Not sure how to handle this situation, but the ***** in me is coming out so I thought I should ask for some guidance. I have been a nurse for a decade. I have ER, cardiac, infusion, med Surg, and travel experience. Right now I am doing home health.
My husband got a DVT and some small PEs over a month ago. Started Xeralto. 3 days later the knee in the leg with the DVT got like 3 times the size. Called his MD's office with concern. We see an NP there, never the doctor. It has been the same NP for at least the last 4 years. And I have never really had a problem with her until now...and mostly because we hadn't gone into the office for anything I didn't already know what to do for until now.
Anyway we went in. She didn't think it was anything more than my husband's arthritis. I asked her if I could let him wear a knee brace with the recent dx of DVT and she said she thought it would be fine. I was really not certain of her answer and she did ultimately decide to have the doctor come look at it. The doctor tried to aspirate fluid but was unable to. Then the doctor said he should do any compression to the leg due to the DVT. That he was going to send us home with antibiotics and something for the inflammation. He then turned to the NO and said what drug can we use that is not an NSAID. Her response was ibuprofen. I was like how about a steroid? Now I was really willing to shake that off as being caught off guard...I've done that too. They also ordered CBC, BMP in a week. But a week later after the steroids ran out my husband's condition deteriorated rapidly. Increased pain in the joint, poor appetite, fatigue. So I called the office and they got a stat MRI which showed menscius tear, ACL tear, and effusion around the joint. His labs showed an elevated WBC of 12, but his knee was swelling so I thought that was probably inflammation. So the office decided to refer my husband to an orthopedic doctor who initially wasn't going to see him for 3 months due to blood thinner treatment.
Well about 1 1/2 weeks later my husband is barely able to get off the couch. They have prescribed Percocet and Tramadol...we were mostly sticking to tramadol. But neither are really helping, he is having other joints swell and cause pain, his appetite is poor, he is sleeping most the day, and we have been weighing ourselves weekly and one morning I noticed he had lost 15 lbs. 15lbs in 3 weeks! That's how bad his appetite is. I call the MD's office and tell them all this because now I'm starting to be really freaked out as I am not sure what is going on anymore. All the NP tells the office staff to do is see if we can get the ortho appointment moved up and run another CBC, BMP. Labs are about the same and we have to weight 2 weeks to see the ortho doctor. I am frustrated at that time because I really don't think this is something for the ortho doctor, I think whatever is going on is more systemic, but I don't want to piss my husband's NP/MD off by being a 'know it all nurse wife'. So we wait. He worsens and we see the ortho doctor. Low and behold the ortho doctor agrees that he thinks the issue is systemic as well and refers my husband to a rheumatologist.
But we are on week 6 of my husband, a bricklayer, who hasn't been able to get off the couch. Like he is only taking a shower every 3 days because he does not have the endurance to do it more frequently. I think my husband has rheumatoid arthritis. Honestly though I'm not really sure what is going on, but I'm not really willing to let my husband go another month like this. I called the MD office to see if he could be on steroids until we get contacted by the rheumatologist because that was the last time my husband was sorta okay. The ortho doctor thought it was a good idea but wouldn't prescribe them as he will no longer see my husband.
But my husband's MD office says that the NP wants him to come back to the office and be seen before they are willing to prescribe anything or refer him to another MD. I ask if my husband can see the MD and not the NP and they are like, "well his care provider is the NP". I kinda feel like the NP knows as much as or less than I do. I never asked her about her experience because I thought it would be rude, but she comes off as someone who has not had much nursing experience before becoming an NP.
I feel like all the questions I ask her she doesn't know the answers to. Frankly I think that is because we are both nurses and those 2 extra years of school for the NP don't really amount to much more than a paper. Kind of just like my BSN...without the decade of experience behind it my BSN is little more than a trophy for suffering through school. I didn't learn how to be a nurse until well after I graduated. I think her experience doesn't lend to having anymore knowledge than I do and that is why I need to see the doctor. Whatever is going on with my husband is out of our league and I want to see someone better educated to know what our next steps are.
