Things Fall Apart, more evidence, US version

SCANALYZER Context
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I’m 78 with mild asthma (inhaler use maybe twice a year). I have been active, doing one hour of aerobics every day 7 days/week, until 5 months ago. Around November 1, 2022, I started my once-a-decade month-long bronchitis. Repeated Covid tests were negative. Just after Thanksgiving, the symptoms left my chest and migrated to my nose & throat - a cold, basically, no fever, no sore throat, but a positive Covid test. It was gone in 4 days.

I never realized until then that habitually, all my life, I have literally run up stairs. Well, I did that around December 1 and thought I was going to die, I was so out of breath (dyspnea). My heart rate was 130. I fumbled to plug in my oxygen concentrator & got it going in panic. I felt better in about a minute. A week later, having forgotten to go up stairs slowly, I had a repeat, so made an appointment with my PCP.

Now, I have coronary artery disease, with a stent in my left anterior descending coronary artery (a.k.a. the “widow maker” [can you still say “widow”?]). I only had one episode of angina just before my stent, but realized afterward that I did have what’s called “angina equivalent” dyspnea on exertion for several years before the stent. Now, this could be accounting for my symptoms - i.e. I could have a new coronary stenosis without angina, whose symptom is dyspnea on exertion (DOE). Here, I used my knowledge of the system to try to find out promptly, without going to the ER.

I saw my PCP, who punted. I then messaged my cardiologist on the health system website, described my symptoms, reminded him of my angina equivalent DOE and asked him to order a chemical (Lexiscan) stress test to look for coronary stenosis. It was negative for ischemia, but has a 10% false negative error rate. So, probably not a stenosis. Then, I got my PCP to order an echocardiogram to rule out other cardiac problems. It was mostly normal, but showed my aortic valve had narrowed somewhat compared to 3 years ago. When I saw the cardiologist, he didn’t mention this. Now I’m wondering if he even reviewed the study, since it was ordered by his buddy, my PCP. So, no clarity yet on that. I did ask him to order pulmonary function tests to see if it was my lungs causing the problem. Again, I gamed the system. Otherwise, I would have had to wait two months to see the pulmonologist to wait another month to get the PFT’s!

So, I waited the two months and saw the pulmonologist 2 days ago. I asked if my PFT results - which showed very mild COPD (basically the mild asthma I knew I had) - explained my severe symptoms and marked impairment of exercise tolerance. She said she didn’t know and prescribed a combination inhaler with a steroid. I explained that my PCP had prescribed one of these meds, called a DISKUS, in powder form and that I could not tolerate it, it caused mucous in my throat to turn to glue - literally unbearable. She said she would prescribe a regular inhaler containing liquid puffs. She told me she, herself, has asthma and can’t tolerate the powder, either.

So, I just got home from the pharmacy, opened the bag and found the DISKUS powder inhaler!. I immediately called the pharmacist (who know me far better than I wish, as between me and my wife we must take 15 rx’s per month). He said they ordered the DISKUS and he would have to call them for the correct prescription, then he would have to order it, that it might take another 2 days to get. Of course, this all happened just before closing time.

So, here is yet another of the rolling failures of systems and products, which have become, literally, part of every day life. This one is critical to my health and remaining days. Were my memory better, I could recount one for each of the past 7 days, but it is too irksome to do so. My head threatens to explode.

Now, after having life-changing symptoms for 5 full months and, seeing three different doctors - waiting 2 months for the last one - I not only don’t have an answer, I get handed the wrong medicine. If that doesn’t work, the pulmonologist will order an invasive cardiopulmonary exercise test. They are presently scheduling those for August and she want top wait a month before ordering it, to see if the meds cure the problem (they won’t).

Bottom lines: no service can be relied upon any more - even health “care”. No product is reliable, works as advertised or lasts. Icing on the cake today - my Apple watch has quit unlocking my Macbook Air. That was a convenience I miss, given my general ineptitude.

BTW, at 78, my actuarial life expectancy is 9.4 years. However, the symptoms I describe seriously reduce that. There is zero recognition of the fact that months of waiting for diagnosis and/or treatment represent significant portions of life expectancy for some of us. I suspect the government’s actuaries are well aware of this and are pleased. My next strategy is to excise my aversion to showing up at emergency rooms. If I decide I need a heart cath (and I may well decide that), I will show up with the chest pain I just developed after months of DOE. I would prefer to have the cardiopulmonary exercise test, but August may be a lifetime away.

Having worked in hospitals for the past 50 years, I believe things were better 10 - 20 years ago. Much more “progress” and we are lost. Please excuse typos and blatant errors. I write therapeutically so my head doesn’t explode.

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Spare a thought for the unfortunate Brit on a National Health Service waiting list – waiting a lot longer than 5 months to see even the first doctor! But that system is “free”, of course.

Back in the good old USA, most of us don’t get to see doctors any more – we have to be satisfied with Nurse Practitioners. Are we not training enough MDs?

Your plan to go to the Emergency Room is sound. Most patients would agree that acute care in US hospitals is generally excellent; the treatment of chronic conditions is where the system seems to come up short. But choosing the optimum time to go to the ER is important!

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Thank you all (y’unz in Pittsburgh-ese) for reading. Your kind attention gave the desired therapeutic effect: unexploded head, without having to resort to duct tape. My inner irreverent, ever-scatalogical medical imp might say it was a Sitz bath for the hemorrhoids of my psyche.

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CW I pray you out live Methusala.

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Thanks. My parents and grandparents all lived to about 90. I suppose I think of this as my ‘goal’, but fear I will be the outlier- on the short side. I am surprised by the number of relatively minor infirmities I have learned to not only tolerate, but feel grateful for- in the sense they are not worse.

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C19 is a chronic vascular disorder that’s transmitted as a often-mild respiratory infection (also as a GI):

This is going to hammer the health care systems to a whole new level of low.

It would have been so easy to eradicate the virus early on if WHO did their job, if Xi’s China didn’t engage in face-saving lies, and if Trump understood science.

Something I consistently hear helps is hyperbaric therapy (hyperbaric chambers to use at home aren’t too expensive) - and there might be effective antivirals coming up in the future.

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I just saw this. “Earthen vessels”…live on, our dear CW!

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No, we’re not training enough MDs. That’s because the doctor’s union (the AMA) is in charge of controlling the supply of doctors. Don’t want to have too many otherwise the price of doctoring might fall!

Don’t worry, when I’m dictator, I’ll fix this.

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I know this view is prevalent, but there are counter factuals. If you don’t count medical students and residents (who don’t know better and are encouraged to join because they think membership enhances their status) the AMA represents around 12% of physicians. It has been in decline and is trading on capital of the past plus name recognition. They behave with self-appointed “moral authority” and most practicing physicians disagree profoundly with its authoritarian central planning approach. Whatever shortage of physicians there may be is easily “corrected” by fiat by administratively elevating nurses physicians’ assistants to de facto physician practice privileges.

You’ll notice, for example, in the endless TV ads for medications, we are told to ask our “providers” to prescribe, not our “doctors”. Now, there is surely a place for some of these services being given by “physician extenders”. However, the meat-fist of the state cannot be bothered with establishing limiting principles when making forays into areas requiring some discrimination in permitted activities of licensed individuals at different levels of education. “They’re there (with loud and persistent lobbying, sub rosa), - turn 'em loose”. Sadly, such policy misadventures rarely become known, as the bad outcomes are sporadic; not like an airplane crash. Thus, much more morbidity and mortality resulting from bad regulation is tolerable, simply because there are no news multi-day news reports of smoking wreckage and hundreds of deaths. The difficulty of getting a handle on many sporadic deaths is quite apparent in trying to determine the actual death count from Covid, for example, where there is actually interest in knowing,

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Is that not what in fact is happening?

It does not seem that long ago when if someone went to see a doctor, he saw a doctor. Now it seems like the standard practice is to route the punter to a nurse practitioner. Seeing an actual MD is not common. It is not clear if this the Western equivalent of Africa’s “barefoot doctor” making up for the under-supply of actual MDs, or if it is the closest practical alternative in the medical industry to offshoring production to low-wage countries. Of course, patients are aware that many X-Rays & other scans are indeed offshored to India for lower-cost interpretation.

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