Archive for the 'healthcare' Category

11
May
13

A little bit more every day

Things are coming along.  To compare:

Four weeks post-op:

Quadriceps tendon ripped bending knee

Seven weeks post-op:

Knee injury quadriceps tendon rupture

Today, just shy of 10 weeks post-op

Knee flex post-op 10 weeks

Of all the things I’ve had to do to get this knee to flex again, this has to be the most difficult:

Knee flex rope pull

It’s part of about 90 minutes in what the physios at rehab call the torture chamber.  When you arrive you’re given a set of exercises that target your problem.  I’ve got about 10 different things to do in order to build up my quadriceps muscles and flex the knee, and could go into detail about each one, but that photo is all you need.  It’s the worst.

The rope is appropriate, because it’s like self-flagellation.  I flex it as far as the muscles will take it, then start pulling slowly on the rope until it hurts.  Then I pull just a little bit more and hold it for 30 seconds.  After about 15 seconds, you start to go a little numb in the head, but wake up again when it’s time to release it.  Then the pain comes back double as you slowly let the foot down to the floor.  Repeat six times, once a day.

Good news!  I get to keep doing this.  My rehab is going to be extended one week, after which I will have the opportunity to drop by the centre for a workout as often as I like.  Physio should also continue twice a week after rehab finishes May 21st.

25
Apr
13

Notes after two days of rehab

There’s a theory about the news business that says they publish stories of disasters in far-off countries to help remind their audience that no matter how bad things get at home, it’s a lot worse elsewhere.

I don’t know how much truth is in that, but I was reminded of it on day two of rehab.  As much of a disruption to my life this injury has been and will continue to be for months to come, it’s a chin scrape compared to the situation of three men I’ve seen in the changing room, therapy pool, leg workout, and stretching classes.

One of them is an older fellow who looks like he’s worked outdoors his whole life.  He has a vertical scar running from way above to way below each knee, and he walks so slowly… I haven’t found out whether he’s got artificial knees, but maybe we’ll get to talking tomorrow.

Another fellow looks completely normal until he’s in the change room, where you see a long, curving scar running from his hip to his knee.  He had a rare form of bone cancer and they’ve installed an artificial femur.  Though he had to stay six months without moving in hospital – I was climbing the walls after six days – he says he’s lucky: the medical technology used to give him the new femur is so new, had he been diagnosed with the disease only three years previously, they would have had to amputate the whole leg. 

The third guy makes me weep just to think about.  He is tall and good-looking, but looks like he’s been in a serious car or motorbike accident.  He has absolutely no use of one arm, which dangles bone-thin, limp and lifeless at his side.  His hip and leg on the same side are very deeply gashed, and he walks very awkwardly.  I haven’t talked to him, am kind of waiting for the right moment to engage him in conversation, so for the moment I remain in respectful awe at his guts and determination as he works his way through the workout routines.

I am so very humbled by what I’ve seen over the past two days.  Though I see it only from a distance, I have a new-found perspective on what it means to be profoundly injured, and the strength these people have to work on overcoming it.

I’m also gaining even more respect for the people who go to work every day determined to help people in such bad shape get well enough so that they can lead a reasonably normal life again.  They see them arrive and leave again a few weeks or months later, like a carousel of pain.  There must be deep satisfaction in knowing their work is vital to the people they treat, but the energy, enthusiasm and often humour with which they approach their work must come from some profound place only they know where to draw from.  I know I wouldn’t last a week in their position.

In the weeks since I’ve been getting around the city for better or worse, I’ve also been on the receiving end of countless acts of kindness from people whose names I’ll never know.  From the man who went all the way back down a spiral staircase to hold the door open for me to make sure I left the doctor’s office in one piece, to the men and women, young and old who without fail will see me with a crutch and stand up and offer me a seat on the bus, to the random people on the street who catch my eye and with a little smile wordlessly tell me: hey, I’ve been there, too – I can only say: thank you, Hamburg.

And there is progress.  One month after the operation, I could only bend it a little:

Quadriceps tendon ripped bending knee

Three weeks later after 12 days of physio and two days of rehab, still a ways to go, but it’s coming along:

Knee injury quadriceps tendon rupture

 

17
Apr
13

Hooray-hooray, it’s not yet May, but rehab starts a week today

I’d love to do a leaping dance, but under the circumstances, maybe not.

Only a few days after receiving word that my medical rehab has been approved by the Berlin powers-that-be I get a call from the clinic saying my three-week program starts April 24.  Yipppeeee!  🙂  I had been counting on it starting only sometime after the first weekend in May.  The clinic here in Hamburg has a great reputation and has just re-opened in brand-new facilities.

It’s just in time.

I’ve ditched the brace that had been clasped to the leg from ankle to hip for six weeks to keep the knee stable after the operation, but there’s still so little movement in the knee, I get worried that it’ll never be the same again.  It’s hard to see over the lip of the hill when you’re standing at the base.

I now get around mostly without crutches with a tension bandage around the knee, but it’s a hop-along scene.  This is what it looked like four days ago when I made the switch:

A friend congratulated me on the quick approval for rehab, saying all the pain they’ll be putting me through to stretch out the tendon again will be worth it.

I can’t wait…

19
Mar
13

jumping through hoops to get rehab

You never really learn how things really operate until you have to deal with them yourself.

All I want is some decent rehab programme, something to make sure I can walk again without a limp after ripping the body’s largest tendon and rendering my right leg useless for the time being.

Ian half-way home to HamburgMy regular doctor was telling me enthusiastically last week about a clinic where I could get a full morning programme of daily physio once the 6-week no-touch rule is over and I can finally take off this dead-weight brace it’s been so fun to drag around.

But when I went Monday to the specialist surgeon to whom he’d referred me to have the stitches removed and we later talked about physio, all he was able to offer me was a referral for two half-hour sessions a week.  The absolute bare-bones minimum available.  In Germany’s two-class healthcare system, if you’re a private patient you get silver service, no questions asked.  If you’re on statutory cover – in German gesetzlich – well, take a number, eh?  Nothing new there.

So this morning I went back to my regular doctor and told him of the enormous gap between what he was talking about and what the specialist gave me.

“Hmmmm…. let me do some quick phoning around and I’ll call you back in later,” he said.

Twenty minutes later he tells me the deal: in order to get rehab, I have to go first apply for it through the bureau that deals with pension issues.   Pension?  That’s the rapidly dwindling sum I’ll get when I retire, isn’t it?  I thought this was medical.

“It is,” he explained, “but your healthcare provider is responsible for your time off work.  They pay for that.  Your rehab is paid for by the pension people.”

The things you learn.

So he gives me a referral for a rehab clinic, reminding that I’ll first have to call the Hamburg pension administration bureau, who will set the ball in motion.

Knowing that sounded just a little to easy for words, I ask for and receive a direct number to call, some tips on what to say, and a merry send-off home.

The number they gave me was not in service.

Digging the right number out of the Internet, I wait on hold for the usual 10 minutes before speaking with a woman who informs me that my pension is administered not in Hamburg, but by the federal office in Berlin.  When I ask for the number in Berlin, thinking this is probably a routine thing,  I get an answer as cold as this late winter and probably as much as I should have expected: you can go find it yourself.

So I dig out the number soon enough and call the Federal Pensions Office and jump through the usual number-choice hoops before speaking with a woman who guides me through pages and sub-pages to the right forms to download and fill out.

There are seven separate forms totalling 17 pages.   Many repeat the same questions in a different way.  Some don’t apply to me, but I have to check a box anyway.  One ominous one involved giving my bank account details to permit them to extract any fees I might have.  No mention of what these fees might be for, or how much they are.

I don’t know why it has to be this complicated, but I suspect they do it this way to turn off those people who are intimidated by officialdom.  There must be a percentage out there who give up before even trying.

After filling all the forms that pertain to me, I have to take the bundle to my doctor to fill out stuff that pertains to them, then take that bundle to my healthcare provider who will fill out more little boxes, then I get to go to the post office and send the bundle off to Berlin.

Right now I wouldn’t be surprised if it takes so long to get approval, I’ll have long since passed the point at which rehab will do any good.

09
Mar
11

A couple of reasons why German healthcare is in such a mess

From some of the highest drug prices in Europe to bloated bureaucracies, there must be a dozen reasons why healthcare in Germany is an expensive mess – about 8% of gross wages for those on the public plan, and rising.

trust me i'm a doctor buttonA few years ago, during what turned out to be the longest stretch I’ve ever had to endure in a hospital, I got a good look at two of those reasons.

It started out as a routine blood test at my family doctor.

“This doesn’t look good” he says when showing me the results.  “You’ve got to see a specialist about this as soon as possible.”

So I get an appointment at a specialist who performs an ultrasound, along with another blood test.   When the tests come back he hums and haws, says it could be this or that, but to find out for sure, we have to take a tissue sample.  Jab a hollow tube through my liver and rummage through what they pull out.

“Just a couple of nights in the hospital,” he tells me.

I get sent to a third doctor, the one who’s going to be taking care of the hospital visit, who performs the third blood test in about three weeks, which comes back with the very same results.

Upon admission to hospital a couple of weeks later, they take another two blood tests, one on admission, another the next day.

“Look,” I tell them.  “I don’t understand.  I’ve got an arm like a junkie’s with all these needles.  Why do I have to get a new blood test every time I’m sent to a new doctor?”

“Because that’s the way we do it here,” they tell me. “You may be referred to another doctor, but they have to take a new test each time.  They can’t take the results of the former doctor at face value.”

I wondered how many billions each year are wasted that way, but it was the hospital visit itself that really opened my eyes to the way the system is set up to rip us all off.

Not only did they only perform the tissue sample the morning of my third day after admission, already forcing me to stay one more night than I’d planned for, but they also arranged to have me undergo a colonoscopy a few days later, because the tissue sample showed nothing abnormal, and they wanted to “make sure we aren’t missing anything.”

That was on a Friday, and they told me I’d have to spend the entire weekend in the hospital waiting for the colonoscopy to get underway the following Tuesday.

What?  Wait f0ur full days in hospital when I feel perfectly healthy just to prepare for another procedure that might not even be necessary?

“Screw you,” I told them.  “I am not spending five minutes in this dump more than I have to.”

Dump?  More like an asylum.  My time until then had been spent enduring the ravings of an attention-starved recovering alcoholic in the bed beside me, who, completely oblivious to the impact his constant ramblings and interruptions had on the rest of us, actually woke me up the night before the tissue sample, because he couldn’t sleep and so was watching his personal TV at 3 in the morning.  Mostly to get away from him, I packed up and left that Friday afternoon, signing a waiver on my way out saying that whatever happened to me that weekend was my own doing.

After a beautiful weekend hiking the storm-swept mid-winter beaches of St-Peter-Ording with K and the little red-haired girl, I showed up Monday morning at the hospital, spent a day drinking gallons of some vile solution turning my backside into a storm drain, submitted myself to an invasion by a 12-foot black plastic snake, and spent a day and a half recovering.  The only thing I was grateful for was their generous application of Demerol.  I liked it so much, I’d have let them do it again just to get more of the stuff.

I told my family doctor all this and he replied with what I’d been thinking all along.  “I’m really sorry you had to go through all that, but hospitals do that all the time..  Every night you stay there is worth a lot of money to them.  They maximise the time you have to stay so they can turn around and bill the health funds.  There’s really nobody checking to see if what they do is really necessary.”

To top it all off, I received a bill from the hospital for the daily user fee we all have to pay.  They completely disregarded the two nights over the weekend I had left the hospital, billing me for the full nine days.

I paid for seven with a note and a letter explaining why, with proof I wasn’t there and all the rest, but the bureaucrats ignored it.  Instead I received a nasty notice threatening me with legal action and all associated additional costs if I didn’t buck up for the two days I did not stay in their comfortable surroundings.

So I paid for those two days just to get them out of my hair, only to find out a few weeks later from my healthcare people that I shouldn’t have, and that I could get the money back if I applied for it.

But by then I was so glad to have the whole sorry mess behind me I didn’t bother.

17
Jan
08

German efficiency costs 10 euros

Goal: reduce unnecessary medical consultations and lower health care costs.

Method: make every patient pay €10 the first time he visits the doctor every quarter.

Result: chaos.

I’m not dying or anything. In fact, based on how often I have called in sick in nearly eight years at my full-time job – that would be twice – I am pretty damn healthy, touch wood.

But over the past six months I have had to see not one but two specialists for completely unrelated and – let me stress this, Mom – non-life-threatening conditions.

Last fall, one of the specialists referred me to a third specialist, and because this new guy is really booked out, I couldn’t get an appointment to see him until next month.

So this is where German efficiency kicks in. I’ll try to keep it simple.

Unless you’re insured under a private scheme and therefore get your ass kissed by everyone the royal treatment, you have to pay €10 the first time you visit your doctor in any quarter. You receive a little receipt with a stamp on it from the doctor to show on arrival at any further medical treatment during that quarter.

Too bad if one appointment is at the end of March, the follow-up the beginning of April. Ten bucks each time.

If you need to see a specialist, your family doctor will write you a referral. So last autumn I took a referral to see one of the specialists, who did some tests, the results of which made him write out another referral to the third specialist.

I phoned the third specialist, but because I couldn’t get an appointment until February, and thus in the new quarter, I had to go back to my doctor to get a new referral. Apparently they die, like mayflies. So I went back to my doctor today to get a new referral. They gave me one, but then they asked me for €10.

Damn. Even though I’d already paid €10 at another specialist’s office this month, and so covered myself for this quarter, I’d left the receipt at home.

No problem, they said. We’ll issue you a bill for €10, and if you come in any time over the next two weeks with the proof you’ve paid the €10, it will be waived. Otherwise you’ll have to pay us €10.

Not wanting to forget the matter, I pedaled home and came back with the receipt within the hour.

Oh.

Sorry, they tell me. We know this says you paid your €10, and we believe you actually did, but because you also need to give us a referral from the doctor to whom you gave the €10, we can’t accept it.

But he’s an ambislambic bardgimologist specializing in midgemriolic gambiderpodery, I tell them, and has nothing to do with this other problem.

Sorry, we need a referral.

So I take the receipt and, since they’re within a few blocks of one other, pedal over to my family doctor and tell the nurses there the whole story. They issue me a referral.

As I was riding back to the specialist I thought, good thing I’m healthy and can take my bike all over the place to do this shit. What if I were really sick, or old, in a wheelchair, or God forbid forced to jump through hoops behind the wheel of a car? I’d probably just drop 10 bucks whenever anyone asked for it just to avoid the hassle.

The receptionist at the specialist’s office looked at the referral, ripped up the bill, and said it’s all taken care of.

Though I know she was just following procedure, I felt like saying thank you and have a nice fucking day.

© 2008 lettershometoyou




The banner photograph shows the town of Britannia Beach, BC, Canada, where I grew up. It's home. But I don't live there anymore.

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