OpenHealth Q&A

Concern Over Lack of Follow-Up and Care by PA

Greetings, I’m a 43-year-old Asian American woman, standing at 5’2" and weighing 145 lbs, residing in Texas. For more than ten years, I have been suffering from chronic pain. Throughout this time, I have explored various treatments, including sessions with chiropractors and injections, and I began seeing a pain management specialist in November 2024. My chronic pain symptoms have considerably worsened, particularly since 2023. Since that year, I have primarily been treated by a Physician Assistant (PA) at a local primary care facility, having met the supervising physician only once during my initial appointment. I have grown increasingly worried due to what seems to be inadequate follow-up regarding my lab results and a tendency to downplay my symptoms, leaving me feeling as if my care is fragmented and focused only on specific issues. This is the most medication I have ever been prescribed, which raises my concerns about the adequacy of the care I am receiving. Is this typical procedure, or is it something I should formally address? Here are my main concerns: My lab results reveal that my liver enzymes have been consistently elevated in 2023 and 2024. An ultrasound conducted in 2023 did not result in any further imaging or specialist referrals despite my elevated enzyme levels. In 2025, my liver enzymes remained high, but the PA attributed this to elevated triglycerides and recommended adding Vescepa to my regimen. My lab results from April 2025 indicated elevated levels in various markers: - **ALT:** 53 U/L (High – norm: 5–40) - **Ferritin:** Elevated 271 (increased to 307 by June) - **B12:** 1170 (high, with no supplementation) - **WBC:** Elevated at 11.8 K/uL (norm: 3.5–11.0) - **Absolute Neutrophils:** 8.44 K/uL (High – norm: 1.5–7.5) - **Absolute Monocytes:** 1.05 K/uL (High – norm: 0.2–1.0) - **Absolute Immature Granulocytes:** 0.14 K/uL (High – norm: 0.00–0.10) - **MCH:** 33.2 pg (Slightly high – norm: 25–33) As part of my treatment, my pain doctor prescribed Lyrica (pregabalin). During my visit with the PA in April, I voiced concerns about experiencing nausea, cognitive fog, headaches, feelings of unsteadiness, blurred vision, and dehydration. The only significant alteration to my treatment was an increase in my Lyrica dosage from 75mg to 150mg. My B12 level was notably high at 1170, and the PA's only response was to schedule a follow-up check on my B12 levels in a few weeks. After stopping Lyrica independently, my distressing symptoms subsided, and I have since returned to taking 75mg, leading to normalization of my B12 levels. I also reported consistent muscle pain, lower back discomfort, and tightness, which resulted in a prescription for 800 mg ibuprofen and lidocaine patches, yet there was no further evaluation or imaging discussion post-visit. My insight about my health changed when I visited a hand specialist for surgery unrelated to this pain. I expressed that I felt as though my body was aging rapidly due to chronic pain. By examining my swollen joints and toes, the doctor noted signs of inflammation and referred me to a rheumatologist, who subsequently diagnosed me with small fiber neuropathy and prescribed Prednisone and Sulfasalazine. The rheumatologist has indicated the need for additional tests for conditions such as lupus and rheumatoid arthritis and has requested a liver ultrasound. They are now referring me to a hepatologist, as the ultrasound revealed signs of fatty liver disease or steatosis. When I informed the PA about my elevated ferritin levels and the potential implications regarding inflammation—with normal iron levels acting as a possible indicator—her response felt dismissive despite her evident understanding of the significance of these lab results. I find myself questioning whether I am overreacting. There has been no conversation about potential liver diseases nor a review of my medications with insights on their effects on liver or kidney function. I was not referred to a rheumatologist nor warned about autoimmune conditions, leading me to feel that my symptoms were trivialized and attributed to the aging process or perimenopause. **Current Medications Include:** - Wellbutrin (Bupropion XR) 450mg - Zoloft (Sertraline) 25mg - Propranolol 20mg (prescribed by the PA) - Diazepam 5mg as needed - Adderall XR 10mg - Pregabalin (Lyrica) 75mg (from my pain doctor) - Fenofibrate 54mg (from the PA) - Atorvastatin (Lipitor) 20mg (from the PA) - Hydrocodone 7.5/325 as needed (from my pain doctor) - Tizanidine 4mg as needed - Prednisone - Sulfasalazine - Duloxetine (Cymbalta) 30mg (tapering off Zoloft) - Curcumin phytosome 6/14 (from rheumatologist) - Neuronrex st 6/16 (from rheumatologist) - Sulfasalazine 500mg 2x 6/27 (from rheumatologist) - Prednisone 5mg 6/27 (from rheumatologist) - Omega 3 2700 (from rheumatologist) - Vitamin D3 1000 (from new PCP) I am aware that this is quite a list, and my goal is also to streamline my medication now that I am consulting with more specialists. Interestingly, my blood pressure, which has been normal previously, only began to rise in 2023. Is it typical for a PA to lack engagement with lab results and side effects? I regret having suffered in silence for so long, only to learn that I likely have an autoimmune condition. Thank you for your understanding.

Answers (1)

7/10/2025, 9:31:16 PM

OpenHealth AI

It's completely understandable to have concerns about the continuity and quality of your medical care, especially given the complexity of your health issues and the timeline you have shared. You’ve raised valid points regarding the management of your chronic pain and lab results; it’s crucial that you feel heard and properly supported in your healthcare journey.

Main Concerns

1. The lack of follow-up and engagement from your PA regarding your lab results and evolving symptoms.
2. Elevated liver enzymes and other concerning lab results not being fully addressed or followed up with appropriate referrals.
3. Your experience of feeling dismissed regarding your significant health issues.

Explanation

A Physician Assistant (PA) typically works under the supervision of a physician and is trained to manage various health conditions, including chronic pain. However, effective communication and follow-up regarding lab results and symptoms are vital for comprehensive care. Your elevated liver enzymes, high ferritin, and concerning blood markers warrant proper investigation, especially since they may indicate liver dysfunction or other underlying conditions.

It is concerning that you've felt your symptoms have been downplayed and that you were not monitored appropriately or referred to specialists when necessary.

Next Steps

1. Request a Review of Your Care:

   • Document Your Concerns: Write down your experiences, including your symptoms, lab results, and how you felt during consultations.
   • Communicate Directly: Contact your PA or the practice to discuss your concerns about the lack of follow-up on your lab results and ask for a comprehensive review of your medical history, including referrals to appropriate specialists like a hepatologist.

2. Seek a Second Opinion:

   • Given the complexity of your situation and the recent diagnosis of small fiber neuropathy, consider consulting another primary care doctor or a pain management specialist who may provide a different perspective and more comprehensive follow-up.

3. Engage with Specialists:

   • Follow through with all referrals to specialists such as the rheumatologist and hepatologist. This is crucial, especially considering your elevated lab results pointing towards possible autoimmune conditions or liver disease.
   • Keep a list of all your symptoms, medication side effects, and lab results to discuss with each specialist.

4. Assess Your Medications:

   • Amidst all the treatments you are on, it’s important to understand how they may interact and their potential effects on your liver or kidney function. Consider bringing this list to your next appointment with a specialist to review the necessity and safety of each medication.

5. Advocate for Your Health:

   • Don't hesitate to express feelings of concern or confusion to your healthcare providers. You have the right to have all your health issues taken seriously and discussed thoroughly.

6. Monitor Symptoms Closely:

   • Keep track of any new symptoms or side effects you experience, especially as you adjust your medications. This will be vital to your doctors in making informed decisions about your care.

Reassurance

Your concerns are valid, and it's crucial to advocate for your health needs. Addressing these issues can help ensure that you receive comprehensive care tailored to your situation. Remember, you are not overreacting; it is perfectly reasonable to seek clarity and reassurance on matters that significantly affect your health and quality of life.