Sunday, June 9, 2013

Our Incredibly Terrific and Terrible Medical System

Ten weeks ago or thereabouts I rolled over in bed  at 3 AM and felt a sharp pain in my right leg.  My lightning-quick mind (Ha) immediately diagnosed the pain as a cramp in my calf.  It was briefly painful but the hurt subsided in short order and I went back to sleep.

Next morning I noticed my right calf was swollen about 20% larger than my left calf.  But, there was no pain---just a stupid looking swollen leg.  Sigh.

Cindy was alarmed when she saw it, but I quietly explained to her that I had had a leg cramp and the swelling was no doubt related to that fact; and besides, the swelling would recede quickly and all would be back to normal in short order.  She immediately called her sister, Patti, who is a nurse, and related my plight to her.  Patti said I should immediately go to the Emergency Room because the swelling could be the result of a blood clot in my leg, and this could actually be a life-threatening condition.  She said if it was a clot, it could "break loose" and travel to my heart or brain.  I refused to believe this sage advice because I felt no pain or discomfort in my leg.

Well, then Cindy started Googling and found out that in all probability I did have a clot.  That's when the nagging started.  I put it off for days, but the swelling in my leg would not recede.  Ten days went by before I went to the doctor.  I now admit I am a stupid man and I should listen to my wife.

Doc took one look at my leg and ordered an ultrasound on my leg that afternoon.  He said if it wasn't a clot (or Deep Vein Thrombosis---DVT), this would be the first time in his career he had seen a leg like mine that was not a clot.

I had the ultrasound and it was confirmed I had a clot behind my knee, causing the leg to swell.  I was sent straight to the ER.  I spent one hour in the ER where I was shown how to give myself two daily shots of Lovenox in my lower abdomen for a week.  I was given a prescription for Coumadin.  I had a five minute  tete-a-tete with the ER doc, who told me to rest and not do anything strainful because if the clot broke loose it could be a very bad problem.

Three days later I was back to see my doc, who changed the dosage of the Coumadin.  One week later I was sent to get an ultrasound of my liver, which turned out normal.  Once a week since then I have had to get blood drawn to monitor my blood - Coumadin level.

So far, my leg swelling has gone down by about half.  Still no pain.  Still taking Coumadin, and the doc says I may have to take it for the rest of my life.

Then I got sent to the Hematologist, who tested my blood for any possible genetic causes for my DVT.  All tests came back negative.  Bottom line is that they do not know what caused the clot.  Many times, a clot can be caused by a long trip in which the patient is unable to move around for long periods---like a plane trip to Europe or somewhere, but I did not have a long trip.  Or, sometimes it can be caused by a genetic change.  Or, sometimes it can be caused by a cancer in the body which causes the blood to clot easier than normal.  Anyway, in my case, they can find no definite cause. 

Jump Shift:  I went to the dentist to have my teeth cleaned two weeks ago.  While the hygienist had me agape she asked me what that scaly growth was on my lower lip.  I told her I had had that for about a year.  Usually it was completely unnoticeable but sometimes it got bigger and then receded---nothing to worry about, I assured her.  She thought otherwise and the dentist informed me I needed to see the Oral Surgeon.  Sigh.

The Oral Surgeon was a nice man.  I would have liked to have had a conversation with him about the time we each spent in the army back in 1969, but he was unfortunately involved in cutting my lip open and sewing it back up with 4 stitches.  I no longer have the growth on my lip but I do have a frightful-looking scab in its place.  Sigh.

The biopsy came back as "pre-cancerous".  Doc says it's no longer a problem, that it was probably caused by too much sun exposure over the years.

Back to the dentist.  I was told I need a crown---one to replace an old crown that had developed a hole in it.  Got that done last Thursday.


1.  If your leg swells up, get to the ER.  Listen to your wife.
2.  My leg continues to improve but is still noticeably bigger than my left leg.  Getting rid of a clot can be a lengthy process.
3.  My medical treatment has been excellent.  Docs and nurses have been a delight.
4.  Medical treatment is insanely expensive.  I mean insanely expensive, as in bearing no relation to reality.
----  ER visit, 1 hour, two prescriptions = $3400
----  14 doses of injectable Lovenox = $850
----  Two doc visits, approx 10 minutes each = $400
----  Two ultrasounds, approx 15 minutes each = $900
----  Visit to Hematologist with blood testing = Not Yet Determined
----  Visit to Oral Surgeon, approx 30 minutes = $900
----  Dental Crown = $950

Even though my insurance paid a big chunk of these charges, I cannot help but see the out-of-control pricing of medical care.  This is a terrible issue for most Americans. 

Thank God I will probably be OK through all of this, but how can this insanity continue going forward?