Hi Alaina,

Thanks for your posts. Changing and finding a new PCP can be very difficult. Personally, I think that is more difficult than changing or finding a specialist. A few years ago I began to search for a PCP because mine was changing to a concierge type practice, requiring an annual fee to remain one of his patients.

What an ordeal. It is not like we can just make an appt. to "interview" a new doc to see if they will be a good fit for us. And if we make an appt. to see them, no insurance is going to pay for our doctor shopping and to pay out of pocket is very expensive. Not to mention all the hassle if the first one, two, or three are not good fits for us.

Even with referrals from family and friends, a doc that works well for others, may not be the doc for us. Guess where I landed ?? If you guessed that I did not change you win. I did not find a replacement and have been paying the annual fee each year for the past few years.

Not only due to the expense that I can not afford, but my PCP is now also aging and I know retirement is not far down the road so I will be on the hunt once again. I have had much better success at finding specialists that fit me to a T with no difficulty. Finding a replacement PCP is an entirely different story.

OK, all that being said, if you are not happy with your current PCP, I wish you an easy road finding a replacement physician that will provide you the care you need and with whom you will be happy. It does not sound as if your current PCP is able or willing to communicate with you as he should and as you wish. It may be time to seek another physician. I am glad that you at least get some information from a helpful staff.

Do you have a cardiologist? If not, do you need a referral to see one? You may want to consider having a check up for any cardiac issues since your pulse rate escalates and you experience shortness of breath along with the feeling that you may pass out. You may need more than just a quick office EKG.

Have you had "any" testing other than just the EKG by your PCP? Any ultrasounds to check your circulation?

It does sound like a work-up may be a good start and not just a pat on the head and pills thrown at you at this time with the symptoms you are exhibiting.

While anxiety can cause all kinds of havoc, personally, I think medical conditions should be ruled out FIRST, before jumping to conclusions of anxiety without good reason to take that route.

I have seen docs throw pills at things when they don't have answers or when pressed for time. It is the quick and easy, move onto the next patient type of practice some doctors have adopted as a means of getting to the volume of patients they have to see in order to make ends meet. This is not always the case but it does happen.

How long has it been since you had a COMPLETE work-up? If it has been over a year, then maybe now is the time to do it. Since you seem to get along well with the staff, maybe you can talk to them about scheduling an extended visit with your PCP in order that he will take the time to be more thorough.

Wishing you the VERY best in your quest for better health and proper medical care.

I think doctors today are so preoccupied with meeting the regulations of the insurance companies and having to "justify" everything they do, every test they order, and the pressure to keep costs down, they sometimes discount the patient along the way and do the least to keep everyone happy. I don't blame them as they are just trying to practice medicine within the parameters they have been squeezed into in today's practice of medicine.

If you do search for another PCP, try to find one willing to buck the system and put his patients FIRST. One of my specialists is like that and he is GREAT. He told me once the BEST thing about being a physician is his interaction with his patients and being able to make their lives better. He despises all the constraints and paperwork. He is happiest when he is in the exam room with his patients, not when he is on the phone with insurance companies fighting for his patients right to care.

First let me say I am so sorry you are going through this! It can be so frustrating dealing with a doctor that doesn't listen to what you are saying. I'm willing to bet that we have all experienced at least one of these wonderful doctors (that was sarcasm).

There are so many things that can alter BP and sometimes it becomes a process of elimination. Ideally they should take orthostatic blood pressures, this means taking it laying down, sitting up and standing up. The majority of the time BP will have little change or it will decrease as you stand up. Unfortunately you get to be the lucky one to go in the opposite direction.

The list of things that can alter our BP is really long so it can be a challenge to narrow down. Anxiety can elevate our BP but so can pain. The thing that confuses me is the dramatic difference between your PCP and PM readings. Are they taking it manually or on a machine. I personally prefer to take it manually because if I got a reading that was outside the "normal" range the doctor would want me to take it manually anyway. Another thing about the machines is often times if you heart rate it irregular it can through off the machines and you will get an off reading.

I also personally have an issue with using the term "normal". What is normal for me may not be normal for you. I feel medical providers need to take the time to look at a patients history and determine what is the patient's baseline is.

Have you tried to take you pulse when this happens? I would suggest having a little notebook with you and write down when this happens and what happens. I have done this before and I found it helped me when I went to my doctors appointment because I was able to say this happened on this day and lasted this long.

Is your PCP in a large practice? I have switched to a different doctor in the same practice and found it easier because I didn't have to get my records sent.

Are your doctors all in the same network? For example my PCP is in the same network as my PM so they can just pull up my electronic record if they have questions. Even better is if they can e-script a medication so once they order the new med if there are any interactions they will receive an error message.

If your insurance does not require a referral I would say go ahead and make an appointment with a cardiologist. Also with regards to the EKG you have to be laying down to do it but I've never heard of waiting that long before they ran it. I would think they should have run a longer strip because it can be really hard to notice some changes.

That's my two cents. Good luck and I hope they find out what's wrong so you can start treating it. Keep us posted!

Hi Alaina,

Based on the two lines above from your post, I want to share a story with you. The second line reminds me of a similar situation I had experienced.

I went to the doc with a complaint of chest pain (angina) that was happening frequently. After first being admonished about not calling 911, he did a quick EKG and it was "normal". He then insisted it was either gastric reflux or sternum pain. I can't think of the medical term at the moment but it is on the tip of my tongue.

He immediately wanted to put me on medication for GERD. I told him that I was NOT having any stomach, esophageal issues, or inflammation of my sternum. I was having angina. (I knew what angina felt like as I had experienced it before, many years previously and had a cardiac stress test at that time which did indicate a mild cardiac problem.)

I refused to take medication for a stomach problem that did not exist and I changed docs.

When I told a different doc of my angina, a quick EKG again was "normal" but he ordered additional testing. After MANY cardiac tests, it was determined that I most definitely had cardiac problems. To keep this from getting too detailed and lengthy, my point is you can have a "normal" EKG during the few seconds recorded in an office exam and be discounted.

OK, I am NOT saying YOU have a cardiac issue. What I am saying is you have been dismissed and not heard and not all testing will show evidence of a problem. If you feel something is not right, you need to be heard. I am not suggesting that you go through a battery of cardiac testing based upon blood pressure readings a day apart with large differences. I am saying that it should not be dismissed if it continues and should be investigated. And I am not suggesting that it is cardiac related. That was just used as example of how docs can be dismissive.

As Nurse Kris has stated, there are a lot of reasons for fluctuating blood pressures.

I had a family member whose BP was not controlled with medications, no matter how many times they changed them or increased dosages. Finally, a doc investigated and it was due to occlusion of the renal arteries. Yes, your kidneys help regulate blood pressure.

I am so poor at putting things into words but the entire purpose of this post is to tell you that you know your body better than anyone and you know when something is not right. Be sure a physician listens to you and takes the time to investigate the symptoms and complaint you express. Also, don't put all your marbles and faith in one simple test.

Some tests are not always correct or do not always show the information sought. Many tests depend upon "interpretation". Recently I had a lab come back extremely below normal levels. My doc did not just accept the lab result. He matched symptoms with the lab and they did not jive. He said, I don't believe this result and had the test repeated. It came back perfectly normal on the repeat. He told that I would be terribly ill for the first lab result to be correct. That I would be unable to eat, would be extremely weak, would be losing drastic amounts of weight, and the list of symptoms went on that would agree with the erroneous lab result. I didn't have ANY of the symptoms he stated. That is how he knew the lab result was erroneous.

ADDED Paragraph: My cardiac issues have continued to worsen over the years, but I am thankful that I found a doc that did not dismiss me, and listened to me back then. Otherwise, I may not have had the care and treatment and may have had a fatal occurrence without the care I have received. My quick EKG's in the office still show "normal" on occasion and are not representative of what is really going on. Longer ones show the abnormalities. Other cardiac tests are even more informational for my cardiac issues.

If you managed to read this post, you have great endurance. Thanks for reading.

Alaina,
My blood pressure reads pretty much as yours; it goes quite high when my pain is way up. Two weeks ago at PM, I was in excruating pain; my pressure was 160/89. Usually BP is taken when sitting and trying to relax with arm proped and is not taken when standing or exerting.

Since I do take medication for blood pressure and meds for edema, my BP is more often in range of 120/70 - 130/70; but again, when in a lot of pain or anxiety so is my BP much higher. Just wondering if this might have anything to do with your BP readings.

Unfortunately the issues with doctors can be quite frustrating.

Gerry

Hi Nurse Kris,

Loved your post. The above part really hit home with me. So true.

I was in the emergency room and on one occasion, after being treated for the purpose of my visit, (broken bones due to a fall), they did not want to discharge me. I had been treated and was just waiting to be discharged. I asked what was the delay and they said, "We can't let you go yet because your blood pressure is high." My response was, sure it is high, I am in pain. Once you discharge me, I get the script filled for pain relief, it will come down. But as long as I just sit here in pain, it is going to STAY high.

They agreed that it was the pain causing the elevation in my BP and finally allowed me to leave. (I do have hypertension and have been on medication for years, but it doesn't prevent an escalation when pain levels skyrocket.)