It has been a while since I have even thought about this thing I consider a scourge on the the current state of health care, let alone comment on it or raise my voice about it. It came to mind today in a roundabout manner in the course of my EECP treatments. I am about a third of the way through to date. My vitals are taken daily before and after each session, and for the last week my blood pressure has been trending downward. Ordinarily, this would be a good thing, however, the trend is dipping low enough to be of concern. In particular, the systolic number is at an all time low for me. My attendants even had each other check it to be certain. This phenomenon can be brought on by any number of reasons, not the least of which being the treatment itself improving the function of my heart. I am convinced that at this point my medications are over-dosed. Two of the blood pressure lowering drugs were doubled by my cardiologist at the beginning of this year in anticipation of an open heart surgery procedure to bypass several main cardiac arteries. Since I decided to not go that route and do the EECP treatment it is only logical that the dosages should return to where they were. I explained this to the nurses, adding that I was aware that no one at the center is in a position to advise on prescriptions. I also added that ordinarily these things are determined by my cardiologist, but I was considering changing him for someone more attuned to the approach I am taking. In so many words, I was honestly informed that I will not find any such cardiologist, not even the hospital group attached to the EECP center. The reason being that there is no big money attached to this method. As if I didn’t already know this. People have to demand this therapy. If they even are aware of it. The bill-for-service machine driving US heath care isn’t going anywhere any time soon. I’ll just stick with the guy who knows my history the best for now and hope he can deal with me.
A number of years ago, I found myself in a position where I needed to hire a lawyer. I did not want to go through this exercise, but it was mandated by this county’s family court. Through no decision of my own, a civilized alternative was not possible at the time. In hindsight, it is clear that both parties would have fared much better in the end, as is often the case. I didn’t want to be hiring anyone, and he really did not want the case in actuality. Oddly, that appealed to me.
I must say that I did get one profound realization from my dealings with this man. I was wrongly looking for him to give me the answer that could not be given. He just came out and stated that I needed to make a decision as to which way to go with the whole mess. How I wanted to deal with it was entirely up to me. All he could do was to help me facilitate the action, and advise the pros and cons of doing so. My life, my choice. Yes or no.
Recently I have found myself in a similar situation of choices to be made in my own regard. I am reminded of my prior legal experience while I am dealing with the medical community at large, although there is a small difference. The pros and cons of my treatment have not been investigated as thoroughly as I think they should be. As I see it, it is part of the machine that health care has become in many ways. The worst and saddest part is that along with that, the overwhelming majority of patients are not empowered enough to participate in their own health issues.
This was very clear when I went in to a EECP (Enhanced External Counterpulsation) center locally yesterday and interviewed the doctor who runs the facility. She was surprised at the level of knowledge I had regarding cardiac artery disease, particularly how I was interpreting my test results and comparing them and developing a rationale of possible ways to go with it. This, evidently, is highly unusual.
As a result of review and basic testing, along with quite a long chat about my general history, I decided to give this non-invasive therapy a shot and see where it takes me before doing something as drastic as CABG, recommended by the hospital cardiologist. In all likelihood it will be of benefit in my case. All indicators are there. It’s an option. A choice. It’s mine.
About two years ago this time of year I started to really feel pretty lousy. It was a slow progression I was adjusting to and taking in stride. As someone once put it to me it was akin to going blind. You don’t notice it happening until you walk into a wall. So it was with me. I had been away from regular medical care for too long and was without the medications I had become accustomed to over decades- not to mention the quarterly monitoring. My regular doctor went out of business years before and my ability to replace that care came up really short. The clinic people would not prescribe what I was getting before because I could not remember the dosages and such. I’m sure that a bout of depression I was going through had something to do with that, along with being out of work on the long-term.
It got to the point where I could not sleep. Over time, I started cross-referencing my symptoms on the Internet, as I could not lie down without having an anxiety attack. It was a slow burn. Like the progression of the illness itself, the information was building up and I was reaching the conclusion that I was suffering from congestive heart failure, or CHF. While on the Internet June 3, 2011, it was announced that a pretty famous songwriter and musician I admired, Andrew Gold, had passed away at age 59 . The cause of death was heart failure. I was approaching 59 in a short two months. Within 48 hours I walked down to the ER and told them they needed to admit me for CHF.
I was subsequently released and managed with medication and dietary modifications. It has been that way since until I obtained health insurance through public assistance. This journey is chronicled in earlier posts right here, so feel free to read through if you have interest in the history. Having insurance put me back into the cardiologists office who put me into the surgeons office. This was all well and good until I questioned the whole thing prior to signing off on a major surgery. A procedure that the public is starting to believe to be “routine”.
Today, we learned that guitar hero to many Alvin Lee passed. You know- the guy with the flying fingers from the “Woodstock” movie and sound track. The cause of death is given as complications resulting from a routine surgery.
I think I’ll ponder choices in this matter a bit longer. The music is speaking to me, once again.
“Generally, due diligence refers to the care a reasonable person should take before entering into an agreement or a transaction with another party.”
That’s a pretty good definition, in general. A friend of mine who happens to work in the legal field reacted to my last post “Wait A Minute…” (https://greasyheart.wordpress.com/2013/03/02/wait-a-minute/) using this term, and in support of where my decision making is going regarding my dealings with health care professionals. I found it interesting. I’m familiar with the term from working in the building design engineering world professionally. It is probably why I am going through this process, being familiar with it. I’m glad the term was brought up, frankly. It made me feel better knowing someone else got it. Up to this point I have gotten enormous support from everyone I know regarding the potential of such a large scale medical procedure as open heart surgery with no mention of this aspect. Maybe it was assumed that I had already gone through this process as a matter of course. Ordinarily, I would have, given my history. This in itself gives me pause. I can only think that trying to survive all the government agencies has had an effect. In those instances, one does not ask questions in addition to what is asked, because it could hurt the result of the benefit they are determining. There is a trickle-down effect in that, and I can see where it spreads unintentionally over time.
In any case, there is no question that this development in my thought processes has come at just the right time. With all due respect to my doctors and surgeons, I realize that because I did not ask along the way, they have not adequately addressed another concept:
In all fairness, nearly two years ago the CT surgeon did mention that at that time what they proposed was considered very, very high risk, adding that with great risk there is the potential of great reward. Tell that to a guy letting it all ride on a single bet in any given casino pit- not me. It’s been over 18 months, my condition is improving vastly, and that explanation won’t cut now. Add to that the fact that they are viewing things through a different lens, and we have ourselves a case of due diligence coming to be.
“Diligence is the mother of good luck.”- Benjamin Franklin
“A Catch-22, coined by Joseph Heller in his novel Catch-22, is a logical paradox arising from a situation in which an individual needs something that can only be acquired with an action that will lead him to that very situation he is already in; therefore, the acquisition of this thing becomes logically impossible. Catch-22s are often spoken with regard to rules, regulations, procedures, or situations in which one has knowledge of being or becoming a victim but has no control over it occurring.“ (source: Wikipedia)
I saw the above image being circulated on social media in conjunction with the “Occupy/99%” movement- which now appears to be growing into a global phenomenon. Take a long look at it and carefully read what this man is saying- what is written on the placard he is holding.
When I read this, I immediately knew where he was coming from. Aside from his misfortune being cancer and mine being congestive heart failure, the severity of our medical conditions were similar. That, and rather than working a minimum wage job I could not take being disabled, I was turned down by the local government offices for assistance because my highly reduced income coming from unemployment insurance through the State is too high to qualify for financial help to get the prescribed further tests and surgery. This, despite decades of my paying into that “policy” through payroll deductions. There is no way to purchase adequate medical insurance privately on that kind of money and still live adequately- even in the most modest fashion. One needs to be abjectly penniless, indigent and/or pretty much on death’s door to qualify given the legislated guidelines. And the jury is out on that as well…
It seems Joseph Heller knew exactly what he was talking about. He was abstractly prophetic as to the situation many Americans are finding themselves in with the onset of age and the dramatic decline and destruction of the healthy economy we once helped to build.
It’s also known as “circular logic”: A “Catch-22”.
A good friend of mine left a comment on the post “Heart Of The Matter”… He apologizes in it for what he called a rant. I did not see it that way, and thought it worthy of a post unto its self. Mildly edited from the original but still continuously intact as to the points made, I am presenting it here:
“In my last 2 years of actually dealing with the healthcare system and experiencing firsthand how it operates I have to say – if it were a business, it would be belly up in no time. Waste, confusion and incompetence are the three key elements of the system. Then add insurance into the mix and you have the mess we call “Healthcare in America” today. God help those with no insurance at all, which I suspect is an ever-growing portion of the population in this country – and the US is one of the only industrialized countries without universal healthcare.
I can’t offer a solution, but I can observe the system is broken and, although the “Obmacare” bill has its merits, it complicates an already complicated system and (IMHO) addresses only part of the problem. We look to other countries using social medicine for a model, yet a not one system has all the answers. Look no further than the British dental care system to see failure – the standing joke of the world (think of Austin Powers’ teeth). Canada has probably the closest thing to a working system, yet there are still issues with eligibility, wait times and payment structures. From my limited understanding of that system, I think it is 70% government / 30% other funding, with the other being the individual, employer, or insurer. One key difference is the salaries of the professionals, which is almost 1/2 of their US counterparts. Part of that discrepancy, I’m sure is, costs for malpractice liability insurance, but mostly, it’s the proliferation of malpractice suits. -JMS”
He ought to know what he is talking about. Thankfully, his bladder cancer appears to be in remission at this point.