Posted on 09/13/2013 8:55:51 PM PDT by trussell
Just saw the doctor. They are trying to get me admitted to the therapy floor for extensive therapy. In the meantime, I get therapy here, just not as much as I would on the 4th floor. It would still be treated like a hospital stay in that I get fed and bathed etc...have access to tv and internet...just much more therapy daily. Sounds like the issue is excessive swelling putting pressure on the nerves and keeping me from walking. I was taught to transfer myself from the bed to a wheelchair and took for a stroll down the hall and back. Hoping and praying the swelling goes down soon and that I will walk again soon.
My Heart and Prayers are with you, Sweet FRiend!
Got told today that my insurance wants more info and if they don’t get it, they are going to refuse me the rehab unit. I’ll have to go home, use a wheelchair and a shower seat/toilet and hope to get better without help. More prayers needed, desperately!
Welcome to third world medication.
Here is an article by a doctor:
When All Else Fails, Examine the Patient?
It’s a favorite tongue-in-cheek line I used when I was a resident on morning rounds with anxious interns and students at my side. After spending the entire night on our feet, we heard exhaustive histories, presented lab results as long as a ticker tape, and proudly displayed X rays and CTs while fighting sleep in the soft glow of the radiology board. Occasionally, I’d ask a salient question, “But what did their physical show?” Sometimes it was obvious the examination was the more cursory portion of the presentation.
I’d like to share a few scenarios that occurred in the short space of just a few days in my private practice to make the point that the physical exam is on the endangered list. These scenarios say a lot about what’s happening with modern American medicine, cardiology included. Please don’t kill the messenger.
Scenario 1
“I’m here for a second opinion with my mother because the last three times we’ve seen our cardiologist, he never once touched her,” lamented the concerned daughter with a smiling geriatric mother at her side. “How does he know what’s really going on without listening?”
Scenario 2
“I saw my doctor the other day. He used to give me a thorough exam. He even found my prostate cancer a few years back, but this doctor that I saw the other day—he’s not the same Dr X,” said the patient. “He even mentioned that I should have blood work now and then come back in four months and said we’d ‘do more blood work,’ but he didn’t even use his stethoscope and I’ve not seen him in months. I don’t think I’m going back.”
Scenario 3
A beautiful, blonde, statuesque patient came to my office for near syncope. Her orthostatic BP was normal. Her labs were normal. The Holter from another facility was benign. Cardiac exam was completely normal, but when I stretched her out on the exam table, her abdomen was rock hard. For all the world, in that position, I thought she was nine months pregnant.
“Are you pregnant, by any chance?” I asked.
“That would be impossible,” she replied. “I’ve had a tubal.”
I actually placed my arms around this gigantic tumor as an OB would do to query for fetal position. “I think you have a very large tumor in your abdomen,” I said, and sure enough, on CT, there was a 16-cm mass accompanied by multiple tumors crowding her entire abdomen.
But, Wait . . . It Gets Worse
She developed chest discomfort a couple of weeks after a completely normal stress cine was performed for preop assessment. She was out of town, and I directed her to go to a local ER. I received a phone call from a healthcare extender, who at the time of our communication (which I postulate should have occurred after a physical exam) was couched in such a way that they seemed to have no knowledge of the issue at hand. I patiently explained the case and said, “Here, take my cell number and ask anyone who would like a discussion to call me. Her stress exam looked great, but I’d check her troponin and if she has ongoing pain, you may even have to take a look at her coronaries because she’s a preop patient. My bet is that she is having pain from a very crowded abdomen.”
But, Wait . . . It Gets Even Worse
The following morning I received a phone call from an intern who said, “Your patient has this odd abdominal pain,” then hesitated as if clueless, to which I impatiently replied, “Yes, and if anyone, anyone, would put their hand on her abdomen, she has a tumor the size of a large watermelon that spans from her symphysis pubis to nearly her diaphragm. It is likely compressing her vena cava in a seated position, causing presyncope.
It’s crushing her bladder such that she has to urinate every hour on the hour all night long and she can no longer have intercourse with her husband without severe pain. You might want to examine her abdomen. I think you’ll be impressed!” and then hung up.
I am not a perfect examiner or a perfect physician. None of us are. I even find things on a second exam that I have missed, like a soft carotid, an abdominal bruit, or a murmur that I’m certain didn’t just occur yesterday, but the point is this: If I don’t listen or touch or feel, I’ll never find it. I’m alarmed because these scenarios are cropping up more often, and harm is coming to the patient population more commonly because of it. Doctors are busy. Constraints on time are greater due to the changing healthcare climate that invites greater revenue if less time is spent in the room with the patient to allow more time to see others. We are relying on healthcare extenders more often, who haven’t spent as many years training in physical-examination technique (hold up! I’m not insulting anyone, just stating the obvious and at the same time, I acknowledge that some patients are examined more thoroughly by healthcare extenders than some doctors and sometimes it’s the only exam they get).
We Are Cardiologists, but We Are Also Internists
It’s okay to examine the patient, find a melanoma, diagnose walking pneumonia, refer a hammer toe for surgery, get a gall bladder removed, discover an uretovesciular tumor that is causing referred chest pain due to a complete ureteral obstruction—these are actual scenarios that occurred in our cardiology office over the past few months.
Some provider somewhere in this disjointed loosely woven patchwork quilt of American medical care must own the process. Someone must declare “the buck stops here” when a patient who has exhausted several avenues presents to us in desperate need. I think the best attitude is this: “If I can’t find it, I will find someone who will,” and then of course, when all else fails, examine the patient.
What are “healthcare extenders”? Are they sort of like textured soy protein?
We are still praying. The medical outlook sounds a bit more encouraging than when I last read the thread, Praise God!, and you are getting proper evaluation unlike the first hospital. I know you’re dealing with a lot of frustration in addition to the neurological problem. We will pray that your spirits lift as well.
It appears I have a nurse who really doesn’t like me. She treated me badly last night, blaming me for her failure to get me on a bedpan before it was too late and her being forced to change my bedding. She came in today and must have been told by her charge nurse that she was to do better or something, because she is REALLY treating me like crap today. She speaks in disgusted tones and grunts, she takes her time getting to me, my IV leaked about a teaspoon of blood and watery liquid and she denies there was a leak, though I saw it for myself! She put in a new IV and was very thorough at moving it around and pushing the needle in and pulling it out several times. She was rough with the needle the same as she is being rough with the bedpan and with lifting my bed up and crushing my knee with the tray. I’m trying to be nice by not demanding a different nurse, but I’m nearing the end of my rope, and if someone is going to hang, it’s going to be her...not me!!
Health care extenders are PAs and Nurse practitioners.
Pray for her. Try to see that nurse for who she *could be* in Christ. That nurse is a person for whom Christ loves, and wants a relationship with. See her potential if she knew Him, and fell in love with Him, finding Him to be her life. Right now she is an angry person. In Christ she could be a sister. Pray for her to find Him. Pray for an opportunity to leave a word with her, regardless how small.
I know, I know... easier said than done! This forgiveness stuff is easy to talk about until we have to do it ourselves. Me, too. When my mother was in the hospital, I was really REALLY peeved at some of those people. So I totally understand.
But you know Jesus... He has a way of sending us disagreeable people He wants to touch. It’s that “love” thing He was always going on about. :)
Everyone, let’s pray again for trussell:
“Lord, we ask again that you would heal trussell. We ask that You would be with her in the hospital, to be very present to her. We ask that when she is alone in the room, that your Spirit would come in a moving way and would touch her and show her Your peace.
“We honor You, Lord, and we praise You for what you are going to do in trussell’s body and life. She does not know why this is happening to her — and all the other trials she has faced recently — but Lord, she loves You and calls You her God. You call her yours, and have put Your Spirit in her. We ask you now to have Your will in her life and in her health. We ask for her to be healed and restored.
“Lord, we pray for trussell’s faith, that she would not go into fear. Help her to trust You through this. Hold her, be with her, and let her know that you are right there beside her, in that room.
“Lord, we praise You for being so wonderful. We thank You for working all this out for trussell, for being so strong for her. Thank You, Lord God!
“We ask these things in Jesus’ Name, amen.”
I am home again, against the advice of my doctor. My doctor wanted me to be admitted to the rehab unit for continued care...my insurance refused to allow that and demanded I be discharged and go home, to a home that is crowded with moving boxes, a step that keeps me from leaving the home on my own, 2 steps to work to get to the door required to care for the dogs, a thin/long hallway that is a tight fit for a wheelchair, doors to the bedroom and bathroom that will not accomodate the chair, no way to cook meals for myself or get my own drinks, a step-over tub...so no baths/showers for me until I’m better which the doctor said could take 2 to 5 weeks. Why can a “doctor” on the other end of a phone line, hundreds of miles away, make decisions on my care more effectively than my doctor? How could they possibly know what’s better for me?
Oh, no!
You need to talk with your doctor about arranging for in-home assistance. If you can’t bathe, get your own food or navigate into the bathroom you need help.
Have you had any progress with your legs at all? Any more ability to move a toe or something?
Ping your prayer list and let them know what has happened. I don’t know how many people are still following this thread.
Update at 171.
I get home health, but it’s 1 person (nurse) twice a week, another (physical therapist) three times a week, another (occupational therapist) who will come twice a week, and another (CNA) who will come twice a week to help with baths etc...
They are only here for about a half hour to an hour each.
So far, the ones that have been here all agree I would be better at an in house rehab.
Only progress, I can move the big toe on both legs.
There are also laws on the books about what can be considered abuse of the disabled or elderly by knowingly placing them into an unsafe enviroment or where their care including basic needs can not be met.
You can have your doctor request a hospital bed, a Hoyer Lift to get you out of bed you son can operate it they're fairly simple, a shower chair with wheels to be rolled into the bathroom as they fit through most doors. If they want to play the home care game instead of rehab then they should make your home as accessible as possible.
The HMO and insurers count on persons not challanging them. In your situation you need adult care/assistance for a few weeks. If they could not have placed you on the hospital rehab floor then they should have placed you in a nursing home for that time frame where assistance for your human needs would be met. The therapy can be done there and many of them have their on therapist. Really though you belong in a spinal rehab unit.
which lawmakers are the ones I should contact? I can find numbers if I know what ones I need to look for. So far, every home health provider that has come agree I should not be home. Even with the family that is here, I should not be here trying to care for myself.
At least today, I have a LARGE lidded cup that is filled with drink for me and my pain meds are next to me...I have a nurse, a PT and an OT coming. I told one of them on the phone yesterday that I had spent all day yesterday unable to get food. I didn’t get anything to eat until almost 7 pm. She said “Oh, we’re going to find a way to fix THAT”
Hey I know it's a lot but usually it works or has worked for us all these years. Tell them you can't walk and were sent home with no help or ways to eat etc. KEEP NAMES OF WHO AND WHEN YOU CONTACTED THEM. If this is Medicaid your state health and human services likely has it's own Inspector Generals Office. They also handle these situations.
Sorry I can't be more help. I know Tennessee's system fairly good and over the years I've been in more of these situations than I care to count. The last round was a couple months ago when the state was paying the medicaid HMO for Medicare Part B co-pays which is injectiables and inhalantandts through Nebulizers and the pharmacy was hitting us with it at $200 a month. This was for Asthma Meds.
There is a condition called Dysreflexia which can happen. If you can't whiz your body can start going into shock. Once symptoms begin it is very important to seek immediate medical help. What they will do is insert a Foley Catheter if it's the bladder and that stops the crisis. This condition is a possibility for spinal cord and spine injury patients. It is not something to let get out of hand. I know this because I was trained to know this from a spinal rehab center. It likely won't happen but it is good to know ahead of time info so you don't let it get too far out of hand.
I’m sorry they sent you home so early and it IS a shame that the insurance panel....who don’t know you and haven’t SEEN your condition...can be in control of what decisions your doctor HAS to make for you. It’s criminal...it’s obamacare in a nutshell.
Prayers that you heal quickly. I wish there was some way that your sweet son could stay home with you for a few days to help get the things you need but can’t get on your own....or your dear daughter.
Thank you so much for the information...I truly appreciate all you have shared with me!
My son is such an awesome student, I couldn’t even consider hurting his grades by keeping him home...plus, if he is absent 14 days during the year, they can hold him back! He’s an A/B honor role, and this year, so far...he’s straight A’s!
As for the daughter, the Landlord would never allow her to stay...under NO circumstances! She stayed while we were moving, but that’s done now, so she had to go home. We don’t have room for her now, this house is really small.
Thank you for the prayers, I need those so bad.
Thanks to EVERYONE for the prayers...you all are so awesome!
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