Questions: "He seems depressed and was having trouble breathing. He has been in constant pain for months. Now he has shingles on his scalp face and eye. He takes pain killers every day and his Dr does not offer any type of pain management that I know of. I think he needs a new Dr. and then you would probably need to wait months to see a new Dr. I asked if he would just call the ambulance - and that way he could get right in ... and maybe they could tell him what to do. I want to set up some apts and go this week or next.”

Answer:  It is obviously hard to know what exactly is going on from this limited information. Please see the following remarks regarding the issues you brought up. The bottom line he needs to see a doctor today.

Breathing:

• Trouble breathing can mean a lot of different things and needs to be addressed by a qualified physician in person. The list of possibilities for shortness of breath goes on for volumes; however, I will address a few potential causes.
• Trouble breathing can represent an acute life threatening illness such as pneumonia or pulmonary embolism. Pneumonia usually has associated symptoms of fever (but not always) and pulmonary embolism usually presents with symptoms of acute chest pain (but not always). Sudden onset or worsening of symptoms needs to be addressed immediately in the ER.
• However, trouble breathing can be a chronic problem such as emphysema.
• Knowing his personal history of prior heart attack, one contributing factor that I would consider is congestive heart failure (this may not be the only cause; sometimes there are many causes for shortness of breath at the same time).
• Congestive heart failure happens when the heart is not strong enough to push the blood/fluid away from the lungs and therefore fluid backs up in the lungs. Congestive heart failure can be mild and treated with medications on an out-patient basis. However, congestive heart failure can also be severe with large pleural effusions which requires management in the hospital.
• Again, any shortness of breath needs to be addressed by a qualified physician; the range of potential possibilities is enormous and there is no way I can evaluate them over the internet. If symptoms are severe and or new he needs to go to the ER.

Depression:

• There are numerous causes of depression. The severity of depression also ranges significantly from mild to severe. As you know, severe depression can also be life threatening, which needs to be addressed in a hospital. 
• Seasonal affective disorder is a possible contributing factor that gets everyone down this time of year. In addition, being sick, especially with a chronic illness will depress almost anyone. Depression also runs in the family. Again, this needs to be addressed by a qualified physician in person. 

Shingles

• Shingles is a painful, blistering skin rash due to the varicella-zoster virus. This is the virus that causes chickenpox. After you have had chickenpox (most of us have), the virus goes dormant, living quietly in your nerves for most of your life. However it can wake up again in the form of shingles. It is not clear why this happens but it often occurs in times of severe stress or illness.
• Shingles often disappears on its own. It usually clears in 2 to 3 weeks and rarely recurs.
• Shingles can also be treated with antiviral medications such as acyclovir, famciclovir, and valacyclovir which can shorten the time of illness. The earlier you start the medications the better.
• Infection in-and-around the eye is an emergency because it can cause permanent blindness. If there is eye involvement, this needs to be addressed immediately in the hospital and treated with IV medications.
• Shingles is also very painful because it is an infection of the nerves. Pain can also be managed with various pain medications. Other medications such as prednisone may reduce swelling in some patients. Antihistamines such as Benadryl can help to reduce itching. Some have used nontraditional methods such as meditation and acupuncture. The list goes on but one of the most important things is to keep the area clean and dry to prevent a secondary infection. 

A different primary physician?

• Knowing the person you mentioned with the above illnesses (name left anonymous for the blog), I could imagine he may not have told his doctor all of what is going on. It is also possible that he may not have shared with you all that his doctor is doing for him.
• However, if he doesn’t like his current doctor, for whatever reason, he can get another doctor. The availability of doctors varies from place to place. However, it shouldn’t take months to get an appointment to see a new primary physician.
• Regarding finding a new physician; an ambulance driver would not know what primary physician to send him to.  This is not their training or role.
• In the short term, he needs to see someone about the shingles eye involvement and the shortness of breath today.
• In the long term, he needs to thoroughly address his many medical problems with a primary physician he is comfortable with. He might want to consider a university doctor.
• If I was looking for another doctor, I would first see who is on my insurance approved physician list. I would also ask around to see who is happy with their doctor and go from there. If you want to help out with this, you don’t have to be in his town. It can all happen over the phone and on the internet. I wouldn’t wait till your visit to do something about getting him a new doctor if you think it is important. I am sure that your other sister who is in his town would be happy to help out with information and transportation.