Posts by Kyle Lee7

Nicole Gray47 said:Please don't lecture me about being uninformed; I've been battling allergic asthma for 21 years now—basically my entire life. What he wrote... well, that's how it always starts. He might have asthma, or he might not, but since he’s just asking us, all we can really do is guess. Until he gets his full battery of tests done, he won't actually know for sure.

Albuterol can be purchased over the counter, which tells you everything you need to know right there. Albuterol is essentially just an inhaler used to "clear out" the airways. If he doesn't want to experiment with medication, I'd suggest he try some medicated lozenges. They shouldn't cause any harm, and they might provide some relief, depending on what he's actually dealing with.

But for now, we can only speculate.😎

Albuterol requires a prescription.

https://mediately.co/en/drugs/1MDtbx...je#undesirable

This isn't chamomile tea. If a pharmacy sells it to you without a prescription, they are breaking the law and being incredibly irresponsible.
It has potentially dangerous side effects and a strict maximum daily dose. Why would anyone take it if they don't have asthma? Albuterol is a bronchodilator, and during an acute asthma attack, it sometimes isn't enough—you might need corticosteroids or even antibiotics if the attack was triggered by a respiratory infection.

I'm speaking from experience here; I've lived with asthma for 39 years. I've actually been brought back from the brink a few times and spent time in the ICU... and trust me, nobody ever told me they had seen a more severe case than mine.☕

As for the question the user posted—to me, it sounds a lot like my own issue, which isn't actually related to asthma. It's that sensation where you take a breath but feel like you didn't "get enough air." There's no bronchial constriction and no wheezing; it feels more like a muscle blockage caused entirely by stress.

Marijuana is everywhere right now, being hailed as both a miracle cure and this totally harmless way to unwind. Honestly, I don't think it's the medical breakthrough people claim it is, and calling it "harmless fun" is a massive stretch. But if you dare to say that out loud, everyone will jump down your throat like you’re some kind of dinosaur stuck in the past.

I’ve definitely been through those stretches at certain companies, and honestly, it’s incredibly draining when you’re the only one speaking up. Dealing with constant friction multiple times a day really wears you down mentally, especially if you aren't someone who thrives on daily conflict. But the absolute worst part is just wondering why *I* have to be the one to handle it—having to deal with reckless addicts on a daily basis. When you're working five days a week, having those extra stressors piled on top of your actual job description is just too much if you value your mental health.

We once had this guy who refused to follow the rules regarding smoking; I remember talking to my manager about it—he was a non-smoker—and he ended up banning it. That colleague held a grudge for years after that. It was such a mess; imagine, he was forced to go out to the balcony just to smoke. ☕

Then, unfortunately, he developed lung cancer and passed away within six months. He was only 50.

stormytinker4 said:Honestly, anyone using the internet today can be misinformed... there isn't much point in commenting without actually engaging in the discussion...

We’re veering off-topic here, but…

Thanks to the internet, it’s easier than ever to be misinformed. Everyone has access to the web, but very few people have enough foundational knowledge—to distinguish nonsense and scams from actual, relevant information—or the ability to think critically.

The average American often has just a high school level of education, and unfortunately, even among those with college degrees, there’s a noticeable lack of logical reasoning, critical thinking, or basic scientific literacy. Very few people have even sat through an "Introduction to Scientific Research" course, to say nothing of anything else.

On the internet, anyone can write just about anything. They throw in a few technical terms and some sensationalist headlines, and that’s often enough to give seriously ill people false hope and part them from their money.

Even looking at little Nora’s trip to America—how many people actually realized this wasn't a standard medical procedure, but rather an experimental treatment (intended for those who truly have nothing left to lose)? At least that treatment followed professional protocols, was properly documented, conducted under controlled conditions, and the data gathered will actually help someone down the road.

And because oncological and autoimmune diseases are so difficult, if not impossible, to cure, we see a "miracle cure" popping up constantly, always framed as "based on my own personal experience." Listen, folks—even if you claim you were 100% cured, you don't actually know what caused it or why. Just because something happened *after* taking a certain supplement, fruit, vegetable, or juice doesn't mean the improvement had anything to do with it (logic, logic, logic!). Even if it did, there are so many variables that aren't accounted for—age, sex, medical history, other medications, supplements, diet, etc.—that a single person's story holds zero statistical relevance.

Because of my own diagnoses and those within my family, I’ve been offered countless "miracle" remedies that are supposedly "vetted by personal experience." We tried some just because they couldn't hurt us; I wouldn't dream of touching others (like marijuana oil—if you want, you can read a patient's blog about someone who didn't get cured but instead became addicted and quite unstable, along with his buddies telling the same fairy tales about how great their recovery is. Anyone reading from the outside can see they are dealing with the same, if not worse, problems than before, plus a newfound addiction).

So, I was reading USA Today today, and there’s this story about a young woman (27).
The article basically claims that the doctor was clueless and didn't even have oxygen on hand.

Look, journalists aren't doctors, but they really should do a bit more homework before publishing stuff like this. I'm certainly no medical professional myself, but I've lived with Asthma since I was six years old. Up until I was 25—knock on wood, since it's been under control since then—there were a few times where my life was literally saved by medical intervention. Beyond that, I've had at least 30 or 40 attacks where the solution wasn't actually oxygen, but an IV injection—usually dexamethasone or aminophylline. Sometimes SoluMedrol, too.
(I just checked their website now, and they’re claiming adrenaline is the first line of defense—though I assume that's only for the most extreme cases. In my experience, they never had to give me that.

The thing is, oxygen alone can't help you if there's an obstruction or a severe airway spasm; the oxygen simply can't get through, so it won't save anyone in that situation.

They also mentioned that the tourist clinics aren't well-equipped, but honestly, shouldn't things like adrenaline or corticosteroids be considered absolute essentials?
I mean, how can a clinic be missing the most fundamental medications needed for an emergency, whether it's an allergic reaction to a wasp sting, deep cuts, or, as in this case, an asthma attack that could turn fatal.

For years now, I haven't even carried a Ventolin inhaler with me, and the one I have at home is actually expired. But after reading this report, I am rushing out to get a new one, and I am never leaving the house without it again—even though I haven't had an attack in years.

Brandon Lopez6 said:So, the assumption is they go once a week for five years, right?
4x12x5=240

But most people actually go once a month.
1x12x20=240

The total number of sessions ends up being the same. And honestly, even if we ignore the fact that everyone is different and plenty of people just try to "patch things up" only for the illness to come back... in my book, you shouldn't be looking at averages when it comes to psychiatry.

I’m not quite sure where you're getting those figures from. If someone is only seeing a specialist once a month, that isn't really psychotherapy—that's just a quick five-to-ten-minute check-in.

Look, I’m talking specifically about psychoanalytic psychotherapy here. If you aren't meeting at least once a week, and if those sessions aren't lasting a minimum of 30 to 40 minutes—ideally 45—then you aren't actually doing therapy. At that point, you're just going in for check-ups.

The therapy I’m talking about isn't meant to be a lifelong commitment; it's designed to last just a few years at most. Also, just to clarify, a referral for therapy isn't quite the same thing as a referral for a routine check-up—with this type of authorization, you actually have the flexibility to visit the clinic up to four times a month.

Look, I think we’re talking about two completely different things here.
If someone is dealing with a chronic condition, like schizophrenia, obviously nobody should be stepping in to limit their autonomy—especially given how those diagnoses are typically managed (not that I’d know much about it; I'm just a regular neurotic myself), and it's certainly not what I'm suggesting here. I was simply mentioning something my therapist pointed out: apparently, there are groups at the psychiatric clinic where people have been coming in for therapy for twenty years straight. The thing is, that specific type of therapy isn't actually designed to last that long. That's all I was saying.

Let's say that person decides to go private and pays $300 out of pocket...$167 If we’re talking about individual sessions, let's be real: if a psychotherapist keeps someone in treatment for twenty years, most people would call that out as an abuse of power or just a way to bleed a patient dry. I mean, think about it—if you haven't made meaningful progress on a core issue within five or six years, something is clearly broken in the process.

Edit: I actually managed to find the original text about this! It's already in English, so I’ll just try to put together a rough translation of the bolded section.

No One goes to therapy for twenty years. In my view, if someone is seeing a therapist for that length of time, they aren't actually receiving therapy. How long someone stays in therapy really depends on the individual and the specific issues they're facing, so there isn't a one-size-fits-all timeline. Generally speaking, though, you can break treatment down into two main categories: short-term and long-term therapy.

Short-term therapy—often referred to as brief therapy—is designed to tackle specific, targeted issues. The core philosophy here is that once you hit those immediate milestones, you start feeling a sense of agency and competence in your daily life. That boost in self-efficacy often creates a ripple effect, positively impacting other areas of your world too. From the very beginning, this type of therapy is structured around a timeline. The goal is to reach specific objectives within a set window, typically ranging from six to twelve weeks, though sometimes it might stretch a bit longer depending on the situation. In my view, the kind of problems which short-term therapy (arguably) addresses best are primarily behavioral. These approaches usually come with very distinct labels based on their focus, such as anger management, impulse control training, or assertiveness coaching. It’s all about providing practical tools for specific challenges.

Long-term therapy is designed to dig deep, tackling those foundational issues and chronic conditions that drive emotional struggles. When you're looking at this level of intensive work, you have to realize it isn't a quick fix; typically, this kind of therapeutic journey spans somewhere between three to six years.The reason this method feels like such a marathon is quite simple: building a genuine therapeutic bond—much like any meaningful relationship in our lives—requires significant time to establish, nurture, and sustain. This type of therapy is modeled after the natural developmental milestones we see from childhood through adolescence. It follows a structured progression through beginning, middle, and final stages. That concluding phase is especially vital, as it represents the individual finally achieving true independence and transitioning into adulthood.

- See more at: http://www.queendom.com/advices/advice.htm?advice=484#sthash.6kvfRi6z.dpuf"

okvirni prijevod:
No One goes to therapy for twenty years. In my opinion, if someone is seeing their therapist for that many decades, they aren't actually receiving therapy anymore.
"Long-term therapy is really about digging deep to resolve the underlying causes and conditions that sit beneath the surface, driving those emotional struggles. On average, this type of process typically lasts anywhere from three to six years."

A few years back, I had an appointment with Dr. Božićević, who specializes in neuropsychiatry, and I’m also under the care of Prof. Brinar, who works in the same field. They explained to me that this used to be treated as one single specialty, but eventually, it branched off into two distinct disciplines: neurology and psychiatry.

Brandon Lopez6 said:schizophrenia, psychosis, zero points?
It's honestly no wonder the healthcare system is in, well, let's just say a bad spot, when patients are busy undermining each other. Someone could easily look at you and ask why you're showing up every single week when once a month (or even every two months) for a check-up would do just fine. ☕

I think you misunderstood my point. 😉
I am talking about psychotherapy for neurosis. Specifically, at a psychiatric hospital. These aren't just routine check-ups.
As far as I know, psychoanalytic psychotherapy isn't typically used for schizophrenia or psychosis.
Psychoanalytic psychotherapy usually consists of a 45-minute conversation once a week. It's indicated for things like stress, anxiety, or depression...
That kind of therapy lasts on average five years, after which it's considered complete. So, there really isn't any sense in people staying on that kind of therapy for twenty years at the expense of Medicare.

Nicholas Myers said:I have to admit, this is news to me. I’ve heard whispers about extra fees floating around, but I haven't seen anyone state this officially.

From what I understand, there are referrals for outpatient care, and psychotherapy definitely doesn't fall under the umbrella of a simple "consultation."

Furthermore, there is no regulation stating a limit on annual visits—the mention of three follow-ups usually refers to post-hospitalization check-ins within a six-month window. There is also no rule saying, for instance, that a GP can't refer someone to a psychiatrist ten times a year.

Those kinds of numbers are just hallway talk, unofficial chatter. Officially, I haven't seen a single document mandating a cap on annual psychiatric visits or a specific number of physical therapy sessions for any given diagnosis. 🤷

Personally, I'm hoping things get ironed out in the end, though it seems obvious that the healthcare system is facing a financial meltdown. Things that used to be taken for granted now require out-of-pocket payments.

I received this information from my therapist and one other person. It’s clear that a lot of this remains vague and poorly defined.
In any case, even if they approve certain therapies, there will be a limit. It won't be like what I've heard—that some people go on therapy for twenty years. Look, everyone needs help, but there has to be some logic to it. You know roughly how long a course of therapy lasts, and while we're talking about several years, twenty?!

And of course, there's always the potential for abuse, but I don't want to fan the flames by making that the focus right now...

My psychotherapist mentioned to me last week that since their rehabilitation program doesn't actually account for psychotherapy (much like how they wouldn't include physical therapy in a standard plan), it falls under the category of a regular psychiatric consultation. Since those are limited to three visits per year, anything beyond that means we'll be paying out of pocket $33.
Normally, you'd see a therapist once a week. If you skip vacations and holidays, that works out to about 45 sessions a year. So, if I'm paying for 42 of them at $100 each, that's roughly $1400 annually just for psychotherapy. It’s still technically cheaper than seeing a private practitioner—who usually charges $300 or more per session—but it feels incredibly silly. I mean, psychotherapy is its own established category, and this specific clinic is a premier referral center that has been doing this for 60 years... and now, all of a sudden, psychotherapy effectively doesn't exist? Unless, of course, the folks over at the psychiatric hospital manage to talk their way out of covering it.

Bit by bit, we are starting to look more and more like the USA (and not in a good way...).
It's honestly not surprising when you consider the fact that 35% of the population ends up subsidizing healthcare for 100% of the users. ☕
Personally, I'm one of those people who pays for the standard coverage plus supplemental insurance, and yet I still end up going to my neurologist privately and my gynecologist privately...

I was actually just about to mention that my neck muscles have been killing me for two days straight now! 🙂

I initially blamed it on my trip to the hair salon; they have one of those adjustable sinks that keeps sinking down, so I had to manually adjust it back up five or six times because my head was tilted at such an awkward angle. Honestly, I think I managed to get a muscle strain just from ten minutes of holding my head in such an unnatural position. Plus, I’ve been doing some weighted neck exercises during my yoga sessions over the last couple of days, so it’s probably just a perfect storm of everything catching up to me at once.

Comparing our experiences, the main difference is where the pain hits. Melissa James70 feels hers right at the hairline, whereas mine is also at the base but slightly higher up. Also, my discomfort is just a quick one-second flash, while hers lasts for 10 to 30 seconds and keeps coming back every minute or so—hers seems to happen at longer intervals.
There are definitely quite a few similarities, though.
I just woke up and my neck is still sore, but it hasn't completely incapacitated me yet, so I'm really hoping it starts to ease up soon.

It isn’t really a throbbing sensation, more like this sharp, sudden, stabbing pain. It feels almost like being poked with a needle.
However, there's a chance it could be a tooth issue, even though I don't feel any sensitivity directly in the tooth itself.

Actually, you know what? That’s not a bad idea at all. It's right near my wisdom tooth—though honestly, there's barely anything left of it but a tiny root and some fragments. I've been putting off getting it pulled and taking an X-ray for over a year now.

The thing is, it doesn't actually hurt, which is why I keep procrastinating. Plus, I have a massive phobia of needles. I had this horrible experience once where my dentist hit a nerve directly; I ended up with half of my face and my tongue feeling completely numb for three whole months. Everything just went totally dead. Back then, I didn't know I was living with MS, but looking back, I can't help but wonder if they were connected. Now, I'm just terrified of having a repeat of that sensation.

vividsailor7 said:That "clause" is just another ridiculous fabrication.
As for that memo, I don't recall reading it myself, but back then (early March), my colleagues and I were basically making fun of Varga and the American Medical Association, so that was probably what we were talking about.
And as for the actual document? It’s probably been shredded or used as a coaster by now.

1. She DOESN'T have to know about Vit. D. As far as I'm aware, it hasn't been included in any official neurological society guidelines yet, even if the research exists.
2. An acute asthma attack is treated with two puffs of Ventolin, and if that fails, you go with 80mg IV Medrol. For severe cases, it's Aminophylline 250 IV along with Oxygen. Why on earth do you need a pulmonologist for that?? There's zero point in changing therapy over a single attack.
Furthermore, you don't go to the municipal hospital for emergencies; you go to the local hospital based on where you live for internal medicine or HS. Every time I'm on call, I have at least 2 or 3 asthma or COPD patients.

Primary health care.

1. Well, I guess they "don't" have to then...
In my case, a neurologist—Professor Brinar—actually prescribed the exact dose I had discovered myself online and started taking: 5000 IU. And yes, there is evidence suggesting that patients with MS seem to deal with Vitamin D3 metabolism issues.
So, clearly, neurologists do know what's up.

2. I know exactly how an acute asthma attack is treated because I've been dealing with this since I was six years old, and now I'm nearly forty. But as I mentioned before, this wasn't an acute attack; it was a flare-up of the underlying condition. It wasn't quite "emergency room" level, but it was certainly "pulmonologist" level. I wanted to know their take—was this a new allergy, maybe my medication isn't working anymore, could it be an infection, or something else entirely?
The problem was, I couldn't actually see a pulmonologist because the wait time is a month. By the time that month passed, I didn't need them anymore.

I should clarify: my asthma is very well controlled. The only Ventolin I have at home expired back in 2007, so that's useless. I don't even take Flixotide or Serevent anymore; I just take one Singulair a day. When I first started, I was on 2x Flixotide and Serevent in the morning and again at night. Eventually, we managed to taper down to just that single Singulair. And that entire process happened under the close supervision of a pulmonologist, not some general practitioner or an ER doctor. That's precisely why—because we reached such a great state through careful monitoring and tapering—it worries me when I notice things starting to slip. Naturally, I want to see the specialist who manages my care, someone who would find it useful to see and hear about the situation right when the decline begins—to understand *why* it's happening and whether I'll need to move back to a stronger regimen.

So, my question remains: who needs a pulmonologist, and when?
Because based on your comments, it sounds like I'll never need one again. 🤷

Nicholas Myers said:Honestly, I couldn't agree more. 🙂

That’s exactly why I mentioned that anyone seeking "real" psychotherapy shouldn't expect to find it with a primary care physician (especially considering how some sort of "quasi-therapy"* is handled and funded by Medicare in general practice clinics).

*Not the right term, I realize, but I don't know what else to call it since I'm not familiar with the official standards (session length, specific techniques, etc.).

The bottom line is that we're on the same page. 🙂

What comes to mind for me is a scenario where a patient has built up a solid, multi-year relationship with their family doctor. In those cases, it's someone they truly feel comfortable confiding in regarding their fears or personal struggles, and that doctor might actually be able to calm them down, offer encouragement, or give some solid advice.

Of course, that’s all assuming there isn't a massive crowd of retirees hovering right outside the exam room door, making every visit to the clinic feel like a major social event. 😁

Brandon Lopez6 said:I deal with different symptoms too, and yeah, it's not the same thing every day, but I know 99% of it can be traced back to anxiety (for example, I don't get my period because of PCOS, not anxiety—that's the 1%). You just have to weigh whether more testing is actually justified. That should be the primary care doctor's job. Personally, it doesn't occur to me to run straight to my GP for heart tests right after having a panic attack where my heart is racing. It's a different story when people refuse to accept that your mental state can cause actual physical sensations, but again, doctors really need to put a stop to that cycle.

My doctor looked pretty annoyed when he saw how many referrals I needed him to write. We both knew it was overkill and that I was fine, but since it was the "next step" I had to take, he wrote them and I went through with the tests. The only thing is my blood work isn't great, but I've known that for a long time since I get checked once a year. Everything else is fine—thyroid hormones, brain CT, EEG, all good.

Yeah, I totally get that.
I wish it were that simple for me. Unfortunately, they eventually diagnosed me with MS... and honestly, I would have signed anything in a heartbeat if it meant the cause was just psychological. Now, I think I might be the only patient with MS who is actually in psychotherapy because of it. 😁

Brandon Lopez6 said:Look, I have a totally different take on this as someone living with anxiety. I've been dealing with this for years, and after getting burned by private doctors earlier this year, I went back to a social psychiatrist at Mayo Clinic. I know I have anxiety. I know it's purely mental. I know exactly when it started and how it feels. But the doctor didn't just suggest—she insisted—that I undergo about 10 different tests, including a brain CT.

It's easy to blame the patient, but there are plenty of cases where the doctor is the one pushing for more testing*. It isn't always (or even intentionally) the patient demanding every single scan. ☕

*She literally told me she wouldn't see me for follow-ups until I finished all the tests because she "couldn't" move forward with my psychotherapy without them.

That is clearly possible too.
In a way, it makes sense if the doctor believes it's necessary, since sometimes you really do need to rule out physical factors.

I originally went to psychotherapy convinced that my symptoms (vision issues) were just caused by work stress, rather than what was eventually suspected—Multiple Sclerosis. I actually refused neurological testing because I was terrified they might find out I have the same condition my mother has. After a few months, my psychiatrist managed to nudge me into getting the tests done, and it turned out I really do have MS, and those symptoms were indeed somatic in nature. By then, we had already heavily invested in therapy, so I continued with it; it’s definitely helping me cope with the MS diagnosis. And I've been going to the Mayo Clinic from day one, and I'm very happy with the care there.

What I wrote earlier was prompted by reading a thread on a psychology forum where most people described the opposite: having a new symptom every single day and begging doctors for referrals, even though they already have a diagnosed anxiety disorder.
Also, I remember once when my therapist's phone rang; he picked up, and I sat there listening to him spend ten minutes explaining to someone that his daughter didn't need a full-body MRI or "some kind of infusion." The guy was trying to pull strings with the hospital director, and everyone was yelling and applying pressure. It was all because no one in the family wanted to accept that her problems were actually psychological, even after every single test came back negative.

vividsailor7 said:To be perfectly honest, I don't get it. I really don't. This whole idea of what exactly is being tallied for whom? It’s completely unclear to me.

See? I told you! This proves that if they had actually stepped up and enforced the mandatory generic substitution policy earlier, oncology patients wouldn't be struggling to get their medication right now. It’s exactly what I’ve been saying all along.
There is no such thing as "the best" or "the absolute worst." Period.
See? This is exactly what I’m talking about (honestly, half the time I believe these stories and the other half I think they're total nonsense). It turns out the generic version actually outperforms the brand-name original.

Since you guys decided to quote my post, I honestly have no idea what I'm even supposed to say in response.

I can't even begin to deal with this level of absolute nonsense right now. Honestly, it’s exhausting. Every single time I think we’ve hit rock bottom with the sheer incompetence on display, someone finds a way to dig even deeper. It’s pathetic. Truly. I’m sitting here staring at this mess and I just want to throw my laptop out the window. How does anyone function like this? It's a joke. A complete and total circus. kaže:
Can someone please clear this up for me? I’ve been managing my thyroid issues with an endocrinologist in a different city for two years now. Am I allowed to just keep seeing my current specialist, or am I going to be forced to handle all my checkups and tests at the hospital closest to home?

In my opinion, it all boils down to your individual LOM.

As far as where we actually live goes, I honestly don't think this is going to affect anyone living in NYC.
Look, her waiting around for you guys to show up with a complete list is one thing—I get that. But claiming she has no idea what's going on? That is a flat-out lie.

I absolutely agree with you. Let me give you a real-world example of how this plays out in the clinic: A patient comes in complaining of some mild abdominal pain. I run the standard blood work, order an ultrasound, check their family history, perform a physical exam—everything looks perfectly fine. Everything points to nothing being wrong. But no. This gentleman insists on having a full abdominal CT scan just so he can "be sure" everything is truly okay. Of course, I take the time to explain exactly why that scan is unnecessary and clinically unjustified. What does he say? He tells me straight to my face that if anything happens to him—say, an acute abdominal issue crops up or he gets hit by a truck anytime soon—he’s going to sue my ass. So, now what? How are we even supposed to move forward from there?
Of course, the CT scan came back clean, and now they’ll just drop that one little fact on the forum. But they won't mention the actual reason why the doctor ordered the scan in the first place! And then, predictably, everyone—and I mean everyone, myself included—is going to start throwing stones and pointing fingers, asking what idiot sent you in for a CT just to soak up unnecessary radiation for no damn reason.
Look, she gave you a perfectly fair answer, and honestly, I have no idea what you're even looking for from us right now.
I honestly lose my mind when I see someone with what looks like a genuine emergency—we’re talking severe abdominal pain or bloody stools—just sitting there waiting in an ER hallway or outside an ambulance bay. It drives me absolutely insane.
What on earth am I supposed to do about this? Honestly, just send them straight to the ER—which is exactly what they could have done themselves if they had any sense. When I’m dealing with an ambiguous situation like this, they simply CANNOT be running emergency cases or taking walk-ins. It’s impossible.
That’s exactly why HS—or what we call LOM—exists.
So, let me get this straight: it’s somehow easier for you people to track down a pulmonologist than it is to just get your own primary care doctor to prescribe some Medrol? You’d rather hunt down a specialist than wait for the one day a month they actually have an opening at the hospital? Give me a break.☕😕

1. She admitted herself that she doesn't know certain things; when I ask her directly, she looks me in the eye and tells me she doesn't know. Even regarding Vitamin D and its impact on MS, I had to find all that information online myself. When I brought it up, she told me she'd never heard of it and wasn't even sure if Vitamin D testing was even performed anywhere in the US...
Since I'm living with MS, I'm personally invested, so naturally, I dig deep, read up, and educate myself from every possible angle—which means I'm at least one step ahead when it comes to new research and developments. Of course, I don't know everything better than she does; I'm certainly not an expert on brain anatomy, but it really bothers me that if she treats patients with MS, she should at least stay current on the latest news...

2. Given that asthma either stays quiet or results in an acute attack, the question becomes: when and why should you go to a pulmonologist? When it's dormant, I stick to the regular prescription I've had for over 12 or 13 years; when an attack hits, then it's an emergency.

When it's quiet, I don't need a specialist, and when it's active, I'm physically unable to make it to a specialist's office.

My pulmonologist doesn't work out of a hospital and doesn't have a small clinic once a week; she works at a community health center in the pulmonary department where there are about ten of them, seeing patients five days a week during all working hours. Essentially, her entire job is seeing patients. So why can't she see a sick patient?
Naturally, I'll go wherever they are willing to see me. I tried once to see the pulmonologist when things weren't quite critical yet, because I wanted to understand why my stable condition had suddenly started worsening. She would have been the best person to tell me, but the people in the ER are just there to put out fires, and Urgent Care acts the exact same way in those situations.
The situation was such that she could see in "real time" how my lungs were behaving and hear it firsthand, rather than me having to recount everything that happened a month after the fact.
I truly don't understand why a pulmonary specialist would have an issue with someone coming in during a flare-up, instead of letting someone who *isn't* a pulmonologist deal with it by calling 911—is that how it works?

Or, if you mean the specialized pulmonary emergency units, like the ones at major city hospitals—unfortunately, I've had the chance to assist someone who was practically dying there a couple of times. I swear, I will NEVER set foot in that hospital or deal with those employees again, no matter the cost. What we experienced there, multiple times, was enough to warrant a lawsuit. The only reason I didn't pursue legal action was that I just wanted to forget the whole ordeal; otherwise, I would have ended up in a massive multi-year court battle. I'm drifting a bit from the topic, but I seriously believe those people are responsible for the death of someone close to me. The behavior of certain staff members, the lack of equipment, and letting a person who is suffocating wait in a hallway while the ER doctor and technician enter five times to literally beg the attending physician to start the exam... all while she and the nurse respond rudely, acting like they're just waiting to go paint their nails. Even today, it still makes me sick.😠
The worst part about it is that in NYC, Jordanovac is the only pulmonary emergency center, so...🙂

Nicholas Myers said:If you look at the billing codes in a standard primary care clinic, Kyle Lee7, you'll see entries for things like "psychotherapeutic counseling" or "superficial psychotherapeutic intervention."

Since I'm no longer working in general practice, I can't give you the exact specifics right now, but these are procedures that don't require advanced training. A standard MD can perform them without being a specialist in family medicine.

So, this "semi-psychotherapy" does exist, and it gets billed—Medicare covers it under certain outpatient procedure codes.

There's no need to question my understanding of psychotherapy. This isn't an official medical seminar, nor is it intended to be a formal academic debate, so precision isn't the priority here.

Thanks.

I agree with everything said here.
🙂

My apologies, I really didn't mean to call you out like that.

I was just expressing my skepticism regarding any kind of psychotherapy intervention being handled by general practitioners—regardless of the specific type. I actually wasn't aware that "psychotherapeutic counseling" was even a formal term used in that context, but after spending years in actual therapy and years bouncing between various doctors and specialists, my personal take is that you really need a specialist for that. Those various bits of unsolicited advice you often get—like being told "you just need to pull yourself together"—simply don't feel useful to me.

In principle, the idea behind this is actually quite good because there are so many logical gaps in the current system. Of course, new ones will pop up, they'll just be in different places.

The worst part, though, is the patients themselves—people who visit doctors, get a whole stack of prescriptions, and then just DON'T TAKE THEM. Or they don't finish the course, or they take them incorrectly. I actually overheard a guy bragging to a pharmacist the other day about how he keeps his medication sitting right in his desk drawer, yet he still makes sure to pick up one or two boxes every single month regardless!

Then you have the patients who get a tiny little twinge in their ear and suddenly demand a full-body CT scan and every diagnostic test known to man.
Or the hypochondriacs and people with severe anxiety who spend YEARS cycling through doctors, running enough tests on the healthcare system to cover ten people, when all they really need is for someone to finally refer them to a psychiatrist. But no, these same Primary Care Physicians insist on writing referrals for heart checks, blood work, thyroid panels, brain scans, this and that... even though the patient is clearly just anxious. It’s like these PCPs should be psychiatrists instead, because every single one of these patients just wants physical proof of a disease. Do we realize how much that costs us?

As for asthma, it’s just "lovely" to hear people dismiss it as some minor, insignificant condition that doesn't require a specialist.
I’ve been on the brink of death a couple of times—struggling to breathe, my oxygen saturation levels tanking... but heaven forbid I actually see my own pulmonologist!
Generally speaking, it feels like the shortage of pulmonologists isn't even a result of this new reform; it's been bad for a long time. Specifically:

I have my own pulmonologist. She sees me maybe once every two or three years just for routine maintenance. My asthma is under control, and my PCP handles my prescriptions. However, if my condition starts to take a turn for the worse—I CANNOT GET TO HER!!!!
I can get an appointment in a month. Wtf? The nurse tells me, "If it's an emergency, call 911; if you're feeling slightly worse, go to your primary care doctor." So what is the point of having a specialist pulmonologist managing my care? If I can't see her exactly when a flare-up happens, what's she there for?
Is she just there for routine checkups when I'm feeling perfectly fine? I don't even need her for that!

The only time I actually want to see a pulmonologist is when I feel my asthma worsening, but BEFORE it reaches the point where I need to call an ambulance!!!!!

It was the same thing back when I was a student and had my records at the campus health clinic; they had a habit of scheduling appointments a month out.
The only way you got seen the same day was if you had a high fever or active bleeding.

That just isn't normal. Even if you have a minor inflammation or something is aching or burning... what is the logic in waiting a month for an appointment, letting everything get worse, spread, and complicate itself, and just suffering through it for thirty days???
Especially since gynecological issues aren't things you should wait on, aside from regular screenings.
It’s like going to a PCP with a throat infection or a bladder infection and being told to come back in a month because it's "not an emergency."

That’s actually how I ended up finding a private gynecologist whom I can see the same day or the next. And that was the first time in my life someone actually asked me, "Have you had your swabs done?" What do you mean, swabs? Heaven forbid a government doctor would suggest that a sexually active person might actually need to get tested once in their life.
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