Medical Overkill?

So a fine flare-up of a chronic bellyache sends me to the Mayo’s ER with chest pains. Six hours of idling around that place in some discomfort yields the discovery that I have not ever had and am not now having a heart attack. The ER doc diagnoses GERD and a probable ulcer, and urges me to make an appointment with a regular doctor.

Now, the problem is, the part of the Mayo that houses its doctors’ offices is halfway to Payson from my house: twenty miles one-way, an hour’s drive through thick traffic.

Anyway, concerned about the possibility of an ulcer, I present myself to yet another new-to-me doctor (you never see the same doctor twice out there). She decides that I need an endoscopy with biopsies for H. pylori and cancer. This unpleasant test entails knocking you out, stuffing a tube down your throat, and cutting a sample out of your stomach lining.  Obviously, since they drug you into oblivion, you can’t drive home.

So I start searching for someone to drive me out there. La Maya is in full crisis mode just now. KJG lives halfway to Yuma on the other side of the valley; asking her to drive to the Mayo would be like asking her to drive to Albuquerque. My son has a difficult time getting off work; besides, I’d just as soon he doesn’t find out about this until I learn what the hell we’re talking about. I call the church and at first am rebuffed, but then reach the head of the health-care ministry, who launches into a full-bore search for someone to make the 40-mile drive with me.

Time passes. Eventually, I calm down enough to think this through.

Item: The Mayo does not take Medicare assignment. This means that Medicare and Medigap will only reimburse—me, not the clinic—for the amounts they unilaterally decide services and procedures are worth. The Mayo will send the bills to Medicare but will not accept reimbursement. This means you have to pay the up front and then collect whatever Medicare and a Medigap insurer will disburse, which comes in little dribs and drabs of $30 or $40 over a period of several weeks, always long after the bill is due.

I figure an endoscopy and two biopsies are going to be bloody expensive. I also despair of finding someone to drive me out there, and I sure as hell can’t afford a taxi, which at best, with the senior citizen discount, would run over $80. A Mayo phone lady seriously suggests I rent a room at the Marriott next to the hospital, for a mere $100 a night, two-night minimum.

So it now occurs to me that really, if I need this procedure, there’s no reason to have it done at the Mayo. Why not find a provider who will accept Medicare assignment and then just have them send the results over to my doctors? Besides, wouldn’t it be better to have a doctor close to hand who can see me for routine issues, rather than having to drive all the way out to Taliesin West for every sniffle and bellyache?

At Angie’s List I find one, count it one, medical practice that’s universally lauded and is not in Scottsdale or way over on the far west side. Make an appointment. Get in forthwith to see a brand-new young doctor. He’s a DO, not an MD, but the old guys who do have MDs aren’t taking new patients, and since he’s the new kid in the practice I figure he’s probably consulting with the bosses, at least until they’re sure he’s not going to kill anyone.

Young Dr. Kildare, as it develops, is an absolute charmer about my son’s age. We discuss my various complaints.

He expresses surprise that the Mayo doc even brought up the prospect of cancer with me, much less went into detail about staging, surgery, and chemotherapy. Gastric cancer, he says, manifests several other symptoms that I don’t have, such as swollen lymph  nodes, bleeding, and weight loss. He says he’s certain that it’s GERD, about which he knows quite a lot because he suffers with it, too. It is possible, he thinks, that an ulcer is forming and suggests doubling up on the omeprazole, which he says needs to be used for three or four months to get the situation fully under control. At this time, he says, an endoscopy is unnecessary. Instead, he thinks it would be better to continue the drug treatment for a few weeks, especially since the ailment is starting to settle down. If, however, break-through symptoms persist, he will want to do an upper GI series or an endoscopy. But not now. Come back in six weeks.

Meanwhile, he suggests I stay off the sauce, refrain from eating large meals, never eat late in the evening, lose weight, and get some exercise.

Huh. Whaddaya make of that?

Sure sounds like I was about to be subjected to some serious medical overkill, doesn’t it? Anyway, the tests are off until we find out whether the omeprazole (which is generic Prilosec) kicks in and and gets this thing under control. There may yet be a tube down the throat in the future, but at least now I should be able to keep the cost of it under control.

And so to the pool, for some of the prescribed exercise…

Image: Flexible endoscope. de:Benutzer:Kalumet. Creative Commons Attribution-Share Alike 3.0 Unported license.

Who was young Dr. Kildare?

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E. Murphy August 10, 2012 at 7:16 am

I don’t mean to be impertinent, but regarding not sharing your medical problems with your son until you are sure of a diagnosis……..I really hate how we women are willing to burden the WOMEN in our lives with our problems but hate burdening the MEN. We protect and coddle men. Women, we lean on.

I’m sorry, Funny, just an observation I notice among women.

funny August 10, 2012 at 7:20 am

@ E. Murphy: That’s because women do not little-woman other women, in general.

I felt I had enough grief without having to convince a man that enough was wrong with me to merit this much hassle, which, as you may know, can be quite a trick. The person who was being protected was moi.

Let me qualify that: Like many men, M’hijito assumes, simply by virtue of my being an older woman, that I exaggerate and dramatize things. It’s part of our culture and there’s not much we can do about it. For that reason, I try to keep quiet about issues like this one until I know for sure there’s something serious enough to discuss.

vinny August 10, 2012 at 7:41 am

Years ago, in my late teens, I had three months taken out of my life due to a severe peptic ulcer. I got the usual treatment regimen: bland diet, antacids, stress avoidance. I couldn’t understand where it came from – before that, and ever since, I had a stainless-steel stomach that could take any amount of abuse.

The pain during an attack was indescribable – like a gunshot wound combined with impaling with a dirty fencepost. The condition cleared up one day and never came back. Kind of like a bad strep throat.

Fast-forward to 2005, when Barry Marshall and Robin Warren get the Nobel prize in medicine for determining that h. pylori was responsible for ulcers all along; an intense round of antibiotics cures it.

So my money’s on h. pylori and good on you for dodging Big Medicine. And good on the state of AZ for allowing someone other than an MD to make a diagnosis (not an option in Canuckistan, not yet.)

funny August 10, 2012 at 8:06 am

@ Vinny: I’m glad you were able to throw that off — probably because you were young at the time. It is excruciating enough that many sufferers think they’re having a heart attack, a credible enough conclusion to get some serious attention at an ER, especially since that much pain shoots your blood pressure into the stratosphere.

It’s important to bear in mind that a DO is an MD light, and that the theory underlying osteopathy is rampant woo-woo. However, in recent years DOs have been receiving training very similar to what you get in an MD program. They often do internships and residencies in allopathic hospitals under the guidance of MDs, and so they’re closer to medical doctors than they used to be. I know one very bright young man who got a DO because he couldn’t get into any medical schools. On the one hand, that should tell you something; on the other, Young Dr. Kildare remarked that he’d done his residency at St. Joseph’s, a highly respected regional medical center.

Money Beagle August 10, 2012 at 9:15 am

Good to hear that you put some thought into it and sounds like you got lucky with getting a doctor with some common sense and experience in these matters. I hope he made the correct diagnosis and that you start feeling better soon.

frugalscholar August 10, 2012 at 10:03 am

This is a typical medical care in the USA story. Very depressing. I wonder if your young DO will eventually take the route of most doctors: recommend procedures and tests that help the bottom line of the practice.

Glad to hear you had a good experience w/ the DO. My son saw one for a skin condition–she refused to prescribe what he needed (something prescribed by another doctor in his college town). Now I’m thinking that perhaps she was not allowed to prescribe it since she was not an MD.

I received a letter a few days later saying she was no longer affiliated with Blue Cross–so maybe she was just a dud.

Karen August 10, 2012 at 3:28 pm

DOs have the same prescribing rights as MDs. They have to pass the same exams.

funny August 10, 2012 at 10:24 am

@ frugalscholar: That’s annoying.

I hope this young doc will be OK, too. That he’s practicing with MDs, I think, is a positive sign.

One DO I saw some time ago advised me to use homeopathic nostrums for a medical issue, which simply astounded me. She seemed intelligent enough, but…that is pure woo-woo. She and her partner also proposed to put me permanently on estrogen for mild osteopenia; when I refused that, referring them to research on the long-term effects of estrogen therapy on post-menopausal women and the controversies about whether osteopenia should even be “treated” at all, they tried to get me to take bisphosphonates (a.k.a. “Drano in a pill”). Her partner tried to scare me into taking the stuff; I went back to the Mayo.

Some doctors will not do business with insurance companies that demand that practices keep their rates low. Blue Cross, I think, is one of these. Some other insurers have a reputation for slow payments and endless hassles (don’t know if BCBS falls into that category), and so doctors avoid them, too.

Karen August 10, 2012 at 3:25 pm

I’m glad you found a doctor who’s willing to work with you. I know I keep pushing this book on you, but if you’d read the book, you’d’ve been able to avoid a lot of the medical angst. (No Guts, No Glory.)

The thing I like most about this book is that his goal is to get you off meds entirely. Omeprazole is only a short-term solution, but it’s prescribed like a long-term one.

funny August 10, 2012 at 4:55 pm

Thanks, Karen. I’ve been a bit too preoccupied to track down the book but will take a look at it. :-)

Crystal @ Broke-Ass Mommy August 12, 2012 at 7:57 pm

I am so glad you received a second opinion! I am personally very fond of doctors that check out realistic alternatives before jumping right to traumatizing tests. I really wish my own doctor wasn’t already in his 60s since it means he will definitely be retired when my body starts revolting against me…

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