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Part 2: Osteomyelitis, Solving a Health Care Puzzle

Recovery from Osteomyelitis is no picnic. I find out there is no such thing as a cure. Duckie will always be considered infected, to some unknown degree. First, I find that out, then I find out other things. We’re in and out of stories, and around the bush and back. I’m happy I have a sense of humor and some training in problem solving: Asking 5 Whys, Root Cause Analysis, Pareto Charting, Process Mapping.

For those of you just tuning in to Duckie’s story please click this link for Part One, “WII:osteomyelitis as Veterans:Duckie (Putting a Healthcare Puzzle Together)”

Sky Game
Duckie and Mr. Incredible at a Chicago Sky Game. Duckie is an avid fan.

 

A quick aside: Duckie married a mildly mentally impaired man, Mr. Incredible. They live with us until the two of them get annoyed with Loved One and me. They stay with Mr. Incredible’s parents until the same happens over there. Duckie stays with me while she recuperates. Mr. Incredible visits. He needs predictability. Nothing is predictable here.

Every week, a Home Health Care Nurse visits to check Duckie’s vitals, take blood, and to replace the valve for the IV antibiotics. Every day, I inject a SASH (Saline-Antibiotics-Saline-Heparin) through the valve. The Saline goes in Push-Pause-Push-Pause. I make the sound between my teeth, exaggerating my breathing so I sound like a peristaltic pump: my attempt at humor.

“What’s that noise?” Loved One asks from the kitchen.

“What noise?”

“It stings. It stings. It stings. I’m fricking tired of this. It takes too long,” whines Duckie.

“That shushing noise; like a leaking valve,” Loved One pipes in from the kitchen.

“It’s just saline.”

“No. What’s that noise?”

“You mean this? Puuushhhh, Paaaauuuse.”

Duckie waves me away like a bothersome gnat, at the same time, she lets out a reluctant chuckle.

A timed, 5 minute push of Antibiotic, then the Push-Pause of another saline followed by heparin.

“We’re done. It takes less than 10 minutes.

“It’s a waste of my time. I fricking hate it.”

The valve is a couple of inches above Duckie’s elbow, the IV threads through the vein and empties just above the heart.

“How are you doing?” asks Nurse Homey.

Duckie smiles at her. “I’m good.”

Home Health
The Home Health Care Duckie receives is the highest quality.

 

Every week, Nurse Homey goes over the previous week’s blood results. I ask questions what the tests numbers and what they means. The indicators of infection are slowly subsiding, but not in the normal range yet.

While Nurse Homey is there, my friend calls to ask for Dr. Bone’s number. Her husband has a shoulder problem.

“Oh, don’t go to Dr. Bone for a shoulder. He does knees,” says Nurse Homey. “You need Dr. BoneB for shoulders. He’s in the same office, but you must ask for him.”

I call my friend back.

Ms. PhysThere comes in twice a week to help Duckie learn how to walk with 50% of her weight. Loved One watches carefully, and reminds Duckie when she puts too much weight down.

“What about her herniated disc?” I ask Ms. PhysThere.

“Herniated disc? There’s nothing in the chart about that.” We go over the exercises Duckie got at the Physical Therapist’s before the surgery. Duckie and I do the exercises together twice a day together.

Here’s what our/my days look like:

  1. Breakfast with Love-One: read newspaper, catch up on e-mail
  2. Work on my novel (I have a goal to finish it by month’s end)
  3. Make Duckie’s breakfast; sit with her and listen to her while she eats; work on quilt for Junior High grandchild graduate (another thing to finish by month’s end.)
  4. Wrap Duckie’s arm; help her shower and change; get her settled with project; load dishwasher, do laundry.
  5. Get ready for home health visits of some sort.
  6. Make lunch.

 

Projects
My quilting and Duckie’s projects.

You get the picture. Somehow in there, quilt did get finished and so did my novel. Yeah! Thank goodness my Dream Job turned out to be a Nightmare and maturity led me to resign before I went berserk. I’d be out of work without enough hours for FMLA. God works in mysterious ways.

We go back to see Dr. Bone, for the post op visit.

“She can go back to work anytime,” Dr. Bones says. “Just avoid tripping, falling, or twisting or walking on uneven surfaces. And keep to 50% weight-bearing. So kept the walker; just use the cane going up and down stairs.”

“She’s a grocery clerk,” I remind him. “She carries customers’ groceries and loads them into cars. The parking lot is often uneven, with pot-holes and all.” All this information is in the file.

“Oh, she can’t do that. See you in another 3 weeks.”

We go back to visit Dr. Infectious. I love Dr. Infectious. He answers all my questions.

“The ESR test measures the amount of time it takes for red blood cells to sink to the bottom of a tube. It’s non-specific, just indicating, among other things, that inflammation is somewhere in the body. The test is over 100 years old.” Another link Duckie has to WWII and Civil War veterans.

Duckie’s ESR numbers are still higher than normal.

“You can probably wait a while for the next surgery.”

“Yes, but in the meantime, I understand she is in danger of a break.”

“That is a risk.”

Our second post-op visit with Dr. Bones allows her to go back to work and 100% weight bearing. In response to my questions, we learn Duckie can go swimming and ride her bicycle. She can go back to work. “Just don’t trip or twist. You are still in danger of breaking the bone.”

“What about the second surgery?” I ask. “When do you want to schedule that?”

“I’ll see you again in 3 more weeks. Maybe she won’t need the surgery at all.”

This surprises me because it does not match what he says before, and it does not match my research. But, as happens to me in many situations, my questions I have fail to solidify in my brain. Dr. Bones is so friendly, grins like we’re old friends. He pats Duckie on the thigh and heads to the next patient.

Duckie and I are already in the car when I remember an important question. I run back inside.

“What about lifting? She’s required to lift up to 50 pounds.”

“Oh no. She can’t do that, says the Physicians Assistant. What does she do?”

“She’s a grocery clerk.”

Dr. Bones fills out a work restriction form limiting Duckie’s lifting to 20 pounds.

All this time Mr. Incredible has turned into The Invisible Man. The few times he’s visited, he’s told Duckie to shut-up and stop crying, he’s complained when she asks him to do something, and he’s generally whiney and difficult. Mr. Incredible does like to be the center of attention. He has had car problems, and his shoulder hurts. Add PMS to the mix and Duckie tells Mr. Incredible “My mom doesn’t want you to come back for a month.”

I did NOT say that. I did say I wanted her to stay at our house until she gets 100% clearance from the doctor.

“I think I want a marriage like Aunt Deanna’s,” Duckie says to me. “A marriage where we just don’t see each other or live together.”

Duckie’s perception of Aunt Deanna’s marriage gives me the giggles. Uncle Mike is a school administrator. When he was well into his 50s, he got laid-off from one school and the only way to keep his pension was to take a job 500 miles away. Deanna is a public health nurse, with a pension also in the balance. Uncle Mike hash an apartment and travels back and forth on the weekends. Aunt Deanna proclaims that time is too precious when they are together; they don’t waste any of it on petty fights. Duckie is right, a long distance marriage seems less stressful for her.

“That’s an idea,” I say.

I am careful not to say things that might come back reinterpreted in a way is slightly eschew. I decide to find a time to talk to Duckie about recognizing the signs of PMS and holding her reactions in check.

“It’s not that time of the month. That’s next week.”

“Just something to think about,” I say.

Duckie’s feeling much better. She is back to work, she walks a couple of miles every day and she purchased the Biggest Loser Work Out DVD. We work out together. He knee is still swollen and it hurts behind the knee. She still has some pain, which I believe might be just sore muscles because she doing so much more. But there’s one more symptom that is troubling.

“Every night I have excruciating headaches. And my brain feels all tingly, like when my fingers go to sleep,” she tells me.
I write down all her complaints; the strange ones and ones I think are from the normal healing process.

We go back what we think is our final Dr. Bone visit. He looks at her leg and the results of her blood work. He takes her temperature.

“The numbers indicate inflammation. There may be some infection left. She needs a cat-scan of the entire leg.”

“What about her other leg? She had other breaks when she was struck by the car. Is there any chance there is osteomyelitis in the other bones?”

I think these are legitimate questions. The look Dr. Bones gives me is like I just asked him to eviscerate Duckie, just in case she has a parasite.

“We don’t like to do that kind of thing because of the radiation involved.”

I explain her headaches.

“We don’t treat headaches. You must go back to her primary care physician for that.”

On the way out, I ask to talk to Billing. Sorting out how Duckie’s insurance company itemizes and matching it to how Dr. Bone’s itemizes is no small feat. An example (not the real numbers) from insurance:

Drilling a hole in Duckie’s leg: $6,000 (Provider not authorized to perform this procedure)

Drilling a hole in Duckie’s leg: $3,000 (40% covered)

Plugging the leg: $5,000 (Provider not authorized to perform this procedure)

 

Plugging the leg: $2,500 (40% covered)

 

Total: $16,500

 

Negotiated: $16, 000

 

Deductible: $5,000

 

Duckie owes Provider $16,500

 

Betty from Billing looks at the bill.

 

“Oh my, I must talk to Dr. Bone about this. We need to charge more. The negotiated price is too close to the actual price.”

 

Yes, she really did say that.

 

“Why are there two billings for each procedure, and who’s rummaging around in Duckie’s leg that is not an authorized provider?”

 

“Oh, one charge is for Dr. Bone one is for his Assistant. Insurance paid for the Assistant, but not Dr. Bone. This says your insurance deductible is not met. Your part is 60% of the bill. We already re-submitted this bill once. You need to talk to the insurance company yourself.”

 

I do. Dr. Bone is authorized. Dr. Bone is in-network so he should be paid 80%. The insurance company will reprocess the bill. That was four weeks ago.

 

I do some more research. The headaches are a side-effect of the medication Dr. Bone prescribed. I call and ask for a different medication; one without this side-effect.

 

Duckie has a site of infection the MRI missed the first time around. There is a “sinus tract infected posterior” to the first one. She needs a Special Specialist. A New Dr. Bone, because original Dr. Bone no longer feels equipped to handle the procedure. This will take another surgery, another round of antibiotics, and some reconstructive surgery yet to be determined, but which may include metal rods and an artificial knee.

 

New Dr. Bone “does not feel he is the best surgeon for Duckie to see.” (This is a direct quote from the message his office left.) New Dr. Bone suggests an associate who will have his assistant call me if he is interested in Duckie.

 

I contact Mayo Clinic. All the research I do, leads me back to Mayo; so I call them. Barb seems sympathetic. She gives me a patient ID and takes notes on the complicated story.

 

“My understanding is the bone is compromised,” I say, quoted Dr. Bone’s Physician Assistant. “Although not an acute situation, the surgery needs to be done, sooner than later.” Barb says someone will call me back. She gives me a number to call, not her, but a bank of 15-20 people who are part of the Mayo Bone Group and will have access to all the information I’ve given. Five days go by.

 

I call the Mayo Bone Group. Dwight starts asking familiar questions.

 

“I explained all this to Barb.”

 

“The information is not in the system. I’ll forward everything over to Barb and someone will get back to you.”

 

“When can I expect a response?”

 

“Two days.”

 

That was today. I’m thinking about calling the Veteran’s Administration. Maybe a WWII veteran can help me out.

 

Yes. Indeed, we have a Health Care crisis. And I don’t think it’s one the Affordable Health Care Act can solve. Here are my first 5 Whys and a What:

 

  1. I would love it if Dr. Bone remembered Duckie and her WWII relatable tale. Still, he’s busy, he has lots of patients, maybe that’s too much to ask. Why doesn’t Dr. Bone bother to read Duckie’s file before each visit?
  2. Dr. Bone prescribed the pain medication. Dr. Pain administered the cortisone (see Part 1.) Of all people, why don’t these doctors seem to know or review the side effects of the medicine they are using and prescribing?
  3. Why do the physical therapists, home health nurses and friendly neighbors seem more responsive and knowledgeable than the doctors?
  4. Why is insurance/doctor billing so complicated?
  5. Why wasn’t a cat-scan done before the first surgery?
  6. What’s going on behind the scenes between the doctors office and the insurance company?

Oooo… My sense of humor may be at the end of its rope.

At the End of a Rope
At the End of a Rope (Photo credit: cogdogblog)

 

 

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2 Comments

  1. Rita Crandell Rita Crandell

    Even the telling of the story was so complicated I had to keep going back to try to figure out the what’s and why’s. Your questions at the end summed it all up. I couldn’t follow the story because it is impossible to follow. Keep posting, keep inquiring (I know you will)

    • Adela Adela

      I found a place in San Diego that specializes in chronic osteomyelitis. If I can rely on the informaiton, and that’s a big IF, much of the first procedure was old school.

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