Tag Archives: medical

What I Learned from Mom’s Hip Replacement

Being involved on the business side of the medical device industry in recent years, I have taken a keen interest in all things healthcare related. I also have a mother who is over 65 by a good deal and has dealt with Medicare and Medicare Advantage programs (in Florida) for some years now. I have had the dubious distinction of sorting through the hundreds of Medicare Advantage programs out there to find some that are appropriate for her and then guide her to reasonable choice. (Thank heaven the government has a website to help with that. I cannot imagine most folks on Medicare coping with that project, but that’s another post entirely.  You can start here if you’re researching the matter yourself:  http://www.medicare.gov/Choices/Overview.asp )

Before the Surgery

My mother complained of a painful right hip for a couple years. Her primary physician finally said mom was a candidate for a hip replacement and she would recommend the operation whenever  mom would like to have it done.  This is a very common operation these days and a good, experienced surgeon will normally yield good results.  Recovery progresses fairly quickly, you can walk again within a couple days, and the patient is back to mostly normal (pain free) in 3 to 4 months.

A separate request had to be made to my mother’s primary doctor to obtain a recommendation on a surgeon, which I thought was odd.  I would have expected her primary care physician to help guide her to a surgeon, but I guess not.  We were given 5 surgeon names, 3 of which, upon investigation, were participating in her insurance plan. Of the 3, we requested that the primary care physician’s office recommend one of the three. We asked around (in the over 55 community in which she lives) about hip replacement surgeons and got additional recommendations, eventually all converging on a particular nearby surgeon.  Surgery was scheduled at Blake Medical Center in Bradenton.

Surgery, the Hospital, and Rehab

Surgery was scheduled and then moved to an earlier date as one became available. She was in surgery maybe 3 hours, then in the hospital for 4 days, then transferred to a physical therapy rehab facility a short distance away that was highly recommended.

I arrived in Florida the day she entered rehab and my sister flew out the next day. We were initially told she’d be in rehab for maybe 10 days. She was in rehab for 15 days. It was clear to me that it would have been longer if I hadn’t kept asking questions about her progress and their expectations.

The rehab facility did physical therapy for patients 5 days out of 7.  Why it was not 7 days out of 7 I don’t know.  Their website claims 7 days out of 7.  I never received an answer.  I was at the rehab facility several hours a day, every day,  bringing what my mother considered “real” coffee, walking around with her, giving her outdoor wheelchair rides, monitoring her medications, and so on.

Her first roommate (two people in every room) was a nearly deaf lady who would turn her TV on so loud that you could hear it from the nurses station down the hall.  It took several days to have my mother transferred to a different room.  Moving was dependent upon somebody else leaving the facility.  There were 55 beds and all were full, pretty much all the time from what I could learn.  Did I mention the food was surprisingly good?!

The staff was wonderful. Everyone we met was helpful, kind, and gave 110% to every task. That was encouraging. I did ask about the medications being supplied in the morning, during the day, and in the evening. Some meds were things we had agreed with her primary care physician that she no longer needed. It was disturbing to see them pop up again. It turns out that older people are seen by several doctors (primary, surgeons, specialists) who do not talk to each other. Each prescribes meds. Sometimes without looking at what has been prescribed by someone else. (My mother-in-law had been prescribed near lethal levels of one med by several physicians before her two sons figured out what was going on with her.)

My mom is becoming a bit forgetful, not Alzheimer’s but forgetful.  Doctors and therapists should not assume that telling older people something is adequate. Things need to be written down and should be transmitted to family members. Even if the older person does not appear to have dementia, it seems to be a natural issue as people age. It is very clear to me that both in hospitals and in rehab facilities, people needs advocates watching out for them when they are not completely able to manage their own care. This appears to be true for everyone, regardless of their age.

Upon entering rehab, we were told that my mother was now under the care of one of the two physicians associated with the rehab facility.  She was there 15 days.  She NEVER saw a doctor of any size, shape or color while she was there.  Her second roommate had been there for a month and she said a woman doctor had popped her head into the room once during that time and asked her “How are you doing today?” and then left.  Without being overly cynical we all assumed that both doctors were charging everyone in the facility (55 patients) on a regular basis for “visits.”  Let’s see, 55 people a day times let’s call it $100 a visit would come to $5,500 a day that Medicare is paying this place for absolutely nothing.  Let’s assume that these two doctors are on call.  Maybe they do get called to deal with a patient once or twice a day, maybe.  Still, $5,500 a day is pretty good.  Times 7 days a week that’s, let’s see, $38,500 a week.  Not bad for being on call and walking through the building maybe twice a week. The nurses and staff do all the work and are very good. I thought the references to patients being under the care of these doctors was pretty clearly fraudulent.

Conclusions

(1) Ask questions. What is being done? Why? When and where will it be done? How long will it take? What are the expectations? When does the patient transition from one stage to another and what are the criteria for transitions?

(2) Watch medications. Who prescribed what? Was the surgeon aware of the person’s previous medications? Does anything conflict with anything else? Are any of the medications to be given on an “as needed” vs. “regular” basis? What are the meds and what is each being given for?  Assuming some of the meds are sent home with the patient, find out again what needs to be given and when.  Then make an appointment with the person’s primary care physician to review.

(3) Watch what you are being billed for. Since most bills will be transmitted directly to Medicare or to the Medicare Advantage health insurance program, this is not always something you see.  I remember when my father died, the doctors charged for several visits “to him” after he had already died. (That was also at Blake Medical Center in Bradenton, FL.) These people have no shame. They simply game the system for their own benefit.  If that explanation seems harsh, the only other explanation is that they are too disorganized to bill correctly, but somehow the errors are always in their favor.  You pick.

That’s what I learned.  I hope it helps you.

And today (3-17- 2010) I learned something else

Martha Coakley, the Massachusetts Attorney General, published a preliminary report titled Investigation of Health Care Cost Trends and Cost Drivers dated January 29, 2010.  I highly recommend you read it.  All 21 pages.  Don’t worry, there are some large graphs!  It will either enlighten you or confirm whatever cynical views you may have about our healthcare system.  The conclusion is that in our free market system, healthcare providers charge what the market will bear.  And that drives up costs. Let’s put it this way: you can pay 280% more for the exact same market basket of healthcare services, depending on where you go in the state of MA.  And we have some pretty fancy, well known medical institutions here.  Mind you, I am not condemning them for this, because I believe those that charge more are also doing more in the community that they are not being paid for.  But the overall report helps explain how broken the system currently is.  I hope you can read this below.  It shows the variation in price for the same services is, broadly, 100% from lowest to highest paid, with the exception of one heck of an outlier which is 280% of the lowest paid.  Still, a 100% difference is a heck of a market premium for healthcare.

Pages 19 and 20 have conclusions, including the following:

Our preliminary findings show that the current system of health care payment is not value-based – that is, wide disparities in payment levels are not explained by differences in quality or complexity of the health care services provided. These findings have powerful implications for ongoing policy discussions about ways to contain health care costs, reform payment methodologies, and control health insurance premiums without sacrificing quality or access in Massachusetts. The Office of the Attorney General looks forward to completing its investigation and to presenting a fuller exposition of its findings through the DHCFP cost containment hearings.

Although our investigation continues, it is clear that prices paid for health care services reflect market leverage. As a greater portion of the commercial health care dollar shifts, for reasons other than quality or complexity, to those systems with higher payment rates and leverage, costs to the overall system will increase and hospitals with lower payment rates and leverage will continue to be disadvantaged. If left unchecked, there is a risk that these systemic disparities will, over time, create a provider marketplace dominated by very expensive “haves” as the lower and more moderately priced “have nots” are forced to close or consolidate with higher paid systems.

The present health care marketplace does not allow employers and consumers to make value-based purchasing decisions. Our findings show the system lacks transparency in both price and quality information, which is critical for employers and consumers to be prudent purchasers.

These market dynamics and distortions must be addressed in any successful cost containment strategy. Payment reform, such as the global payment methodology recommended by the Special Commission on the Health Care Payment System, may result in system benefits such as better integration of care. But, a shift to global payments may not control costs, and may result in unintended consequences if it fails to address the dynamics and distortions of the current marketplace.

We need universal healthcare.  And we aren’t likely to get it in the near future, no matter what Congress does.

Tinnitus

My Story

Many years ago I was sick with what I thought was a bad cold.  After a couple days it seemed like more than a cold, in fact it felt like what I imagined pneumonia would feel like due to a heaviness in my lungs.  The cause was a classic sick building situation.  I was driven to a friend’s doctor, told him I thought I had pneumonia, he took an x-ray and said I was fine.  Two weeks later the doctor’s office phoned and said they looked at the x-ray again (must have been a slow day) and decided I had viral pneumonia.  There is no known cure for viral pneumonia.  Eventually I got over it and life goes on.

About 6 months later I was aware of a persistent ongoing noise that did not reflect noises in my environment.  A doctor I had seen before recommended seeing a neurologist who did a bunch of tests and gave me the bad news:  viral pneumonia had stripped the myelin sheath off my nerves (some, not all, I presume), leaving me with lifelong tinnitus and some physical strength asymmetries.  Everything else is back to normal. There is, of course, no known cure for this variety of tinnitus. Or for damaged myelin nerve sheaths.

A Possible Solution for Some

Some 10 to 50 million Americans reportedly have tinnitus, depending on who you believe.  Most of it is caused by physical damage to delicate ear structures from work conditions, loud music, explosions (gunfire, airbags going off…) and other loud noises. A single loud noise or loud noise over a period of time may be the instigator.  Inside the cochlea there are tiny hairs that are easily bent out of shape by loud noises.  Thus tinnitus.

Anatomy of the human ear.

There is no known cure for this variety of tinnitus, either.  Maybe.  For those whose tinnitus was caused by noise, I do have a suggestion.  (And I’ve tried a lot of things.)  At one point I investigated a delightful and very skilled Chinese acupuncture specialist who said he MIGHT be able to help, but it would take several treatments, it would hurt, and he could make no guarantees.  In the past I’ve had amazing experience with acupuncture resolving pain and speeding up injury recovery from torn muscles.  I was willing to do anything to regain some quiet.  We tried it.  The needles went into the web between my thumb and index finger, which would appear to have been the LI 4 point in the diagram below. (Not completely sure.  I recall it being more in the web than in the hand itself.)

I have never felt pain like that… unbelievable… tears flowed from my eyes like a faucet.  In the end it didn’t work.  He had been able to cure some people this way, but I now suspect they had a different underlying problem from my situation.  In any event, that’s my main contribution to the discussion of tinnitus. (A solution that didn’t work for me, but might work for you.)

Distant Solutions and Immediate Coping

Science News magazine/online recently (1-25-2010) had an article on how prions might be the proteins that cause the myelin sheath to grow and possibly regrow.  That gave me a bit of new hope that a cure might one day be found for my type of tinnitus sufferer.

http://www.sciencenews.org/view/generic/id/55594/title/Prion_protein_is_not_all_bad

A reader of this humble blog told me that you have to be a Science News subscriber to be able to read the above link.  I apologize to any and all who have been inconvenienced by this.  To briefly summarize the article, ” A new study suggests that the normal form of prion protein helps maintain the insulation that speeds electrical signals along nerve fibers.” Prion proteins are known to cause bad things like mad cow disease and wasting in deer, as well as a similar problem in people.  The article goes on: prions “may direct cells called Schwann cells to wrap around neurons and produce myelin, a type of insulation that aids electrical communication between nerve cells.” While there’s more, the key to me is that it may be possible to regrow that myelin sheath. However, it is July, 2011 as I type this and I haven’t encountered anything about further progress. The study in the article was done at the University of Zurich, although a comment from someone at the Dartmouth Medical School in Hanover, NH leads me to hope that possibly some work in this area could be ongoing in the USA.

It turns out there are many more causes for tinnitus than I imagined.  I came across a blog entry

http://www.toahealthybody.com/what-causes-tinnitus/

that listed 10 causes, and none of them included viral pneumonia.  I wrote a subset of this entry as a comment.  So there you are.  There’s also a William Shatner video on the web where he asks for donations to the American Tinnitus Association.  I did a search for tinnitus on Twitter but was disappointed to see that some comments were meant to draw you to sites selling products I don’t think would do any good.  But, again, my problem may not be your problem.  WebMD has a thorough treatment of the subject starting here,

http://www.webmd.com/a-to-z-guides/ringing-in-the-ears-tinnitus-topic-overview

The only information of value to me in the WebMD article is that I must reluctantly admit when I cut down on coffee, the tinnitus is less bad than on the days when I drink 6 or 8 cups.  (Oh, come on, you know those days…. )

To those of you suffering with tinnitus, my sympathies.  I find it best to keep busy and distracted.  Music helps.

http://www.medpagetoday.com/Neurology/GeneralNeurology/17709

But I think music always helps.  To quote one of my favorite people, Frank Zappa: “ Information is not knowledge. Knowledge is not wisdom. Wisdom is not truth. Truth is not beauty. Beauty is not love. Love is not music. Music is the best.”  (I have that on a t-shirt actually.)  He also said “Jazz is not dead, it just smells funny.”  Gotta love that guy.  Peace.