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CF requires a test to clear my medical; family doc can't find anyone to do it

Arcset

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Howdy,

Short version: My application is on hold until I pass the medical.  I require a test to be done in order to prove to the CF that I am fit for duty.  The test needs to be done by a rheumatologist, not the family doctor.  Unfortunately, my family doctor was unable to find any rheumatologists that could perform the test.  My family doctor has written a short letter explaining that she was unable to find anyone to perform this test, but I know that doesn't change the fact that the CF still requires the necessary proof before letting me in. 

Long version: Years ago I was misdiagnosed with a condition called Raynaud's Syndrome.  The rheumatologist that diagnosed me never performed any sort of testing or whatever to confirm if I had it; she merely looked at me and said that I had it.  Since she was a doctor in a specialized field, who was I to argue?  After having my medical done, the sergeant told me to get a letter from my family doctor to clear me fit for duty.  I get the letter, submit it, still get declined because of the condition I had.  I went to go see the rheumatologist that made the diagnosis in order to get information that might help me challenge the decision, and instead find out that I never really had the condition.  In her words, she said that I did not have the condition in the "classical sense", later clarifying that I don't have the condition at all.  She wrote up a letter recanting her decision about the diagnosis, and then referred me to a dermatologist to confirm that I had nothing.  Met with the dermatologist, everything was fine, got a letter from him too.  I submitted both the letter from the rheumatologist recanting her decision and the letter from the dermatologist confirming that nothing is wrong, and got declined a second time.  The CF wants me to have a test done, one that should have been done initially by the rheumatologist in order to make a proper diagnosis (had she done this, she would have saw that I did not have this condition).  I went to my family doctor a few weeks ago to get a referral to a specialist that could perform this test, however she was unable to find anyone to perform it.  Now, I'm unsure how to proceed because it seemed like there was only one way to clear myself of this medical problem and no one is willing to do it.

For anyone wondering, the test is called a Cold Stimulation test.  Basically, a finger thermometer is attached to a finger to measure the temperature, then that hand is submerged in ice water for 20 seconds, and then the finger gets attached to the thermometer again and the amount of time it takes for the finger to return to the pretest temperature is recorded.  If it returns before 15 minutes, everything is fine; longer than 20 and something isn't right.

I'm going to go back to the recruiting center and hopefully meet with the medical personnel to see if they know what I should do next, but if any of you have advice, please offer it.  Thanks.
 

ballz

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*Disclaimer* I have no recruiting experience or medical training. The below post is just the direction that my brain would be taking me when trying to solve this problem if it were me...

If I were you I'd ask the rheumatologist about the nearest place that it could be done. She ought to help you out, considering her misdiagnosis is now causing you problems, and she is held to the standard of professional liability in law and all.

Since you are in Hamilton (according to your profile), you might be able to go to the US and pay for it to be done. I would let your rheumatologist know if you are willing to go this route or not so she knows... And I would check to see with the CF if this would be accepted by the medical authorities before going this route.
 

medicineman

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ballz said:
Since you are in Hamilton (according to your profile), you might be able to go to the US and pay for it to be done. I would let your rheumatologist know if you are willing to go this route or not so she knows... And I would check to see with the CF if this would be accepted by the medical authorities before going this route.

If you're from around Hamilton, I'm having a bit of difficulty with your family doc not being able to find a rheumatologist or vascular specialist around that can do this - you're in the Golden Triangle of Canadian academic medical centres between McMaster, Western and U of T.  I suppose you could talk to someone in Buffalo - it's another academic medical centre - on the caveat, as ballz mentioned, that you clear it through CFRC Medical first, lest you be out a bunch of money for nought.

MM
 

Arcset

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When I mentioned the test to the rheumatologist, she had no idea what it was, so I don't think she'd be able to offer any advice on where I could go to get it done.  I'll go to the CFRC on Monday and talk to someone there to see if the CF would accept a paid test being done elsewhere, even in the United States.

As for my family doc not being able to find anyone, she went on a whole rant about how rheumatologists don't do shit and don't do tests of any sort; made them sound like the laziest type of specialized doctor around.

Thanks guys.
 

medicineman

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To be honest, I've never heard of this test before nor is it in much of my literature - Raynaud's is a clinical diagnosis based on presentation.  The problem is that it is often a symptom of other problems, which may be what the RMO is concerned about.  As for rheumatologists being lazy, well, in their defence, by the time patients get to them, their family doc has already ordered pretty much everything that needs to be ordered to make a diagnosis that's in their Bailey wick.

Hope things get sorted out otherwise.

MM
 

Blackadder1916

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An interesting situation, however I am inclined to think there is more to it than simply a previous misdiagnosis that has to be proven to be such by means of a specific test.

I will preface my remarks by stating that it has been some years since I was directly involved in military medical administration and even longer (some decades) since I had any involvement in hands-on patient care.  However, I did once assist a doctor in performing a "cold stimulation test" back in the 1980s at NDMC before I was commissioned.  The patient was a civilian female (dependant spouse?) who was on the CPU service for this particular problem because she had been previously a patient of the CPU director.  I can't remember what the specific diagnosis was; through most of her multiple admissions (long periods including a referral to the Mayo Clinic in the USA) no definite conclusions were reached.

Since it (the test) appeared to be an unusual event over three decades ago, I wondered what was the current practice and why would it be a mystery to a practising rheumatologist.  If it was a common procedure, then surely it would eligible for reimbursement under the OHIP Schedule of Benefits.  A quick scan of the schedule found no mention of such a procedure, but I could have missed it or (if billed) be included in another code.  In practising google-medicine, I find that the test is often referred to as a "screening test" for Reynaud's (perhaps more in a GP's toolbox rather than a specialist) and on some sites (patient advocacy centred) there are those who decry it as unnecessary and potentially dangerous.

And from the American College of Rheumatology (couldn't find a similar Canadian site) this patient handout makes no mention of "cold stimulation test".
http://www.rheumatology.org/uploadedFiles/Raynaud's%20Phenomenon(1).pdf
How is Raynaud’s diagnosed?

To diagnose Raynaud's, your doctor will ask detailed questions about your symptoms and medical history, and conduct a physical examination. Your doctor may also run tests to rule out other medical problems that may cause similar signs and symptoms, such as a pinched nerve.

To distinguish between primary and secondary Raynaud's, your doctor may perform an in-office test called nail fold capillaroscopy. During the test, the doctor examines your nail fold — the skin at the base of your fingernail — under a microscope. Tiny blood vessels (capillaries) near the nail fold that are enlarged or deformed may indicate an underlying disease. However, some secondary diseases can't be detected by this test.

If your doctor suspects that another condition, such as an autoimmune or connective tissue disease, underlies Raynaud's, he or she may order blood tests, such as:

Antinuclear antibodies test. A positive test for the presence of these antibodies — produced by your immune system — indicates a stimulated immune system, and is common in people who have connective tissue diseases or other autoimmune disorders.

Erythrocyte sedimentation rate. This blood test determines the rate at which red blood cells settle to the bottom of a tube in the space of an hour. A faster than normal rate may signal an underlying inflammatory or autoimmune disease. Autoimmune diseases are commonly associated with secondary Raynaud's.

There's no single blood test to diagnose Raynaud's. Your doctor may order other tests, such as those that rule out diseases of the arteries, to help pinpoint a disease or condition that may be associated with Raynaud's.

As Medicineman has already pointed out the RMO may be concerned about underlying conditions that present with Reynaud's-like symptoms.  After all, you did seek medical care for the problem at one time.  Doctors don't troll the streets for random individuals and make up complaints - at least not often in Canada.  Without knowing the contents of the letters from your FP and rheumatologist, it would only be an assumption that perhaps they didn't adequately address the original problem beyond saying it wasn't Reynaud's.  It would not be the first time that a civilian physician's report did not satisfy military requirements.  Of course that doesn't solve your problem.  While the RMO may be requesting this specific test (for whatever reason), it is possible that he may be the one that is incorrect in thinking that it may be a standard diagnostic test.  The impression I've reached (and I could be wrong) is that it is not.
 

Arcset

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I see the point you guys are making with the RMO being concerned it could be an underlying condition to something else which is why they're insisting this testing be done.  That being said, Raynaud's can present itself and not be part of any other condition, aka Primary Raynaud's.  Secondary Raynaud's is when it's associated with something else.

As for finding someone to conduct the test in present day, that might be more difficult than I anticipated.  I called my family doc recently to find out the specifics of what happened when she tried to get me an appointment with someone, and found out that the test seems to be obsolete nowadays.  If this method of testing has in fact become obsolete (either because it's not definitive or harmful), does anyone have advice on what to do? 

Sorry for all the questions, it's just that I really want to get in and will keep trying so long as there's some sort of a chance it could work (450+ days since application submission, 2 medical declines, and a partridge in a pear tree).  I appreciate all the help you guys have given me.  Thanks everyone.
 

Blackadder1916

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Arcset said:
As for finding someone to conduct the test in present day, that might be more difficult than I anticipated.  I called my family doc recently to find out the specifics of what happened when she tried to get me an appointment with someone, and found out that the test seems to be obsolete nowadays.  If this method of testing has in fact become obsolete (either because it's not definitive or harmful), does anyone have advice on what to do? 

Since it seems it will be damned near impossible for you to do the test requested by the RMO, your first course is to inform the medics at the recruiting centre and ask their advice.  You should also request your FP (who may be getting exasperated at being requested to do work that is not billable to OHIP - have you had to pay for this?) to reply to that last letter (was it addressed to him or you? it makes a difference) saying the same thing he told you - "can't find anyone to do the test because it is no longer done".
 

Arcset

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I was always planning on going to the CFRC on Monday and asking them on what to do next, so that part will be taken care of.  As for my family doc, I have not had to pay for her to make these calls.  With regards to the letter that I received from my family doc, it says the following:

"To Whom It May Concern:

This is to confirm that we were not able to arrange for the cold stimulation test because there was not any Rheumatologist in our area that is providing the test."

My name and info are on the letter as well as my family doc's contact information, so I'm hoping that when I meet with the medical personnel on Monday I can have them call her so that they can get the specifics, and then proceed from there.  The letter doesn't mention that the test might be obsolete; that bit of information I received from the secretary when I called the office.
 
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