28 – Radiology

Most of the past year has gone by with no real issues. The Obama Health Care Law got passed, and I sort of lost my motivation to cast some insight into how the government provides health care.

That said, I am facing an issue now that prompts me to start documenting things.

Several years ago when I was getting a CAT scan on my liver, they noticed some small nodules in my right lung. This was while I was at Bethesda, and I went back several times to have them checked over the course of a year or so. The nodules weren’t increasing or growing, and the tentative diagnosis was that I had simply gotten salt water in my lungs or something at one point and the tissue had surrounded it, sort of like an oyster makes a pearl by surrounding sand with its mucus or whatever.

Anyway, during a recent prep for an annual physical exam, my primary care manager (PCP) scheduled me to have another CAT scan. He said that if this CAT scan showed no growth or additional nodules, the diagnosis would be complete and the existing nodules would just be considered benign tissue growth.

So I had a CAT scan back in December.

I got a call from my PCM last week. He said that the radiologist at Balboa had written that one of the nodules was 6 or 7 millimeters in diameter. Well, the previous scans had specified 6 millimeters. And the current radiologist cannot determine whether or not things have changed unless he sees the old CAT scans from Bethesda.

As I mentioned in posts 22 and 23, here in the second decade of the 21st century, the radiology departments of Naval Medical Center, Bethesda and Naval Medical Center San Diego apparently do not have access to each others radiology files. Nor, apparently, do they talk to each other.

In short, my PCM told me that the onus is on me to get my old CAT scans from Bethesda so the radiologist at Balboa and compare them.

I am going to be back in Washington DC in early March, and I will go to Bethesda to get copies still again of my radiology files. Between now and then, however, I think I’ll go up to Balboa and try to get an audience with the head of the Radiology Department to find out why the Navy is so incredibly backwards and behind times in this area of sharing medical data.

27 – Primary Care

I went to North Island Branch Medical Clinic at about 1:50 pm for a 2:00 pm appointment.  I checked in and within about five minutes a corpsman had me back in an examination room taking my vital signs.  My PCM came in a few minutes after she had finished.  He sat down and reviewed why I was there; he had obviously read my record well before coming in.

So, my cholesterol is totally normal.  The 10 mg dose seems to be working fine, and he’s going to keep me on it.

My liver functions are slightly elevated again.  That could be the statin, or it could be the wine I drank in Argentina a few weeks before my blood work.  In any case, the readings are down from my first visit, and I’m satisfied.  We’ll just check them throughout the year from now on.

We also talked about me getting a physical in May.  Again, he had obviously looked at my record, and he knew I was due for a colonoscopy.  What he hadn’t seen was an entry for some pulmonary nodules they had found in Bethesda a few years back.  He ducked out to find that entry, and when he came back he said that in general, you watch pulmonary nodules for two years.  If there are no changes, you basically let it drop.  In my case, I was just a few months shy of two years the last time they looked (and there were no changes), so he put me in for another CAT scan.  If there are no changes this time, we’ll close the book on it.

So the plan now is that in mid-May I’ll come in for some blood work in preparation for my physical, and I’ll schedule a complete physical for the end of May.  In between, I’ll get another CAT scan of my lungs.  And in later this year he’ll refer me for a colonoscopy.

I left and went to the pharmacy to pick up my prescription for 10 mg Zucor.  That took about 20 minutes due to the fact there were a lot of active duty people in uniform getting prescriptions, and they (naturally) get priority.

26 – Primary Care Scheduling (and Rescheduling)

As noted in Post #20, back last fall my blood work indicated high cholesterol. The fact is, I had been diagnosed with high cholesterol years ago and was prescribed a statin, Zucor, for lowering it.  For the most part, I stuck with the schedule, and my cholesterol decreased significantly.  But because I take it at night I often forgot, and in the highly erratic environment of this past year, I finally just let it go for a while.  And of course, my cholesterol went way back up.

My PCM and I decided to try switching my pill taking to mornings, and only half the dose (10mg instead of 20mg). The idea was that I’d do this for a few months…get some lab tests…then make a determination about which way to go.

So I cut all my meds in half and started taking them in the morning with my Prilosec, which I take upon waking up and never forget to take. That gave me a good reminder to take my Zucor, which I’ve again been taking religiously since switching to mornings.

A few weeks ago I had the blood drawn, and made an appointment to see my PCM on Monday, 01 February. No problems in either the lab work or the scheduling. Then I remembered last Friday that my wife uses the car on Mondays, and I had to change my appointment. A quick call Friday afternoon to Tricare, and the appointment’s been changed to Tuesday, 16 February.  All of this was so quick and easy I almost forgot to make note of it.

25 – Treatment: Orthopedics

I’ve postponed my shoulder operation indefinitely. I would have had to wear some sort of cast for a month after wards, then do almost nothing with that arm for the second month, then do light physical therapy during the third month, then move on to full physical therapy during the fourth month. Being so out of commission for the better part of four months is a bit much just now. The fact is, the SLAP tear is not really bothering me all that much; there’s really only one movement I (rarely) make that causes me pain, and that pain is minor. So I think I’m going to try a regimen of exercise, acupuncture, and massage to see if I can get some improvement without surgery. In the worst case, I’ll do the surgery at some point in the future when either (1) the shoulder is bothering me to the point of having an adverse impact on my daily life, or (2) I have the time to sit back for four months of recovery.

24 – Treatment: Gastroenterology

As discussed in post #17, my wife had to have some probing done by the Gastroenterology (GE) Department (i.e., a colonoscopy and esophagogastroduodenoscopy (EGD)), and so a few weeks ago we went in.

The appointment was for 0730, but we arrived as requested at 0700 for in-processing. That went smoothly and she was taken back on time at 0730. The initial estimate for her release was 0900.

I checked in with the desk at 0830 to see how things were going, and they told me that there had been an emergency GE situation, and that my wife’s procedure had been pushed back. The new estimate for her release was 1000.

There was a still further small delay, and they finally finished the procedure at 1000, and she was out of the recovery room at 1030.

The results of the EGD were that her throat is normal. From the colonoscopy the doctor said that there was no tissue associated with the blob they had picked up on the CT. They did find a small polyp, however, which they sent to pathology. The doctor said he would call my wife within two weeks with the results. I asked if he meant that he would call only if there were a problem, and he said no, he would call regardless.

Follow up: The doctor called about a week later he said that the lab results showed that what he had cut out was really just a bit of inflamed tissue, and not a polyp after all. He then said that she’s good for another 10 years. As my wife’s father died from colon cancer just two or three years after getting a clean bill of health on a colonoscopy, I doubt my wife will wait comfortably another 10 years to get her next colonoscopy. Nonetheless, she was relieved.

23 – Radiology

As mentioned in post #22, I had an MRI of my shoulder done in Bethesda last June, and brought the CD to San Diego with me where I attempted to have it used by the orthopedic surgeon who’s going to be operating on my left shoulder. He could not open the file, and the Radiology Department at Balboa couldn’t, either. Balboa told me that I needed to get it in DICOM format.

So I was back in Washington DC last week, and I swung by Bethesda to get a new CD with the pictures in DICOM format.

The guys in Radiology told me that their files were in DICOM format. But they said that the files could only be opened in Windows XP, not Windows Vista or Windows 7, and that perhaps that was the problem. I asked them if they could call Balboa to clarify, and they looked at me as if I were nuts. In other words, no, there is not telephonic communication between the two Radiology Departments.

So, on the off chance that the CD they had originally given me was scratched or corrupted in some other way, I asked for a new CD, which they promptly produced and gave me. The next time I’m at Balboa I’ll see if they can open it, or set their machines to a Windows XP compatibility mode.

22 – Radiology

Last June I had an MRI done on my left shoulder when I was back east at Bethesda Naval Hospital.  I brought some CDs or DVDs with the imagery of that MRI out here, and when I saw my orthopedic surgeon (post #21) I took them.  Unfortunately, the surgeon couldn’t open them; he said they were in the wrong file format and that I needed to either get the file format changed, or bring a print out.

I was a little irked, but since I go to Balboa quite a bit with my wife I figured I’d just drop them off and have them put into the local MRI file format.  So a couple of weeks ago when I took my wife to physical therapy, I did just that.  A few days later I got a voice mail from the Radiology Department.   I couldn’t make out the entire message, but the essence was to come in and get my disks.

Today my wife had some gastroenterology procedures (post #23), and I swung by the Radiology Department to get my stuff.  The story is that apparently Bethesda used an MRI format that is no longer current.

For starters, one would think that two major hospitals in the United States Navy would have some way of electronically sharing this type of information.  And that was my first question to the Radiology technician.  Apparently this capability is planned, but still a ways off.

That aside, one would think that the two largest hospitals in the United States Navy would have a clear agreement on MRI file formats.  For that matter, one would think that all Radiology Departments in the Navy, if not the entire military, would have a common standard.  But no.

Normally I’d have been supremely irked, because normally I would insist on a new MRI.  In this case, it turns out I’m going to be in Washington DC the second week of November, and I can swing by Bethesda and try to get my MRIs in the correct format.  If I can, then I’ll only be moderately irked.

21 – Treatment: Orthopedics

I visited my orthopedic surgeon for the first time today to discuss my impending operation on my left shoulder (see posts #13 and #18).

The appointment was for 2:00 pm, and I arrived exactly on time. They took me back to the exam room at about 2:05. The nurse or physician’s assistant or whatever asked me if I had had an MRI. I had brought some CDs of my MRI that was done in June back east, and I gave them to her.

I waited, and waited, and waited. At 2:30 or so I was getting pretty impatient, and then the doctor walked in. It turned out he was so late because they had been trying to read my MRI results, but apparently the file types were incompatible.

We briefly reviewed my situation, and he did a couple of tests on my arm. Apparently the tests confirmed what the previous orthopedic surgeon had written (post #13), and what my Bethesda radiology report had said. So he gave me the run down on surgery.

It will take place on a Thursday morning, on an outpatient basis. Because they will anesthetize me, I will need someone to drive me home. After surgery I will need to wear a sling for a month, although I’ll be able to remove it to drive and do a few other activities. After a month, it will come off for good, although my activity will be limited for another month. During the third month I’ll begin strength-building exercises, and during the fourth month I will increase the exercises.

After he left, the surgery scheduling nurse came in, and we discussed the process by which we will schedule the surgery. Essentially, she needs to submit it to TriWest and get approval, then she’ll contact me and we’ll schedule it. I didn’t quite follow the discussion, but it turns out TriWest doesn’t allow this operation to take place in a professional center; rather, it must take place in a hospital. So we’ll be doing it in the hospital across the street from the orthopedic group.

After the surgery scheduler left, some sort of medical worker came in and fit me with the sling/brace I’ll need to wear, and also asked if I wanted to buy a device for surrounding my healing shoulder with chilled water for $250 (TriWest won’t pay for it). I told her I’d do some research and get back to her on it.

I was out of there by about 3:00 pm.

20 – Primary Care

I had a 1:00 pm appointment with my Primary Care Provider at the North Island Clinic. I arrived at 1:00 pm on the dot and checked in, and the corpsman was taking my vitals by 1:02. By 1:05 I was in the PCM’s office, and before I could even check my Blackberry for messages he was in there.

Although obviously a no-nonsense sort of guy, he had all the facts on hand and was clearly up to speed on my case.

First thing he asked was how my dermatology referral went. I showed him my scars from the keratosis cutting and freezing (see Post #19), and filled him in on what the dermatologist said.

Then he asked about my left shoulder and right knee. I told him about my initial orthopedic visit, and that I have an appointment tomorrow with the guy who will presumably be doing my shoulder. He asked a couple more questions to ensure he was clear about exactly what was going on, and then moved on.

The next item was my liver readings. He told me that the blood test of a few weeks ago (which I forgot to document on the blog) showed that my ALT readings had dropped dramatically and were now only slightly elevated, and that the AST readings had also dropped and were actually within normal range. We attributed that to a combination of no wine with dinner, along with the fact that I had stopped taking statins for cholesterol. That was the good news.

The bad news was that my bad cholesterol readings had shot up from my having stopped taking statins.

So the plan is that I’ll resume taking statins, although only 10mgs a day, in the morning with my Prilosec, and get checked again in three months.

As an aside, I stopped taking statins a few months ago because I kept forgetting to take them. The problem was that normally statins are taken at night, and it’s hard for me to remember to take them then. I have no problem taking Prilosec first thing in the morning, because each morning is essentially the same. So we decided I’ll take the statin in the morning with my Prilosec, and see how things look in January.

The final item we discussed was that fact that he was going to be my PCM (see Post #5). Originally, he was not officially assigned as my PCM, and he said we needed to figure that out. But he has subsequently been assigned, and he’s quite OK with that. End of story.

I was out of there by 1:25 pm, and he wished me luck with the orthopedic surgeon as I was leaving.

19 – Treatment: Dermatology

My dermatology appointment was scheduled for 9:15 am with a civilian dermatologist at a medical professional center in San Diego (see post #9). In fact, the same place where my orthopedic group is. So there was no problem finding it or finding parking.

I arrived a few minutes early, filled out the forms, and waited. I also had to pay a $12 co-payment fee, which was a new thing for me. I don’t remember reading anything about that anywhere, and I’ll do some research to check it out.

At 9:30 the physician’s assistant took me back to an examining room, looked at the forms I had filled out, and asked me a few questions. Then she went to get the dermatologist.

The dermatologist was a really nice guy. He’s a former Navy medical officer, and he originally comes from Philadelphia (not far from where I was raised). So we had a few things in command and hit it off immediately.

I gave him my story: over the years I’ve had a number of moles removed that have all been benign…the dermatologist at Bethesda wanted me to come in every six months or so because of perceptible sun damage on my neck…the orthopedics people back east had noticed a big spot on my back that they suggested I have checked…and I have a wart on my right arm that’s been there a while and has gotten noticeably bigger, as well as a new spot close by.

He did a scan of all these things, and basically said there was nothing to be concerned about. The things on my back are common skin blemishes — some form of keratosis — that come with age, especially to fair skinned people. And the wart on my arm is actually the same thing, and nothing to worry about. But because of the location, he wanted to remove it.

So he gave me a little shot of lidocaine and cut the wart off, and he squirted a bit of liquid nitrogen on the nearby patch to freeze it off. He said he’ll send the wart in for biopsy, but he doesn’t expect anything negative (although he’ll call me if there is anything). Then the physician’s assistant gave me some follow-up care advice for where the wart was cut off, and I left.

I was out of there by about 10:00 am.