You should have NO problem going to Hopkins with Medicare. There is NO referral needed under Medicare. It is my primary insurance and I live in VA, so I travel to Baltimore to see him (about 3 hours each way). Medicare has always covered my care at Hopkins (most of my specialists are there). The Sjogren's Center can assist you with information about insurance coverage.

One of the many aspects of autonomic neuropathy is cardiac vasospasms. Vasospasms can cause symptoms very similar to heart attack...because the arteries can collapse briefly during the spasms and therefore reduce blood flow for short periods. This would include feelings of pressure in the center of the chest, some tightness, left arm, neck, or jaw pain, and even back pain. Everyone is different in how these symptoms present.

Any and all chest discomfort should be evaluated by a cardiologist or someone in the ER or your PCP. Sjogren's (and other autoimmune diseases) can cause inflammation in the arteries and other blood vessels and this inflammation increases the risk of plaque building up or CAD (coronary artery disease). Please get this evaluated.