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Re: Personal Experience with Some of the Problems in Heath Care.
Story continued from post #45.
Fortunately, as things turned out, shortly after the onset of wife’s problem she called a friend of hers just to say “hello” and in the conversation wife mentioned her hand problem. The friend related she too had had a “hand problem” and her son, an attorney usually representing insurance companies, recommended a particular hand surgeon as a doctor who had impressed him during some depositions and wife’s friend saw him and received treatment that proved effective. End result, wife went ahead and made appointment with hand surgeon which ended up being over two months off because of his schedule.
After the fiasco with the neurologist, wife was still 28 days from appointment with the hand surgeon. So she went ahead and continued the course of medications the neurologist has prescribed, but cancelled further follow up appoint there. Her hand disability continued to worsen over the four weeks.
Hand surgeon examined and x-rayed her hand, reviewed the notes we brought from the neurologist including the normal electrical studies and said, he thought the problem was likely anatomically within a centimeter of a specific point in her hand, BUT he would like to try to prove that it was not explainable some other way, such as tumor somewhere between the brain and the wrist or due to some ulnar nerve problem between the hand and armpit—specifically in the elbow region of the nerve’s path—it was this latter differential diagnosis that seemed most important.. Recommendation: see another doctor for repeat nerve and muscle testing and clinical opinion and have an MRI of left hand. Hand surgeon recommended a specific doctor, and we saw her five days later.
The female physiatrist, practices physical medicine, reviewed neurologists notes, hand surgeon’s note, got some of wife’s history again, performed her own physical examination and repeated testing of just three nerve in wife’s left arm (neurologist had originally tested 5 major nerves in left arm) along with some pertinent muscles stimulations. It seemed to me, a layperson with regard to what this doctor was doing, that she was experiencing some sort of difficulty with her equipment, which involved a computer and a program, so she tested the nerve in wife’s unaffected right arm.
Physiatrist’s conclusion: thought wife might have a problem with the ulnar nerve in the elbow region, BUT also thought problem could be just within the area of the palm of the left hand. This doctor agreed with hand surgeon, that an MRI should be done of the left hand and wrist.
MRI of hand was negative. Hand surgeon called us (which is something that saves everybody a lot of time—though not so easily compensated via charging the insurance company or patient) and said he could not isolate the problem and was therefore hesitant to make any recommendation for surgical exploration of the ulnar nerve in wife’s hand or at the elbow. I guess someone more of a layperson than I would have stopped searching for a solution at that point and accepted that wife’s destiny was living her life with a gimpy dominant left hand.
Never was I given any reason to doubt this hand surgeon from the face-to-face contact my wife had with him with me watching. Despite that, I had called a university based hand surgeon who had trained where I had during the same time, and a guy I knew reasonably well. His opinion from the records I sent him and photos of wife’s hand led him to state: He would get an MRI of the armpit area to rule out a tumor there, however unlikely, and assuming nothing is noted on that MRI, he would recommend that the hand be explored. The risks of doing that were negligible—but there were risks. Not to explore the hand would be a mistake in his opinion.
So during the phone call with the hand surgeon, I asked him what if his son (who was currently completing a fellowship in hand surgery) had exactly the same problem as wife’s. Would he be willing to offer nothing now? Surely not, so I asked him what would he now do for his son? I also told him of the other hand surgeon’s opinion, a fellow of whom he knew generally but not personally.
His answer was to get another neurologist’s consult, and he gave us a name, and for wife to get some more x-rays of chest to rule out a cancer in the top of one of her lungs and an MRI of the nerves in the left armpit.
We saw the second neurologist, who also up-coded his services by one level, whose opinion was the problem was likely at the wrist or in the hand, probably not at the elbow, thought "it would not be a terrible thing to explore that area with the understanding that one knows for sure if anything will be discovered in terms of explanation much less treatment.” This neurologist told us during the visit that he had never seen anyone recover much following surgery if one had as much loss of function and muscle wasting as wife had present as the moment he was seeing her.
Hand surgeon called us again. Would explore hand, would have office set up surgery. Wife had surgery, hand surgeon found “band” that could account for the ulnar nerve compression and released it. Incidentally on the morning of hand exploration, wife asked surgeon to do a surgical release of a painful “trigger-thumb” problem that had developed as the hand disability had progressed probably due to alterations in how she progressively modified the use of her left hand.
End of story, sort of, surgery worked. Healing progressed as hand surgeon outlined it could with regard to how quickly injured nerves regenerate if they are going to do so. Over two years later hand functions normally within wife’s ability to determine. She thinks there might be a little less strength in the hand than there was before the emergence of the problem. All sensation that was lost has returned, and all muscle wasting which was quite remarkable in degree and appearance was grossly returned to normal.
Story continued from post #45.
Fortunately, as things turned out, shortly after the onset of wife’s problem she called a friend of hers just to say “hello” and in the conversation wife mentioned her hand problem. The friend related she too had had a “hand problem” and her son, an attorney usually representing insurance companies, recommended a particular hand surgeon as a doctor who had impressed him during some depositions and wife’s friend saw him and received treatment that proved effective. End result, wife went ahead and made appointment with hand surgeon which ended up being over two months off because of his schedule.
After the fiasco with the neurologist, wife was still 28 days from appointment with the hand surgeon. So she went ahead and continued the course of medications the neurologist has prescribed, but cancelled further follow up appoint there. Her hand disability continued to worsen over the four weeks.
Hand surgeon examined and x-rayed her hand, reviewed the notes we brought from the neurologist including the normal electrical studies and said, he thought the problem was likely anatomically within a centimeter of a specific point in her hand, BUT he would like to try to prove that it was not explainable some other way, such as tumor somewhere between the brain and the wrist or due to some ulnar nerve problem between the hand and armpit—specifically in the elbow region of the nerve’s path—it was this latter differential diagnosis that seemed most important.. Recommendation: see another doctor for repeat nerve and muscle testing and clinical opinion and have an MRI of left hand. Hand surgeon recommended a specific doctor, and we saw her five days later.
The female physiatrist, practices physical medicine, reviewed neurologists notes, hand surgeon’s note, got some of wife’s history again, performed her own physical examination and repeated testing of just three nerve in wife’s left arm (neurologist had originally tested 5 major nerves in left arm) along with some pertinent muscles stimulations. It seemed to me, a layperson with regard to what this doctor was doing, that she was experiencing some sort of difficulty with her equipment, which involved a computer and a program, so she tested the nerve in wife’s unaffected right arm.
Physiatrist’s conclusion: thought wife might have a problem with the ulnar nerve in the elbow region, BUT also thought problem could be just within the area of the palm of the left hand. This doctor agreed with hand surgeon, that an MRI should be done of the left hand and wrist.
MRI of hand was negative. Hand surgeon called us (which is something that saves everybody a lot of time—though not so easily compensated via charging the insurance company or patient) and said he could not isolate the problem and was therefore hesitant to make any recommendation for surgical exploration of the ulnar nerve in wife’s hand or at the elbow. I guess someone more of a layperson than I would have stopped searching for a solution at that point and accepted that wife’s destiny was living her life with a gimpy dominant left hand.
Never was I given any reason to doubt this hand surgeon from the face-to-face contact my wife had with him with me watching. Despite that, I had called a university based hand surgeon who had trained where I had during the same time, and a guy I knew reasonably well. His opinion from the records I sent him and photos of wife’s hand led him to state: He would get an MRI of the armpit area to rule out a tumor there, however unlikely, and assuming nothing is noted on that MRI, he would recommend that the hand be explored. The risks of doing that were negligible—but there were risks. Not to explore the hand would be a mistake in his opinion.
So during the phone call with the hand surgeon, I asked him what if his son (who was currently completing a fellowship in hand surgery) had exactly the same problem as wife’s. Would he be willing to offer nothing now? Surely not, so I asked him what would he now do for his son? I also told him of the other hand surgeon’s opinion, a fellow of whom he knew generally but not personally.
His answer was to get another neurologist’s consult, and he gave us a name, and for wife to get some more x-rays of chest to rule out a cancer in the top of one of her lungs and an MRI of the nerves in the left armpit.
We saw the second neurologist, who also up-coded his services by one level, whose opinion was the problem was likely at the wrist or in the hand, probably not at the elbow, thought "it would not be a terrible thing to explore that area with the understanding that one knows for sure if anything will be discovered in terms of explanation much less treatment.” This neurologist told us during the visit that he had never seen anyone recover much following surgery if one had as much loss of function and muscle wasting as wife had present as the moment he was seeing her.
Hand surgeon called us again. Would explore hand, would have office set up surgery. Wife had surgery, hand surgeon found “band” that could account for the ulnar nerve compression and released it. Incidentally on the morning of hand exploration, wife asked surgeon to do a surgical release of a painful “trigger-thumb” problem that had developed as the hand disability had progressed probably due to alterations in how she progressively modified the use of her left hand.
End of story, sort of, surgery worked. Healing progressed as hand surgeon outlined it could with regard to how quickly injured nerves regenerate if they are going to do so. Over two years later hand functions normally within wife’s ability to determine. She thinks there might be a little less strength in the hand than there was before the emergence of the problem. All sensation that was lost has returned, and all muscle wasting which was quite remarkable in degree and appearance was grossly returned to normal.
of having me as husband and knowing another hand surgeon, that she might otherwise have failed to be able to get that led to her being treated even by the hand surgeon whose treatement in effect produced a cure. Remember, he was reluctant and without my goading him, I don't think he would have operated on wife. All of this occurred in the greatest era of science in medicine, and there still be a big chance of luck in how things can turn out.
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