Adventures in fee-for-service medicine

That'll be $45, cash only. Now go away.

Finally saw a doctor about my chronic inflammation of the tootsies problem:  burning sensations, redness, swelling, extreme sensitivity to any kind of touch, and, eventually, blisters and sores, spreading to both feet but confined to the area of the toes. In recent years the condition had gotten bad enough to make me semi-non-ambulatory for extended periods during the Fall and Winter months when the condition flared up worst.

I found the MD I ended up seeing almost by accident, since the internet listing I had initially settled on was a misprint of some kind, misidentifying a cardiologist as a GP.  One referral later I was, however, in contact with the doctor’s office, and making an appointment.

To my surprise, the condition was diagnosed as the result of circulatory issues, possibly Peripheral Artery Disease or something similar.  I’d be more specific, except the doctor was uncommunicative.  I’m left to wonder, for instance, if some of the collateral damage, the blisters and so on, originated in over-application of pointless athlete’s foot and other non-remedial remedies, or whether it was more directly related to the real problem.  In short, though his examination seemed thorough, the doctor struck me as a distracted individual with (social) circulatory problems of his own – minimal explanation or advice, no comparison of options, no real discussion at all other than the idea that a re-check in January would determine whether we had to escalate beyond the anti-clotting drug and antibiotic he prescribed.  Maybe he was having a bad day… Maybe he just didn’t like me.

Within a few hours of my first dose, I knew things were not going well.  I’ve had a headache somewhere between annoying and blindingly incapacitating since Friday, only just now clearing up, now that I’ve stopped taking the pills.  After the pain-wracked delirium of trying to sleep last night, I had no choice about that:  The idea of putting the pills in my mouth again is kind of terrifying, and I don’t think I could bring myself to take them.   Toes do seem a little better, though, possibly a result of the antibiotic, but the odds are that it’s the source of the headaches.

I’ll have to decide whether to find another doctor, and then how to handle this thing.  My research, reverse-engineered from the prescriptions and drug info, has led me to believe that physical exercise is an excellent therapy for peripheral circulation problems.  Since money is short, maybe it would be better to spend it on a guided fitness program rather than on expensive, migraine-inducing drugs and cheap, uncommunicative, un-invested doctors.

37 comments on “Adventures in fee-for-service medicine

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    • Cilostazol. Apparently very widely prescribed for PAD, PVD, and the like. Note: I have not been diagnosed with diabetes. I am a light smoker, getting lighter even as we speak.

      Sulfamethoxazole and Trimethoprin – antibiotic combination..

      (So. you’re a doctor as well as a magic plastic amphibian? I’ve never asked, never wanted to pry, but my guess has been that you were an early retired lawyer, but with medical experience of some kind from your telling, so maybe forensic medicine? Either that or you struck it rich on black bean futures, and read law for fun. I won’t feel offended if you prefer not to answer.)

  1. Don’t be an idiot. First step, call the doc and tell the nurse about your reaction to the meds. Then take it from there.

    You need confidence in your doc, but from your account, you don’t have enough to base a vote of non confidence just yet.

    Yes do stop smoking and get some exercise, but if you have an infection, these will do nothing for that.

    • Not much I can do about being an idiot, but, yes, I do intend to call the office today, and I haven’t quite given up on the doctor just because he was gruffly unsympathetic. The drugs did seem to help with the infection, but the underlying problem has been going on for years, and very likely isn’t susceptible to quick cures. If I’m going to seek a second opinion and a 360-degree confrontation with the situation, that’ll have to await a more precise diagnosis.

    • One thing I’ll note is that the Doc’s staff – nurse and receptionist – compensate somewhat for his demeanor by being quite warm and solicitous. So maybe the ecology of his office is somewhat in balance. Maybe he’s a brooding genius and they are his connection to the very mortal world. Could be.

  2. Just so everyone knows that the yoga-guy didn’t suddenly abandon the Tsar in his time of need, I’ve been emailing him with my yoga advice. He’s been fairly cooperative for a self-admitted “idiot.”

  3. Gonna have to work on it some more.

    I’m going to find a different doctor. The reply to my report of a negative reaction to the prescription was a without-explanation prescription for a drug that’s four times as expensive – very – presumably to be taken indefinitely. I just don’t think that anyone who was interested in helping me out would do that. They’d at least explain to me what I’d be risking under various alternatives instead of leaving me to dream up worst case scenarios.

  4. I mean, really, my dogs have gotten much, much better, more thoughtful treatment from their various vets. They always explain what thing a has to do with thing b and why treatment x is recommended instead of y, and are available for questions.

  5. I have my RN sister checking on Cilostazol. I’d ask my semi-retired veterinarian brother to chime in too but he works on Mondays and Tuesdays. He likes to help animals and people whether or not they are attractive and well-behaved and I think he does a better job at it than most human doctors, it’s true. His least favorite people are human doctors who consistently come in with animals that they mistreat in one way or another, usually in connection with their hubris.

    • That’s appreciated. But we’re now on to Plavix, which is rated modestly superior to low-dose aspirin, at ca. 70 times the expense (i.e. $200/month vs. $3/month), in the treatment of PAD – though the large studies mainly concern people who have suffered heart attacks or strokes.

      Anyway, I’ve been doing a lot of research, and now have a lot of good questions for a doctor who is actually willing to talk with me.

      Or I could save my money, do aspirin, exercise, better diet, and total smoking cessation for two months, see if my tootsies clear up, and then see another real doctor. Remember, it’s not like I’ve had a stroke or can’t walk a few blocks without sufering leg pain. The toe thing has been going on for years already. Cilostazol isn’t supposed even to start to work for up to two months.

  6. Scott Miller: His least favorite people are human doctors who consistently come in with animals that they mistreat in one way or another, usually in connection with their hubris.

    That sounds like a very, very sad story or a few very sad stories.

  7. I’m informed that you look to be sufficiently nourished….

    how’s your blood pressure?

    and, this is really important, does your urine appear to be blue or almost purple ?

  8. Blood pressure good, I was told (actually been told that more than once over the last year or so). Blue urine? Almost purple? Are you kidding?

    My urine is the same beautiful golden hue, within a certain range, that it’s pretty much always been except for when I had a kidney stone, at which time there was blood involved.

  9. if your urine is not blue, this is a good sign!!!!

    (figured you might want to hear that things aren’t terrible.)

    but for special occasions, take two of these.

  10. she not only loves the pictures, she adores doing the dressing changes.

    if you had waited for your toes to go necrotic, she might have gone to visit.

  11. ain’t no joke to me…..she used to go “ghouling” on Friday nights…..riding the ambulances to get consents signed by the families of the freshly killed and attending the autopsies to see that the organs were harvested, iced, and sent off to those waiting.

  12. You should look up the versions of “Amfortas! Die Wunde!” on YouTube. Would have been perfect wedding music for you, but, if somehow you missed it, maybe you could suprise her for your next anniversary… Assuming she isn’t already a bigtime Parsifal-Wagnerian.

    Couldn’t find with real-time translation so here are the lyrics in English for you love-birds, or love-frogs, or whatever…

    Amfortas! The wound! The wound! It burns in my heart!
    O lament! Lament! Fearful lament! From deep in my heart it cries out [from deep within it cries out].
    Oh! Oh! Misery! Full despair! I saw the wound bleed; now it bleeds inside me [now it bleeds in myself].
    Here – here!
    No! No! It’s not the wound [The wound it is not].
    Flow in streams, my blood, from it! Here! Here in my heart it burns! The yearning, the fearful yearning, that has overtaken my senses!
    Oh! Love’s suffering! How everything trembles, quakes and quivers in sinful desire!

    Isn’t that sweet?!

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