Tuesday, January 03, 2006
Details, details of my CE.....
I just finished typing up a play by play of the consultative exam (CE) I had to do last week for Social Security. I tried to remember absolutely as much as I could in case the details of the exam are called into question. It's very common to be told one thing in the exam and then the doctor tells Social Security something different. So this is bascially a CYA move on my part. I'm re-printing it here in its entirety (except for the doctor's name) for those of you who might be interested......
Notes on Consultative Exam for Social Security
December 29, 2005
I was driven to the exam by a friend so that I wouldn’t get lost or be too fatigued afterward to drive myself home. We arrived 15 minutes early as requested in the paperwork I had gotten.
The first thing that happened was the assistant got my height, weight, blood pressure and tested my vision. Then she did a blood draw. She had to do it twice because one of my veins shut down before she was able to collect enough blood. After the second attempt, which was quite painful at the end, I became dizzy and nearly fainted. I had to sit quietly for awhile before getting up, and I had trouble thinking clearly for quite some time after.
Following the blood work, I was returned to the front office where I waited an hour. While waiting, I ate a rice bar to see if I would feel less fuzzy-headed. It didn’t help. I also had to make a trip to the rest room as sitting in the chair was becoming painful. Later, I did some stretching in the chair because I was stiffening up. I was told the doctor was reviewing my records this entire time.
The doctor directed me into her office herself. I asked if my friend could come with me as I had memory trouble and might forget to tell her things she needed to know. She said there was no need, that this would be a quick exam.
She mainly wanted to talk about my Sjogren's syndrome since her husband has it too. I explained how the illness was causing neurological, cognitive, joint, and digestive problems in addition to the usual dry eyes and dry mouth. I did sum up the course of my illness because over the past eight years I'd had many mis-diagnoses. I told her how I have episodes that appear like MS exacerbations with neuropathy, speech problems and motor skill problems and that the only thing that has helped them has been prednisone. She wanted to know how I was diagnosed with Sjogren’s when I was sero-negative. I said my ENT could see the extreme dryness in my mouth and nose and the damage typical of the disease, so he did the conclusive lip biopsy.
The "routine physical exam" mentioned in the letter was brief. The doctor noted the extensive medical records given to her by Social Security and said she really didn't need much more from me. She looked at my hands, feet and knees where I have arthritis. I had compression hose on my lower legs, but she didn’t have me remove them; she just checked my toes and rolled one of the hose down on my calf briefly. I told her about my lymphedema and how I may have the beginnings of vasculitis with the petechia and the redness in my legs and face upon exertion or a warm shower. She also had me lie on the table so she could examine my stomach. I had trouble climbing up there even with the step and even more trouble lying back due to pain and stiffness. The exam of the knees was also painful. She checked my hearing, eyes and balance. I told her how I was deaf in the right ear and was suffering hearing loss in the left ear due to tinnitus. I told her that the tinnitus was so loud that I could hear it over my own voice and that nothing completely drowned it out. I also talked about my vertigo.
I had brought with me all my medications as instructed in the letter. The doctor didn't even look through them and was actually more interested in my typewritten list of medications and supplements. She was particularly interested in the Evoxac as it is prescribed for Sjogren’s syndrome.
When I spoke of my cognitive dysfunction, she dismissed it as just stress, even when I gave clear examples of how my abilities had permanently declined. I told her how I would be doing the same repetitive task for an entire shift, and suddenly I would forget the proper keystrokes, even though I’d been doing them every 15 minutes or so throughout the night. I also mentioned that I was transposing numbers, causing me to accidentally delete advertisements from the newspaper page right before it was due to print. I said how my proofreading was affected because I could not remember how to spell words and didn’t recognize misspelled ones on the page. And I told her that I could not remember my software training for more than a day or so. For comparison’s sake, I told her that when I’d been healthy and was working for a radio station, I was able to screen calls, cue a talk show host, cue a remote site, play commercials, back time closing music, switch to a network newscast and operate a tape player all at the same time. Now I can’t do a simple repetitive set of keystrokes and not mess up.
I had intended to mention how my fatigue, pain, hearing loss, neuropathy and digestive problems also made me unable to work, but they sort of got glossed over. She indicated she knew about them from my records. I did mention that I had been falling asleep at my desk at work pretty much every night, but she was not interested in more details about that.
I was in the doctor's office for approximately one hour. Most of this time was spent in conversation. By the time it was finished, I was in pain from sitting in the chair, my stiffness was worse, and I was quite exhausted.
Notes on Consultative Exam for Social Security
December 29, 2005
I was driven to the exam by a friend so that I wouldn’t get lost or be too fatigued afterward to drive myself home. We arrived 15 minutes early as requested in the paperwork I had gotten.
The first thing that happened was the assistant got my height, weight, blood pressure and tested my vision. Then she did a blood draw. She had to do it twice because one of my veins shut down before she was able to collect enough blood. After the second attempt, which was quite painful at the end, I became dizzy and nearly fainted. I had to sit quietly for awhile before getting up, and I had trouble thinking clearly for quite some time after.
Following the blood work, I was returned to the front office where I waited an hour. While waiting, I ate a rice bar to see if I would feel less fuzzy-headed. It didn’t help. I also had to make a trip to the rest room as sitting in the chair was becoming painful. Later, I did some stretching in the chair because I was stiffening up. I was told the doctor was reviewing my records this entire time.
The doctor directed me into her office herself. I asked if my friend could come with me as I had memory trouble and might forget to tell her things she needed to know. She said there was no need, that this would be a quick exam.
She mainly wanted to talk about my Sjogren's syndrome since her husband has it too. I explained how the illness was causing neurological, cognitive, joint, and digestive problems in addition to the usual dry eyes and dry mouth. I did sum up the course of my illness because over the past eight years I'd had many mis-diagnoses. I told her how I have episodes that appear like MS exacerbations with neuropathy, speech problems and motor skill problems and that the only thing that has helped them has been prednisone. She wanted to know how I was diagnosed with Sjogren’s when I was sero-negative. I said my ENT could see the extreme dryness in my mouth and nose and the damage typical of the disease, so he did the conclusive lip biopsy.
The "routine physical exam" mentioned in the letter was brief. The doctor noted the extensive medical records given to her by Social Security and said she really didn't need much more from me. She looked at my hands, feet and knees where I have arthritis. I had compression hose on my lower legs, but she didn’t have me remove them; she just checked my toes and rolled one of the hose down on my calf briefly. I told her about my lymphedema and how I may have the beginnings of vasculitis with the petechia and the redness in my legs and face upon exertion or a warm shower. She also had me lie on the table so she could examine my stomach. I had trouble climbing up there even with the step and even more trouble lying back due to pain and stiffness. The exam of the knees was also painful. She checked my hearing, eyes and balance. I told her how I was deaf in the right ear and was suffering hearing loss in the left ear due to tinnitus. I told her that the tinnitus was so loud that I could hear it over my own voice and that nothing completely drowned it out. I also talked about my vertigo.
I had brought with me all my medications as instructed in the letter. The doctor didn't even look through them and was actually more interested in my typewritten list of medications and supplements. She was particularly interested in the Evoxac as it is prescribed for Sjogren’s syndrome.
When I spoke of my cognitive dysfunction, she dismissed it as just stress, even when I gave clear examples of how my abilities had permanently declined. I told her how I would be doing the same repetitive task for an entire shift, and suddenly I would forget the proper keystrokes, even though I’d been doing them every 15 minutes or so throughout the night. I also mentioned that I was transposing numbers, causing me to accidentally delete advertisements from the newspaper page right before it was due to print. I said how my proofreading was affected because I could not remember how to spell words and didn’t recognize misspelled ones on the page. And I told her that I could not remember my software training for more than a day or so. For comparison’s sake, I told her that when I’d been healthy and was working for a radio station, I was able to screen calls, cue a talk show host, cue a remote site, play commercials, back time closing music, switch to a network newscast and operate a tape player all at the same time. Now I can’t do a simple repetitive set of keystrokes and not mess up.
I had intended to mention how my fatigue, pain, hearing loss, neuropathy and digestive problems also made me unable to work, but they sort of got glossed over. She indicated she knew about them from my records. I did mention that I had been falling asleep at my desk at work pretty much every night, but she was not interested in more details about that.
I was in the doctor's office for approximately one hour. Most of this time was spent in conversation. By the time it was finished, I was in pain from sitting in the chair, my stiffness was worse, and I was quite exhausted.
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