The Pharmacy Chick

Flying the coup in retail

Surgery Centers and Lets make a deal Part II

Filed under: Uncategorized — pharmacychick at 6:01 pm on Saturday, January 24, 2015

Mr Chick survived his surgery.  Of course I knew he would, God is good and is in control.  The doc came out ( who I hadn’t noticed until now was built like a brick #$@&house and  appeared to lift logs as a hobby I think) and said it seemed to be successful and they achieved a “nice decompression of the nerve root”.   I was ready to see him and he said soon, but not right now because ” we gotta wake him up”.

Waking him up can be an issue with Mr C.  He is known as an anesthetic lightweight. Once he had some dental work and the doc gave him two pills to take 1 hour before the procedure.  He was wiped for the rest of the day. No memories what so ever.  Even the dentist was amazed at how  he was.  I brought some humor into the situation when I picked him up ( almost literally) and said ” come on honey, lets go to the Jewelry store…”  The dentist said ” Hide your wallet!!”

Ultimately he did awaken after surgery ( sort of) enough for me to come and sit with him.  If you have ever heard the term “chemo brain” you can understand this.  “anesthesia brain” is the same.  He wavered in and out of lucidity, and asked me the same questions over and over. I didn’t care. I just sat there with my kindle in one hand and his hand holding my other one while he snoozed and then asked his same set of questions. Slowly he awoke enough to accomplish two requirements to leave:  Stand up and pee. I never did go back to the waiting room. They had a special exit for the patients, so I never found out if the guy talking to the TV ever came back out and made peace with the contestants on Lets make a Deal.

Unlike the dental work, THIS anesthesia took a lot longer to work out of him than a couple of hours.  He slept most of the first and second day.  But I got him up every hour for a walk, critical for clot prevention and healing.  He trundled across the house back and forth then back to bed. Id hold him in one place over the potty so he could piddle…his balance wasn’t so hot yet.

He can have very intelligent conversations with people..and remember little to none of it 2 hours later. This morning we went for a walk, our first foray outside and we walked to our little park near our house with a beaver dam in it.  we looked at the dam and walked home.  2 hours later we walked to a different part of the same park to look a the other beaver dam.  He said ” I dreamed about a beaver dam I think”. I said ” no honey, You SAW a beaver dam today”  He said ” I did? when?” and I said ” Today, 2 hours ago when we walked”. He looked at me and said ” we did?”  …Yup, we did. This is post surgery 48 hours.  He is managing on very little oxycodone ( 5 tabs in the last 48 hours) so I am pretty sure that anesthetic isn’t totally out of his brain yet.

Its too early to tell how successful the surgery is in treating the numbness. That can takes weeks to go away. I am optimistic and have faith that all will turn out good.

Time to wake him up and take him for another walk.  I need another beaver dam to show him I guess!

 

Surgery centers–and Lets make a deal! part I

Filed under: Uncategorized — pharmacychick at 6:35 pm on Thursday, January 22, 2015

There was a day many years ago when a person needed a type of surgery, no matter what kind and the experience was more like checking into a medical hotel than a hospital.  One would arrive the night before,  enjoy the evening with a prepared meal, tv, hang around the room and wait for the procedure that would occur the next day.  That day is gone.  I totally get why.  I mean what is the point of having a perfectly healthy person spending the night in a hospital under the tutelage of qualified medical personnel?

The day arrived finally for us to check in for Mr Chicks procedure.  We had been given a list of things to do ahead of time: Fill out this medical survey online ( 30 minutes of agony for Mr C who hates surveys),  sleep on clean sheets, wash body twice with Hibiclens, quit these meds, TAKE these meds,  wear all clean clothes. etc etc.  With the military like precision, we dutifully did all our tasks as to have NO chance of being sent home.

Our arrival time was to be 630 am.  Still dark we arrived just before 630 to find the doors locked, but with a button to hit for the surgery center.  They buzzed us in.  ” Surgery Center”.  That is another concept that has been foreign to me.  The last time I needed surgery ( age 16) I went to a hospital….in an operating room…and spend 3 days there…for a simple knee surgery.  This was going to be a ” day” surgery, something I thought would be reserved for hang nail removal and perhaps toe nail clipping accidents.  No,  they do pretty big stuff as day surgeries now.  Once you are awakened, can pee and fart, out you go. Real operating rooms, real doctors, anesthesiologists, etc!

Ill give them all credit tho, they are as efficient and as professional as any big hospital. If anything, its more personal because there is just a few people there.

They took Mr C away to be prepped and came to get me after about a half hour and I got to see him in his paper dress and blue hair net.  By then he was hooked up to his IV and speaking to the Anesthesiologist…who looked very familiar to me. She sounded just like one of my customers and had the same last name. Turned out to be her sister.  Small world. We told her that Mr C was considered an anesthetic lightweight.   A few minutes later and a shot of versed and Mr C was off in lala land. I left for the wait room with my phone, kindle and a puzzle book.

In one corner of the room was a nice man working on his Mac and on the other side of the room was me with my kindle.  It was so quiet and peaceful with the puffy couches and enough magazines to  keep me busy for hours if I wanted.  About 20 minutes into the wait a couple walked in.  They were obviously of little means, which means nothing in needing health care, but they were heavy smokers and both rather “odd”.  He cared for her deeply as he seemed to like touching her ( and I wondered if I should leave or they should get a room). The problem was the strong odor that came along with them of smoke and alcohol.  If they got the same directions we did about wearing clean clothes and bathing twice in soap, she didn’t do it.  The smoke smell was bothersome to my nose and lungs.  I didn’t want to just get up and move so I pretended to need to use the bathroom and took the key and left.  When I came back I returned the key and looked at the magazines on the OTHER side of the wait room.

Sadly he had found the remote for the one tv in the small space, and was trying to get the TV on. It wasn’t working very well and I was praying ” Thank you god for keeping it off”.  But he finally figured out the remote and ” Lets make a deal ” was filling the room instead of quiet Muzak. Then it got weird when he started talking to the TV and the contestants. He was engrossed in the proceedings on TV, and always seemed to need to move.  Kinda of a twitchy writhey kinds of person. The odor was manageable now that I was about 20 feet away in stead of 5. He wasn’t happy with some of the choices the contestants made and let the TV know.  Thankfully the nurse came out to collect him to go and see his wife/partner. After he left I went over and turned off the TV.  Mr Mac looked at me and said “Oh, THANK YOU!”. I just said ” I work in noise all day every day, its nice to have some quiet”.

I quietly waited for the dr.’s return.

 

 

The Patient Patient III A date in stone

Filed under: Uncategorized — pharmacychick at 12:03 am on Sunday, January 18, 2015

Becoming a patient when we are used to being providers has been quite the experience.  When a prescription that had been promised never arrived at the pharmacy of choice ( mine), we waited a couple of days then checked with the office.  ” no chart notes indicated that a script was supposed to be called in” she said. ” But I’lll check on it…”  Later that day the RX in question eventually arrived at its intended destination.

But…that got me to thinking.  If no chart notes were ever dictated about the rx, were there any chart notes bringing us to a surgery date?? That he was a candidate??  Should I call?

Yup, I should call. So I rang up his assistant and explained the reason for my call. She was very understanding and said she would look into it.  Now I have no idea what happened behind the scenes.  It could very well have been all in the works or it could have been completely forgotten, Ill never know.  What I do know is that 2 days later she called me up and we chose a surgery date.

Jan 22.  So, if you are a follower of my little blog, say a prayer that day that all goes well 🙂 and that I can start blogging on perhaps more fun topics!

I’m sure that much fun will be written about whatever happens in the paper dress on the 22nd.  Mr Chick is quite the lightweight on anesthesia.  He can be very entertaining whilst on these drugs! Remind me to share about his adventures on Halcion  when he got his crown last year!

 

The patient patient: II Visiting the holy of holies: the surgeon

Filed under: Uncategorized — pharmacychick at 5:19 pm on Thursday, January 8, 2015

One might think that visiting a neurosurgeon ( or any specialist for that matter) is akin to asking for a private audience with the Pope, President or somebody of equal stature and significance.  AND you would be right…at least in the opinion of our insurance company AKA the GATE KEEPER ( insert a deep bow here). We must seek permission ( a referral) in order to see somebody.   We were both grateful that our request to be seen was granted without much delay, but “delay” is relative  because when we called to make an appointment with his Holiness, it was met with ” our first appointment is somewhere in 2017″.

Ok, that is a bit of an exaggeration.  It was 2015. However thru a bit of creative maneuvering ( an intervention of sorts) from our friend Dr PCP, Dr Holiness was able to see us earlier.  Well, NOT HIS exact Holiness, but another Holiness in the same clinic because there were 5 Holinesses and Dr PCP liked one the best but he didn’t want to look at Mr Chicks case. While Mr Chick was quite uncomfortable, he wasn’t totally incapacitated so Dr Holy I  said ” I declare thee not worthy of my time”.  So Holy II accepted our case ( MRI, chart notes etc).

Im going to pause here to reflect on something I found very profound when it comes to health care providing.  Tho I have moved away from speaking of the business of pharmacy, Id like to draw a comparison/contrast of seeing various health care providers. Pharmacists are quite like the great unwashed when it comes to providers…at least in my opinion..based on many years of being one.

When we walked into the surgeons office the first thing I noted with the distinct lack of noise.  It was quiet. You won’t see that in a pharmacy. The woman at the  desk would address me at precisely the moment she wanted to…after she finished her phone call.  There is no rush at the counter, or pushing or shoving and certainly no LINE. The phone rings very quietly in stead of the annoying SHRILL that my 6 lines have. Its very “library”-like.

Doctors offices pretty much know ahead of every day what kind of work load they will face..its on their appointment list….APPOINTMENT list.  THAT is the major difference between what I do and what they do.  I have no idea what is going to happen every day. I am at the mercy of the patient. I have to see and wait on every person what walks up to the counter regardless of what else I am doing or how many prescriptions I already have.  THEY rule not me. And if they don’t  get what they want all they have to do is whine and some middle manager with a white shirt on will make sure I am embarrassed an humbled by my behavior. In a doctors office, the staff rules.  You sit quietly and wait. You don’t get to see the doc until he is ready to see you. And he pretty much minds the time.  If you think that your 30 min appointment is going to be stretched into an hour because you have a hundred questions, good luck with that.  But if some Joe Doe wants to hijack me and agonize over Dayquil or Sudafed for a half hour, God help me. Back to Dr Holy II

Dr Holy II was a very amicable man. Tall and thin, both in stature and hair, he reminded me very much of my first boss. I like to see doctors who have some level of physical fitness and his pictures in the office seemed to indicate he pursues a lot of activities. Once the niceties were over Holy II gave Mr Chick an assessment of his back health and thru various modalities discovered he had a significant reduction in function and strength on his left side from the herniation. He produced the MRI and brought out a skeleton of the back, showing what he’d LIKE to see and what he ACTUALLY saw.   They were miles apart.

In summary, he felt that he was a suitable candidate for what he figures to be a highly successful microdiscetomy.  He feels that the nerve is being damaged  by the compression but is likely salvageable if we get the pressure off before the damage is permanent.  He said this, that, and the next thing about what we need to do over the next several weeks until he can schedule surgery including trying Gabapentin.

He said ” we will e-script in a prescription into your pharmacy of choice”  The pharmacist in me said ” this should be interesting”.

Guess what was never received at the pharmacy?  The E-script.  Mr and Mrs Chick. Just another patient waiting for something that isn’t going to come.We actually had a good laugh as we waited 3 days before we called the office to inquire about the awol rx. The answer wasn’t encouraging:  ” oh, we have no chart notes that any prescription was to be sent”.

Nice.  More to come later 🙂

Mr Chick, the patient patient.

Filed under: Uncategorized — pharmacychick at 3:18 pm on Tuesday, January 6, 2015

Sept 20 2014 proved to be the day that the Lord moved us from one path to a detour  not of our choosing.  Whilst doing nothing more than pondering the selection of a pair of trousers from the closet, Mr Chick reported to have been struck by lightning that started at his hip, moved south to his foot and permanently resided there like a barbecue fire.  At that moment, he went from a perfectly well functioning adult to a man who couldn’t stand up, sit down or walk without great discomfort.  About all he could do comfortably was to lie down…and that wasn’t much of an option.

And in that moment, we went from “provider” to “patient”

Being the trooper that he is, he went to work.  How he got there while driving flat was somewhat of an endeavor but he did get there.  He is no slouch, his job requires attendance as obligatory as mine does so ” calling in sick” might as well be grounds for treason or a guillotine. Calling in sick usually requires a death certificate, and that is iffy.  Employees are required to die on their days off and find appropriate replacement coverage.

While neither of us are physicians we are pretty well versed in the human body and we knew he had either herniated or ruptured a disc.  Our first call was to our PCP whom also happened to be our friend.  He said ” MRI” first step.  He also said ” by the way, I am retiring at the end of october and going overseas to do some medical missionary work”.  Well, that wasn’t the best of timing but at this point we didn’t have much we could say about that.

Getting an MRI isn’t just as easy as walking into the imaging center and saying ” Get er done”, unless you plan on paying full price out of your pocket. No,  we  ( being the doctor) had to request a PA.  Then the fun began.  The office sent us via phone to a imaging center near our house….that had closed 2 years ago.  The phone still worked but it re-directed us to its remaining office about 50 minutes away.  We talked with person 1 who said they do appointments on mon, wed and thursdays only.  Then we talked to person 2 who said person 1 was incorrect.  Person 3 said we had to pay a 500.00 “deposit” on  the procedure.  But the insurance said our copay was about $100.00.  One lady at insurance said NO PA required and next person on the line said it was required.  It was frustrating to call and get different answers every time a different person picked up the phone.

An aside:  on a scale of 1-10,  I would rate myself a solid 9 as far as knowledgeable about  insurance and its rules and procedures.  Only an insider in the insurance industry might have a better go at it, but after all these years, I  know the verbiage, the routes and how to say WHAT to get what we need.  Nevertheless….

It took nearly 2 weeks before it was all straightened out–correct information, correct pricing and correct location about 4 miles from the house. It confirmed what we had believed:  Herniated disc right on the sciatic nerve and moderate to severe stenosis.  Ouchie.

Dr PCP said the first step would be to have a cortisone shot injected in to the site to reduce the swelling.  Getting that authorized was about as simple as navigating razor wire buck naked.  You may actually survive it, but you will be shredded in the process. It  took nearly 3 weeks of waiting, a dozen phone calls and actually required a hospital admission ( give me your clothes, here is your paper gown). The doc was very nice, very thorough and said basically ” ya, it may or may not help”.

It was a 5 minute procedure that took about 5 HOURS from  parking lot to parking lot. It was a process nearly identical to getting the MRI. Only this procedure cost us out of pocket about 700.00.  So we are now into it about 800.00 give or take.  We got the itemized bill later ( much later) on.  The “cost” of the triamcinolone injection ( drug only) was 125.00.  I should have bought it from my wholesaler and handed it to the doc…” here, this is same med only you won’t charge me a ten-thousand fold price increase for it”  ( that might have not gone over so well ya think??)

They said it would take 2 weeks before we might see a benefit.

No benefit was seen after 2,3 or 4 weeks.  More to come.. Time to see his holiness the surgeon…