Dollars & Docs

Today have to decide whether to cancel the stress test the Mayo has set up for me on Thursday, and by extension the endoscopy they want to subject me to next Wednesday. It’s a dollar decision as well as a matter of interminable distance (the Mayo Clinic is 20 miles from my house) and suspicion that I’m about to be overtested and that there are less invasive ways to diagnose the present complaint than by sticking a tube down my throat and cutting chunks out of my stomach.

I’ve made an appointment with a doc in nearby Sunnyslope, in a practice that’s part of John C. Lincoln Hospital. He will take Medicare assignment, which means just about anything he chooses to do to me will be almost free. The Mayo does not, and so I’ll be paying through the wazoo for the nasty test they want to subject me to as well as for the stress test, which they demand that I take first. So that’s issue #1.

Issue #2 is that I’m just getting over another bout of plantar fascitis, which hurts like hell. I’ve barely been able to limp around the house. This particular recurring annoyance is something that takes about 8 to 10 weeks to get over, and after two months of pain it’s finally beginning to fade. Another two weeks without excessive irritation, and it should be healed up. However, it still hurts to walk, and I can’t even imagine how I’m supposed to RUN on an inclined conveyer belt.

Assuming I can do it, a) the pain will shoot my blood pressure even higher than it already is and b) you can be sure trying to run uphill with a wrenched Achilles tendon and a screaming painful heel is going to set me back several weeks in the healing process. As soon as the weather cools enough, I want to start walking again, but with this kind of pain that’s out of the question. I really don’t want to aggravate it.

So my sense is that I should cancel these tests and, if they’re to be done, have them done at Lincoln where I won’t have to face yet another financial disaster. This summer has been hellish enough in the dollar department.

There’s about a 4% chance that what ails me is a gastric cancer. On the one hand, I suppose one would like to ascertain, one way or the other, whether that’s the issue. On the other, by the time a gastric cancer is symptomatic, it’s too late—if that’s what the problem is, I’ve got about 6 months of not very good life left, and one way or another, it doesn’t much matter what is done about it. So I suppose a delay of a few days, by way of preserving capital, won’t make much difference one way or the other.

The ER staff did an abdominal ultrasound and could not see any masses. Over at the clinic, the young Mayo doc says that gastric cancer spreads to the liver first, once it metastasizes, and they couldn’t see anything in the liver, the kidneys, or the gall bladder, all of which they were especially interested in. She takes that as a good sign. And I take it as another good sign that the pain is finally gone and I’m now only mildly bilious and even that, only occasionally—rather than sick as the proverbial dog.

A 4% chance that it’s cancer means there’s a 96% chance that it’s not. The two issues working against those odds are the plexiform neuroma, which ups your chances of cancer and which causes a type of gastro-intestinal cancer that’s virtually impossible to treat, and the fact that gastric cancers have a genetic component and my mother apparently died of one. Apparently. That’s one man’s opinion: my beloved, now semiretired old doctor’s speculation made long after she was reduced to an urnful of ashes. She never saw a decent doctor and so we don’t know what specific cancer she actually had. But…it’s there, as a possibility.

At any rate, I think if it were cancer it would not stop hurting, as it did abruptly yesterday morning. And if it were cancer, there would be signs of internal bleeding, which so far is not the case. Since this is the second episode I’ve had in the past year, by now surely it would have metastisized and would probably be shedding blood. So I think it’s safe enough to delay the torture until I can get to another doctor whose ministrations aren’t going to break me up in business.

It’s frustrating. I’m nervous about John C. Lincoln, whose quality is no better than any of the other ordinary hospitals in the city. The only one that consistently scores well in clinical excellence and patient safety is the Mayo; there’s one in Scottsdale that does pretty well most years. The rest…well, we saw what happened to SDXB’s mother, who was rescued from a post-operative heart attack only because a cleaning lady happened to wander into her hospital room to pick up the trash and noticed that she was in distress. And what happened to mine, for that matter: a nonstop horror show. That’s pretty typical.

So it may be better to shell out the extra dollars to stay in the Mayo’s system. But I am running out of money, and with all the expenses, planned and unplanned, that have happened over the summer, the savings I’ve used to live on since Layoff Day will be exhausted by November 1.

I mean, really: if I have the new guy order the tests at Lincoln and I just MUST continue to traipse out to the Mayo to see whatever resident they happen to assign to me on any given day, I can have the results sent over to the Mayo and not have to pay extra for the privilege. If I like the new guy, I’ll just continue with him, and he’s right around the corner.

The two senior guys at the Lincoln practice say they specialize in gerontology, which would be nice assuming they don’t patronize. Depends on their personalities and whether they have any common sense, I guess. One of them has been practicing for 30 years, so he should be getting long enough in the tooth to realize old people are not children and not idiots. Well…most doctors think patients are idiots, and half the time they’re right about that. But one doesn’t need the preconceptions about age layered on top of it. The two senior guys are both MDs, but at this time they’re not taking new patients.

The new kid, whom I’m seeing and who just joined the practice, is a DO, which may or may not be a bad thing. One DO I visited was heavy into woo-woo—tried to get me on homeopathic nostrums. But recently I saw a dermatologist with a DO who seemed to have a scientific cast of mind. At least, he didn’t suggest treating plexiform neurofibromas with herbs and roots. Or bottles of water containing .001 to the –100th percent of some supposedly active ingredient. At any rate, the young fellow has two senior docs who apparently have a lot of experience, and one would expect they probably consult with each other on occasion. So…there’s hope for an actual doctor-patient relationship here.

Interestingly, yesterday’s abrupt improvement seems to be holding. This morning: no pain, no discomfort, no burping, and no general annoyance. To the contrary, I actually feel very good just this minute. I suspect that would not be the case if the past two or three weeks’ manifestations were cancer. So, the alarm bell is turned off, for the nonce.

Welp, the hour grows late. I’d better go swimming if I’m ever gonna get in the water before the blasting sun rises over the yardarm.