Weekly Wrap-Up (24-28 October)

In case you missed it (ICYMI), here’s a list of the links that appeared on One Sick Vet’s Facebook page this week:

Monday: New post

Sometimes the Stars Align – But You Still Have to Check Your Six

Tuesday: More problems at VA hospital in Chicago

http://www.foxnews.com/politics/2016/09/29/new-low-dead-veterans-left-in-va-hospital-morgue-for-weeks-without-burial.html

Wednesday: Wearable tech not shown to help people lose more weight than standard weight-loss techniques

https://www.ncbi.nlm.nih.gov/pubmed/27654602?dopt=Abstract

Thursday: Good news! Tricare has updated preventive screening standards to align with “the American Academy of Pediatrics’ standards for care of well children over age 6.” Tricare will now pay more (and military families pay less) for certain preventive care screenings

http://www.moaa.org/NewTRICARE/

Friday: Since the 2017 cost-of-living adjustment (COLA) is so small (.3%), some retirees may be on the hook for Medicare Part B premium increases

http://www.moaa.org/Content/Take-Action/Top-Issues/Retirees/Diet-COLA-May-Cause-Headache.aspx

Sometimes the Stars Align – But You Still Have to Check Your Six

Just a quick update to explain why it’s been so quiet on the blog this month.

I finally had the “do-over” for the surgical procedure that was cancelled when I had the allergic reaction to the antiseptic.

Because I had lost confidence in the VA hospital, I switched from handling this procedure through the VA to handling it through Tricare.

In an interesting twist of fate, my new doctor has the same rare allergy that I do, which meant I didn’t have to worry about accidental exposure to that substance in the operating room.  Bonus!

However, as it turns out, I still had to remain extremely vigilant.  Although my allergy is clearly marked in my records, few people seem to understand how this allergy translates to real life, which results in interactions such as these:

[Scene: Pre-Surgery area]

Nurse 1:  Hi, I’m Nurse NAME, and I’ll be going over your paperwork with you today.  How did you clean prior to surgery?

Me:  I took a shower last night and a shower this morning.

Nurse 1: With soap and water?

Me: Yes.

Nurse 1: Were you given the pre-surgery paperwork suggesting you cleanse with Hibicleans prior to surgery?

Me: Yes.

Nurse 1: And did you follow those procedures?

Me [mildly sarcastically]:  No.  I’m allergic to Chlorhexidine, so I thought that would be a bad idea.

Nurse 1: Oh.

[Note: This means that the military hospital gave me a standard pre-surgery paperwork package instructing me to clean myself at home with a substance to which I have a documented allergy.  There is apparently no control in the hospital procedures for this mistake.]

[Scene: Pre-Surgery area.  Later…]

Nurse 2 (LPN): Ok, I’m here to get you prepped for surgery.  Do you have any allergies?

Me: Yes, I’m allergic to Chlorhexidine.

Nurse 2: Ok, I see that in your chart.  I’ll write that on your wristband.  [Writes on wristband, and attaches it to my arm.]  Ok, now I’m going to insert your IV. [Opens IV kit.]

Me:  Are you going to use an alcohol wipe to clean the site?

Nurse 2: No, I’m going to use the wipes in the IV kit – Chloraprep wipes.

Me [Firmly]: No, you’re not.  I’m allergic to those.

Nurse 2: Really?

Me: Yes.  They contain Chlorhexidine.

Nurse 2: Oh. …  Ok, I guess I’ll go find some alcohol wipes.

[Note: This indicates that the hospital does not have special IV kits for individuals with Chlorhexidine allergies, which is somewhat understandable given that it is a rare allergy.  However, it also indicates that medical personnel are inadequately trained on Chlorhexidine allergies and required modifications to standard procedures.]

Bottom Line: Given the lack of awareness by medical personnel of Chlorhexidine allergy (an antiseptic widely and frequently used in the medical field) and its practical implications (changes to materials used in standard procedures), I am deeply grateful that my surgeon has the same rare allergy and could maintain a safe environment for me in the operating room.  I am particularly grateful for that given that (1) I had to be extremely vigilant to avoid exposure (and another allergic reaction and cancelled surgery) prior to surgery, and (2) I could not maintain vigilance in the OR since I was anesthetized.

If you have a similar rare medical allergy, please learn as much as you can about sources of exposure, and be very cautious to avoid exposure in medical environments.  Do not rely on medical personnel being informed and aware – they probably aren’t.

Note: Check Your Six is an aviation term meaning to watch for attacks from behind.  It more broadly means to be situationally aware and to maintain vigilance.

Weekly Wrap-Up (17-21 Oct)

In case you missed it (ICYMI), here’s a list of the links that appeared on One Sick Vet’s Facebook page this week:

Tuesday: New data may lead to better understanding of Crohn’s disease.

https://www.sciencedaily.com/releases/2016/09/160920151435.htm

Wednesday: When asked about incorrect data on VA hospital leadership replacement, VA Undersecretary for Health David Shulkin responded: “We tend to use lots of numbers and that can be confusing, and what I’m trying to do is simplify the message, so here’s my message: I need help,” Shulkin said. “I need the right leaders to come in and to take these positions of responsibility on behalf of the country, and I don’t care if it’s 90%, 80%, or 60%. I know I have openings and I don’t have the applicants.”

http://www.usatoday.com/story/news/politics/2016/10/18/veterans-affairs-managers-transfer-new-leadership-medical-centers/91965888/

Thursday: Article on living with depression. “For years I believed that I had to surmount my depression, to overcome it, to wrestle it into submission so that I could be normal. The diagnosis has allowed me to accept that “normal” may just mean being able to engage with my loved ones and my work. “Normal” means knowing I have a chronic illness and treating it so that I can do the things that make me content.”

http://www.elle.com/life-love/a39440/double-depression/?src=socialflowTW

Friday: Heads Up! Tricare approved pharmacies changing 1 Dec.

http://www.military.com/daily-news/2016/09/30/tricare-pharmacy-network-adds-walgreens-removes-cvs.html?ESRC=todayinmil.sm

Weekly Wrap-Up (10-15 October)

In case you missed it (ICYMI), here’s a list of the links that appeared on One Sick Vet’s Facebook page this week:

Monday: Dealing with Depression

“I’m writing this now to remind myself how wonderful it is to breathe and live and feel human, both because I need a reminder for next time depression lies to me and tells me it will never go away, and also because maybe you’re in the hole right now and need a reminder that it will get better.

It will.

And then maybe it will get bad again. The ups and downs are always there for those of us with forever broken brains. But that’s okay because you come back out. The good is worth battling through the bad. It’s so worth the meds and the therapy and the time and effort and the waiting.”

http://thebloggess.com/2016/10/10/up-and-down-and-up-again/

Tuesday: Traveling with Allergies or Asthma

http://www.michiganallergy.com/travelallergies.shtml

Wednesday: Onset Of Allergies Over Age 40
(Not as uncommon as you think)

http://www.michiganallergy.com/allergyonset40.shtml

Thursday: Relaxation Techniques

http://www.michiganallergy.com/relaxation.shtml

Friday: Article about Paralympian Sgt. Elizabeth Marks (USA)

“When I step onto the blocks, I never think, ‘I want to win,'” she says. “I think, ‘I want to pour all of myself into this race because there are people who can’t physically, mentally or emotionally, do that.’ So it’s my way of performing for them.”

http://www.espn.com/espnw/culture/feature/article/15702441/the-things-carries-story-paraswimmer-us-army-sergeant-elizabeth-marks

Weekly Wrap-Up (3-8 October)

In case you missed it (ICYMI), here’s a list of the links that appeared on One Sick Vet’s Facebook page this week:

Monday:  New Post

Medical Procedures: What It’s Like to Have an MRI (with contrast)

Tuesday: One survivor’s perspective on Breast Cancer Awareness Month

http://gettingthewordswrong.com/2015/10/why-october-is-hard/

Wednesday: A former NFL player created a specialty gym to train and rehabilitate disabled veterans.

Thursday: How the sugar industry manipulated scientific dietary research

” All in all, the corrupted researchers and skewed scientific literature successfully helped draw attention away from the health risks of sweets and shift the blame solely to fats—for nearly five decades. The low-fat, high-sugar diets that health experts subsequently encouraged are now seen as a main driver of the current obesity epidemic.”

http://arstechnica.com/science/2016/09/sugar-industry-bought-off-scientists-skewed-dietary-guidelines-for-decades/

Friday: Airplane Travel Tips for Allergy Patients

http://www.michiganallergy.com/airplane.shtml

Saturday: Humor

 

Medical Procedures: What It’s Like to Have an MRI (with contrast)

The first MRI (magnetic resonance imaging) I ever had was a cerebral MRI in a foreign country.  I hadn’t been in the country very long, and didn’t speak much of the language.  I also didn’t know much about the procedure.  All I knew is these people with whom I could barely communicate were going to look inside my head.

The MRI was state-of-the-art – a small, donut-shaped open MRI machine:

The nurse, however, was another story.  She had no bedside manner, or rather, her bedside manner was very stern and unyielding.

My referring physician had requested an MRI with contrast, which means “dye” was injected into my veins through an IV.  The dye helps the radiologist see certain areas more clearly.

After the nurse inserted the IV and began administering the contrast, I felt a burning sensation in the arm in which she had placed the IV.  I was concerned that I might be having an allergic reaction to the dye, because I had read that was possible.  I asked the nurse if the burning sensation was normal (I rather doubted that it was).  Once she understood my question (it took several attempts, due to the language barrier), her response was “That is not possible.”

It has been over 15 years since this experience, and I still remember it vividly.  I am in a hospital gown in a cold room in a foreign country, and I am having what seems to me to be an abnormal response to this medical procedure, and all the nurse will say is “That is not possible.”  I asked again.  Again she responded “That is not possible.”  I started to get excited:  “It must be possible, because it is currently happening TO ME!”  

I could not believe that I might die of a routine medical procedure because the nurse refused to acknowledge my reality.  I had driven myself to the procedure, and I wondered how long it would take before anyone figured out what had happened to me.

I continued to express to the nurse that I thought I might have a problem and I was not satisfied with her answer.  Finally she snapped, “The only way that would be possible is if I had missed the vein, and I did not miss the vein!”  Case closed, as far as she was concerned.

I finally decided I would either die or I wouldn’t, but I didn’t seem to have any control over the outcome.  So I made my peace with it, and continued on with the procedure.

I was given ear plugs, because the machine can be loud.  After I inserted the ear plugs, I laid back on the patient table, someone tucked a foam wedge under my knees for comfort and placed a thin blanket over me for warmth, fastened a basket-type device around my head (see image at beginning of post), and I was eased into the MRI “donut.”

I don’t remember much from that first MRI, except that it didn’t seem that bad, and it was over fairly quickly.

I didn’t die from an allergic reaction to the dye, obviously.  But I was correct that the burning sensation was not normal.  Miss “That is not possible” was wrong.  As it turned out, she had not missed the vein – she had gone completely through it.  I figured this out the next day, when I woke up with a huge black & green bruise on the inside of my elbow, surrounding the IV site.

Presumably enough dye reached my brain for the radiologist to get adequate images, since my doctor was given results, and I didn’t have to re-do the procedure.

Since then, I have had several more MRIs – a few more looking at my brain, and ones looking at my hand/wrist, elbow, and shoulder.

Here’s what I’ve learned about MRIs:

There is a wide variety of condition of equipment and pleasantness of experience.  The “donut” open MRI was the nicest equipment I have experienced.  Many facilities do not have them, or only use them for certain patients (obese, claustrophobic, etc.).

The nicest facilities now have headsets for the patients to wear during the procedure, and will play your choice of local radio stations or even subscription radio (Sirius XM, etc.).  Time passes more quickly when you are listening to your favorite jam.

The worst experience I have had was at a military facility.  The MRI was in a trailer in the parking lot – it was on loan from the VA.  Yes, I had to walk across the parking lot in my hospital gown to get to the trailer.  The machine was small, so the table that I laid on was narrow, and the machine opening was tight too.  That’s the closest I’ve come to feeling claustrophobic in an MRI machine.  The machine was old and VERY LOUD.  There was no music.  No headsets.  Only ear plugs and disappointment.  And a lot of vibration.

The MRI machine cycles through various “runs.”  In most facilities, the technician will talk you through the procedure while it is happening, informing you when the next run is starting, and how long it will last.

You have two-way communication with the technician at all times.  You also have a “panic button” in your hand that you can press at any time if you want to disrupt the procedure and get immediate assistance.

The machine makes noises at different frequencies and volumes during the different runs.  Some runs are quieter and less noticeable.  Other runs are loud, and you can feel the vibration in your body.  Some feel like thuds.  It doesn’t hurt, but some runs are louder and less pleasant than others.

The contrast agent (“dye”) does not normally burn.  You usually can’t feel it at all.  Sometimes it might feel a little cold initially.  Sometimes you might get an odd taste in your mouth (kind-of metallic).  Side effects are rare, but can happen.

In my opinion, cerebral MRIs are the easiest, because all you have to do is lie on your back and not fall asleep.  (Some people might not agree, as a cerebral MRI guarantees that your head must be inside the machine, whereas if they are imaging your arm or leg your head might not have to be inside the MRI machine.

NOTE: It is very important that you not move while the MRI is being conducted.  Moving can blur the images, and the procedure, or portions of the procedure would then need to be repeated to get clear, accurate images.  This is also the reason that the body part to be imaged is typically placed in a surrounding device to help stabilize it.  This is also the reason you cannot fall asleep, as you might move in your sleep.

For me, the MRI of my shoulder was no big deal.  The wrist and elbow were more memorable.

In order to get the images they needed of my elbow and wrist, I was required to lie in less comfortable positions.  Although the techs propped me on various pillows and foam wedges to hold my body in the position they needed, my muscles started to fatigue during both of these MRIs.  I was trying to prevent my wrist and arm from shaking, but the muscles became so fatigued that I was unable to prevent the muscle trembles by the end of the procedures.

In particular, for the elbow MRI, I was positioned with the injured arm straight out above my head, in front of me, like Superman’s flying position.  For this procedure, I laid on my belly, rather than my back.  Despite my best efforts, I could not keep my arm from shaking by the end of that procedure, although the tech said the images came out ok.

The procedure typically takes about 45 minutes.  Afterward, the tech will typically check the images to see if any runs need to be redone.

Bottom line:  MRIs are loud, but the procedure isn’t a bad experience.  They are not painful.  I have never felt claustrophobic, although I came close in the tiny, old military MRI machine.  If you are claustrophobic, make sure you are referred to a facility that has an open MRI machine and has experience with claustrophobic patients.  Also, you can get a mild sedative if you need one to help you get through the procedure.

[If you think you will need a sedative, make sure you bring a wingman/battle buddy to drive you home.]

It is very rare to have an allergic reaction to the contrast agent.  The pre-procedure paperwork will explain the type of agent used and possible side effects.  If you have any concerns, discuss them with your referring physician or with the MRI facility staff.

You can resume your regular activities upon completion of the MRI – it’s not a procedure that requires recovery time afterward.

Don’t worry that you will get a nurse like I had for my first MRI – “That is not possible.” 🙂  Every tech I have had in the US has been very helpful, very knowledgeable, and most of them have been very reassuring.  They know the procedure can be a bit intimidating for many people, and they typically go out of their way to make it as pleasant as possible for you.