healthcare (12) a personal experience

This is a chronicle of my infirmities and slow recovery from August 2010 through April 2011. It's the sad story of one MD who didn't listen carefully, another one who didn't consider possibilities beyond his narrow specialty and failed to communicate his treatment/prescriptions to my general physician (for fear of leaving a record?); of one DMD who rushed to the wrong diagnosis, but also of my GP who finally found the central problem and organized the healing process. The automatic approach of the initial specialists was to prescribe increasingly stronger medicines.

In August 2010, while on vacation in Maine, I developed a painful infection in my left ear that was similar to the one of August 2009. Because of the eventually successul treatment by my own nose and ear specialist in the fall of 2009, I told the physician in the hospital e-room in Maine what medicines had worked the first time, i.e. 10 days of 2x 40mg prednazone, 2x 30mg, 2x 20mg, 4x 10mg + painkiller (after a treatment with 850mg amoxicillin had failed. The e-MD (in his early 60s, who looked like he had been called from a family picnic) said: This time we don't need that, and he prescribed 500mg amox and tylenol with ear drops (to no effect and 3 weeks later I needed the maximum daily dose of tylenol just to make the pain bearable). My e-room co-pay was $ 110.

From Maine, Colette, my partner, had made an appointment with the local nose/ear man and he resorted again to the prednazone regime which turned out less successful in that while the infection appeared healed, a nagging pain persisted. This pain eventually spread from the ear to my left sinus and my jaw and was especially annoying in the lower rear molar. So I had my dentist take x-rays of the root canals but he could not see anything wrong and suggested I go to a colleague who was a nerve specialist. The new x-rays also showed no problems and after a probing discussion the colleague was sure I suffered from trigeminal neuralgia; I got a cortisone injection and an 800mg motrin pill on the spot plus two prescriptions (and if that didn't help, I should come back). I drove home and to the pharmacy more or less in a daze. The medicine alleviated the pain, but clearly didn't solve the problem. As my insurances do not cover dentistry, I was out of $ 275 plus the high co-pay of the new medicine.

One of the incidental results of my continued discomfort was that I felt chilly all the time, lost my appetite (by April of 2011 I had lost 30 lbs)as well as my ability to taste, my energy and desire to work in the garden or go birding. Nor did I write any blogs. The loss of my taste was the worse part as all wine began to taste as if it had been in an open bottle for 2 days or more. On my birthday and at Christmas I served some of my best 1999 burgundies that were highly appreciated by everyone but the few sips I took were sour, sharp and almost bitter. I also gave up reading as bending my head over a book became painful after four or five pages. We even raised the television so that it was eye-level as I sat on the couch, but as I was loosing my the hearing in my left ear, it had to be turned up so loud that it was uncomfortable for others to be in the room.

By November I was deaf in my left ear and at the same time the right side of my face became very painful; the pain began where my neck met my lower jaw and was concentrated around my ear and sinus. I went back to the nose/ear man. This time Colette, who thinks most men don't tell the doctor everything and thus do not ask the right questions, came along. Out came the colorful pictures, a suggestion I see a specialist ear surgeon who would likely perform a masteroid operation on my left ear that was still giving problems even after he had put in a tube to facilitate the draining and relief the pressure. He did not find evidence of an infection in my right ear. He repeated his promise to send the info about his treatment to my GP. He gave me four names of ear surgeons, two of which were at the Un. of Pennsylvania, but refused to recommend one over the others or to make an appointment. When I later saw my GP for a regular appointment he recognized 2 of the names and one of them had successfully treated several of his other patients. When C. asked the GP whether he had received the promised e-mail info from the nose/ear man (who had his office in the same building) he said, he got something stressing the possibility of the masteroid operation. Meanwhile the nose/ear man prescribed Naproxen 500mg, a stronger painkiller. I took it very carefully having read the possible side effects that were even more scary than some of those I described in a previous entry, none of which I experienced. Perhaps because some of the stuff that I had been taking since August was still in my system or because of the combination of Naproxen and my daily blood pressure pill, I wasn't so lucky this time. The second night, getting up from the toilet I felt dizzy and grabbed the edge of the sink, but I missed the door post and fell, unconscious into the door of the bedroom. This woke up Colette, normally a deep sleeper. I came too sitting on the edge of the bed. I heard Colette's voice asking me what day it was. Eventually I said: What day was yesterday? She said: What did we have for lunch yesterday? After a while she said we had steak and I knew it must have been Sunday and today was Monday. After which she let me sleep.

In the morning she made an emergency appointment with my GP. After a fairly long exchange with Colette (who didn't let me drive), he concentrated his examination on my neck. He decided that all the previous problems and the painkillers likely obscured the real cause of my suffering. He arranged for x-rays and an MRI. These showed two badly worn cervical vertebrae and a narrowed nerve canal. He assumed that because of the pain as well as the increasing despondency I had tended to bend my neck and bent my back which could have aggravated the condition. In any case, he consulted a colleague and they decided I should have cortisone injections in my upper back near the spinal cord. The colleague explained the procedure, complete with pictures, but I don't think I paid much attention, for I could not now describe the procedure. As Colette had gone to France where her 92-year old father was dying, my son Robert drove me to the hospital and he nodded wisely during the physicians explanation, which was taken as approval. In any case I was now so desperate and anxious for any remedy that I would not have said n in any case. The purpose of the procedure was to reduce the pain, which it actually did, with so far none of the possible side-effects.

I was also prescribed a long course of physical therapy, whose basic exercises I am still doing fairly regularly (which adds about half an hour to the leg exercises I have continued since the phys. therapy for my knee replacement in 2000). I even took my weights with us to Maine this August. I can't say that I am 100%, but then I have not been 100% since 2000. I get easily tired (though I walked and hour in the sand of Popham Beach looking for birds) and after I walk up the slope of our woods from the creek, I'm out of breath. I also started driving again, to the post office etc. in March and longer distances in late April.

All that was left after the cortisone injection was going to the ear surgeon recommended by my GP from among the 4 names given by the nose/ear man. Although I favored waiting until the possibility of bad weather was diminished, C. insisted on making the appointment for when her classes started and she would be back from France (her father finally died during the night before her departure). It so happened that the record snowfall of this winter fell on the weekend before the appointment so that the drive into Philadelphia was not much of a problem for Colette. Penn, where my son was born and where I got my M.A. and did most of my research for my Ph.D. thesis and subsequent publications, had much changed since I was last there in the early 90s. The medical complex was unrecognizable and the walk from the parking garage to the waiting room seemed like a maze and one kind intern guided us all the way. The surgeon and his assistants appeared to have successfully complete a course in "bedside" manners. His examination room was equipped with some fancy high tech diagnostic equipment, including a microscope that projected on a tv screen. His first pronouncement was: I don't have to operate on this. The he took out a polyp, checked my right ear and pronounced it healthy but "can't do anything about the hearing in either ear." Because of the draining, however diminished in my left ear, he suggested I get a hearing aid only for my right ear (which I got, at a cost of an unreimbursed $2,800). He prescribed an antibiotic pill and ear drops and told me to come back in a week. At that visit he was satisfied with the progress and took out the tube. I had two more check ups, two weeks apart and by early April was declared completely healed: But here is my card and call me if...

Since April of this year I have lived without any pills, other than a high blood pressure pill and a serious weekly dose of vitamin D and only see my GP on a regular schedule. Undoubtedly the aging process aggravated these health problems as it certainly does the psychological impact of realizing that without the physical exercises I would become a burden for Colette, etc. I still lack energy or perhaps it's the will to do things. But after 2 hours on this blog I feel mentally tired and have frequent "senior moments."

While this blog concentrates on my ear infections and worn cervical discs and focuses on the health care delivery system OF AN INSURED PERSON, it also highlights the costs of that delivery system. Fortunately I did not need any hospital stay as I did after my knee operation, but as all the insurance statements have finally come in and my co-pays billed, these 8 months set me back $1200 (+the 2800 for the hearing aid). Considering that the insurances (Medicare+United Health) paid on average 90% of the consultations, procedures and medicines, the total cost of these treatments was some 12.000 dollars, a sum the uninsured poor can hardly afford. The Penn specialist alone was $2300 which may be why in the waiting room for that department there were very few poor looking patients.