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Medical Forum / Diseases and Disorders / Sinusitis / August 2006Good sinus doctor in the atlata area
Does anybody recommend a good sinus doctor in the metro atlanta area? Thanks. Dr. Pugliese is an infectious disease doctor who aggresively treats chronic sinusitis in the Atlanta area. He has offices in several locations. He is not an ENT so does not do surgery, ect. He is more the type of doctor that will look at your medical records and LISTEN to YOUR SYMPTOMS. He uses both antibiotics and antifungals, sometimes IV if he thinks it is necessary. You probably wouldn't want to go this aggresive as a first line approach, but if nothing else helps, he is very good. I ended up having to have surgery anyway, but he virtually kept me alive until then. There are very few infectious disease doctors who want to deal with chronic sinusitis patients. Kathyw > Does anybody recommend a good sinus doctor in the metro atlanta area? > > Thanks. > Dr. Pugliese is an infectious disease doctor who aggresively treats > chronic sinusitis in the Atlanta area. He has offices in several > locations. He is not an ENT so does not do surgery, ect. He is more > the type of doctor that will look at your medical records and LISTEN to > YOUR SYMPTOMS. He uses both antibiotics and antifungals, sometimes IV > if he thinks it is necessary. Does he sell his own IV services, or does he refer to the in plan infusion services of patients' insurance? Just wondering, because this has been a confounding conflict issue in Lyme disease treatment, for instance. Susan My insurance completely covered all of my costs. I have BCBS PPO. > Does he sell his own IV services, or does he refer to the in plan > infusion services of patients' insurance? [quoted text clipped - 3 lines] > > Susan > My insurance completely covered all of my costs. I have BCBS PPO. That wasn't my question. Who was the infusion service provider? Susan > x-no-archive: yes I'm sorry. I didn't understand your question. I just thought you wanted to know if insurance covered it. My brain is still a little fuzzy (well actually a lot). I don't know who the infusion service provider was. I'll try to look later and see if I have any of the supplies or labels left over. It has been over a year ago since I had it, > > My insurance completely covered all of my costs. I have BCBS PPO. > [quoted text clipped - 3 lines] > > Susan > I'm sorry. I didn't understand your question. I just thought you > wanted to know if insurance covered it. My brain is still a little > fuzzy (well actually a lot). I don't know who the infusion service > provider was. I'll try to look later and see if I have any of the > supplies or labels left over. It has been over a year ago since I had > it, It's okay, please don't go to extra trouble. Susan Susan, as a former management person for a medicaid HMO, the way we handled this was to pay the physician office services (E&M codes) and there were infusion companies which we paid separately. IV therapy was used for outpatient treatment of both acute infections, and we had a few patients on prolonged treatment for chronic Lyme disease with PICC lines in. It's more a payor issue. Few MD's are set up to provide infusions in the office. When I worked for a staff model HMO, we gave our infusions in the office-- it kept costs in house. Now in private practice, we call an IV therapy company for at home IV therapies. As you know, benefits can vary widely. The only IV we ever refused (at the HMO) was for a surgeon who had the nurses in the local ER start his IV's, then made the patients drive over to his office with the IV in, pay out of pocket--to the surgeon-- for this, and then ran the cases in his office. That wasn't ok.As a medicaid provider, our patients were never liable for out of pocket costs, the provider was the one who didn't get paid if they did something not covered in the contract. I'm out of that world at this point. Just on the other end, trying to get paid for what I do.... Judy > x-no-archive: yes > [quoted text clipped - 8 lines] > > Susan > Susan, as a former management person for a medicaid HMO, the way we > handled this was to pay the physician office services (E&M codes) and [quoted text clipped - 16 lines] > I'm out of that world at this point. Just on the other end, trying to > get paid for what I do.... Judy, some entrepreneurial docs have set up their own infusion services, which they insist is the only IV service provider that is good enough for their chronically ill, desperate for treatment patients to use. IV abx seem to be rx'ed a lot more often, and for longer durations than these docs. Susan Susan, There are a few physicians who run "Chronic Lyme" practices who do resort to these practices, which are really all about making money. In these days of declining reimbursement and third party payors, people look to all sorts of questionable practices to generate revenue. (Think of all the laser hair removal centers....) It's really too bad, because patients need care and their needs get lost in this desire to generate revenue. Judy > x-no-archive: yes > [quoted text clipped - 27 lines] > > Susan > Susan, > There are a few physicians who run "Chronic Lyme" practices who do > resort to these practices, which are really all about making money. Yes, that's happened. BTW, chronic Lyme is real, not deserving of quote marks, except perhaps in those particular physician's offices. ;-) I've learned that there are chronic sinusitis docs augmenting their income in the same way. In > these days of declining reimbursement and third party payors, people > look to all sorts of questionable practices to generate revenue. (Think > of all the laser hair removal centers....) > It's really too bad, because patients need care and their needs get > lost in this desire to generate revenue. Yup. The insurance lobby beat the medical lobby for control over how much health care we get and who gets to go home with all the marbles. Susan Susan, Sorry about the quotes around chronic lyme disease, I do believe there are prolonged symptoms if the infection isn't treated early enough, or sometimes even if it is. Spirochetes are nasty. I think there's controversy about long term IV treatment. (And we know that meta analysis articles suffer from bias--what studies are included, etc.) I have discovered at least 3 physicians who run practices devoted to chronic lyme disease. They are never affiliated with hospitals and their criteria for including/diagnosing patients can be so broad as to be questionable. The rest of the infectious disease community does not agree with their approach, and these ID people aren't doctors who dismiss the long term sequela of lyme disease. I just think these few doctors practice medicine outside the mainstream, and when I've spoken to one of them, there were claims of "miracle cures" of problems that defy cures. I hate to both see patients be told that their symptoms aren't real and the opposite, which are doctors who prey on the desperate. Judy > x-no-archive: yes > [quoted text clipped - 19 lines] > > Susan > Susan, > Sorry about the quotes around chronic lyme disease, I do believe [quoted text clipped - 3 lines] > meta analysis articles suffer from bias--what studies are included, > etc.) Judy, I think it's probably also unusual to be bitten by a tick that's carrying only one infection. I think it's Krause at U. Conn whose theory is that babesiosis in particular is behind uncurable late Lyme in many cases. Anecdotally, after 3 1/2 years of chronic Lyme that needed constant abx, my child was cured by a trial of zithromax and atovaquone. We can't test for the organisms with any reliability, the literature is full of cases in animals and humans where sx persist even after lengthy treatment. There's no controversy here when you talk to researchers *off* the record. It's no different than the doc who told you he'd cured you with surgery, so leave him alone. > I have discovered at least 3 physicians who run practices devoted to > chronic lyme disease. They are never affiliated with hospitals and > their criteria for including/diagnosing patients can be so broad as to > be questionable. There's no question that this happens, and with sinusitis, too, BTW. But the doc who treated my child, and my doc, both are affiliated, both got paid our negotiated insurance rate, and both dx and tx chronic TBDs. The science behind the issue doesn't change just because some cash hungry opportunists got involved. The rest of the infectious disease community does not > agree with their approach, and these ID people aren't doctors who > dismiss the long term sequela of lyme disease. Uh, yes, they do, if you're a patient. I've heard them say that if they even think a family member has been bitten, they give them 4-6 weeks of doxy. You can't get treated if you have the damned tick attached, if you're not family! What they say, and what they practice clinically are two different things. The IDSA guidelines are total political crap. I just think these few > doctors practice medicine outside the mainstream, and when I've spoken > to one of them, there were claims of "miracle cures" of problems that > defy cures. Uh, Judy, I haven't found any superior qualities within the mainstream. What I've found is academically affiliated docs and researchers saying off the record that their careers are in jeapardy if the treat and even publish truthfully about chronic TBDs. > I hate to both see patients be told that their symptoms aren't real > and the opposite, which are doctors who prey on the desperate. The mainstream docs are equally predatory, but what they're protecting is their careers, not wanting to fall out of stop. Docs like those we use in my family are secure enough, and well read enough to reject both camps, the opportunists and the IDSA. Susan Susan, I found my first case of babesiosis this year: I'm back in a private practice where patients can actually afford to get labwork done--vs. the inner city community clinics. I found that the rheum person wouldn't help me, so I called upon ID. I think it's vastly underrecognized--there was a recent article in our local paper about how common it is, but they said it was usually self-limited in healthy people. I think we agree about the health care system and how messed up it is. I spent a few years in academia--I had idolized it from afar--and it nearly killed me. I've also been personally harmed by national experts and helped by local doctors who "think outside the box". So, "do no harm" just isn't the standard anymore, if it ever was. That's why we have to learn and advocate for ourselves and find the people, like our allergists, who hang in there with us. Judy > x-no-archive: yes > [quoted text clipped - 59 lines] > > Susan > Susan, > I found my first case of babesiosis this year: I'm back in a private [quoted text clipped - 4 lines] > how common it is, but they said it was usually self-limited in healthy > people. Mazel tov! :-) I think it's not only underrecognized, but finding it on a smear or any other lab is apparently rare past the acute febrile stage. My child never tested + (though TBDs weren't looked for til after 6 mos. misdxed with mono), but we suspect that babesia are what caused the early enlarged spleen. > I think we agree about the health care system and how messed up it > is. Sistah! > I spent a few years in academia--I had idolized it from afar--and it > nearly killed me. I've also been personally harmed by national experts > and helped by local doctors who "think outside the box". That's my point; the chronic Lyme docs who're just quietly taking care of their patients without setting up infusion services, etc. are staying below the radar, fearing prosecution or just wanting to do their jobs. It's easy to label all of those on the activist side of the debate as quacks with so many visible medical miscreants. But they exist in all cases of chronic diseases where mainstream medicine isn't working, not just Lyme. The difference is how much insurance money and unscientific thinking is guiding the Lyme mainstream. > So, "do no harm" just isn't the standard anymore, if it ever was. Exactly. Now it's "do no harm that the rest of the community isn't doing." :-( > That's why we have to learn and advocate for ourselves and find the > people, like our allergists, who hang in there with us. We are so on the same page. My allergist strives to emulate Osler for real, not just in fantasy, as his father did. Fortunately for me (not for him!) he says he can't afford to retire. :-) I think his dad practiced until they carried him out of the office. Susan |
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