriting. We don't want you breaking any laws. frankly, i should have looked to see if someone (outside of myself--slightly different case recording over phone) has done this before.

i have been sick for a long time. many years ago i confessed to an outiside internist (he first diagnosed me with my autoimmune disease in '88) that i hated doctors. he turned to me and said 'god, don't apologize for that. You will be one of the ones' that lives'. I've been hacking away ever since.

I think I will make an appointment with a cardiologist Monday and get my records from the VAMC in the meantime. They have done three echocardiograms on me and a stress test, but all were of poor quality. I had an EMG done for my PN and it was of poor quality. All the doctors were non-English speakers. How can you trust these jerks for anything? I would not like to have to depend for my life on these clowns.

I have DMII and now have HBP and cataracts and VA says there is no connection. After my CUE is decided I will file for all these conditions. The VAMC with its electronic medical records is supposed to be total care for us, and yet they never follow up on anything unless you get down on your knees and beg them.

Edited November 30, 2008 by pattik

[stillhere]

John, I agree with some of the others you need to go to an outside cardio doc and get a complete workup. Have them give you a report of what they find. the VA denied my heart disease request for over 3 years until I suffered a heart asttack in 05! Only after that did they give me heart disease secondary to DB2! i am now rated at 60% heart because of the damage done with the heart attack.

Please go to a cardio doc as sonn as you can!

Stillhere

[Chris111]

one doctor said i have ischemic heart disease due to trauma from military service; what is the current rating on that?