Wit's End [NA]

[Mtns2Skies]

Okay I'm probably going to overshare a bit here but I'm incredibly frustrated by the situation I'm in, and frankly am looking for any suggestions of what to do.

I'm a regular blood donor (young and healthy), and donated blood last month which is what started all of this. The phlebotomist, well wasn't very good. She stabbed my right arm 3 times and ruined the vein, so switched to my left arm and she went way too deep, when finishing the donation when she pulled the needle out it hurt like HELL.

So I give it about a week, and I can't extend my arm without searing pain shooting down it and the needle site hadn't healed, but there wasn't any discoloration or anything. I call my local PCP which apparently is now out of network with the new insurance I have at a new job (The insurance literally goes county by county). I convince them to see me anyway, they get me a nurse practitioner that's available and they do an ultrasound to check for a blood clot with none found, she just told me to take advil and give it two weeks. Two more weeks go by, not any better. I call the same PCP and tell them this, and they refuse to see me because I'm out of network they're no longer my PCP. I offer to pay out of pocket etc, but they don't want to do that. Well, that kind of sucks okay I call around to all of the doctors that would be in-network and they're either not seeing patients or not going to see a new patient for 8 months to a year. Okay fine, I go to urgent care, they're great, but don't know what's wrong - give me an antibiotic to see if it gets better - another week goes by no change.

I find an in-network vascular specialist, give them a call it sounds like they're concerned and know exactly what's going on and schedule me for several appointments as quickly as they can... then they call me back about 2 hours later to let me know they cancelled everything because they don't have a referral from my PCP. I say they're not my PCP anymore because of insurance reasons and can't get a referral from them. Then I called urgent care to get a referral but they say in their system my old PCP is still my PCP so they aren't going to provide the referral...

So what exactly am I supposed to do? I feel like I've been treated like a criminal for trying to use the healthcare system, I've been debilitated and largely unable to use one of my arms for over a month now, and don't have any remaining avenues to get help.

 

[Salty]

Okay I'm probably going to overshare a bit here but I'm incredibly frustrated by the situation I'm in, and frankly am looking for any suggestions of what to do.

I'm a regular blood donor (young and healthy), and donated blood last month which is what started all of this. The phlebotomist, well wasn't very good. She stabbed my right arm 3 times and ruined the vein, so switched to my left arm and she went way too deep, when finishing the donation when she pulled the needle out it hurt like HELL.

So I give it about a week, and I can't extend my arm without searing pain shooting down it and the needle site hadn't healed, but there wasn't any discoloration or anything. I call my local PCP which apparently is now out of network with the new insurance I have at a new job (The insurance literally goes county by county). I convince them to see me anyway, they get me a nurse practitioner that's available and they do an ultrasound to check for a blood clot with none found, she just told me to take advil and give it two weeks. Two more weeks go by, not any better. I call the same PCP and tell them this, and they refuse to see me because I'm out of network they're no longer my PCP. I offer to pay out of pocket etc, but they don't want to do that. Well, that kind of sucks okay I call around to all of the doctors that would be in-network and they're either not seeing patients or not going to see a new patient for 8 months to a year. Okay fine, I go to urgent care, they're great, but don't know what's wrong - give me an antibiotic to see if it gets better - another week goes by no change.

I find an in-network vascular specialist, give them a call it sounds like they're concerned and know exactly what's going on and schedule me for several appointments as quickly as they can... then they call me back about 2 hours later to let me know they cancelled everything because they don't have a referral from my PCP. I say they're not my PCP anymore because of insurance reasons and can't get a referral from them. Then I called urgent care to get a referral but they say in their system my old PCP is still my PCP so they aren't going to provide the referral...

So what exactly am I supposed to do? I feel like I've been treated like a criminal for trying to use the healthcare system, I've been debilitated and largely unable to use one of my arms for over a month now, and don't have any remaining avenues to get help.

Ouch. I've given over 10 gallons of blood and been stabbed by the worst of them. Never experienced anything like that though. Nerve damage maybe?

Last time I went to the doctor for something, I'd already been suffering for a month, they sent me for a MRI, insurance denied it. I screwed around for another month and it was finally getting better so I dropped it. So, maybe the modern answer is to suffer for 3 months?

 

[Velocity173]

Jeez if it’s that bad I’d just roll into the ER then. Might seem like overkill but I wouldn’t chance it.

I understand your pain when it comes to PCMs though. Been through three because Tricare keeps dropping them or they don’t accept Tricare. Not sure which but I play musical PCMs every other year.

 

[Tools]

So there I was…

Flat on my back with what I presumed was a herniated disc.

Try to sked a MRI… we can get you in, in THREE WEEKS. It’s about 3 grand, what’s your deductible? “Uh, no insurance.”

Oh, come right in, that’ll be $400.

WHA??? Why did I EVER use insurance?

Because it’s ILLEGAL to not use insurance if you have it… which means it would have cost more and I’d have spent THREE MORE WEEKS lying on my back pooping myself BECAUSE I COULDNT MOVE.

Dude, I got nothin for ya, but feel your pain. And we complain about the FAA…

 

[Van Johnston]

I am a regular platelet donor and have an occasional complication, but not as bad as yours. One thing I have learned is your first call should have been to the blood bank. They caused this, and they should fix it. I don’t know what kind of response you’ll get calling a month later, but they need to know.

Another thing; over time time my sticks got progressively harder and more painful. One phlebotomist attributed it to scar tissue in the vein, so I switched arms. If this arm ever gets to be a painful as the other one was, I’m done.

 

[Mtns2Skies]

One thing I have learned is your first call should have been to the blood bank. They caused this, and they should fix it.

The RedCross doesn't seem set-up for this. It was just endless call center employees that just wanted to schedule more donations, and didn't seem to have any avenues to help other than "go see your primary care"

So, maybe the modern answer is to suffer for 3 months?

It doesn't seem to be nerve damage but rather vascular because if I do extend my arm, I'll lose circulation for about 5 minutes before it returns (maybe a badly collapsed vein?). Yeah you may be right, my insurance switches back over in January. I'd be more willing to suffer for months if I saw *any* improvement, but unfortunately not.

 

[Morgan3820]

Only slightly relevant. But I stopped giving blood a while ago when I realize that it was just a business and I was making a free donation. When I looked into it five years ago the hospital paid $400 for a pint of blood that I gave for nothing.

 

[Salty]

Only slightly relevant. But I stopped giving blood a while ago when I realize that it was just a business and I was making a free donation. When I looked into it five years ago the hospital paid $400 for a pint of blood that I gave for nothing.

I can see where you are coming from, but it does cost money to train people, get to a convenient location, process the donator and blood, store it, transport it to where it's needed, etc. It would be a waste for each hospital to run their own programs and then still have to trade with other hospitals anyway (which would cost $ to transport). The system seems odd, but I think it makes sense.

 

[Baked Potato]

That's horrible - I don't have anything constructive to add but just want to say that I feel for you

I broke my ankle and can't even walk for six weeks, let alone fly. So I'm gounded for the time being, and this will certainly put a damper on my training.

I hope you get the situation resolved, or that it gets better for you on its own. The US medical system can be quite dystopian at times.

 

[robin ardoin]

I developed a severe thrombophelbitis after a donation years ago. Same symptoms as you. The vein took nearly 25 years to recanalize. If you can feel a good pulse in your radial vein and normal color in your palm/digits then there should be no thrombus, or 'clot', in the artery. The affected vein may be warm and tender but the overlying skin not overtly red and no fever. If just thrombophlebitis it will eventually resolve.

Don't get me started on blood/tissue donations. I was involved in an attempted development of a bone tissue bank at a major medical center and the 'non-profits' had that squelched politically as soon as they saw we were serious. The dean of the medical center told my department chief that it was not going to happen, end of discussion. There is big money made from donated tissues. Certainly they are needed but full disclosure should be made to the donor/family of donor by the collecting agency.....and it is not.

 

[Mtns2Skies]

It took several calls, but finally got into a specialist... hopefully smooth sailing from here. Honestly I'd even feel better if anyone I saw up to this point had any idea what was wrong, but they go "huh" and throw meds at it.

I developed a severe thrombophelbitis after a donation years ago. Same symptoms as you. The vein took nearly 25 years to recanalize. If you can feel a good pulse in your radial vein and normal color in your palm/digits then there should be no thrombus, or 'clot', in the artery. The affected vein may be warm and tender but the overlying skin not overtly red and no fever. If just thrombophlebitis it will eventually resolve.

How long for your arm to be useable again?

 

[PaulS]

Yeah, this sucks. My sop with these people is they get up to two tries. If they miss and start digging around with the needle I tell them to stop, next up. No need to be nice. When I had my meniscus fixed, two nurses came in to put an iv in, I was dehydrated, so they poked around, both arms, a total of six jabs, couldn't get it. They were getting ready to go in again and I told them, no f'n more. They left, the anesthesiologist came in and asked me what's up? I told him they jabbed me six times, were digging around and I was already bruising. He sat down, got prepped, and popped it right in. One of the nurses came back and apologized, told me the nurse who usually does the ivs was out that day, and that they hadn't done it in a few years, they generally did paperwork. That's when I decided to never let anyone do that to me again. Don't be shy for things like that. I hope it heals up.

 

[172andyou]

No need to be nice.

One can absolutely be nice, and still call a halt to the process. Just sayin'

Being nice doesn't mean not standing up for yourself (or your arms!).

 

[Velocity173]

After seeing dudes pass out just from blood tests, I don’t do the donation thing. I’ll stick with Army regs and “aircrews will not be regular blood donors…”

 

[robin ardoin]

It took several calls, but finally got into a specialist... hopefully smooth sailing from here. Honestly I'd even feel better if anyone I saw up to this point had any idea what was wrong, but they go "huh" and throw meds at it.


How long for your arm to be useable again?

It was painful to flex for over a month but I could use it, short of heavy lifting, after a couple of days.

 

[Zeldman]

WHA??? Why did I EVER use insurance?

When having insurance became mandatory under law, I dropped insurance. I found out being a cash payer cost less than monthly insurance payments. Insurance runs health care and many times it really ties the doctors hands.

Yeah, IVs. I give folks one chance to make a stick. Mess that up and time to get someone else.

 

[Daleandee]

After seeing dudes pass out just from blood tests, I don’t do the donation thing. I’ll stick with Army regs and “aircrews will not be regular blood donors…”

Reminds me of the story of asking the doc's advice when confessing to breaking one arm in three places ... "well, stay out of those places!"

 

[tspear]

Curious on mandatory to provide insurance. I did some quick web searching since I have not heard this before; and wanted to see what was up. But I cannot find anything on it.
I have multiple times, at local urgent care centers if I know what I am going for, not provided health insurance (cash strep tests are cheaper than insurance, cash they let the nurse do it, with insurance I have to see the doc to authorize the nurse to run the test). When asked by the front desk at the urgent care, I say not going to provide it, they say "ok. Cash?". I say yes.

Tim

 

[DJTorrente]

Only slightly relevant. But I stopped giving blood a while ago when I realize that it was just a business and I was making a free donation. When I looked into it five years ago the hospital paid $400 for a pint of blood that I gave for nothing.

Same can be said of Osh Kosh and all those people volunteering while EAA collects $40 ea. per day.

 

[ateamer]

Only slightly relevant. But I stopped giving blood a while ago when I realize that it was just a business and I was making a free donation. When I looked into it five years ago the hospital paid $400 for a pint of blood that I gave for nothing.

Maybe you’ll change your mind when someone you love has their life saved by donated blood.

 

[kmacht]

Call your insurance company and ask for a list of primary care physicians covered under their plan in your area. Take that list and start calling to see who is accepting new patients.

 

[Mtns2Skies]

Call your insurance company and ask for a list of primary care physicians covered under their plan in your area. Take that list and start calling to see who is accepting new patients.

Well, that kind of sucks okay I call around to all of the doctors that would be in-network and they're either not seeing patients or not going to see a new patient for 8 months to a year.

Seems to be a doctor shortage.

 

[JOhnH]

That's horrible - I don't have anything constructive to add but just want to say that I feel for you

I broke my ankle and can't even walk for six weeks, let alone fly. So I'm gounded for the time being, and this will certainly put a damper on my training.

I hope you get the situation resolved, or that it gets better for you on its own.

My feelings exactly.

The US medical system can be quite dystopian at times.

Understatement of the month.

 

[JOhnH]

Seems to be a doctor shortage.

Which was 100% predictable starting around 13 years ago.

Even though I am all for providing healthcare to even the most indigent, I think there would have been a better way. I have suggestions, but I'm already pushing the limits here.

Further, we have to stop demonizing "rich doctors". They work hard. Not too many are good enough to be doctors. And they still don't make as much as NBA or NFL players even though their job is harder and more important.

 

[GeorgeC]

Seems to be a doctor shortage.

obPoA: there is no doctor shortage, just a pay shortage.

 

[kmacht]

obPoA: there is no doctor shortage, just a pay shortage.

It’s more than a pay shortage. Becoming a doctor is hard. You give up 8 years of your life to school, residencies, insane work schedules, no family life, etc just to start at the bottom of your profession. Not many people are willing to do that anymore so you get fewer doctors.

 

[172andyou]

obPoA: there is no doctor shortage, just a pay shortage.

Jesus, we already pay our doctors 50% more than the rest of the first world. How much more is it gonna take!

(Hint: It's not a pay problem. It's that the entire system, from education to corporate structures to insurance to autonomy to lack of respect, is completely broken. Pay these people a million a year and all your gonna get is people that retire younger because every year they hate their jobs more)

Also, why is it that the answer to the doctor problem is "just a pay shortage"
And the answer to the lack of warehouse or fast food worker problem is "no one wants to work anymore"

 

[JOhnH]

(Hint: It's not a pay problem. It's that the entire system, from education to corporate structures to insurance to autonomy to lack of respect, is completely broken. Pay these people a million a year and all your gonna get is people that retire younger because every year they hate their jobs more)

The question is why do they hate their jobs more now than they did a few years ago? I have some opinions on that.

Also, why is it that the answer to the doctor problem is "just a pay shortage"

It's not JUST a pay shortage. The doctors I know are more frustrated with the rules, regulations, policies, restrictions and long hours of paper(computer) work placed on them when they should be doing their jobs

And the answer to the lack of warehouse or fast food worker problem is "no one wants to work anymore"

That's a whole 'nuther discussion. The reasons are completely different.

 

[Morgan3820]

Maybe you’ll change your mind when someone you love has their life saved by donated blood.

I see your point. FWIW, I have donated a few gallons over the years. Honestly, I just got tired of getting stuck several times before the struck an artery.

 

[Morgan3820]

The question is why do they hate their jobs more now than they did a few years ago? I have some opinions on that.

It's not JUST a pay shortage. The doctors I know are more frustrated with the rules, regulations, policies, restrictions and long hours of paper(computer) work placed on them when they should be doing their jobs

That's a whole 'nuther discussion. The reasons are completely different.

Don't forget the debt. The school where my daughter goes charges $60K a year tuition plus fees. And then you have to live. $400K is not unrealistic debt load when it is all said and done. Then there is the BS. Dealing with administraters with a tenth of your education/investment. Why would someone want to do that when you could set yourself up in the HVAC contracting business and make more money with less stress.

 

[hindsight2020]

Well, the AMA ain't exactly innocent here wrt to supply issues. doctors may not want to admit it, but ask them about NPs and PAs and watch the S300 missile racks pop off. We're all rent-seekers in Shawshank....

 

[172andyou]

Seems on point here. It's not just that we pay the most. It's that we don't even get much for it. Money is clearly not the issue.

 

[TCABM]

Seems on point here. It's not just that we pay the most. It's that we don't even get much for it. Money is clearly not the issue.

View attachment 122440

70+% of adult Americans are overweight, obese, or morbidly obese. Those conditions alone are costly to treat when people refuse to eat right and exercise. Secondarily, things like arthritis being treated with total joint replacements, cataract lens replacements, and then there’s end of life care that runs close to $20k/month that most other countries don’t even entertain as options.

 

[danhagan]

It doesn't seem to be nerve damage but rather vascular because if I do extend my arm, I'll lose circulation for about 5 minutes before it returns (maybe a badly collapsed vein?). Yeah you may be right, my insurance switches back over in January. I'd be more willing to suffer for months if I saw *any* improvement, but unfortunately not.

I work in the imaging field ... not all sonographers are the same, and there are a LOT of self trained "specialists" out there. When you say you "lose circulation extending your arm", that smells like compartment syndrome and if from a hematoma, they should see it. If they don't, they should have done comparative imaging on the non-effected side to see if there's any difference (this is for soft tissue evaluation - vascular evaluation also needed).

Here's the problem: The Sonographer might be looking for soft tissue damage only and isn't vascular board certified and knows nothing of vascular compartment issues. The registry is ARDMS for general and they should have that AND RVT (registered vascular technologist) behind their name.

Had one of these cases last year after blood donation ... person had a nasty venous thrombosis in the cephalic vein. If your phlebotomist is performing "small circles" with that needle hunting a vein, stop them immediately ...

Lastly, if you were at our facility I'd check the radial and ulnar arteries in normal and then have you replicate the complaint position and check that Doppler waveform as well (basic compartment syndrome protocol) ...

 

[hindsight2020]

*TLDR warning*

In fairness, obesity is a pass-through euphemism for poverty, since healthy food, like every artifact of living in this clownshow, is overpriced in the US. American foodstuff is hot trash, and that's before one addresses food deserts in a country that couldn't spell public transportation if an 1890s streetcar ran it over at runaway throttle.

Even if one were to stop the conversation at that reductionist moralizing about people going to McDonalds, the dirty little secret still remains that our healthcare system profits massively from the very unwillingness to facilitate access to preventive medicine in the first place. Very much akin to the trope about dentists not wanting oral hygiene education to get in the way of their pediatric fillings cash cow.

As to the clinical side, hoo boi. The stuff my ACU RN wife sees in that TX level I trauma hospital, is the consequences of poverty-induced, lack of preventive medicine. Most of it preventable, but more saliently, all allowed to fester, by design. And here's another hot take: the hospital admin low-key triages for insurance/payable status, and chucks the cost-shift cases (largely immigrant cases, but some native uninsured also are in that mix) off property asap, to a medical malpractice degree imo.

I'll be my wife's sock-puppet account on that one, as she's afraid to speak out. Point blank she has caught and stopped attempted discharges by rapacious case managers that would have resulted in an uninsured/poor person going septic as they were to board a 3hr flight back to family. Inconvenient whistleblowing for the hospital, as the intervention required in order to re-stabilize the patient a mere 8 hours later was surgically invasive in nature and expensive. This level of economic capture should alarm everyone, as it could be any one of us staring the business end of that medical neglect, if not for one conscientious nurse who isn't afraid to lose her job over a principle, and only because she has a working husband to fall back on (a relative luxury in this economy not afforded to all bedside staff). The level of malfeasance in medical practice in metro USA is scary cynical, but we don't talk about fight club.


The point about end-of-care costs is 100% agreed on. Problem is we also then turn around and get all puritan/superstitious about end of life legislation, sans a couple corners of the country where they allow you to retain agency on that front. People complain about "death panel" boogeymen, but they won't let a man the legal allowances to die in dignity either. Schizophrenic clown country.

In principle we agree, chopping out geriatric expenditures would basically deflate the whole thing down to Eurozone expenditure/outcome ratios. But who's gonna tell grandma 'No'? The US HC industry ain't gonna do it, and the politicians ain't gonna do it either. Old people vote, and most people don't want to die, even when their quality of life is that of a forgotten rotting fruit in the back of the kitchen counter, with fruit flies circling overhead. I have a whole chapter devoted to my proposed solutions but it would get the esteemed OP's thread locked, and since my intent is not to hijack the thread, I'll digress here.

 

[Racerx]

Ugh. My only advice is to not wait it out. If the answers they're giving you don't sound right or if they seem wishy washy, go somewhere else. Don't let them play pin the tail on the diagnosis...thats how you got here. As difficult as that seems. After my primary care blamed allergies and prescribed claritin for enlarged tonsils when I was 22. I went to the otalaryngologist. No primary care approval. He said we can try Claritin and give it a few weeks and then call me to schedule surgery....or we can schedule it now. 2 weeks of hell but I no longer snore and raw fruit and vegetables no longer make my throat itch.

I've long thought we need a gym membership style solution to this insurance madness. Pay premiums to larger health group that has the ER, the specialists, primary care, etc directly every month. Services on an as needed basis. Cut out the middle man. Not a club member, pay cash or GTFO.

I havent had a primary in 10+ years. If something's amiss I'll go to a specialist or urgent care. Was going to go to a primary care a couple months ago but they're all booked. Haven't had the issues you do finding someone in network. But I pay for my own insurance so I can control whos in my network.

 

[GeorgeC]

I've long thought we need a gym membership style solution to this insurance madness. Pay premiums to larger health group that has the ER, the specialists, primary care, etc directly every month. Services on an as needed basis. Cut out the middle man. Not a club member, pay cash or GTFO.

I've lost two PCPs to concierge medicine so far.

 

[Walboy]

since healthy food, like every artifact of living in this clownshow, is overpriced in the US. American foodstuff is hot trash

I don't find that to be true at all. The produce section here is quite reasonably priced. Meat prices have increased with inflation but if people would eat smaller recommended portion sizes those prices are reasonable too. Processed and precpackaged foods are a lot more expensive. I know people who think a large pizza is a single serving for one person. Look at people's shopping carts, it's loaded with crap and that's a choice people make.

Obesity and chronic health problems (metabolic syndrome) are fascinating topics. I personally think it's mostly a matter of choice.

Staying healthy is simple, it's just not easy in today's world of conveniences. It takes effort that most people don't want to undertake.

 

[bnt83]

I've went to GP (small office) for abdominal pain, x-ray didn't do much. Took blood wont have result till later. I went to work (desk job). Get home and at about 5:30pm I get a call "your white count is really high go to the ER"

I pack mystuff and went to ER (big hospital with trauma unit and all that) with abdominal pain getting worse by the minute, clearly appendicitis, been gaslighted by the staff, finally a CT is ordered and "by golly you have appendicitis" we can get you into surgery tomorrow" this is over a span of about 5 hours.

I've already kicked the go-to-the-Dr-can so far down the road because I never go to the Dr or ER until I'm afraid I'll die if I don't. FWIW I've had body parts amputated from every limb, I know what pain is and I WAS IN PAIN.

I looked everyone of them in the eye and told them "high white count - no spleen - been on all different kinds of immunosuppressants in my youth - if my appendix bursts and results infection you'll have huge mess on your hands." No changes to surgery schedule. Pain is bad enough its heard to breathe.

The worse worst abdominal surgery in my lifetime, but it really went well and they are damn lucky IMHO 5 or 7 days inpatient with lot and lots of draining. Surgeon says, "you were a mess we had to cut all this out and..."

IDK what kind of patients the ER constantly gets but jeez. Maybe my ESG score is too low to get better service.

 

[172andyou]

70+% of adult Americans are overweight, obese, or morbidly obese.

Good point. Yes, the US has spectacularly failed to treat obesity. Get that under control and lots of people have improved lifespans and quality of life. This is absolutely a massive failure of the current approach in the US, which is more like "disease management" than "health care".