Getting the doc to order a DEXA

[Kitchenbuddy]

I went to the doctor for a yearly physical which was so frustrating. The muse asked me a bunch of cognitive and safety questions then when it came to pain she interrupted my answer and moved to the next question. When the physician assistant came in we were discussing meds which I take very little. I want to find something safer for my bones instead of taking pantoprazole for Gerd, but she says the pantoprazole is keeping my barret's esophagus from returning and that the pantoprazole is not that harmful for my bones. This worries me but she says my throat is more of a concern than my bones. The dexa scan I had 3 years ago was -3.5 and I requested another one and she refused to give me an order because I am not on any medication for osteoporosis. I explained to her the importance of knowing the health of my bones but she would not budge. I am so frustrated about this. Wishing to find better ways to take care of my health issues without all the risk. Sorry this is too long.

[1whoisblessed]

Can you find a new doctor?? I know it is something that is important, we need to be able to take a part in our health. I think it is concerning that she refused to manage all of YOUR concerns.

[Kitchenbuddy in reply to 1whoisblessed]

I have a goid primary physician, but unfortunately he joined a group of physicians and now I usually see an assistant. My next yearly check is with my primary physician and I will ask again at that time. It takes a long time to get an appointment with a new doctor. My one consultation is that all the years I have not lost height and I am very active with exercise and getting out and about. Going to address with my GI specialist for suggestions about changing meds. Seems I am helping one thing and creating another problem.

[1whoisblessed in reply to Kitchenbuddy]

I understand. My PCP just recently conceded my care(osteoporosis) to an endocrinologist. It will take 3 months before I can get an appt. I too stay active with exercise, socializing, volunteering, and time with my precious grandchildren.

I was caught off guard by my diagnosis, I was changing my workout routines to accommodate my changing posture. It was my rehab M.D. who recommended my bone scan,(Dexa -4 spine) which took 3 months (2/23)to get. In the meantime, I fell and broke my right shoulder.

I had a brain aneurysm in 2018 and a cerebral hemorrhagic stroke the next day. I am grateful to be alive and give glory to my Father in heaven for the fact that I am a living, breathing, walking miracle. That being said, I am left with spasticity on my right side and muscle contracture (shortening of the muscles) because of the spasticity. It left me unable to drive because of no flexion in my right foot/ankle. Challenging right? Not as challenging and life-altering as osteoporosis, it is trying to rob me of my ability to stay active. I will not surrender, I pray and grow in my faith. I will keep fighting the good fight.

I encourage you to keep fighting for your health. I don't know if you have a relationship with God, but encourage you to look to Him to navigate through this difficult season in your life. Praying for you.🙏

[Kitchenbuddy in reply to 1whoisblessed]

Thank you. Best Wishes!

[josephinius1 in reply to 1whoisblessed]

Wow, you've really had a time of it. Thank you for sharing your perspective. I appreciate your faith and positive outlook. AND your suggestion that it's osteoporosis that is turning your life upside down, even relative to previous life threatening events. I have felt similarly, though I've not experienced anything like what you have. My new PCP actually said he could not understand why I'm taking this so seriously. There are lots of reasons actually, not least of which is that my doctors didn't take my complaints of back pain seriously, or even mention osteoporosis when I broke my wrist four years ago, but even if they could be excused (because they don't screen for OP before 65, and I was 61 when I was finally diagnosed, only because my husband insisted I get a DEXA,) I've been living with its effects now for at least four years, and it's not nothing. Maybe if you were sedentary, anyway, it wouldn't be a big deal, but I was quite active. Activity is supposed to be good for your bones, but for me, it was also therapy. It was about the only non-negotiable item on my to-do list. And when doing what's supposed to be good for you becomes what makes your life a bleeding misery, and you don't even know why, (at least I know why, now, so there is that,) it's...hard. I think almost everyone agrees that chronic back pain is bad, maybe the worst. What I think even 90% of OP sufferers don't realize, as they quote whatever source that says "osteoporosis is not painful (unless you've fractured,)" that it's not just fractures that are painful. If you lose height (I'm down 3 inches already, and sure, that's "normal", if you're 80,) you are changing the functionality of everything below the collarbone and above the thighs. Maybe your body adjusts; for me, it's been very fast: I lost an inch just between January and July; the first two (inches) were not that noticeable, but I could feel it happening with this last one, feel that my ribs were settling onto my pelvis, could feel that I had less room to expand my diaphragm (especially if I was sitting.) It IS easier now but I still wear a brace often just to unfold the section below my ribs that's caving in on itself.

I also probably have lost some height due to "mild scoliosis" which I may have always had but which I suspect is part of the osteoporosis package, because why wouldn't it happen if your bones actually get smaller?

And if your bones are smaller, muscles, ligaments, etc. aren't supporting your bones like they used to.

I hope this doesn't happen to me, but a client who's had vertebrae subluxate said I'm at high risk of that, too, and...why wouldn't I be?

All of which makes strengthening the muscles in my back that much more important, and fortunately, I have stayed active, my muscles aren't entirely atrophied, but, I have to be super careful with what I do because apparently, even a slight twist could cause a fracture. (I am feeling so compressed now, though that it makes me wonder if I'm actually not more stable? Early on, that was also a major weirdness, feeling like my vertebrae might actually fail to line up, and I would go down. Now my issue is that I'm stiff, have way less mobility.)

Anyway, you get the picture. Osteoporosis may not end your life, it may not be "cancer" but it IS chronic, it IS sneaky, and based on my experience, you have to be on top of it 24/7. (I have had many a night where I've had to wake up to turn over, so...yeah.) It's still new to me, maybe in 5 years it will be old hat, but it's certainly not "no big deal" as my PCP insisted.

Again, thanks for sharing. (I'm having another sleepless early morning; it makes me contemplative, and allows me way too much extra time. :-/)

[1whoisblessed in reply to josephinius1]

Wow, what a trial you are going through. How uncompassionate of your PCP to relate his sentiment to you.

I currently have to turn over several times a night to stay comfortable, wasn't sure if that was related to my osteoporosis or not.

Thank God your husband insisted you get a DEXA!

We have been given many challenges to claim victory over.

Blessings.🙏🙌

[Kitchenbuddy in reply to josephinius1]

Yes my bones are small and the tendons in back of ankles pull and hurt all the time that worsens with some exercises. I am an occupational therapist so that helps me with planning how I need to do things. After giving my physicians office a not so good of a review the nurse called and said she would request a DEXA for me. They are insisting I take vitamin B12 injections everyday for one week then once a week after that for Anemia. Not sure if they are covered by Medicare so I am trying to get that figured out. In the mean time I got a recorded message that I have an appointment with my primary physician on Tuesday. Hopefully then I can get some answers. Why do we have to fight so hard to get things figured out. If they would only listen.

[HeronNS in reply to Kitchenbuddy]

It's really good that you are able to keep up with exercise. Have you seen my story? It may give you some ideas about other ways you can help to maintain (even improve) your bone density. Also perhaps when you finally get to see your physician you could make sure that you have at some time been tested for "secondary causes of osteoporosis" in case there are other issues besides your medication.

healthunlocked.com/pmrgcauk...

osteoporosis.ca/medical-con...

[Kitchenbuddy in reply to HeronNS]

Thank you. I have read your story. I agree staying active will help. Best Wishes.

[kimmw728]

this is extreme: find a new doctor. Your PA is not following guidelines. PAs are undertrained, too. You could order it yourself or research a REMS scan. I recently fired my internist for mismanagement. It’s so frustrating. I wish you all the best.

[SliderMurphy]

Find a BETTER Doctor! Oh my.

[intexasnloveit]

A friend told me a while back that she wasn’t married to her doctor. I thought what great insight. When our doctors stop listening to us, maybe it’s time to move on. I’m always looking for someone that will partner with me. No one knows our bodies better than we. Best of luck.

[yogalibrarian]

I think are new healthcare provider might be needed....

Pantoprazole is the scientific name of the compound. Its brand name is Protonix. And that is on American Bone Health's list of medications that are bad for bones. americanbonehealth.org/bone...

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From Drugs.com (drugs.com/pantoprazole.html)

Tell your doctor if you have ever had:

*low levels of magnesium in your blood;

*lupus; or

*osteoporosis or low bone mineral density.

You may be more likely to have a broken bone while using pantoprazole long-term or more than once per day. Talk with your doctor about ways to keep your bones healthy, especially if you are an adult over 50.

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You didn't give us your age or what country you are in That may impact how eaisly you can change providers or get a DXA.

One strategy is to run the FRAX (frax.shef.ac.uk/FRAX/tool.a... assessment or American Bone Health's Fracture Risk Calculator (FRC) (americanbonehealth.org/calc.... If you are outside the US you'll need to do FRAX rather than FRC.

That will give you your 10-year fracture risk which I expect will be high. That might help push them to schedule a DXA. Fractures can be life-altering or life-ending. But some healthcare providers just haven't been trained in bone health and have another focus.

Good luck. I hope you are able to find a new provider or get a more sympathetic response from your current provider.

[Kitchenbuddy in reply to yogalibrarian]

I am 67 and I take 40 mg pantoprazole a day. I have a barret's esophagus so that is why my doctor will not take me off of the meds as he believes this will protect my throat. I will watch things closely and do what I can to protect my health and I will push for that DEXA at my next appointment. Thanks for the info.

[yogalibrarian in reply to Kitchenbuddy]

I think this is not one of life's "either or" decisions. You (your doctor) need to protect both your throat and your bones.

I think (and I am not a doctor) that your doctor needs to:

*order the DXA and run the FRAX to determine your fracture risk

*determine if there is an alternative medication for barret's esophagus that might be easier on your bone health

*depending on the DXA and FRAX prescribe an osteoporosis medication

You can support your bone health with lifestyle, diet, and exercise, but considering your age and your last DXA that probably won't be enough. You will probably need one of the osteoporosis medications.

That being said, you may also need a different healthcare provider or a specialist.

[gerrirose]

This is just classic doctor arrogance. Too common for sure.

[Hidden]

That would be the last visit I made to that doctor.

[TWEETYCAT]

I don't know how old you are, but if you are a senior, you are allowed a dexa every 2 years on medicare and every year if your doctors order it. They cannot deny you a dexa if you have osteo and it is outrageous that she denied your request. Is this an independent doctor or in a group? If you are on medicare, go to Quality improvement organizations web site and locate a representative in your city. They will get away with this only because a patient allows it. We must fight for our health care and must speak up and insist on things like a dexa and is our right to do so. If you are not on medicare, contact the administrator over the group of doctors that you go to.

[Kitchenbuddy in reply to TWEETYCAT]

Yes I am a senior. I am going to request an appointment with my primsry. I have to go in tomorrow for more labs as I have a low blood count discovered in routine labs.

[Southerngirl2787]

PA's are not doctors, nor Nurse Practitioners! I see two NPs, I like them both, in fact, I like them better than the doctor's they work under! But one I fired, refused a DEXA order request, and I had a parathyroid tumor/adenoma and the surgeon who removed that said no matter what, get a DEXA every year going forward. She refused the DEXA because I refused Osteo meds...and I refused them after the tumor was removed as the surgeon said "no need, now your bones will repair themselves normally." Which they did! Until another NP reduced my estradiol, in error, and a year after that blunder, I was losing bone density again! If they would only listen to us. New DEXA last year was ordered by neurosurgeon after fusion surgery, he had to use extra screws and said "your bones don't look the same"...he's done a dozen surgeries on me, so he should know. Spine DEXA was 3.9! I was back to 1.0 before the estradiol error! I was in healthcare 30+ years, and the patients who did the best were the ones who were the "loudest" and kept harping for the correct services.

[99real]

This is what worked for me when the PCP refused my getting a DEXA scan because I wasn't 65 yet: I looked up my insurance coverage, found the language saying the insurer would pay for a DEXA scan if I was 10 years postmenopausal (as if the PCP or insurer would know that answer). Upon reviewing the language, the PCP made the referral for the test. I would imagine whether you have national health insurance, Medicare, or private insurance, there will be language that may be useful in backing up your request.

[BanjoGal]

Perhaps find a different doctor

[UkuleleStrummer]

I understand what you are saying. I had several significant tests done recently without any follow up except a call from the nurse who was unable to answer my questions. At my annual PE, I wanted to talk about the results and my doctor told me not to interrupt so she could finish going over my labs. Later I saw she documented that I was hard to get focused. I am sorry for your experience. I am so accustomed to preventative medicine and not the evidence based medicine that is being practiced now

[simpleguy999]

Gosh, sorry to read about your experience with your doctor. I think Medicare pays for a Dexa test once every 2 years unless your doctor requests one before then. I found several places online that will do a Dexa test for individuals without a doctor's order for $50. You might do a google search to see if you an find a place nearby that will do it cheaply. My doctor didn't request a Dexa for me when I last saw him so I plan to pay for one out of my pocket.