Docs, Docs, Docs and Furniture

Part of our task while in the midwest included Doc Appointments. We used to allow a couple days…bang them out and then leave again. Now that I am officially “old” (i.e. Medicare Eligible) It has been 45 days since our “routine” appointments, yet it seems the Docs want to see more (and more, and more) of me. Meanwhile, Liz who has not yet achieved Medicare eligibility, WAS done in 2 days, and IS amused at the attention focused on me.

Liz DID have a tense encounter with her cardiologist, tho. We had a couple hours between her regular Doc and her Cardiologist appointments, so we went to Binny’s – a Chicago Liquor Institution. The larder was bare, so I acquired a bottle. Or Three. Actually, The Holy Trinity. Scotch, Bourbon AND Rye. Then we went to the Cardio Doc, who started the appointment by reviewing Liz’s answers to the lifestyle questions.

Doc: “Do you Drink?”
Liz: “Socially, only. Maybe once or twice a month…”
    (Uncomfortable pause as the Doc notices the Binny’s bag by Liz’s feet, with THREE bottles of Spirits in it…)
Dan: (Recognizing the Elephant…and Fifths…in the room)
Dan: “That’s Mine!”
     (As though THAT made it better)

Actually, Liz’s Cardio is cool – and we all laughed about it…

I’ll skip to the end, before telling the “rest of the Story,” so no one worries (or celebrates) the premature end to these missives. I am FINE, and the Economy, in particular the medical-industrial complex is even FINER (if by “fine” we mean “Flush with Cash.”).  Knowing that,  you can read what follows in the spirit that it was attended,  and the spirit that ALL these blog posts are intended:

You Cannot make this sh*t up!

So…..I ENGAGED IN MY first ever Medicare Lifestyle Baseline Examination. You know, the one where they ask you new and exciting diagnostic questions such as, “Do you fall frequently?”   and,  “Do you have anyone who can help you if you do.”  I apparently answered the latter question wrong – I said “no” since I do not fall. Doc looked suspisciously at Liz, and then no doubt considered activating a second-level social worker visit to arrange for safe senior housing!! (Doc said EVERYONE answers that question wrong…which begs the question:  Why ask it?)

Next, they gave me 3 random numbers and told me to remember them. Then they tried to distract me. Never mind that it is PERFECTLY NORMAL and USUAL to, as I have done for many years, go to the grocery store, buy a bunch of stuff but NOT the item you went to the store for. For the record, I remembered the numbers!!

But not to be deterred from a perfectly good opportunity to bill Medicare for more services, they discovered I apparently exhibited an abnormal EKG. A SERIOUS abnormality!?  So the Doc Referred me for 3 tests: a Calcium Score, a Nuclear Stress Test (nothing to do with North Korea, but still stressful) and an Echo Cardiogram.

These were scheduled surprisingly quickly – only delaying us in Chicago for about 10 days.  Not to worry, though, we spent the “waiting” time  actually visiting friends and restaurants. While in Chicago for the Medical Maelstrom, there was a party held for us by our Magnolia Neighbors.

TWO opportunities to eat Burritos;  best in the country we always thought and of which we are now certain, due to EXTENSIVE research!

Several chances to host folks at our bus, parked at Illinois Beach State Park.

And, we played a small (very small) part in the 80th surprise birthday party for friend and furniture-maker extraordinaire, Bob White.

Speaking of furniture, we also spent about 9 days in Bob’s driveway, while he constructed a couple of things for our new bus. One was a multi-compartment cabinet that nicely contains appliances such as our Instantpot, as well as a liquor storage and serving area. As always, we are SOOOOO grateful to Bob for accepting the challenge of working on furniture for us. The bigger challenge, working with ME – replete with all my personality quirks.  The fact that he has done so several times now nominates him for Sainthood —  The requisite miracle required for canonization is that he has not yet killed me.

Furniture Going in

Furniture3

Furniture2

Furniture1

Anyway,the results were in….

• The Echo Cardiogram showed my heart was pretty normal.
• The Stress Test showed that I had already had a severe Heart Attack and was probably dead.
• The Calcium score revealed minimal Calcification, but 3 nodules in my lung.
  Could be cancer, usually not.

At this point Liz was having a heart attack!!

After thorough analysis, the Doc expressed reasonable confidence (though he was not entirely positive) that I was not dead.  But felt like he needed to order…

MORE TESTS.

The first was a CT Scan to examine in more detail the nodules that were accidentally discovered when the Calcium scan revealed I did NOT have Arterial Stenosis. Yep. That followup CT Scan revealed that I have Nodules, confirming the previous CT Scan that showed I had Nodules. This suggested…

ANOTHER TEST.

This time, the plan was a repeat CT Scan in 90 days to see if the nodules changed. I told the doc OUR PLAN was to be in Canada in 90 Days…where a CT Scan would be impossible. Since the radiologist HAD also suggested that perhaps a PET Scan could be done immediately (instead of waiting 90 days to do another CT Scan) … The Doc ordered…

ANOTHER TEST

The PET Scan, had to be justified to Medicare vs. just waiting 90 days.  Doc did this on the basis that I am a high risk patient (since I was a smoker). Whatever works, however I only ever smoked a pipe – this was a beat ago and I never inhaled, like my hero Bill Clinton.  Why did I smoke?  A Pipe gives a wise man something to think about and a fool something to stick in his mouth.  And apparently access to PET scans. 

So, I was now in line for a CT Angiogram AND a PET Scan…the former to resolve the discrepancy in the other cardiac tests and the latter to examine the nodules in more detail. I don’t know why they couldn’t just put the quarrelling Radiologists in a Cage and let the winner decide how sick I was. Anyway, These tests could not be scheduled for several weeks, so we went bopping around the midwest a little MORE.

In mid-bop, the Hospital Called. Apparently a machine needed to be installed and they wanted to change the time of one of the tests to afternoon from morning. Still three weeks out. I said, “Sure, and if it would help in all your installation scheduling,  and other people’s tests,  we can come ANY time…cuz that’s just the kinda guy I am!!!” (In fact, the sooner the better, I thot, but did not say!)

The guy called me back a couple hours later and said, “Can you be here Wednesday?” (It was like MONDAY!!!). I said, “You mean like this coming Wednesday?” “Yep,” he said. We said “sure,” knowing we could decamp in Minneapolis and get to the Hospital easily.

I said, “We’ll have to sleep the night before in the hospital parking lot…”

There was a pause on the line. The guy then said, “Wait…like in the lot? You’ll be sleeping in a parking lot?”

The Hospital is in Libertyville – a NICE suburb…people don’t sleep in cars in the hospital parking lot in Libertyville! Like when I answered “NO” to the “do you have anyone to help you when you fall?” question, I am pretty sure he was about to call social services to help find a homeless shelter for us, the CT Angiogram being less important in his mind.

Sensing the confusion, I said, “NO NO. We LIVE in an RV…”
I don’t think that helped his confusion at all. Then I sent him a Picture!

He said, “AHHHH. Park by the Hospital Health Club – that Lot is never full. See you Wednesday!”

So, I had the CT Angiogram, which revealed that I was  NOT dead.   And also had no significant stenosis or blockages in any Cardiac Arteries.

And the PET scan, which revealed that the lung nodules did not display the metabolic activity that would be expected of something malignant,. And that nothing else between my knees and brain did either! I guess if they are going to go all PET on you, they figure they might as well scan all of everything! Liver. Pancreas. Kidneys. Stomach. Bladder. All normal. Except my Spleen –Splenomegaly (meaning enlarged). Soooo…

ANOTHER TEST?

No. Not this time.  According to my Doc, if I play Professional Football or other contact sport, it would be of concern. Try not to get punched in the stomach, he said.  This is a REAL PROBLEM for me as we stay in people’s driveways,  and as I work with Bob building furniture!  I guess I need to learn to behave myself less I risk a ruptured spleen!   ;-(

Along the way, I have been learning a little more about how medical care works (or doesn’t) in the USA. I learned that there is a new law that sez the hospitals have to release the lab results unedited and raw directly to patients.  I am sure this is for their amusement, and the amusement of their families and confidants.  Between Dr. Google and ChatGPT, I am also sure this is causing the entire medical profession agita as patients everywhere leap to false conclusions, prescribing cures for said conclusions based on TV Pharmaceutical Commercials!!!    For example,  directly quoted from my test results:

— I am “Grossly Unremarkable.”
     Several friends thot I could be one or the other, but not both. Debate continues about which.

—  “Noted to be somewhat tortuous.”
    Many thought this was totally appropriate for me

—  I am also “Right Dominant”
    Friends thought the  machines definitely needed to be recalibrated, knowing me to lean left on most things.

My closest friends were reassured, though since the results confirmed what they already knew:

— “No Activity noted in Brain.”

I bring all this up because, at the end of the day, I am FINE. Never had any symptoms. Fairly active lifestyle; able to resist most Southern Fried Food (redundant, I know). I still have a weird EKG and lung nodules, but no underlying anything to fuss about. Doc was going to put me on some Cholesterol drugs and recommend a low fat/cholesterol diet, but then realized based on the battery of tests, that those particular indicators are already quite low,  and our diet is already pretty good. So, Doc told me to get on with my existing life; including visiting Canada later this summer!!! Eh!

SPOILER ALERT! Semi-Political Rant coming…

I am GLAD that the abnormal EKG was uncovered, and that all the “bad” reasons for it were examined and eliminated.  And that I have the time and resources to be able to cycle through the Medical Machine for over a month.   I COULD have been really sick, in an invisible way. Dropped dead, actually. Had I been ACTUALLY sick, this testing regime was aggressive and would have helped address things early and effectively. Having seen some of the preliminary bills, there was well more than $50K in imaging studies to ascertain this!!! Almost all of which will be covered by Medicare. For me, with persistence and a bit of luck, the system worked.

Many are not so fortunate. Or so Proactive. 

This really makes me stop and think about the state of our medical system; one where we spend considerably more than ANY other first world economy on “care” (almost twice per capita than the next highest…Germany). In 2021, that was almost $13,000 Per Person!! That is 16% of our GDP!

Yet the spend is NOT equitable, nor particularly effective when outcomes are measured quantitatively. Choose your metric:

— Life expectancy? At 79.11 years, the US ranks 46th, behind EVERY country we would consider our first-world peers, and even behind ones we wouldn’t, such as countries like Macao and Cuba!!!

— Infant Mortality? 50th overall, again behind the entire first world AND Cuba.

— Avoidable Deaths? Iceland is best with 82 per 100,000. USA had 238. US ranks LAST among high-income nations, despite spending more per capital on healthcare.

There is something wrong! I would say rotten in Denmark, but Denmark ranks far ahead of us in all these metrics. What is actually rotten is right here in the USA!

Considering how much the USA spends on healthcare,
why do we have such a mediocre system,
which produces at best mediocre outcomes for most,
objectively measured??? 

And, 

Why to people defend the current system,
which produces such haphazard and mostly subpar results,
instead of DEMANDING change?

We (Liz and I) are attentive to routine visits and wellcare because we have always had insurance that encourages this. This probably saved Liz’s life already, and might have saved mine based on the initial test and possible reasons. We can afford to be proactive, both in time and cost. Many people cannot be, and/or are not so proactive.

And when we DO engage with the system, there is the cost and outcome problem. Is the problem with PEOPLE or the system. Or both?

Some say it is because 40% of Americans remain uninsured, and so are not seeing Docs or engaging proactively as they should.  But all that does is make our spending per capita all the more outrageous and ineffective!

I doubt it is a problem with healthcare providers…Many doctor friends describe the incentives they have in their practices, which are to see patients FAST and interact more with the computer than the patient. And I had a bunch of fancy tests, all ordered by my providers — which in my case confirmed all is A-OK, but might have indicated a serious issue BEFORE it was life-threatening. For many, those tests are inaccessible for a variety of structural reasons.

I don’t know what all the problems are in our system – I just know as a consumer that we pay a LOT of money and get poor results. As a consumer, if your Internet provider did this, you would change up! If your car mechanic performed as well for as much, you would be writing bad Google reviews and going elsewhere.  Possibly even engaging an attorney. 

Yet, we seem unable to even consider alternate systems – ones that are working OBJECTIVELY much better and more efficiently in other places. People even DEFEND the current system; claiming we cannot afford a single-payer or a government-operated system.  Systems that are proven to be less expensive and more effective in other first-world countries. 

Worth saying again:  We are already paying more per capita, with worse results than MANY countries with government-operated healthcare.

WHAT IF we suddenly had a single-payer system, where all $$$ were spent/managed on behalf of the patients, not the for-profit companies that currently control the spend? WHAT IF no “healthcare $$$$” supported shareholders in private, for-profit companies that DO NOT PROVIDE HEALTHCARE? I ASSUME this is so far not the case because too many people (mostly working for insurance companies!) are making too much money to support (or allow) any kind of meaningful change.

It’s also because Healthcare (and any attempts at substantive restructuring) get caught in our political us vs. them dynamic. I would posit that, ESPECIALLY with regard to Healthcare, there IS NO “THEM,” there is ONLY US!!!

I surely HOPE some of the candidates striving for our votes will start discussing things like this at some point.

Rant over!!!! Harrises out!!