Category: Health

Had an interesting exercise in pandemic exposure.  I’ve been avoiding human contact since before I retired five years ago, but I digress.  First followup with Dr. Donner yesterday went well.  The bone grafts appear to be taking hold with no untoward indications.  I actually started walking somewhat normally, although still very time-limited, within just the past few days.  Secondary symptoms including various pain sources are all diminishing now – for the first time in 15 months.  Talk about awkward.  I wanted to hug the guy!  

Since I was already out anyway, I decided to stop for breakfast at my favorite Greasy Spoon on the way home.  I suppose it was good timing, because everything is now closed for dining-in.  Guess I got lucky.  Or not.  We’ll see if I turn up sick in a few days.  Back to normal today – avoiding human contact.

Yesterday’s Symptoms Log:

16 MAR 20: 1st followup w/Dr. Donner showed the bone grafts healing as expected. All other symptoms have evened out and diminished noticeably. Midsection still tensing hard, but the back brace makes walking tolerable. Nerve jolts are beginning to subside with the switch that was turning it on (spinal stenosis from an inflamed, festering injury) is gone.  My body still knows it has a major repair underway, but it is now successfully dealing with the surgery, instead of a losing battle against an internal injury.  I’ll try to to ramp up later this week after another little cold snap.

The topic should be left hip replacement complete, but it’s been so long (13 months) since Dr. Park broke my back, that’s a distant memory.  Here’s what my lumbar looks like now.  New rods and screws in the vertebrae compliment titanium hip prostheses on both sides.

It wasn’t too bad of a procedure – seems less traumatic than a hip replacement.  But the accompanying nerve pain is a new twist.  Not much in the way of rehab needed, just alot of hurting until it sticks and grows in.  They gave me a stout brace that works way better than the riding belt I was using all last year.  All the staff at RMR were great, and of course Dr. Donner has my undying gratitude.  I was not going to make it much further.

Am I too melodramatic?  The death spiral has begun:

“20 JAN 20: Worsening symptoms now include the left leg and right shoulder. I suspect the present shoulder portion may be related more to the preexisting cervical condition itself being somehow aggravated by the worsening lumbar, due to lack of therapy(?). Re-started cervical spine decompression last week, but staying away from inversion on the lumbar for now. Radiculopathy is forcing me into a state of complete immobility. Glutes, erectors, obliques and thighs totally exhausted, stiff and sore 24×7. Any ambulatory activity at all is a difficult, painful struggle. Fusion surgery scheduled for Feb 11th.”

In addition to a cane, on-and-off over the past year I’ve simultaneously used a combination of two assistive devices, a kidney belt and sacrum support belt, to stabilize the lumbar whenever I expect to be leaving the house or doing anything on my feet for more than a few minutes at a time.  They helped extend up-time quite a bit on numerous occasions, but have little effect now.

Better get your ducks in a row, Mr. Mike.  Everybody works for somebody, and I’m working my way up the chain.  We will get action on your ECHCS attitude problem, sooner or later.  Might want to show this one to Tommy, see if I’m on the right track…

Considering the lead time and difficulty getting this scheduled, orthopedic surgery  seems to have become a scarce commodity.  Too bad it took over eleven months just to get somebody to diagnose the damn thing.  But our new spine guy Dr. Donner, comes highly recommended, pumping them out on a weekly basis.  Next up:  Hip Replacement Recovery and Repair, aka Lumbar Spinal Fusion.

I’ll be going to the UC Medical Center of the Rockies for the procedure.  The short video linked below illustrates what will be happening.  What do you call a combination of terror and anxiety?  Mine is a single-level, so I suppose fairly straightforward in general back surgery terms.  This condition is relatively common and benign compared to some of the stuff they see from car crashes, sports injuries and whatnot.

Every back injury starts with an annular tear.  My heart goes out to Ryan Shazier – he got a really bad one.  If a small one is all you have, good luck getting a doctor to diagnose it unless you are either paralyzed or screaming in pain.

 

But that’s not the end of it, in this case either.  Delegating only works when the tasks get done.  I imagined somebody in the Senior Executive Service, responsible for a brand new multi-billion-dollar hospital, might have learned that by now.  Response to my little malpractice expose’ was disappointing, to say the least.  This particular bureaucrat didn’t have the integrity to respond himself, assigning it to an underling.  Paraphrased from govspeak:  “Privacy concerns prevent sharing information, and if you want anything done about it, do it yourself.”  That is what we may expect in terms of administrative response to criminally-negligent VA healthcare.

When I write a letter to a government official, I expect a response from the person addressed.  Delegate the writing to an underling, but at least have the integrity to put your own name on it.  Does seem consistent with contemporary governance attitudes these days, tho.  Ivory towers only go so far.  Good luck, Mr. Kilmer.  You had you’re chance.

It’s a very personal thing, certainly varied by the individual in myriad ways.  The big factors in that equation could be viewed allegorically as a culinary recipe, with similar ingredients from the different food groups substituted for flavor, consistency and caloric content.  I alluded to how that works for me at the end of the ECHCS feedback post.  Please allow me to break it down here, just to be very clear.

The VA gave me two things, and took one away.  They gave me alot of un-anticipated pain and disability(PD), both physical and emotional.  During the discovery phase lasting many months, the 2nd ingredient, cognitive dissonance (CD), was mixed in.  That can really fuck with a person’s head after awhile.  Then towards the end of my ECHCS relationship, to seemingly sort of seal the deal, they took away any hope for relief.

Mix those three things in somebody’s head, and you have a viable recipe for suicide brewing.  The problem with the recipe allegory is when converted to the simpler, colder mathematical equation, the result solved for on the right can be only one of two things:

PD + CD + Hope = Life

PD + CD – Hope = Death

I hope that spells it out clearly enough for anyone who might be interested.

Never let it be said I am ungrateful.  I always send thanks to where/whoever it is due.  Oddly(?) written communication with providers in “the system” includes only an ill-conceived “Secure Messaging” function.  In terms of basic healthcare applications, that was clearly nothing but a source of delay and confusion, at least for me and continues to this day.  I won’t follow up on the thread recently started with my new PC in the Cheyenne part of that system.  It went un-answered.  They probably assume anything to do with me is unlikely to turn out well at this point:

I don’t know how secure it is, but it definitely is not functional as a means of supporting patient/provider communication.  That took three days to get nothing accomplished or even acknowledged.  Maybe Annie is a sock, and the CYA effort continues?  Who knows.  Hard to tell with this so-called form of communication.  Look at any of these VA web sites and they are plastered with Facebook, Instagram, whatever-the-fuck social media “connect with” bullshit.  They cannot even connect the dots in their own records, much less connect with patients.  It’s not working – just like the suicide prevention program(s).

The IRIS (Inquiry Routing & Information System) system was the only way I could find to communicate.  That ultimately did not work for me either, apart from maybe this last little bit, even after my symptoms log snippet from the 1st complaint was input into the official record.  I still can’t be sure patient advocate Mr. Peterson got the message, but he did return my call, so we’ll call it good:  

Facts, or lack thereof, I should say.  Seems like alot of controversy surrounding facts these days.  Look no further than the screen in front of you for the problem.  I’d guess it holds around a 70/30 split fiction/fact ratio these days.  That’s only when anybody is even paying attention.

Here’s some of what’s going on at the new Aurora VA facility:

Orthopedics Policy:  Err on the easiest and least expensive side of patient care decisions.  The benefit of any doubt will not go the patient.  The following fundamental, systematic failures presently support this policy:

1. Empathy. VA staff are pre-disposed to doubt, minimize and overlook patient concerns.  Rhymes with apathy.
2. Stove-piping. Poor internal coordination between clinics and doctors hurts patients with delays.  More critical aspects fester in wait.
3. Communication.  Electronic gobbledygook is no substitute for human interaction.  Then review #1.
4. Diagnostic Stratification. Diagnostics start with #1 & 3.  Do the work being called for, and stop looking for reasons not to.

Despite needing to Google half the terms I see in them, it doesn’t seem that difficult to read and understand my medical records.  I can only speculate that doctors did not look back far enough and/or spend enough time putting 2-and-2 together.  My diagnosis obviously became an exercise in futility right off the bat, for some reason.

The patient experience becomes a never-ending series of Q/A repeated over-and-over, with outstanding issues not tracked and run to ground.  The record becomes a lengthy discourse of random doctor-speak appended over months and years in my case, never to be deciphered into a coherent single patient picture in anyone’s mind ever again.  It’s just reading comprehension and listening – basic stuff.  VA staff did not appear to be interested in taking the time to exercise these skills with me.

Being steered back to Primary Care becomes a time-wasting, stove-piping exercise in futility.  Slow response, vague steering and push-back from Primary Care injected an insurmountable confusion factor.  That should never happen, with the possible exception of dispensing dangerous drugs and the like.  Primary care should be a patient-led exercise, at least in my case, if they are really listening.

The VA has a serious cultural problem. Seems it’s been around for awhile, with my experience only occurring in the last 7 years or so.  No amount of lip service from any new director will ever change that.  When directly confronted with an obviously distressed patient, staff routinely minimized and waved away my complaints and pleas for help.  Schadenfreude and inadequate training are apparent, to me – totally unacceptable.  Organizational culture becomes emergent with (or without) training.  What I experienced tells me it’s off the rails at the new Aurora VA.

This is a warning to prospective orthopedic surgery patients everywhere.  Outcomes like this do not seem to be all that uncommon, yet somewhat understandable, considering the nature of orthopedic surgery.  The ongoing year of mistreatment that followed in my case, is shocking.  And remember:  You are approximately 9,000 times more likely to be accidentally killed by a medical professional than anyone wielding a gun.

Here’s what a leaking disc looks like almost a year later.  Any questions, Dr. Knight?

ECHCS’ Official Feedback for 2019.

Specific VA personnel issues pertaining to my case appear below. Several things called out with an *asterisk, are directly quoted from official VA records.

A.  To the forgetful Post-Op nurse:  Before “not wanting to wake up” the patient to bring medication on schedule, review the Doctor’s orders and improve your understanding of basic pharmacology regarding the specific medications you are dispensing.  Do not allow patients to slip into excruciating breakthrough episodes.  Failing that, when they do wake up screaming from the pain running up and down their spine, for example (not the hip) annotate the record, if you can find the time at 3 o’clock in the morning.  Remember arguing about the numbers when  the patient said “OK then, it’s a 10?”  Your career is coming to a close soon if this isn’t the last wake-up call like this you get.(LATE UPDATE LATE 2022: It would now seem this was their 1st attempt to take me completely out of the picture, obviating any need for accountability or claims processing)

B. To the Physical Therapist who noted: “*Pt reports he feels like he has a bag of cement around his pelvis” The term used was concrete underpants. It’s still being used today.  In one ear, out to the computer incorrectly and done isn’t working.  The hip twisting was a bad idea, too.  Patients coming apart with back injuries don’t like it.  Hip surgery patient with the opposite side of their body so contorted from muscle clenching it makes that leg a half inch shorter, are a “bad” thing.  Why they might feel compelled to make their own lift shoe in order to be able to walk, is another big, red flag.  You might be in the wrong line of work.

C. To the Primary Care Physician who observed: “Sometimes it just takes longer to get over an operation.” Contrary to ECHCS rumors these days, the human body heals at relatively consistent rates, based on age, nutrition and other factors.  Patients with unexplained issues need a call made.  You seem to be pushing them in the wrong direction.  Consider working on the listening skills if you have any plans for career advancement.

D. To the PA who observed: “We don’t usually see this on the right side after a left hip replacement.” Take some Ibuprofen and come back in a couple months is not the correct response to that situation.  The email saying “*he can go to the ER.” can be particularly insulting, under these circumstances.  But it did get into the record, so 2-for-2 on the keyboard skills.  Knowing the ER is not a real option, making a good rabbit hole to throw somebody down only makes more futile work for the ER.  Avoiding work is not what we do here.  You are in the wrong line of work.

E. To the Surgeon who remarked: “I’ve done many of these procedures and never saw anything like this before.” Many people drive up and down I-25 for years and never get in a car accident. What does either of those things have to do with “my” surgery recovery?  Your education didn’t stop when you got your license to practice.  That’s what we’re calling this one: a “practice” session.  Much better attention to detail will be needed, going forward.  One of your colleagues inadvertently gave you up.  This either was or will be, your last chance.

F. To the rehab doctor who quipped: “Since January, huh? Looks like it’s chronic now.” Your medical opinion is the only thing that matters.  We have an idiot in the Oval office now because of what things “look like.”  You got it wrong, demonstrating inappropriately presumptuous hubris, failure to read and understand the records, and failure to read and listen to the patient.  Your job was literally done for you, and you still turned it down.  You are in the wrong job.

G. To the Joint Doctor who noted: “…*thinks he got a back injury…” Yes, they certainly do think about that all the time, when they are injured. But it’s mostly a feeling – pain inflicted by one of your doctors, in this case.  Here’s what the record said about what the patient “thought:”  “*Mr. Shaffer has had low back pain that got worse after his hip replacement.”  An open-ended therapeutic misadventure for the patient is ongoing to this day due in large part to your failure to recognize and properly refer the case.  Your PA might remember shuffling them out of the exam room literally yelling “I can’t walk with this shit!”  Comprehend the message left with you the day you met that man, as well as the one left here now – for the benefit of your next patient.

H. To the Chief of Orthopedics who replied: “*I don’t see any delay in care from the orthopedic point of view…” That seems to be an issue for almost everybody addressed here, right down the line – seeing any problem at all.  Did nobody want to see the back injury?  Or want to even admit the patient had a serious back injury?  People reading the record can’t not see it.  Is there a filtered “from the orthopedic POV,” only you see?  The record tells a different story.  Characterizing the symptoms expressed all along as anything “normal” is absurd.

Now that everybody is on the same page with the blanks filled in a year later, what is your definition of the term “delay” in this context?  The patient is still stumbling around crippled a year later.  Can you explain why the MRI he literally demanded in June did not happen in January?  We already know how he slipped through the PA net under your direct purview for 3 months.  Any indication what the problem there might be, in your orthopedic POV?  Your cursory dismissal of his complaint effectively sentenced him to an ongoing year of misery and frustration.  How many others like him out there?  Any of them still alive, Chief?

In a nutshell:  You took a disabled vet, disabled him some more, rubbed it in, flatly refused to diagnose and treat, driving him to the brink of suicide as he unsuccessfully sought help from a healthcare system ignoring his pleas.

Fair criticism?  I look forward to speaking with people interested in exploring this narrative further, in detail, fact or general intent.  Big suicide prevention push going on lately, I hear.  Now you know all about how that works for me.  Push this.  On the inside.  I mean that literally – inside of who or whatever you think might have a relevant problem inside of it.