Category: Paul

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.

As expected, the Discogram was positive.  So, under my particular circumstances, we’ll open it up, clean out the mess, screw it back together with some metal pins, cross our fingers and wait a few more months.  Longest goddamn hip replacement EVER.  Here’s a little tutorial for those interested in more details about what I’m now facing.

And also as expected, my FOIA request(s) for information about the case turned up next to nothing, save one important exception.  Dr. Sylvestri responded to my initial complaint – just not to me – stating he saw nothing wrong.  I bet he doesn’t see much wrong with the gaps in VA healthcare that stole a year from my life (so far) and nobody seems to want to talk about, either.  They hurt me.  Bad.  Over a long period of time, and it’s not over yet.

Early on in this fiasco, my general perception of the way I was being treated suggested to my paranoid intuition, that I was being deliberately deceived.  It was just too blatantly unbelievable.  Turns out they are simply oblivious – right up and down the chain, including everyone in between.  Professional healthcare providers – oblivious to the suffering of one of their patients.  Now I’m not sure which is worse.  Maybe employee apathy isn’t real high on the radar.

I bet there are vets like me out there who might have given up.  I’m suicidal, for chrissakes!  Now I get it – the “VA thing,” that is.  So they do studies to try and figure it out, then give you a phone number to call.  Brilliant.  It’s not working.  My only question to the VA overlords might be:  Why was someone like me sitting here on a badly torn L4-5 annulus writing blog posts about it all year instead of going to the head of the line for whatever they needed the minute something like this crops up?  A satisfactory answer to that would be worth quite a bit to the next collateral damage victim.

The answer is right here, and I figured it out back in September.  Some things you can’t put a price on.   Epilogue coming in Chapter X – Formal Feedback – written down the way I used to give it face-to-face in the Air Force.  It’s not going to be pretty, but pretty much exactly how it appears in some of the AF records “I” wrote.

Dr. Donner will get to the bottom of my back injury in 8 days.  Latest from the Symptoms Log:

7 NOV 2019: Here’s the list:
Morning acute pain from swollen L4-5
Insomnia (from above)
Aberrant nerve signaling (muscle twitching, mostly right glute)
Muscle tightening/clenching when standing or walking (Glutes, erectors and right thigh) – with associated acute muscle pain if pushed more than around 10-20 minutes, depending on what I am doing
Muscle knotting in both glutes, right erectors and right shouler/back
Limp to the right
Ilial flaring badly/acutely
Entire right side of body lit up with the tension thing (I can actually feel in the right side of my head)

BP steadily on the rise for the past couple months – presently clocking around 150/90, but I think my own general anxiety level might be contributing to that. I have to remember to try it right after I wake up to go to bed one of these days.

It’s interesting to note how apologetic Rebecca was when telling me I’d be waiting a whole 2 weeks to get in for this.  The Aurora VA Neurology queue was 2 months, last I heard.

The weed horse has alot of life left in it. So I’ll keep aggressively beating it.  It’s not going away, and it certainly won’t die.  How do you un-beat the near-dead horse Christianity and Capitalism tried to kill?

I just realized personal corroboration for the NORML post linked above.  All through this back injury nonsense I’ve been confronted with doctors over and over again who didn’t seem to think there was anything wrong with me.  I wonder why…

There is no question Cannabis effectively calms the muscle spasms invoked by this particular back injury.  My entire midsection, down the right leg and up into the right shoulder were literally locked with muscle clenching throughout January and February this year, immediately following the left hip surgery.  At the time, it was just a bad reaction to the surgery.  Took 6 months of hacking through the thickest jungle of VA bullshit I’ve ever experienced to clear up that little misunderstanding.

It’s still terrible – I’m just growing accustomed to it.  Still rolling big knots out of my buttocks and back every night.  Still slightly limping to the right – with a fresh hip replacement on the left.  Go figure.  Like I told Chris the other day, I don’t care about the pain.  That’s no picnic either.  All I really want is to just be able to walk again.

Then that article popped up in my news feed this morning and I had an epiphany.  I remembered sitting in Annie’s office being interviewed at the Loveland VA a couple weeks ago.  It drew out late into the afternoon, and I was sitting there literally twitching from time-to-time because I hadn’t had any medication all day.  No – not the meth-head tweaker-type drug-withdrawal twitch.  It’s a unique little doodad this thing does when the glute receives some aberrant, momentary little jolt from the festering nerves in there that just sorta radiates out into the leg and up the back.  Left un-treated, it continues spreading further, more intensely, eventually clamping down and not releasing any time I’m on my feet.  It’s the body’s natural radiculopathy reaction to nerve root damage.  I wonder if Annie noticed me starting to do that, at the worst I’ve been in probably the last 2 months, or since my last T-break.  I’m pretty sure MJ is the biggest thing keeping me going right now.

But what about every other prior doctor visit so far this year?  They saw a healthy-looking 60-YO without a cane (most times) appearing to walk normally, good vitals – WTF?!  It’s easy to see how George was fooled.  I showed up at the first followup 2 weeks after surgery, off the hydrocodone already, rarin’ to go.  But I never recovered.  How much you wanna bet the Cannabis has been masking my symptoms all year long – enough to the point where doctors were slotting me into their personal whiny hypochondriac category right off the bat?

Just a theory.  But if that’s the answer to my VA problem, it’s still the wrong answer.  I’ve been telling them about it for years, turning down the pharmaceuticals.  KInda hard to get with the program when people can’t agree on how to conduct what program.

I was hoping to get this done in 10 installments.  After meeting with the folks at the Colorado Spine Institute today, that is finally starting to look like a real possibility.  Yesterday was also a stroke on the plus side for a change, when as expected, the EMG test turned up negative.  That’s a GOOD thing – still no nerve damage – or so they say.

CSI looks like the real deal.  I don’t doubt the last 2 spine guys are knowledgeable professionals.  But they aren’t good doctors, in my estimation.  The 1st guy had a canned spiel ready for me, and when specifically questioned about my 1 specific complaint, both of us gazing at the MRI display, his response was “what, that little thing – that’s nothing.”  The 2nd guy just flatly refused to do what I knew then needs done.  And just for the record, Dr. Knight with the rehab gang in the Aurora VA also flatly refused.  I haven’t even met Dr. Donner yet, but his PA, Chris took the time to ask all the right, carefully reasoned diagnostic questions, AND explain in detail the complicated mess of potential implications and outcomes.

So I’ll undergo a CT Discogram soon as we can get it scheduled, and see what happens.  Best guess prognosis at this time seems to lead to a fusion procedure.  Or it could be nothing, maybe something in-between.  I’m not exactly looking forward to another surgery, but I can’t go on like this.

 

There’s a couple of things about my current healthcare misadventure really bothering me.  One I understand, the other I do not.  I understand how the healthcare system is not set up to care for patients like me.  It is dealing with a big population of crybabies who cannot stop complaining after they stub their toe.  No biggie.  I get that.  What I do not understand is how torture became an acceptable course of diagnostics.

I’ve been left to rot, suffering with a painful, debilitating, un-treated back injury all year – forced through hip replacement rehab, where the biggest obstacle was not a freshly installed prosthesis.  Let them go until something happens or they scream loud enough to get someone’s attention?  Has it really gotten that bad?  Have the diags ballooned to such expense doctors are being discouraged from ordering them?  Must be, because I have this uncanny ability to know when I am hurt.  It’s called being a conscious human being.  That part is getting real old.

These things typically take a long time to heal – if they do at all.  The bad ones don’t.  This is a bad one.  Read the goddamn MRI report.  Still no medical attention as called out in said report, 9 months on – after seeing what, 7 doctors now?  I’m losing count.  Oh wait – not entirely true – I got a bottle of muscle relaxant pills from my new PC.  They do help a little.  But they are TOXIC, like most pharmaceuticals, and are only to be used for a max of 3 weeks.  It’s something, I suppose.

Read the goddamn Annular Tear lesson.  Dr. Mork is telling my story better than I can.  So, without enough time to read and just do your fucking jobs, the un-written policy appears to be, at least in part:  “Ensure diagnostic torture protocol and procedures are strictly adhered to whenever it starts looking like we screwed up.”

(Late Update:  as expected, after the new referral from last week didn’t show up, a call to the Loveland community desk or whatever they are calling it this year, found it in “status unknown” state.  I repeated all my information to the nice lady for the eleventy-seventh time while she set the wheels in motion.  Again.  And again, and again…)

Thinking back from the start of this fiasco, it all makes sense now – particularly the part where they start withholding pain med to help gauge your take-home prescription.  That is permanently seared into my memory.

It’s so easy to slip through the cracks.  I feel like I’ve been fighting a losing battle against the system all year and gotten to the point where just struggling through daily life and trying to deal with this at the same time has left  me so physically and mentally exhausted I’m ready to throw in the towel.  After seeing the KMS gatekeeper Dr. Knight Tuesday, we’ll do the EMG test, and see what they say about that.  I imagine it will be either inconclusive, or find some unrelated issue I don’t care about, like the carpal tunnel last time.  Guess what she said when I told her my pain was getting worse and definitely not chronic but acute?  “So this has been going on since January, huh – looks like it’s chronic now.”

Fortunately, the first real ray of hope since July came Thursday with Dr Thieman, my new PC out of Loveland.  I’m not a religious person, but by some miracle apparently, he was familiar with something at least similar to my issue and and is sending me to see a spine guy who might recognize it as well.

After the MRI finding was made back in June, I’d have let Brinkis get away with blaming it on me!  All he had to say was something like “…occasionally we see this in older patients with weakening structures due to disc degeneration, etc.  It’s not too serious, just takes a long time to heal, so now we need to…”  And that would have been the end of it.  This is starting to feel like an “innocent until proven guilty” proposition where nobody even wants to look at the evidence.  They are maintaining my toxic annular tear innocence at all cost.  Too bad I’m the one paying the bill.

Yeah, I definitely got crushed.  I’ll be going for a 3rd with my new PC next Thursday.