Sunday, April 24, 2016

Shedding Pounds By Shedding Organs

back home

My new weight loss program

Standing by the hospital bed, the two nurses discussed the patient’s status. They reviewed recent ultrasounds, CT Scans, and the importance of “you have to go before you can go”. At some point I just looked up at the two of them and said, “I am being transformed from a 61 year old man to a 29 year old in the Maternity wing.”

Welcome to a very special Health Insurance Issues With Dave. It must now be obvious that some of the posts of the last year dealing with doctor interaction and cancer treatment were, in fact, about me. I apologize for being less than 100% transparent. I kept waiting for my Emily Litella moment. It just never came. (By the way, the links are footnotes that attempt to make these posts more informational and entertaining. Take a moment to enjoy Gilda Radner).

This post will discuss my last two weeks in stark detail. The picture above was taken Thursday, after I got home. Yeah, Happy Ending. Still, my story is still evolving and so is yours. And though less than pleasant, this is very relevant to you.

My annual physical has always included bloodwork. My PSA started to climb a few years ago. Nothing shocking. Not too high. No spikes. I didn’t have ANY problems, but I could hear my prostate calling. I finally had a biopsy last fall. The news wasn’t good. I had a Gleason Score of 7.

In some countries an otherwise healthy, asymptomatic man in his early 60’s would be monitored. Prostate Cancer moves slowly. In the US we aggressively tackle Prostate Cancer now, while the patient has the best opportunity to not only withstand the process of surgery or radiation, but to lead a long, normal life post-treatment. I opted for a combination of hormonal and radiation treatments. This was detailed in my last post.

I was invited to participate in a clinical study. Part of the protocol was another CT Scan. My last was just outside the timeframe. OK. One more test. The test results were fine, except that there was a shadow on my left kidney. The subsequent ultrasound was not determinant, but it wasn’t good. The next CT Scan was focused on my kidneys. I had a mass, approximately 10 cm wide, on the base of my left kidney. It didn’t matter if it was benign or malignant (probably), it had to come out. The radiation was put on hold for a couple of months so that this could be resolved.


This picture is of me walking into University Hospital Wednesday morning, April 13th. I had to accept that this was to be the first day of my process. It might be a year before I felt this good again.

The goal was to remove the mass and a small part of my left kidney. The surgeon would attempt to utilize minimally invasive techniques. But if he didn’t like what he saw, I had been warned that he wouldn’t hesitate to open me up and take the entire kidney. I should be able to leave the hospital Friday or Saturday. Sunday was my worst case scenario.

The surgeon removed the mass and part of my kidney. The doctors were concerned about my post-surgical bleeding. They took me back in, briefly, early that afternoon. Ten hours later we came close to ending my life as we ended the day. I was bleeding to death. You aren’t supposed to remember these incidents. I recall the room in vivid detail. At some point I attempted, with my left hand, to authorize another complete surgery while keeping my blood-soaked gown away from the form.

Let us at this point finally end the irrelevant notion of patient controlled cost containment. The patient, a 61 year old man who had never had any previous medical issues and was not on any medications, needed a major operation. He had done his part. Do We Save His Life? That is a YES or NO question. What if he had been 71? 81? 91? This is a question that we, as a society, must answer.

So, we all agreed to save my life. Yeah! Now, who’s paying? We have several ways to pay for medical services:
  • Government
  • Private Business (Insurance)
  • Some combination of government and insurance
Self-pay is not an option. Who but a very few could guarantee the availability of liquid assets when needed most? What society would turn away most of the truly ill? And how could the medical industry depend upon us to meet our obligations?

And just as important, who decides how much the medical providers (doctors, pharmaceutical companies, hospitals, labs, etc.…) get to charge for their goods and services?
  • Government
  • Private Business (Insurance)
  • Some combination of government and insurance
  • Or are the medical providers allowed to charge whatever the market will bear?
They rushed me into surgery in the early morning hours of Thursday, April 14th. The surgeons removed the balance of my left kidney and my spleen.

Each patient is connected to an impressive array of computers. Each machine has its own set of bells, horns, and alarms. Sleep and silence have been disrupted by an alarm. Every minute of an alarm feels like an hour. Alone in the darkness you first need to determine if it is your alarm. Why is it ringing? Am I Ok? And if it isn’t you, you relax for a moment before you wonder how that other guy is doing.

I awoke in the intensive care unit. Sally and Jennifer had been through the entire previous 30 hour adventure and were visibly relieved. They were allowed to dab my lips with a wet sponge. I was moved within a few hours to a surgical step-down unit. They gathered my stuff and put a long stainless steel cylinder next to me on the bed. “What’s that”, I asked. “That’s what’s keeping you alive”. I tried to move over and give them room for two.

I had been told that there was an almost sadistic nature to the way nurses and techs woke you up all night to draw blood and take tests. I greeting my nurses, nurse’s aides, and tech by name. Their presence proved that I was still alive. And I was only going to be able to leave the hospital with their help.

I had a great team. I recall these names: Nurses Becky, Sue, Lauren, Jen, Katarina, and Megan. Assistants Dave, Marie, and Debra. The surgeons resolve a problem. The nurses heal the patient.

Mark was one of my nurses in the step-down unit. Mark is in total control of his little corner of the world. Lucky for me, I got to spend about twelve hours there. He was the one to track down XL sized hospital socks, reassure Jen and Sally, and remove the catheter. Mark decided that I had to get out of the bed and take a wheelchair to my room on the 5th floor. There was push back. Didn’t matter. Mark was my first step towards recovery.

Nurses tell the truth. It is sometimes the patient’s responsibility to ask the right questions, but the nurses are your advocates. I was fortunate to have Tom for a couple of days in a row. He answered every question. He helped me to mentally prepare for my recovery.

I got home the afternoon of Wednesday, April 20th. I’m OK. Really. I’m almost fine. I’ve very tired and it will take a while to be back to 100%. I will share the bills with you as they come through. I’m curious as to what this all cost. I bet it would be cheaper and easier to drop a few pounds by going to Weightwatchers.

Thursday, April 7, 2016


Big Bucks

Consumer Directed Health Plan. One of the biggest jokes in the health insurance industry is the illusion of control. We pretend that you, the consumer, can control your medical expenses. We created products that, by law, have high deductibles, no office visit copays, and no Rx card. We know that you will shop for the best deals in primary care doctors and cardiologists. We are counting on you to force the doctors to justify every blood test, CT scan, and procedure. You know that you are a great shopper. Here’s your chance to prove it.

Can you shop for a deal when they are wheeling you in to the hospital with a blocked artery? “Hold up Mr. EMT. I just got a text alert that Hillcrest is having a sale on bypasses this week.”

But of course, none of this is real. There is no way to know the real cost of medical services in advance. And who amongst us wants health care by the lowest bidder? Plus, do we know anyone who is prepared to say to his doctor, “Another surgery? Gosh I don’t think we should spend so much just to save my life.”

The client is in the early stages of his treatment for prostate cancer. He and his doctors discussed the various ways to remove his prostate, external beam radiation, and even radiation seeds that can be implanted. The patient chose external beam radiation. The doctors then suggested that he also have hormone therapy.

Hormone therapy almost appeared to be an afterthought. By taking pills or getting shots the patient would inhibit testosterone production, shrink the prostate, and slow the growth of cancer. What shot? Which pill? The patient was told that the nurse practitioner would tell him when they met.

The client had a shot and got a bill a few weeks later. Ready? The shot cost $34,228.50. Surprise. The Anthem Blue Cross negotiated price for the shot was $18,932.99. The client’s deductible was $5,500. He blew past that. The client maxed out his share and Anthem paid the rest.

I looked at the bill and the first question I had was, “Did they buy you dinner?” I mean for this price he should have received a gift card for The Cabin. Sadly, all he got was an off switch for his libido. My second question was, “Is this some new miracle drug?” No, he was given Lupron which has been in use for over 30 years. The good news that it was a double shot, good for 6 full months.

$34,228.50 for one shot. Who knew? That’s easy. Everyone but the patient.

We have no control. Remember our friend the next time you wonder why your insurance premiums are going through the roof. I wouldn’t have done anything differently. You would have been just as surprised as he was. This shot is just one more example of a broken system in search of a solution.