Thursday, February 10, 2011


BV NEARLY SHUT DOWN
AND THE IMPORTANCE OF THE CLINICAL PRACTICE OF MEDICINE

Had it not been for the document I posted last night on Presas-Garcia, this morning would have been the BV's last post. I am tired. I will do my best to keep it going while we see how the FBI reacts to the collusion between Presas-Garcia and Healthsmart's Ted Parker.  The VA as a system celebrates incompetence. There are many extraordinary doctors who work hard day and night to provide quality care. But there is also the administrative side which works day and night to make life a living hell for the veterans.

We now know why for 10 years I have been getting weaker and weaker in my legs, hips and lumbar area.  For ten years one quack intern or resident in the speciality clinics just making up bizarre explanations while blowing me off.  The system is so bad in San Antonio that the radiologists just sign off on any piece of crap read a resident or intern may provide on your MRI or any other radiological exam.  The bottom line problem is the medical school which is run by quacks who refuse to hire competent instructors who are in fact the attending specialists at the VA.   The only speciality clinic I know of with a competent attending physician is the pain management clinic and he does not work for the medical school.  And he is living proof fellows can be supervised by highly qualified and  competent specialists.

My MRI according to the radiologist is within normal limits for a 51 year old man - 2 years ago.  But I got lucky - my pain management doctor decided to look at the MRI himself and found the read was incomplete. 

This is where his years of clinical practice made the decision.  My primary care physician initially referred me to neurology in SA.  At the time the VA SA did not have a pain management clinic.  They had a PMR clinic, which is a waste of humanity and should be shut down, or neurology.  It was the PMR doctors who made it known MRI's and x-rays are worthless and that people should just lose weight - a cure all for everything.  I was told to stop wearing belts, but to also wear loser fitting pants - never mind mine were already falling down - hence my need for a belt.  For 2 years it was one bizarre recommendation after another with zero treatment or examination.

Neurology outright refused the referral made by my primary care physician.  The MRI read indicated  everything was within normal limits so the doctor in training who makes the decisions refused the referral to neurology.  This is when the former head of all the doctors intervened and set me up as one of the first patients in the new pain management clinic.

The picture above is not mine, but looks amazingly like mine.  It took about an hour for them to prep the spine with the needles.  That was moderately uncomfortable.  The test involves injecting a liquid at 100 psi.  If the dura around the spine is intact you feel nothing.  If the dura around the spine is torn you feel horrific pain.  Based on what he had seen in the MRI he saved the disc he felt was the problem for last. I did not know this.  This way he had two good discs as tests to see I felt no pain.  Yea, I felt pain on that third one.  Because they are looking a a live x-ray using dye they could actually see the spinal fluid leaking out of the spine.

My doctor knew based on what I was describing that I had adhesions on the spine at L4 and L5.  This is the clinical experience.  An experienced clinician can pinpoint the part of the troubled area of the spine based solely on what you are experiencing.  So I had chronic numbing in the left thigh, numbing of the legs while sleeping on my back, neuropathy starting in my feet and moving up my legs, with an emphasis on the left side, while I slept.  Hip pain emulating from the groin area.  All of these things indicate adhesions at L4 and L5.

The game plan was to try and treat the hips and adhesions with separate procedures.  After the second caudal raz eventually failed on the adhesions and he did the third he knew for sure there had to be an ongoing pathology to explain why the adhesions keep on coming back.  The only explanation was spinal fluid leaking through the dura.  The caudal raz is a great procedure - I always got three months of relief before the neuropathy reappeared, and then got progressively worse. 

My doctor knew based on his read of the MRI that the dura looked suspect.  Again you combine this with the clinical experience and you get answers.  He had to do several caudal raz to insure there was an ongoing pathology.

In March I will undergo Electrothermal Catheter Therapy.  After the procedure wherein with a wire they basically burn the tear closed, I will be even more limited in my walking or movement than I am now.  I will be wearing a back brace for 2-3 months, off and on.  It is not a 24 hour thing.  There will be almost no driving allowed. Short trips will be allowed - 20 minutes of driving at a  time.  The tear in the dura needs to be allowed to heal.

For the next several weeks I am limited in what I can do so as to minimize the tear in the dura. 

I was to get on a plane next week to see an endocrinologist in NY.  I cannot fly until May or June.  The VA as far as I can tell will not agree to the treatment being recommended by the outside endocrinologist.  No one at the VA Harlingen can tell me anything.  I can say for sure a  decision has been made to keep me in the dark.  The recommendation was sent on February 24th and no one seems to know anything beyond they have the recommendation.

The VA Harlingen is so overwhelmed phone calls are no longer an option.  Yesterday twice I was disconnected while the phone range.  There are so many people calling you get  disconnected because of too many rings.  If you get through you are put on hold for an hour whereupon you are then disconnected.  This happened to me twice.

Last week I visited the clinic and was told I could not see a  doctor, but that a nurse would let my doctor know I was waiting on a decision about the testosterone treatment.  The nurse assured me that the following day she would call me and tell me what was happening with my treatment.  Nothing - absolutely nothing.  Since then I have not been able to get through on the phone.

Today I am asking the legal department at the VA in Washington to see if they can find someone willing to answer the phones and get answers.  I will then be labeled difficult.  The VA Administration in Harlingen demands that all veterans simply walk away from the lack of care.  They will not address the personnel problems.

I get the budget it tight - but when you are at a point that you are so overwhelmed that the doctors can no longer meet the needs of the veterans and the phones cannot be answered, as the Chief Administrator you call in the press so as to put public pressure on Washington.  This is not acceptable.

I have no problem spending the $200 plus a month for the testosterone injections.  All I need is a written prescription, and I cannot get that.  I will give the private endocrinologist one last chance to provide me the written prescription and if she does not I will make an appointment with an endocrinologist in Harlingen and pay for it myself.  I will then submit all of the bills to the VA.  This is what went out in my letter this morning to the legal department for the VA.  He can either get me treatment or I will pay for it myself and then file a formal claim with the VA. 


I am off to bed - the fatigue from the hormonal deficiencies the VA is refusing to treat has me in bed for 20 hours a day.  9 hours sleep and a pot of coffee do nothing to wake me up in the morning.

I will do my best to keep the BV going now that it looks like we may be at an end with this BISD mess.

If you read the Brownsville Herald you are the reason BISD is the mess it is - it is time to cancel your subscription.

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