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Medical Forum / Diseases and Disorders / Prostate BPH / May 2006Does a Uro. do kidney biopsy exams
As a result of having red blood cells in my urine, my doctor referred me to a urologist. I have edema and some other symptoms of kidney disease. It's my "guess" that the blood in the urine is the result of a kidney disease. Is it possible for a uro. to do a kidney biopsy to rule in or out kidney disease as a cause for the blood in the urine? I already know that the uro. will conduct various tests and exams to rule in or out the various causes of blood in the urine. I should note that I asked my doctor to refer me to a kidney specialist but he refused to do so because of the rules of my insur. company. Jason > As a result of having red blood cells in my urine, my doctor > referred me to a urologist. I have edema and some other [quoted text clipped - 11 lines] > > Jason Jason...please tell us what the rules were that prohibited your primary care physician from referring you to a nephrologist. I am interested. Sounds like more HMO bullshit to me :-) . Jason Johnson wrote: > As a result of having red blood cells in my urine, my doctor > referred me to a urologist. I have edema and some other [quoted text clipped - 11 lines] > > Jason Jason...please tell us what the rules were that prohibited your primary care physician from referring you to a nephrologist. I am interested. Sounds like more HMO bullshit to me :-) . It's HMO bullshit. The rules state that my doctor needs a medical reason to refer me to a kidney specialist. I have edema but it's not a serious case of edema. There are several causes of edema. Perhaps if kidney disease was the only cause of edema, my doctor could refer me to a kidney specialist. Almost every item on my kidney function blood tests and urine tests are within normal limits mainly because I am now a vegetarian. Therefore, the insur. company would hassle him if he referred me to a kidney specialist. I don't know what sort of punishement they use on doctors to keep them from referring patients. I know that I have kidney problems since I read a book that was written by a kidney specialist. I have many of the symptoms that he mentioned in his book. In another newsgroup, some of the posters tried to convince me that I don't have a kidney disease. They may be correct but how could I know for sure unless I have the proper tests such as a kidney biopsy? I hate HMOs. Jason > Jason Johnson wrote: > > As a result of having red blood cells in my urine, my doctor [quoted text clipped - 33 lines] > sure unless I have the proper tests such as a kidney biopsy? I hate HMOs. > Jason I doubt that the primary care doctor has any control. The HMO reviews the test results and probably not authorize the kidney specialist. I would say it is now up to your URO to determine if a kidney specialist is needed. Perhaps you can be thankful there is not a government bureaucrat somewhere in the line deciding which doctor and treatment you will be allowed to have (in the very distant future). Your experience is exactly why I found a way out of HMOs about 10 years ago. I concluded the savings were not worth my not being able to search out the doctor I want. Those that use them usually say "I have no complaints". I then ask if they ever had a difficult medical problem that needed a specialist or something that made you uncomfortable with the specialist provided by the HMO. I guess the bottom line is you get what you pay for. The doctor of a friend recommended that he go to the Mayo clinic. The HMO refused to pay saying there were adequate doctors available locally. That doctor immediately dropped all patients from that HMO. The local doctors (and there were several of them) all concluded he suffered from a bone infection. They removed large sections of his jaw bones and did other treatment without success. Finally they sent him to Mayo. It took the Mayo doctors 20 minutes to point out he has a small tumor. Fortunately very slow growing. The friend then remembered one of the doctors commenting "I wonder what that lump is?". Several years of cosmetic surgery followed. Jason Johnson wrote: > In article <e58d69028ne@enews3.newsguy.com>, "Pete" <pete@nospam.net> wrote: > [quoted text clipped - 34 lines] > sure unless I have the proper tests such as a kidney biopsy? I hate HMOs. > Jason I doubt that the primary care doctor has any control. The HMO reviews the test results and probably not authorize the kidney specialist. I would say it is now up to your URO to determine if a kidney specialist is needed. Perhaps you can be thankful there is not a government bureaucrat somewhere in the line deciding which doctor and treatment you will be allowed to have (in the very distant future). Your experience is exactly why I found a way out of HMOs about 10 years ago. I concluded the savings were not worth my not being able to search out the doctor I want. Those that use them usually say "I have no complaints". I then ask if they ever had a difficult medical problem that needed a specialist or something that made you uncomfortable with the specialist provided by the HMO. I guess the bottom line is you get what you pay for. The doctor of a friend recommended that he go to the Mayo clinic. The HMO refused to pay saying there were adequate doctors available locally. That doctor immediately dropped all patients from that HMO. The local doctors (and there were several of them) all concluded he suffered from a bone infection. They removed large sections of his jaw bones and did other treatment without success. Finally they sent him to Mayo. It took the Mayo doctors 20 minutes to point out he has a small tumor. Fortunately very slow growing. The friend then remembered one of the doctors commenting "I wonder what that lump is?". Several years of cosmetic surgery followed. None of the things that you stated shocked or surprised me since I have had to deal with this issue for the past two years. I decided to pay extra for a PPO (did I get that right?) since I was promised that I could see any specialist that I wanted to see without getting a referral from my GP. That did not work since none of the specialists would see me unless I was referred from my GP doctor. I later learned that specialists made that decision since my Blue Shield PPO program refused to pay them if specialists determined that certain patients did not have a medical problem. However, they would pay the specialists if patients were referred even if the specialist later determined that they patients did not have any medical problems. It's a mess. I wish that I was rich and could therefore avoid dealing with the insurance mess. Jason > In article > <bNYdg.172945$eR6.40836@bgtnsc04-news.ops.worldnet.att.net>, Rich256 [quoted text clipped - 89 lines] > the insurance mess. > Jason Jason...You really have me confused here. Do you belong to an HMO, or to a Blue Shield PPO network, or both ???? Jason Johnson wrote: > In article > <bNYdg.172945$eR6.40836@bgtnsc04-news.ops.worldnet.att.net>, Rich256 [quoted text clipped - 89 lines] > the insurance mess. > Jason Jason...You really have me confused here. Do you belong to an HMO, or to a Blue Shield PPO network, or both ???? Hello, It's a Blue Shield PPO network but in my town it's nothing more than an HMO since none of the specialists will see me unless I am referred by my regular doctor. I was told that the reason is because they the specialists are only 100% sure they will be paid is if their Blue Shield patients were referred by their regular doctors. It's a mess. Jason > Jason Johnson wrote: >> As a result of having red blood cells in my urine, my doctor [quoted text clipped - 35 lines] > for sure unless I have the proper tests such as a kidney biopsy? I > hate HMOs. Jason Jason...That's why I stay with my Blue Cross (every open season), even though the doc's are dropping it because they don't pay enough. I don't need a referral, but certain specialists may require one anyway. I would think that your doctor would be able to short circuit the bullshit (especially if you were close to him). In other words ("he needs a medical reason") should be general enough just for him to go ahead with the referral, unless he has no doubt whatsoever that you do not have a kidney ailment (and he has no way knowing that categorically - I do not believe). This is total bullshit IMO, if you have a strong concern about your kidneys. Are you able to switch to a non HMO provider, or are you locked in with what you have. Having said all that, you do have to be cautious about self diagnosing yourself, and "playing doctor" (as was discussed in the sci.med ng). However, if you are truly concerned about your edema (which you have the right to be), I think your doctor should refer you to a nephrologist, if you request him to. Pete >> Jason Johnson wrote: >>> As a result of having red blood cells in my urine, my doctor [quoted text clipped - 56 lines] > > Pete Being quite familiar with the structure of HMOs it may well be that it will be the URO that has to do the referral to a nephrologist. And that may be only after additional approval by someone (an administrative doctor?) in the HMO. The reason they can maintain their big staff and provide medical service at cost less than other insurance is sort of obvious. >>> Jason Johnson wrote: >>>> As a result of having red blood cells in my urine, my doctor [quoted text clipped - 62 lines] > their big staff and provide medical service at cost less than other > insurance is sort of obvious. I understand HMO's also Rich (as well as medical insurance in general), but there are different kinds of HMO's (the Kaiser Permanente kind - ?sp - the bad kind where you have to go to a doctor in one of their centers), and the other kinds (eg MDIPA - MD is for Maryland, where I live - and is offered by my federal retirement insurance coverage during open season). MDIPA, actually has more providers than my Blue Cross (and I can go to any doctor in the whole state of Maryland), and it is way better from a cost standpoint (premiums, deductible, catastrophic, etc). However, they still have the friggen rules for the referral crap, and your primary doctor is in charge (da da da da), except where a specialist may have to refer you to another specialist, like you mentioned, which is just another level of crap. It is a bureaucratic, administrative mess at best, and I don't choose to get involved it (with all my medical problems); plus with my Blue Cross, I can go to any doctor in any city in my surrounding states (I live in a tristate area so to speak), or any doctor in the country for that matter. I prefer to be in charge of my medical management, and not have to kiss my primary care doctor's a.s every time I want to see a specialist, and that is all I have done, is go to specialists, in the last 15 years. Bottom line is that HMO's suck royally, hands down, non negotiable in my humble opinion. Have a nice day :-) ...Pete Rich256 wrote: > Pete wrote: >> Jason Johnson wrote: [quoted text clipped - 66 lines] > their big staff and provide medical service at cost less than other > insurance is sort of obvious. I understand HMO's also Rich (as well as medical insurance in general), but there are different kinds of HMO's (the Kaiser Permanente kind - ?sp - the bad kind where you have to go to a doctor in one of their centers), and the other kinds (eg MDIPA - MD is for Maryland, where I live - and is offered by my federal retirement insurance coverage during open season). MDIPA, actually has more providers than my Blue Cross (and I can go to any doctor in the whole state of Maryland), and it is way better from a cost standpoint (premiums, deductible, catastrophic, etc). However, they still have the friggen rules for the referral crap, and your primary doctor is in charge (da da da da), except where a specialist may have to refer you to another specialist, like you mentioned, which is just another level of crap. It is a bureaucratic, administrative mess at best, and I don't choose to get involved it (with all my medical problems); plus with my Blue Cross, I can go to any doctor in any city in my surrounding states (I live in a tristate area so to speak), or any doctor in the country for that matter. I prefer to be in charge of my medical management, and not have to kiss my primary care doctor's a.s every time I want to see a specialist, and that is all I have done, is go to specialists, in the last 15 years. Bottom line is that HMO's suck royally, hands down, non negotiable in my humble opinion. Have a nice day :-) ...Pete It's different in my town. Blue Shield has a terrible reputation related to their PPO program. I don't think that my employer has a Blue Cross program as an option. I will check during the next open enrollment period. Some of the insurance companies are no longer part of the package--I don't know the reason but it's probably related to money. Jason > Rich256 wrote: > >> Jason Johnson wrote: [quoted text clipped - 100 lines] > know the reason but it's probably related to money. > Jason Probably money? There isn’t anything else. Although I often sympathize with the doctors. After paying their malpractice insurance, treating uninsured patients and accepting deep discounts from Medicare and HMOS, paying their rent and help and supplies, they may end the week or month at a loss. Next question was going to be is there even a nephrologist that will accept your Blue Cross? Maybe the URO is considered "close enough". Jason Johnson wrote: > In article <e5afif0229q@enews2.newsguy.com>, "Pete" <pete@nospam.net> wrote: > [quoted text clipped - 101 lines] > know the reason but it's probably related to money. > Jason Probably money? There isn’t anything else. Although I often sympathize with the doctors. After paying their malpractice insurance, treating uninsured patients and accepting deep discounts from Medicare and HMOS, paying their rent and help and supplies, they may end the week or month at a loss. Next question was going to be is there even a nephrologist that will accept your Blue Cross? Maybe the URO is considered "close enough". I don't know--it would be a good idea for me to find out if Blue Cross is an option during the next open enrollment time period. It only happens once a year. If we don't switch during the open enrollment time period, we have to keep the plan we had during the prior year. My Blue Shield program will pay any specialists as long as there is a referral. I don't know the real reason why my doctor referred me to a uro. instead of a nephrologist. It was probably a judgement call. Most cases of blood in the urine are NOT related to kidney problems so therefore it made sense that he referred me to a urol. I believe that he should have referred me to a nephrologist since the nephrologist could have discovered the reason for the blood in the urine as well as the cause of the edema. I doubt if insurance was an issue related to this particular referral--just a judgement call. I believe that the judgement was wrong but I can't tell a doctor what to do. Perhaps I should have asked him for the reason he referred me to a urologist instead of a nephrologist. If I had it to do over again--I would have asked him for the reason. I now wonder if the nephrologists in my town accept patients from Blue Shield. They probably do. jason > In article > <AK4eg.175120$eR6.22743@bgtnsc04-news.ops.worldnet.att.net>, Rich256 [quoted text clipped - 144 lines] > probably do. > jason Jason...let me expand on Blue Cross/Blue Shield (B/C and B/S) a little (at least my federal retirement coverage). I have both B/C and B/S. B/C is for hospital stuff, and B/S is for doctor stuff (for a nutshell definition). One is really useless without the other. I am surprised that you have Blue Shield without the Blue Cross (ie, what happens if you require a major hospitalization - eg, major car accident, or other serious condition). I don't understand why you keep saying you will check on Blue Cross. You need both the "cross" for the hospital stuff, and the "shield" for the doctor stuff. As far as your primary care doc referring you to the uro first (before a nephrologist), that is the logical sequence and he probably figured the uro will forward you on to the nephrologist if necessary, like Rich said. I can see you need some minor tune up work on going to doctors :-) . I have been to approx 75 docs in my life, and I hate the bastards (except for a few like our marvelous Dr. Sancha in this group). Call the nephrologists in your area and ask them if they take your Blue Shield. It is a simple phone call. Take care :-) ...Pete Jason Johnson wrote: > In article > <AK4eg.175120$eR6.22743@bgtnsc04-news.ops.worldnet.att.net>, Rich256 [quoted text clipped - 144 lines] > probably do. > jason Jason...let me expand on Blue Cross/Blue Shield (B/C and B/S) a little (at least my federal retirement coverage). I have both B/C and B/S. B/C is for hospital stuff, and B/S is for doctor stuff (for a nutshell definition). One is really useless without the other. I am surprised that you have Blue Shield without the Blue Cross (ie, what happens if you require a major hospitalization - eg, major car accident, or other serious condition). I don't understand why you keep saying you will check on Blue Cross. You need both the "cross" for the hospital stuff, and the "shield" for the doctor stuff. As far as your primary care doc referring you to the uro first (before a nephrologist), that is the logical sequence and he probably figured the uro will forward you on to the nephrologist if necessary, like Rich said. I can see you need some minor tune up work on going to doctors :-) . I have been to approx 75 docs in my life, and I hate the bastards (except for a few like our marvelous Dr. Sancha in this group). Call the nephrologists in your area and ask them if they take your Blue Shield. It is a simple phone call. Take care :-) ...Pete I just checked my Blue Shield of California card and Blue Cross is NOT written anywhere on that card. You may live in a different state. We have different plans to choose from once a year during the open enrollment period. I don't remember the plans (other than Blue Shield) that were offered. I was only guessing when I mentioned Blue Cross. It's possible that in this state--Blue Shield and Blue Cross are combined and they just call it Blue Shield whereas in your city or state--they are separate programs. I know that I can go to a local hospital and use my Blue Shield to pay for it. I plan to ask the uro. to refer me to a neprologist if he can not determine the source of the blood in the urine. Once I see the neprologist I am going to request a kidney biopsy to rule in or out kidney disease. One person in another newsgroup indicated that I needed to see a psychologist since I was obsessed about my medical problems. That made me laugh. It makes more sense to try to find the reasons for the 1.edema 2.metabolic acidosis 3.blood in the urine. If it's not a kidney disease--it's something else. My research indicates that there is a medical problem (eg kidney disease, liver disease) that causes those symptoms. Thanks for your support. The insurance mess is making it difficult for me to see the specialists that I would like to see. Jason > Jason Johnson wrote: >> In article [quoted text clipped - 191 lines] > for me to see the specialists that I would like to see. > Jason Okay Jason...it appears there is a nomenclature/symantics issue here - NBD. Many years ago when Blue Cross first started (back when an ER visit was only 25-50 dollars), there were two distinct parts (ie the "cross" and the "shield"). I just refer to it today as Blue Cross in a generic sense, although my offiial insurance is called "Care First Blue Cross Blue Shield - Federal Employee Program"- wow! Take care...Pete Jason Johnson wrote: > In article <e5cn5702uth@enews4.newsguy.com>, "Pete" <pete@nospam.net> > wrote: [quoted text clipped - 193 lines] > for me to see the specialists that I would like to see. > Jason Okay Jason...it appears there is a nomenclature/symantics issue here - NBD. Many years ago when Blue Cross first started (back when an ER visit was only 25-50 dollars), there were two distinct parts (ie the "cross" and the "shield"). I just refer to it today as Blue Cross in a generic sense, although my offiial insurance is called "Care First Blue Cross Blue Shield - Federal Employee Program"- wow! Take care...Pete I work for the STATE of CALIFORNIA. It's possible that is the reason for the nomenclature/symantics issue. It's just referred to as BLUE SHIELD in relation to my insurance and the exact words on my insurance card. The official name written on one of the booklets is: "Blue Shield of California--An Independent Member of the Blue Shield Association." Does that help clear up the mystery? Jason > Jason Johnson wrote: >> In article <e5cn5702uth@enews4.newsguy.com>, "Pete" <pete@nospam.net> [quoted text clipped - 213 lines] > Does that help clear up the mystery? > Jason Jason...I googled your insurance and apparantly you must have one of the HMO versions (versus PPO) of "Blue Shield of California". I say this since you have all the referral rules you mentioned. You may want to consider switching to a non HMO type during open season, although it may cost more, and may not suit your specific needs...Pete Jason Johnson wrote: > In article <e5dfai02io0@enews1.newsguy.com>, "Pete" <pete@nospam.net> > wrote: [quoted text clipped - 216 lines] > Does that help clear up the mystery? > Jason Jason...I googled your insurance and apparantly you must have one of the HMO versions (versus PPO) of "Blue Shield of California". I say this since you have all the referral rules you mentioned. You may want to consider switching to a non HMO type during open season, although it may cost more, and may not suit your specific needs...Pete Thanks for your post. Yes--it clearly states HMO on the front of the card. However, it has a special feature. The official term that is written on the cover of the booklet is "Access + HMO". I copied this statement from the booklet: "You may arrange an office visit with a specialist in the same medical group or IPA as your Personal Physician without a referral from your Personal Physician, subject to the limitations described below..." I found out the hard way that one of the "limitations" is that the specialists in the medical group or IPA mentioned above have to agree to see you without a referral. If they refuse--that option becomes of no benefit to me. One of the ladies that works for one of the specialists told me that Blue Shield may not pay the specialists unless patients were referred. In other other words, it's related to money. I blame Blue Shield--not the specialists--for this problem. If they always paid the specialists--they would see and treat Blue Shield Access + HMO patients without a referral. It's a mess. So, in fact, all that I have is an HMO. I plan to choose a different plan (PPO) during the next open enrollment period. It was my impression--that what I had was more like a PPO than a HMO but I was wrong. The booklet contains misleading information. Lots of my fellow employees were misled by the information in that booklet--we all believed that we were getting a PPO type program. Thanks for your help. Jason > Jason...I googled your insurance and apparantly you must have one of > the HMO versions (versus PPO) of "Blue Shield of California". I say [quoted text clipped - 31 lines] > Thanks for your help. > Jason Good idea...I could not work with an HMO type program, like I explained earlier. Make sure to inform your fellow employees also if you can :-) ...Pete > Jason...I googled your insurance and apparantly you must have one of > the HMO versions (versus PPO) of "Blue Shield of California". I say [quoted text clipped - 31 lines] > Thanks for your help. > Jason Good idea...I could not work with an HMO type program, like I explained earlier. Make sure to inform your fellow employees also if you can :-) ...Pete Pete, I doubt if any of them will choose the Blue Shield Access+ HMO program since it's nothing more than an HMO. Blue Shield may have fooled us one time but they won't be able to fool us again. I will choose a PPO program during the next open enrollment period. Thanks for your advice. I filed an appeal with Blue Shield related to this issue and they blamed the specialist for the problem. They said that all of their doctors in their plan are free to accept or reject (self-referred) patients. Of course, they will reject patients like myself if they are not 100% sure Blue Shield will pay them. It's a catch 22 situation that I can NOT Win. Jason J Jason Pete wrote: > Jason Johnson wrote: >> In article <e58d69028ne@enews3.newsguy.com>, "Pete" <pete@nospam.net> [quoted text clipped - 59 lines] > > Pete Being quite familiar with the structure of HMOs it may well be that it will be the URO that has to do the referral to a nephrologist. And that may be only after additional approval by someone (an administrative doctor?) in the HMO. The reason they can maintain their big staff and provide medical service at cost less than other insurance is sort of obvious. You must be correct. Someone else told me the exact thing in another newsgroup. Jason Johnson wrote: > In article <e58d69028ne@enews3.newsguy.com>, "Pete" <pete@nospam.net> > wrote: [quoted text clipped - 37 lines] > for sure unless I have the proper tests such as a kidney biopsy? I > hate HMOs. Jason Jason...That's why I stay with my Blue Cross (every open season), even though the doc's are dropping it because they don't pay enough. I don't need a referral, but certain specialists may require one anyway. I would think that your doctor would be able to short circuit the bullshit (especially if you were close to him). In other words ("he needs a medical reason") should be general enough just for him to go ahead with the referral, unless he has no doubt whatsoever that you do not have a kidney ailment (and he has no way knowing that categorically - I do not believe). This is total bullshit IMO, if you have a strong concern about your kidneys. Are you able to switch to a non HMO provider, or are you locked in with what you have. Having said all that, you do have to be cautious about self diagnosing yourself, and "playing doctor" (as was discussed in the sci.med ng). However, if you are truly concerned about your edema (which you have the right to be), I think your doctor should refer you to a nephrologist, if you request him to. Pete Pete, I am hoping that the urologist will refer me to a kidney specialist if he determines the source of the blood in the urine is not related to the the urethra or prostate cancer. One of the other posters indicated that one specialist can refer patients to other specialists or at the very least tell the GP to make the referral. It's a mess. I would like to know whether or not I the edema is caused by kidney disease. One person in another newsgroup implied that means I was obsessed about having kidney disease. If a biopsy indicated that I did not have kidney disease, the obsession would come to an end. I should note that I call it a "concern" instead of an obsession. If you had edema, would you ignore it or do everything in your power to find the exact medical reason that you had edema? Jason > Jason Johnson wrote: >> In article <e58d69028ne@enews3.newsguy.com>, "Pete" <pete@nospam.net> [quoted text clipped - 78 lines] > find the exact medical reason that you had edema? > Jason Jason...I would try to find out what was causing it, up until a point where you were beating your head up against the wall. I have urological problems that I can not get answers to, and it really pisses me off (no pun intended). I do think you should see a nephrologist (by asking the uro to refer you - and hopefully he will), so that you can at least get more of a "piece of mind", which is important. Pete Jason Johnson wrote: > In article <e5a9k802hrq@enews4.newsguy.com>, "Pete" <pete@nospam.net> > wrote: [quoted text clipped - 81 lines] > find the exact medical reason that you had edema? > Jason Jason...I would try to find out what was causing it, up until a point where you were beating your head up against the wall. I have urological problems that I can not get answers to, and it really pisses me off (no pun intended). I do think you should see a nephrologist (by asking the uro to refer you - and hopefully he will), so that you can at least get more of a "piece of mind", which is important. Pete Pete, I will follow your advice. I am glad that at least one poster understands the importance of "piece of mind". I had to laugh when the poster told me that I should see a psychologist related to my "obsession" related to my medical problems. It makes more sense to you and me to find a cure for our medical problems or at least to find the cause of our symptoms. Jason > Jason Johnson wrote: >> In article <e5a9k802hrq@enews4.newsguy.com>, "Pete" <pete@nospam.net> [quoted text clipped - 102 lines] > problems or at least to find the cause of our symptoms. > Jason I agree Jason. I am a certified expert on "piece of mind" after getting screwed over, and abused and insulted, by many doctors in my life - lol . I hate shrinks worse than doctors, and do not consider them legitimate medical professionals except for severe psychotic syndromes. You don't want to get me going on shrinks :-) . Keep pursuing the nephrologist referral with the uro, and keep us posted. But I doubt you will be able to make him (the nephrologist) do a biopsy, if he doesn't feel it is necessary. At least you will get his viewpoints and opinions...Pete Jason Johnson wrote: > In article <e5cl7f02rot@enews4.newsguy.com>, "Pete" <pete@nospam.net> > wrote: [quoted text clipped - 104 lines] > problems or at least to find the cause of our symptoms. > Jason I agree Jason. I am a certified expert on "piece of mind" after getting screwed over, and abused and insulted, by many doctors in my life - lol . I hate shrinks worse than doctors, and do not consider them legitimate medical professionals except for severe psychotic syndromes. You don't want to get me going on shrinks :-) . Keep pursuing the nephrologist referral with the uro, and keep us posted. But I doubt you will be able to make him (the nephrologist) do a biopsy, if he doesn't feel it is necessary. At least you will get his viewpoints and opinions...Pete Pete, I agree with you. However, I would hope to convince him to do non-invasive tests such as ultrasounds. I would also request tests to determine the cause of my metabolic acidosis and edema. One of the problems is that the many changes I have made in my diet--eating low acid foods--and taking various vit., minerals and herbs--causes standard blood tests and urine tests to show that I have none of the common symptoms of kidney problems and metabolic acidosis. Only special tests could detect those problems. For example, if I went to Mexico and purchased blood pressure medication at a pharmacy and took it--when my doctor in America took my blood pressure--he would believe that I did NOT have a blood pressure problems. I am masking the metabolic acidosis and kidney problems as a result of the special diet and taking supplements. It's a "catch 22" situation and I can win. The insurance issue is making it worse since I can't see specialists unless I am referred. What should I do? I should note that I will not know for sure whether I have a kidney disease unless I have a biopy. Jason > Jason Johnson wrote: >> In article <e5cl7f02rot@enews4.newsguy.com>, "Pete" <pete@nospam.net> [quoted text clipped - 137 lines] > sure whether I have a kidney disease unless I have a biopy. > Jason Jason...when you see the uro, make sure to discuss the possibility of him doing a cystoscopy on you (where he can also get a good look at your bladder, as well as the prostate), and maybe rule out some of the causes of blood in your urine. Just a suggestion. He probably will run his rinky dink tests first (like the stupid dipstick urine test which means nothing). Let us know what the uro says when you go to him. When is your appointment? Pete Jason Johnson wrote: > In article <e5deg602hjo@enews1.newsguy.com>, "Pete" <pete@nospam.net> > wrote: [quoted text clipped - 140 lines] > sure whether I have a kidney disease unless I have a biopy. > Jason Jason...when you see the uro, make sure to discuss the possibility of him doing a cystoscopy on you (where he can also get a good look at your bladder, as well as the prostate), and maybe rule out some of the causes of blood in your urine. Just a suggestion. He probably will run his rinky dink tests first (like the stupid dipstick urine test which means nothing). Let us know what the uro says when you go to him. When is your appointment? Pete Pete, One of the posters (I don't remember which one) told me that if the uro. plans to do a urine test that I should not exercise for at least a week prior to the urine test since exercises can cause trace amounts of blood to appear in the urine--do you think that is good advice? My appointment is three days from now. I am compiling a list of questions and comments--can you (or anyone else that reads this post) think of any questions or comments that I should add to the list? I will keep you updated. Jason Jason...when you see the uro, make sure to discuss the possibility of > him doing a cystoscopy on you (where he can also get a good look at > your bladder, as well as the prostate), and maybe rule out some of [quoted text clipped - 18 lines] > I will keep you updated. > Jason Jason...don't know about the exercise question. Ask him if he will look at your urine under the microscope (he should anyway, or his tech should have - but they may just do the dipstick in the office, which I consider next to useless, especially if you just peed recently, and aren't getting a fresh specimen first thing in the morning, da da da da). You can also ask if you could get a urine culture. I would think he would do a digital exam to check your prostate, and you may want to ask him if he can do an expressed secretion by massaging the prostate and looking at the secretion under the microscope also (for bacteria and/or white blood cells). The problem is if you ask too much, he will probably label you as a "know it all" ,and you risk losing him. It doesn't sound like you have bacterial prostatitis (and the non bacterial kind is much more prevalent), but I would hope he would at least do a digital exam on your prostate - if not I believe you will have wasted your money on the visit. That is very basic and will give him an idea of how big your prostate is (in grams or cc's - one gram is approximately equal to one cc based on tissue density), and if there are any texture problems. If he does the digital exam, ask him approx how big your prostate is, and if it felt boggy or hard, versus normal. He may also do an abdominal ultrasound. I'm sure you will explain your main concerns about the edema, and blood in your urine, but I would definitely ask about a possible cystoscopy at a later date if his basic check systems don't show anything up. If a cystoscopy doesn't show anything, then I would think a referral to the nephrologist would be in order. Make sure to post back with your visit results :-) ...Pete Jason...when you see the uro, make sure to discuss the possibility of > him doing a cystoscopy on you (where he can also get a good look at > your bladder, as well as the prostate), and maybe rule out some of [quoted text clipped - 18 lines] > I will keep you updated. > Jason Jason...don't know about the exercise question. Ask him if he will look at your urine under the microscope (he should anyway, or his tech should have - but they may just do the dipstick in the office, which I consider next to useless, especially if you just peed recently, and aren't getting a fresh specimen first thing in the morning, da da da da). You can also ask if you could get a urine culture. I would think he would do a digital exam to check your prostate, and you may want to ask him if he can do an expressed secretion by massaging the prostate and looking at the secretion under the microscope also (for bacteria and/or white blood cells). The problem is if you ask too much, he will probably label you as a "know it all" ,and you risk losing him. It doesn't sound like you have bacterial prostatitis (and the non bacterial kind is much more prevalent), but I would hope he would at least do a digital exam on your prostate - if not I believe you will have wasted your money on the visit. That is very basic and will give him an idea of how big your prostate is (in grams or cc's - one gram is approximately equal to one cc based on tissue density), and if there are any texture problems. If he does the digital exam, ask him approx how big your prostate is, and if it felt boggy or hard, versus normal. He may also do an abdominal ultrasound. I'm sure you will explain your main concerns about the edema, and blood in your urine, but I would definitely ask about a possible cystoscopy at a later date if his basic check systems don't show anything up. If a cystoscopy doesn't show anything, then I would think a referral to the nephrologist would be in order. Make sure to post back with your visit results :-) ...Pete I have already made a hard copy of your post and will add some or all of your suggestions to the list that I am working on. Doc helped to educate me about some issues. He even helped me to make sense of an electrolyte blood test that was very confusing to me. He determined from one of the blood tests that my GFR score was about 75%. A typical man (with "normal" kidneys) has a GFR score of 100%. I still don't understand the exact reason that my kidneys are not working as well as they should. I am just glad they are still working. Thanks for your post. I will study the hard copy later today. Jason |
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