Drug Interactions
So what caused all this? Might it have been the heparin? The heparin and aspirin? The beta blockers? The proton pump inhibitors? No one I talked to at the hospital, other than the one phlebotomist, thought an external cause likely. Everyone knows (!) that heparin clears the body too quickly for any lingering effects. Unless, of course, one is older because drug clearance takes longer the older one is. (Apparently the warning about bruising and bleeding for two weeks after stopping heparin is strictly for the rubes.) And I wasn’t aware, since it wasn’t mentioned, of the possibility of bleeding thanks to beta blockers. (It appears that beta blockers were not an issue for me because, without aspirin in my daily meds, there was no bleeding.)
What about proton pump inhibitors? One of their rare side effects is to strip away the enteric coating on aspirin, thus, theoretically, increasing the risk of adverse gastric effects like, say, bleeding, associated with salicylates (aspirin’s family name). Then there’s the interaction between lisinopril and aspirin. Seems there’s a possibility, at least in some patients, of ACE inhibitors and aspirin canceling each other out. Two pills, no benefit.
All of which suggests that the logical scientific explanation of my adventure is…bloody shit happens.
Advanced Medical Directives
After the endless tests and procedures and infusions and drawing of who knows how many vials of blood, my wife and I decided to establish advance medical directives to constrain the enthusiasm of the medical profession for trying just one more thing on us as we age, grow frail, and seek care. We, along with millions of others, have been influenced by a piece by Ken Murray entitled How Doctors Die. Hint: not usually in the ICU.
Would you buy this?
Of course, in the United States, once medical intervention ends, financial wrangling begins. If you are not employed by a company with a health insurance plan, your only hope of getting health insurance is as an individual, and that’s neither easy nor cheap. My wife and I are fortunate to live in a state with a long-established high risk pool. (For Tap’s non-U.S. citizen readers who may live in countries with public or government health insurance rather than private health insurance, a high risk pool is formed from the people who are rejected by regular private health insurance companies. The usual reason for rejection is “pre-existing conditions” which could get worse and cost a private health insurance company money by requiring that it pay for treatment. The ticket for admission to a high risk pool is a rejection letter from a private health insurance company.) Not all states have high risk pools which is why, in a time of high joblessness, millions of U.S. citizens have no health insurance.
The adventure I have related above produced a bill in the neighborhood of $100,000USD. The case could be made that much of that expense went to treating what is called an iatrogenic disease: a disease caused by treatment. Like sins, iatrogenic diseases can be matters of omission or commission. Not doing something that should have been done, doing something that shouldn’t have been done, or forgetting that the difference between a medicine and a poison is the dose. In my case, I had been taking aspirin for over two years with no untoward effects. Several hours on a heparin drip and, well, you’ve already read that part.
Resolving who pays what percentage of which means going through all the bills from the hospital and all the EOB (Explanation of Benefits) sheets from the insurance company. Seeing where they overlap and where they don’t. I’m happy to report it’s finally over…after months of confusion over a staggeringly opaque glitch that was very difficult to explain and nearly impossible to understand.
Life goes on…
As for me, at this moment, I’m fine. I’m fortunate that my physician also has a heart condition and can sympathize with me about the side effects of beta blockers. With his permission, I have discontinued them in an attempt to lift what had become a fatigue verging on depression. Seems to be working. No signs of blood showing up where it shouldn’t and no longer any anxiety over taking a dump. After all the turmoil and drama, I am now taking just two lisinopril and a capsule of fish oil every day. No aspirin, no beta blockers, no proton pump inhibitors.
And maybe this is as good as it gets. Every morning I wake up is a win. Every day that I make my wife and myself scrambled eggs for our daily weekday breakfast is a benediction. Eggs benediction.
Afterword
While adding the last few technical details to this tome, I came across this definition of Massive Lower Gastrointestinal Bleeding (LGIB) on Medscape.
Massive lower GI bleeding is defined as follows:
- Passage of a large volume of red or maroon blood through the rectum (yup)
- Hemodynamic (blood movement) instability and shock (yup)
- Initial decrease in hematocrit (Hct) level of 6 g/dL or less (concentration of red blood cells in blood)(yup)
- Transfusion of at least 2 U of packed red blood cells (RBCs) (try 6 U for just the first episode)
- Bleeding that continues for 3 days (yup)
- And then I came to the final portion of the definition of Massive Lower Gastrointestinal Bleeding…
- Significant rebleeding in 1 week
This stopped me cold. “Significant rebleeding in 1 week.” That’s a pretty accurate description of my experience. I bled, I went home, I bled again. And not one medical professional I talked to during my first bleed — not one technician, not one nurse, not one specialist, not one doctor, not one surgeon — ever mentioned the possibility of “Significant rebleeding in 1 week.” No one. Not a whisper.
Even the phlebotomist who said cardiac patients returned a week later with GI bleeds didn’t mention a reprise of bleeding within a week. Maybe they weren’t familiar with this definition. Maybe this definition is not accurate. Maybe it’s not useful to tell someone they will be back in a week with the same problem. Maybe they were as hopeful as I was that this was over. No telling.
I read more of the definition: LGIB has a mortality rate ranging from about 10-20%, with patients of advanced age (>60 – that’s me) and patients with co-morbid conditions (e.g.,…transfusion requirements in excess of 5 units…(also me))…at greatest risk. That put my chances of surviving at 4 in 5. Or, from the other side, my odds of dying at 1 in 5.
Wow.
And then I thought back over the entire experience. There is really not a lot to do in the event of a LGIB. Just keep the patient’s blood pressure and blood volume near normal…and hope the patient’s own coagulation eventually stops the bleeding. The medical version of running out the clock. And that’s what I got. I ran up a bill for $65,000USD for stabilization while my body was bleeding. And went home after it stopped.
And I’m still here.
Well, while I’m still here, I’ll be here, fully present. And glad for every day.
The game, for now, is not over.
Well, I did not notice this box but the one down below so I posted a response down there and goodness knows where it went. I am a dufus.
In summary, amazing story Mrlipid. I’ve not been at this site lately but I have time on my hands of late so thought I’d poke around and your story caught me off guard.
Sounds like you have a wonderful woman at your side! I was amazed at the amount of blood you lost. In game turns I am giving you +20 end, +15 str and I am tossing in +5 spell power for your consumption of a twilight drug. 🙂
Hope you continue to do well.
Gah!!!!!!!!!!!!!!!!!!!!!!! That was scary but infectious reading!! Glad it has a happy end but really, every time I get reminded about the health insurance American-style I get shivers.
Amazing experience, Mr. Lipid and one that, hopefully, being as challenging as it was, really made the taste of living ON for you better.
@Auditrix: I do have a wonderful woman at my side. Thanks for the good wishes.
@Meho: Every day’s a win. And everything tastes great.
Jesus, Mary and Joseph! Your whole story just reinforces my thought that “modern” doctors are simply casting chicken bones and hoping for the best.
So glad you lived to tell the tale, MrLipid.
@Toger: Thanks. I’m grateful I’ve got a place to tell it. And long-time friends who are willing to listen.
I felt a bit jelly-like reading chunks of that, absolutely terrifying but wonderfully written. I’m so glad you’re feeling well now mrlipid and I hope it continues, I don’t think you can go wrong with daily scrambled eggs for breakfast though. Eggs benediction indeed!
I’ll echo Meho’s thoughts on American healthcare. 100,000/60,000USD is just a staggering amount, and let me get this straight: the insurance company pays that? How much does healthcare/insurance usually cost from month to month then?
And thanks for the How Doctors Die link, that was a real eye-opener.
@Gregg B: Thanks.
Here’s a breakdown on the costs. The total bill for the heart attack and two GI bleeds came to $ 100,000. The bill for the heart attack care came to about $ 35,000 and the bill for the bleeds about $ 65,000.
I pay roughly $ 625/month for insurance with a $ 2000 deductible. I’m on the hook for the deductible plus a percentage of total bill after that. Which means the out-of-pocket cost to me was about $ 3000 and the insurance picked up $ 97,000.
If at all possible, I plan to die like a doctor.
Lipid also pointed me to the How Doctors Die link. Eye-opening is right. It’s something that’ll always be in my mind from now on when there are medical emergencies.
We could have a long, long talk about American healthcare, but it wouldn’t make anyone happy. My mother was in the hospital a couple weeks ago – one week, $55,000. The battles with Medicare are as epic as the battles with private insurance, which will actively look through your entire health history for a reason to refuse you when possible. “You were hospitalized with a minor stroke? Well I see here that you were treated for a concussion 35 years ago. Preexisting condition. No coverage, sorry (we’re not sorry).” What’s most baffling is why so many Americans vehemently oppose reform.
I’ve given MrLipid very strict instructions (a) not to have another heart attack and (b) not to go through any of that again. Assuming he follows my orders he”ll be with us for a good long time! 🙂
One of the advantages of being in a high risk pool is that the high risk pool, by definition, assumes preexisting conditions…and has no choice other than to ignore them. It’s the insurer of last resort and can’t be fussy about old concussions. Or hang nails.
I pay tax of around £600 per month and earn around £1,500 after tax. The tax I pay covers all my health care and local services such as council tax and the amenities they provide, bin collection, police, fire services; basically everything that’s public sector my taxes go towards.
I would consider £500 a month for all this (considering 99% of services I don’t use) rather a lot of money, but I’m incredibly grateful for the NHS. I’ve been nothing but ill all year and have had dozens of trips to the doctors. I also dread to think how much removing my tonsils would have cost privately.
Lipid, I shall finish reading your article (tonight, promise)
As trivia, Lewis, I did some Googling and in the States an uninsured tonsillectomy would set you back about $6000 for the procedure. There’d be added costs for any blood or lab work, anaesthesiologists, and of course if you have to stay in the hospital overnight that’d be a large addition. I’d say it could be managed for around $8500 all-in.
What’s so maddening about MrLipid’s experience, beyond just the scare, is that 75% of it was caused by doctors. Well-meaning doctors, sure, but aside from the initial issue it was, as he put it, a “disease caused by treatment.”
I made the shocking mistake to read this when I was hungry and a little tired. TWICE. Both times I wound up feeling a bit dizzy. It reminded me of my own (nowhere near lethal!) agonising visits to the hospital a couple of years ago, all bottoms and colonoscopy. I hate that feeling of being so vulnerable and fragile, that there are things inside of us that might just go pop and bust; and that’s what MrLipid’s incredibly matter-of-fact monologue brought home. Even though it was the treatment that was life-threatening that the original problem.
Glad you made it through MrLipid, despite the better efforts of your doctors =)
@Harbour Master: Thanks. Glad to be here.
I take it as a huge compliment that you read it TWICE.
Ah, I wish I could say I read the whole thing twice! I just got queasy and had to stop until I had got some food inside of me. But I did read the passages about your first bout of “diarrhoea” twice, once to make just to work myself into queasiness, second time to prove I was good to continue.
@Harbour Master: Then I take it as a huge compliment that you got through it. 😉
That was extremely brave bit of writing mrlipid. I commend and thank you deeply for it. Admitting vulnerability and owning it like that is against the big book of macho rules (and more manly than not crying or remaining stoically silent).
Having had my share of brushes with the American medical miasma, I could really relate to much of the what you revealed. Your use of wit and humour through the piece helped soften the ugly truths spilling out of the experience. Out of compassion, and simply to relieve a bit of misanthropic disdain for industrialized health “care”, I took a Rango break about half way through. If the writing was of less quality I surely would not have returned; but, you have a gift for storytelling.
Here’s to hoping that you find more beauty in your future than in your past, and more joy in your present than in paths not taken!
Bravo.
@Brown Fang: Wow. I’m humbled. Thanks.
De nada. 😉
I apologize for all the typos in my post (wrote quick without editing).
Bloody hell, mrlipid. Bloody hell. Glad you are still with us. I’m 61 and so far haven’t had the pleasure of any long hospital stays. You always think you’ll be different, that the docs and tubes and machines won’t get to you but it always does. And yes, first rule, ALWAYS be nice to the nurses.
Wow mrlipid, I don’t even know what to say. Horrendous experience, fantastic bit of writing. Glad you are still with us and hopefully you will never have to go through that again.
Thank you for sharing your experience with us. It was eye opening and has given me plenty to think about and be thankful for. You tend to forget how quickly your life can be turned upside down and what we take for granted on an everyday basis.
Much health to you my friend and to all fellow Tappers.
@Scout: Bloody hell, indeed, Scout. Bloody hell, indeed.
For what it’s worth, I’m 61, too.
@tanis38: Thanks. Life is fleeting. Don’t miss it.
Mr Lipid, that was very scary to read but so marvelously written. In the beginning, it sounded like what I experienced about a year ago when my husband had a quadruple bypass. He had been suffering pain while playing tennis for quite a while and never told me. Finally he went to the doctor. We were lucky that he came through it with flying colors, thanks to a wonderful cardiac surgeon. But your story quickly descends into horror. It makes me angry that the medical profession didn’t do better by you. I am so glad that you survived your ordeal. Take care of yourself and enjoy your eggs.
MrLipid, first let me say I’m happy to hear that you FINALLY got through that horrible ordeal. I also admit I had to cut your story up in separate parts to read, because I get queasy and faint easy when it comes to blood and needles and the ilk. I can’t imagine confronting one’s mortality to that extent. The worst I went through was having my appendix removed (which wasn’t great). Health is very fragile, thinking of how complex our bodies are and what all can go wrong. It’s also scary how much we still have to learn about how to properly diagnose and treat various ills. Depending on our medical system to be the knower of all is … well … probably a tad misguided. Still, it is amazing the talents that the doctors and nurses and specialized surgeons all possess and the benefit to humanity that they bring. It also brings to mind how much faith the world puts in all these prescriptions. While true that many are life savers, it’s scary to realize how dangerous side effects they can bring when combined with others. All in all, we just put our faith in the system I guess and keep our fingers crossed. My personal mentality is to not take drugs unless I absolutely have to. Other than a daily vitamin, that’s about it.
I wish you well and hope you now have many healthy years in front of you to focus 100% of your energies on Tap Repeatedly again. 🙂
@Pokey: Thanks. Glad to hear your hubby is doing fine. As for the medical profession not doing better by me, I think they did their best. The nurses were great. As far as my ordeal, I’ll paraphrase the pilot’s line about landings: any hospital visit you can walk away from is a good one.
@lakerz1: Thanks. Didn’t realize I was writing a serial. 😉 I tend to forget that it’s a big advantage to have no issues with blood or needles. If you want to read a book that may tell you more than you want to know, read Overdiagnosed: Making People Sick in the Pursuit of Health by H. Gilbert Welch. Yipes! And now, your kind wishes in hand, back to the games!